DOLENTIUM HOMINUM No. 81 – year XXVIII – No. 1, 2013

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

Proceedings of the XXVII International Conference

Organised by the Pontifical Council for Health Care Workers

The , Setting for Evangelisation: a Human and Spiritual Mission

15-16-17 November 2012 New Synod Hall

DH81eng.indd 1 02/08/13 17:34 Zygmunt Zimowski, Editor-in-Chief correspondents Monsignor Jean-Marie Mupendawatu, Executive Editor Rev. Mateo Bautista, Bolivia Monsignor James Cassidy, U.S.A. Rev. Rude Delgado, Spain Rev. Ramon Ferrero, Mozambique Rev. Benoit Goudote, Ivory Coast Editorial Board Professor Salvino Leone, Rev. Jorge Palencia, Mexico Rev. Ciro Benedettini Rev. George Pereira, Dr. Liliana Bolis Mrs. An Verlinde, Belgium Sr. Aurelia Cuadron Professor Robert Walley, Rev. Giovanni D’Ercole, F.D.P Dr. Maya El-Hachem Rev. Gianfranco Grieco Rev. Bonifacio Honings Monsignor Jesús Irigoyen editorial staff Rev. Joseph Joblin Rev. Vito Magno, R.C.I Dr. Colette Chalon Dr. Dina Nerozzi-Frajese Mrs. Stefania Casabianca Dr. Franco Placidi Dr. Antonella Farina Rev. Luciano Sandrin Dr. Matthew Fforde Monsignor Italo Taddei Dr. Guillermo Qwistgaard

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

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Cover: Glass window Rev. Costantino Ruggeri

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

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Contents

6 Meeting of Reflection and Prayer 31 The Hospital of the Holy Spirit in Sassia: of Health-Care Workers its History and Mission with the Holy Father on the Occasion Prof. Gianni Iacovelli of the Year of Faith at the End of the XXVII International Conference 36 The Historical Genesis of Fra’ Pascual Piles Ferrando, O.H. 6 Introduction H.E. Msgr. Zygmunt Zimowski 40 The Centuries-Old Religious Role of the 8 Meditation of St. Jane Antide Thouret H. Em. Cardinal in Roman Hospitals Sr. Anna Antida Casolino 11 address of His Holiness Benedict XVI 48 On the Pathway of Learning and Charity: the Human and Spiritual accompanying of Medical Students Prof. Cav. Benoit Lengelé, MD, PhD Thursday 15 November 53 Military Hospitals and I. History and mission the Evangelisation of Peace Gen. Vito Ferrara 13 Opening Address by H.E. Msgr. Zygmunt Zimowski 55 Hospital Management H.E. Msgr. Zygmunt Zimowski Between Rationalisation and the Defence of the Right to Health 15 The Decree Ad Gentes Dr. Anthony R. Tersigni in the Life of the Church Today H. Em. Cardinal 58 Biomedical Research in Hospitals Jean-Baptiste Pham Minh MA¯ n Dr. Ornella Parolini 18 Prolusion 63 The Vocation of a University Hospital Hospitals: Settings for Dr. Sandro Caffi a New Evangelisation H.E. Msgr. Salvatore Fisichella 64 Telemedicine: a Medical Reality that Calls on Ethics 22 The Role of the Hospital in Dr. Giovanni Putoto International Health-Care Policies Dr. Anarfi Asamoa-Baah 66 Healing Spaces: The Science of Place, Spirituality and Wellbeing: Implications 25 recommendations and Perspectives on for the Hospital Environment and Health Pastoral Care for Health-Care Workers Prof. Esther M. Sternberg, M.D. in Africae Munus, the Post-Synodal of Benedict XVI 70 Round Table H. Em. Cardinal Wilfrid Fox Napier, O.F.M. Hospital Workers: Evangelisers of Life 27 Hospitals: Temples of Humanity and Crossroads of Peoples 70 1. The Administrator H. Em. Cardinal Willem Jacobus Eijk, Dr. Orochi Samuel Orach

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75 2. The Medical Doctor 122 4. Central and South America Prof. Daniela Terribile H.E. Msgr. Sebastián Ramis Torrens T.O.R. 83 3. The Nurse 123 5. Sr. Alžbeta Bc. Jana Galgóciová, H.E. Msgr. 85 4. The Volunteer: 125 6. Oceania Volunteers in Hospices, Hospitals H.E. Msgr. Donald Sproxton and Home Care for the Elderly in Poland Ms. Anna Janowicz 127 III. The spirituality 88 5. The Chaplain and deaconate Don Werner Demmel Of charity

127 The Hospital Chapel: a Beating Heart of the Mission of the Church for the Sick Friday 16 November Fra’ René Stockman, F.C. II. Ethics and humanisation 131 Vocation to and Charismatic Witness in Places of Care 92 Health Care between Being and Acting: Mother Laura Biondo, F.S.C. a Balance of Charity Fra’ Mario Bonora, P.S.D.P. 134 Home Care for the Sick Dr. Konstanty Radziwill, MD, PhD 94 The Humanisation and Fairness of Care and Treatment in 136 The Hospital Chaplaincy Health-Care Institutions Fra’ Benigno Ramos Rodríguez, O.H. Prof. Enrico Garaci 142 The Human and Spiritual Formation 95 Hospitals: Bioethical and of Hospital Voluntary Workers Biopolitical Problems Dr. Salvatore Pagliuca Prof. Francesco D’Agostino, 151 Spirituality as a Resource in Situations 98 Hospitals as Guardians of Life of Illness in a Secularized Society Prof. Riccardo Marana Prof. Dr. Arndt Büssing, M.D. 107 Ethical Committees 155 The Mission for the Suffering in Hospitals Today of the ‘Merciful’ Prof. John M. Haas, Ph.D. Dr. Manuel de Lemos

157 The Humanitarian and Missionary Role 111 Round Table of the Order of Malta Hospitals H.E. Baron Albrecht Freiherr von Boeselager IN a Changing World 111 1. Catholic Hospitals in 161 Engaging Catholic Health Providers in a World Undergoing Transformation: to Scale Up HIV Testing and Treatment ‘Wells’ of Encounter with Christ Mr. Gregg H. Alton H.E. Msgr. Joachim Ntahondereye 164 Conclusions 114 2. : Catholic Hospitals Msgr. Andrea Pio Cristiani in a Challenging World H.E. Msgr. Bernard Blasius Moras 165 Concluding Reflections 119 3. and Recommendations H.E. Msgr. Robert J. McManus, D.D., S.T.D. Fr. Jacques Simporé, M.I.

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The Hospital, Setting for Evangelisation: a Human and Spiritual Mission

15-16-17 November 2012

New Synod Hall Vatican City

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Meeting of Reflection and Prayer of Health-Care Workers with the Holy Father on the Occasion of the Year of Faith at the End of the XXVII International Conference 17 November 2012 • Paul VI Hall

PROGRAMME Introduction

Opening Song Hymn of the Year of Faith H.E. Msgr. when he knelt down in front of Introduction by Zygmunt Zimowski the baptismal font in the His Excellency Monsignor President of the church of Wadowice. Zygmunt Zimowski Pontifical Council At the beginning of his Petrine President of the for Health Care Workers, ministry, the Pope returned to the Pontifical Council for the place where his personal journey Health Care Workers of faith had begun. He returned to the moment when his parents took our Eminences, Your Most him to church so that through the Reading of the Word of God YReverend Excellencies, dear door of Holy Baptism he would priests, men and women reli- be introduced into the great com- First Reading gious. I am very happy to greet munion of the children of God. the organisers of, and those tak- The Pope returned to the sources. Psalm ing part in, these two important There is something extraordinary events: the joint congress of Ital- in that image of the Bishop of Hallelujah ian and European Catholic doc- kneeling in front of a sim- tors on ‘Bioethics and Christian ple, old, baptismal font. Reading from the Gospel Europe’ (which is currently un- During this Year of Faith it is derway) and those taking part in suitable to reflect on the meaning Comment the XXVII international confer- of the sacrament of baptism and Cardinal ence, which had just ended, on the to bring to our minds the baptis- Angelo Comastri subject: ‘Hospitals as Settings for mal font of our parish churches of the Papal Basilica Evangelisation: their Human and where our journeys of faith be- of St. Peter in the Vatican Spiritual Mission’. gan, our drawing near to the com- Vicar General of His Holiness I also greet most cordially the munity of believers. At the same for the State of the Vatican City various organisations that dedi- time I want to thank God for our cate themselves to the sick and parents and for the parish commu- Testimonies the suffering, and in a special way nities where our faith matured. the UNITALSI. On Sunday 16 October 2011 Prayer of the Faithful Dear sick people, thank you for the Holy Father Benedict XVI your presence! celebrated the Holy Mass for the Final Prayer We now want to prepare our- New Evangelisation. During his selves spiritually for the meeting homily he spoke the following Final Song with the Holy Father on the occa- important words: ‘Precisely in or- sion of the ‘Year of Faith’ in order der to give a fresh impetus to the ADDRESS to be true evangelisers, because of mission of the whole Church to OF THE HOLY FATHER our baptism. lead human beings out of the wil- BENEDICT XVI One of the most moving mo- derness in which they often find ments during the pilgrimage of themselves to the place of life, the Holy Father the Blessed John friendship with Christ that gives Paul II in Poland in 1979 was us life in fullness, I have decid-

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ed to proclaim a “Year of Faith”, The meeting of Jesus with the The Year of Faith must also be which I shall have the opportunity Samaritan woman at Jacob’s well used to return to the spring of liv- to illustrate with a special Apos- is the beginning of a wish for ing water, that is to say to baptis- tolic Letter’. faith: ‘The people of today can mal water. The apostolic letter Porta Fidei still experience the need to go to We could in the end ask our- of Benedict XVI helps us to un- the well, like the Samaritan wom- selves: what is the purpose of derstand better the reasons for an, in order to hear Jesus, who in- prayer? The answer cannot be his Year of Faith. ‘Only through vites us to believe in him and to given in terms of human utility believing…does faith grow and draw upon the source of living or efficacy but in terms of gratui- become stronger’1 and thus faith water welling up within him (cf. tousness and of life, of gift and of must be explored and thought Jn 4:14)’, writes the Holy Father service. Prayer is to be more: to about anew. Today the task of the in his Porta Fidei, be new men. In addition, prayer Church is the new evangelisation, ‘We must rediscover a taste for acts to give more: to be the serv- which is possible only when, on feeding ourselves on the word of ants of life. To be and to give: this the one hand, we are able to jus- God, faithfully handed down by is the yardstick of authentic prayer, tify the credibility of what we be- the Church, and on the bread of measured by the person of Christ lieve in, and, on the other, we are life, offered as sustenance for his and the needs of friendship and to- credible witnesses though the ex- disciples (cf. Jn 6:51)’.4 Thanks tal giving of life: ‘For even the Son ample of the Christian life. The to that meeting in the heart of that of Man did not come to be served; Pope emphasises the importance woman the seed began to sprout, he came to serve’.7 It is precisely of the liturgy and the sacraments: the seed that grew and led the Sa- in prayer that one learns to receive ‘Without the liturgy and the sac- maritan woman to be a witness the gift of God so as to become, we raments, the profession of faith to faith: “Come and see the man as well, gift for others, to receive would lack efficacy, because it who told me everything I have the transformation that enables us would lack the grace which sup- ever done, could he be the Mes- to love more and to serve better. ports Christian witness. By the siah?”5 How much the life of this Let us remember the words same criterion, the teaching of the woman changed after this conver- spoken by the priest during our Catechism on the moral life ac- sion! We can meet Jesus Christ in baptism: ‘This is our faith. This quires its full meaning if placed in prayer: ‘The wonder of prayer is is the faith of the Church. We are relationship with faith, liturgy and revealed beside the well where proud to profess it in Jesus Christ prayer’.2 we come seeking water: there, our Lord’! Faith without charity does not Christ comes to meet every hu- bear fruit. Benedict XVI writes in man being. It is he who first seeks this document: ‘“As you did it to us and asks us for a drink…Para- Notes one of the least of these my breth- doxically our prayer of petition is ren, you did it to me” (Mt 25:40). a response to the plea of the liv- 1 Benedict XVI, apostolic letter, Motu These words are a warning that ing God: ‘They have forsaken Proprio ‘Porta Fidei’, 11 October 2011, n. 7. 2 Benedict XVI, apostolic letter, Motu must not be forgotten and a per- me, the fountain of living waters Proprio ‘Porta Fidei’, 11 October 2011, n. 11. ennial invitation to return the love and hewn cisterns for themselves, 3 Benedict XVI, apostolic letter, Motu by which he takes care of us. It is broken cisterns that can hold no Proprio ‘Porta Fidei’, 11 October 2011, n. 14. 4 Benedict XVI, apostolic letter, Motu faith that enables us to recognize water!’ (Jer 2:13). Prayer is the re- Proprio ‘Porta Fidei’, 11 October 2011, n. 3. Christ and it is his love that im- sponse of faith to the free promise 5 Cf. Jn. 4: 29. pels us to assist him whenever he of salvation and also a response of 6 Catechism of the , ‘Prayer in the Christian Faith’, nn. 2560- becomes our neighbour along the love to the thirst of the only Son 2561. journey of life’.3 of God’.6 7 Cf. Mk 10:45.

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Meditation

H. Em. Cardinal cause they are ill-informed about formulate certain assertions that Angelo Comastri it. They imagine that it involves are truly shaking. Well aware that Archpriest of the Papal Basilica simply worship of a God who is revelation of the omnipotence of St. Peter in the Vatican, seen as great, powerful and eter- of God as omnipotence of love Vicar General of His Holiness nal; and this is precisely deism imposes a total revision of the for the State of the Vatican City (the religion of philosophers) scale of values, he was to write: which is as distant from the Chris- ‘If I speak in human and angelic tian religion as atheism is, which tongues, that is to say that I had is its complete opposite. The God all imaginable leaning, but do not 1. The Polish writer H. Sinkie- of Christians is not a God who is have love, I am a resounding gong wicz (1846-1916) bequeathed to simply the author of geometrical or a clashing cymbal that lasts for us a moving historical novel en- truths and the order of the ele- a few seconds and then falls in- titled ‘Quo Vadis?’. In this work, ments…the God of Abraham, the to silence as though nothing had which is set at the time of the fe- God of Isaac, the God of Jacob; happened. And if I have the gift rocious persecution carried out the God of Christians is a God of of prophecy and comprehend all by Nero, the author imagines a Love and of consolation, He is a mysteries, that is to say even if conversation between a Roman God who fills the souls and the I had degrees from the most fa- officer, called Vinicius, and the hearts of those whom He has tak- mous Church universities, but do Apostle Peter who has arrived in en possession of; He is a God who not have love, I am nothing: an Rome from far away Galilee. The makes everyone feel, internally, absolute zero’. Roman officer only knows about their own misery and His infinite Why are these statements legit- Christianity through being with mercy’. imate in Christian terms? Let us a young Christian woman called These are sacrosanct affirma- keep the question and slowly ar- Lucia, with whom he is in love. tions and ones that are evangeli- rive at an answer. But Vinicius is bemused by the cally true. Indeed, the news that novelty and the simplicity of the God is Love, which is the ‘Good 2. During the month of Septem- Christian message and asks the News, that is to say the Gospel it- ber of the year 1896, exactly one Apostle Peter for his help in un- self – this news upsets the ranking year after her death which took derstanding it. of values used amongst men and place at the youthful age of twen- “The Greeks”, observes the Ro- offers a key by which to read the ty-four, Therese de Lisieux, by or- man officer, “brought philosophy events of human history in a com- der of the Prioress of the Carmel, to the world and this is a merit that pletely new way. wrote the second ‘little notebook’ will remain for ever. The Romans The English journalist Mal- of the memoirs of her life. brought to the world law and the colm Muggeridge, after going She narrated that at a certain organisation of the State: this is to the ‘Home of the Immaculate moment of her short existence she also an extraordinary fact, it is Heart’, and having met Mother had experienced a terrible identi- before everyone’s eyes. But you Teresa of Calcutta amongst her ty crisis. Strong opposing feelings Christians”, he asks, “you Chris- poor people on a number of occa- boiled in her heat: she thought tians, what have you brought that sions, exclaimed: “the revolution that to be a saint one had to tread is new to the world?” of Christianity is here in its en- all the pathways of heroism. She Peter, according to the narrative tirety: charity is worth more than thus desired to be a Carmelite hid- of Sinkiewicz, listens carefully to all learning”. This famous jour- den from the eyes of the world but the Roman officer and then with- nalist of the BBC remembered at the same time she wanted to be out any hesitation answers him: Mother Teresa speaking the fol- an apostle and missionary of the “We Christians bring Love to the lowing words: “When we die, we Gospel in all the corners of the world! We bring the greatest and will take with us just one suitcase: earth. She wanted to be a priest most revolutionary news, which the suitcase of charity. Everything and thought with how much love is this: God is Love!” else will not go beyond even the she would have welcomed Je- Perhaps, today, we have some- threshold of the cemetery”. sus in her hands and would have what lost awareness of how much And Anthony Frederick Oza- given him to souls. But at the this news is sensational and of the num could rightly say: ‘What we same time she wished not to be a consequences that it has for our give is only truly ours: indeed priest, following the example of lives. what we give will remain ours for St. Francis, who ‘refused the sub- , that great and eternity, whereas everything else lime dignity of the priesthood’. fervent Christian thinker, in one we rent for a very short period of The young Carmelite religious of his famous pensées writes: time’. suffered and it seemed to her that ‘Many people find reason to For this reason the Apostle the wind of desires for holiness curse the Christian religion be- Paul, with full legitimacy, came to had gone mad inside her soul. She

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wrote: ‘During prayer my wish- Therese de Lisieux find peace precise intentions. He says: “I tell es made me suffer a real martyr- in her discovery that love is the you, in just the same way there dom’. But specifically in prayer spring and the completion of all will be more joy in heaven over God offered light and peace to the vocations in the Church? Is the one sinner [the Greek text lays heart of Therese. Indeed, when heart of Christianity truly to be emphasis on this particular point reading the Letters of St. Paul she found here? – over one sinner] who repents came across chapter XII of the than over ninety-nine righteous First Letter to the Corinthians. 3. Let us go to the Gospel. people who have no need of re- There the Apostle explains that The Evangelists, in agreement pentance” (Lk 15:7). the Church is the mystic body of with each other, tell us that Jesus Jesus, therefore, is speaking Christ and that in this body there amazed his contemporaries with about heaven: but heaven is God! are many members and all of his goodness: a 360 degree good- He, evidently enough, wants to them are required for the life of ness, which was limitless, disarm- correct those who are scandalised that body. Therese wrote down in ing, gratuitous, ready to take the by the revelation of the unheard- her diary: ‘The answer was clear first step. At a certain point some of goodness of the Father that but it did not meet my wishes and people began to murmur. The they perceive through the vari- it did not give me peace. Just as Evangelist Luke tells us: ‘The tax ous actions of His person. And Mary Magdalene when bending collectors and sinners were all he wants to invite those who are over the empty tomb ended up by drawing near [the verb in the im- scandalised to realise that God is finding what she was looking for, perfect indicates a habitual action] totally different from how they so I myself, in lowering myself to to listen to him, but the Pharisees imagined Him: God is infinitely the depths of my emptiness, rose and scribes began to complain, more good! so high that I was able to achieve saying, “This man welcomes sin- And for this reason God would my purpose’. ners and eats with them.”’ The like to save everyone (not only Indeed, when reading the Hymn Greek text translated literally ninety-nine sheep but all hundred to Charity of the Apostle Paul, reads: “This man leans towards of them), He would like to em- Therese understood that charity is the sinners and eats with them”. brace everyone, grasp everyone the indispensable point of depar- And they were scandalised. ‘So to His heart in order to fill them ture and the ineluctable point of to them he addressed this parable. with His joy. But man is free, man arrival of all vocations: and thus, “What man among you having a can reject, he can refuse Love and in living charity, all vocations en- hundred sheep and losing one of exclude himself from Love: but counter each other. them would not leave the nine- God remains tirelessly and faith- With these splendid words ty-nine in the desert and go after fully Love. Therese confided her wonder- the lost one until he finds it? And The possibility of getting lost, ful discovery: ‘Charity has given when he does find it, he sets it on therefore, lies in the mystery of me the key to my vocation. I un- his shoulders with great joy and, human freedom and not in the derstood that if the Church has a upon his arrival home, he calls to- limits of divine mercy. Let this be body made up of different mem- gether his friends and neighbours clear, bers then the most necessary or- and says to them, ‘Rejoice with Let us follow Jesus again. At gan, the noblest of all, is not ab- me because I have found my lost the Last Supper, with an unheard- sent from her; I understood that sheep’”’ (Lk 15:1-6). of gesture, he further reveals the the Church has a heart and that It is evident that Jesus told this mystery hidden in the heart of this heat burns with love. I un- parable with the precise inten- God. He gets up from the table derstood that only love makes the tion of correcting the idea of God and sets himself to washing the members of the Church act; that that his listeners and denigrators feet of the Apostles. Note this: if love were to go out, the Apos- had in their minds. Jesus first of amongst the Apostles there was a tles would no longer proclaim the all says: but you, when you lose traitor, there was the man who was Gospel; and martyrs would refuse a sheep, would you not leave the going to deny him and the others to shed their blood. I understood other ninety-nine in the sheepfold were to flee during the hour of the that love includes all vocations. to look for the one that was lost? Passion. Jesus had every right to Then, in the excess of my deliri- This question surprises us say: “ungrateful worms, go away, ous joy, I exclaimed: “Jesus, my somewhat. We would be at peace go far away from me!” love, I have finally found my vo- with the ninety-nine sheep in the Instead, he washes their feet so cation: my vocation is love! Yes, sheepfold and send the lost sheep as to say unequivocally that God I have found my place in the to the devil. But God’s behaviour loves us not because we are good Church and this place, my God, is different – divinely different! but because He is good: and His you gave me! In the heart of the And with refined delicacy, Je- goodness is a challenge that pro- Church, my Mother, I will be sus employs the radiant figure of vokes us and constantly knocks at Love. Thus I will be everything! the shepherd who, carrying the our door. If we open our hearts, That is to say I will thus live all wounded and tired sheep on his we are saved and God celebrates vocations, because the soul of all shoulders, returns to the sheepfold the return of one of His children. vocations is love”. after an unending say of search- And when the goodness of God It is incumbent upon me at this ing. At this point he engages in a finds hospitality in our hearts, a point to pose a question: why did leap of thought which reveals his wonder takes place: those who

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draw near to us perceive a myste- near to the bed of a child who counter our brethren: the person of rious Presence and perceive, with- spontaneously reached out his pride is alone, dramatically alone, out knowing this, a wind from arms to him and declared: “Pope and is incapable of fraternity, be- heaven, which leaves those who John, I can hear that you are here, cause pride is a wall that separates do not believe, as well, thoughtful. but I cannot see you…because I you from everyone: from God and The Servant of God Paul VI am blind!” The Pope caressed the from men. On this point I would turned to his friend Giuseppe child and with a start of Chris- like to relate to you an episode Prezzolini, a non-believer, to have tian wisdom said to him in a low that is truly illuminating. advice about the best ways “to en- voice: “My child, we are all a little Msgr. Loris Capovilla, who ter into dialogue with those who blind!” And he lowered his eyes so was the secretary of the Blessed were distant” in order to “make as not to show that he was weep- John XXIII, confided to me what the Church credible for contem- ing. “We are all a little blind!” happened on the same day as the poraries”. “Holiness”, replied the To encounter the Lord and His election of that Pope. When John Tuscan writer, “there is only one mercy we need humility: humili- XXIII went onto the balcony of way. The men of the Church must ty that is knowledge of our limits, St. Peter’s Basilica for the first be above all else good and have awareness of our radical poverty, ‘Urbi et Orbi’ blessing he tried to one purpose alone: to create good awareness of our blindness, and see the people who thronged the men. There is nothing that attracts awareness that we all need to be square: he heard their voices but like goodness because there is saved. he could not see them because the nothing else that we non-believ- The blind men of Jericho floodlights of the various televi- ers are so deprived of. The world opened themselves to Jesus sion channels prevented him from is full of intelligent people: what through the humility of a peti- seeing beyond them. is absent is good people. Forming tion: “Lord, have pity upon us!” At the end of the ceremony them is the task of the Church: to It was at that moment that there the Pope left the balcony and re-attract men to the Gospel, eve- begun their healing: it began to went into the Hall of Blessings. rything else is secondary”. start from their souls which were He stopped and declared: “The immersed in humility. The mira- strong lights prevented me from 4. But how is it possible to open cle of the healing of the blind was seeing the people. I have learnt a hearts to the flood of the goodness only a confirmation of this. lesson: if I want to see the faces of God? What makes possible the Blaise Pascal acutely observed: of my brethren, the lights of pride encounter between our misery and ‘The last step of reason is to rec- must always be turned off”. the infinite Love of God? We are ognise that there is an infini- To end, I hope that you will given the answer by the Gospel of ty of things that go beyond it: it have such hearts: in this way you the two blind men who, sitting by is weak if it does not manage to will truly be able to bend down the side of the road, are the image know this’. And Mother Teresa of before the others and you will also of the poverty of the whole of man- Calcutta added: ‘Humility is the be transparent and thus allow the kind, and of our poverty as well. most intelligent virtue because it Light of God and the Love of God The Blessed John XXXIII, throws us into the arms of Truth to pass through you. And thus you when visiting the ‘Bambino Gesù’ and of Charity’. For this reason, will see very many people healed: Hospital on the occasion of Holy humility is indispensable not only certainly in their souls, and, God Christmas of the year 1958, drew to encounter to God but also to en- willing, in their bodies as well.

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Address of His Holiness Benedict XVI

Your Eminences, Venerable Brothers in the Episcopate and in the Priesthood, Dear Brothers and Sisters, I offer you a warm welcome! I thank the President of the Pontifical Council for Health Care Workers, (Health Pastoral Care), Archbishop Zygmunt Zimowski, for his courteous words; I greet the distinguished speakers and all those present. The theme of your Conference – “The Hospital, a Place of Evangelization: a Human and Spiritual Mission” – gives me an opportunity to extend my Greeting to all the health-care workers, and in particular to the members of the Italian Catholic Doctors’ Association and of the European Federation of Catholic Medical Associations, which has examined the subject “Bioethics and Christian Europe” at the Catholic University of the Sacred Heart in Rome. I also greet the sick people present, their relatives, the chaplains and the volunteers, the members of the associations, and in particular of the Italian National Union for the Transport of the Sick to Lourdes and International Shrines (UNITALSI), the students at the Faculties of Medi- cine and Surgery and those who are taking degree courses in the health-care professions. The Church always turns with the same brotherly spirit of sharing to all who are suffering, enliv- ened by the Spirit of the One who, with the power of love has restored meaning and dignity to the mystery of suffering. The said to these people “know that you are not... abandoned or useless” (cf. Message to the Poor, the Sick and the Suffering, 8 December 1965). And in these same tones of hope, the Church also reassures health-care professionals and vol- unteers. Yours is a special vocation that requires study, sensitivity and experience. Nevertheless, a further skill which goes beyond academic qualifications is demanded of those who choose to work in the world of suffering, living their work as a “human and spiritual mission”. It is “the Christian science of suffering”, explicitly pointed out by the Council as “the only one that can respond to the mystery of suffering” and of bringing to the sick “relief without illusion”. The Council says: “it is not within our power to bring you bodily help nor the lessening of your physical sufferings.... But we have something deeper and more valuable to give you.... Christ did not do away with suffering. He did not even wish to unveil to us entirely the mystery of suffering. He took suffering upon Him- self and this is enough to make you understand all its value” (ibid.). May you be qualified experts in this “Christian science of suffering”! Your being Catholics, without fear, gives you a greater re- sponsibility in the context of society and of the Church: it is a real vocation, as has recently been witnessed by exemplary figures such as St Giuseppe Moscati, St Riccardo Pampuri, St Gianna Be- retta Molla, St Anna Schäffer and the Servant of God Jérôme Lejeune. This is also a commitment of the New Evangelization in the times of an economic crisis that are cutting funds for health care. In this very context hospitals and structures for assistance must re- think their role to prevent health, first and foremost a universal good to be guaranteed and defended from becoming a mere “product” subjected to the laws of the market, hence accessible to few. The special attention owed to the dignity of the suffering can never be forgotten, applying also in the

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context of health-care policies the principles of subsidiarity and solidarity (cf. Caritas in Veritate, n. 58). Today, although on the one hand because of the progress in technology and science the ability to heal the sick physically is increasing, on the other, the ability to “care for” the , seen in his integrity and uniqueness, appears to be weakening. Thus the ethical horizons of medical science that risks forgetting that its vocation is to serve every person and the whole person, in the various phases of his or her life, seem to be dulled. It is to be hoped that the language of the “Christian sci- ence of suffering” – to which belong compassion, solidarity, sharing, self-denial, giving freely, the gift of self – become the universal lexicon of those who work in the sector of health-care assistance. It is the language of the Good Samaritan of the Gospel parable, which – according to Blessed Pope John Paul II – may be considered as “one of the essential elements of moral culture and uni- versally human civilization” (Apostolic Letter Salvifici Doloris, n. 29). In this perspective, hospi- tals assume a privileged position in evangelizing, because wherever the Church is the “bearer of the presence of God” it becomes at the same time “the instrument of the true humanization of man and the world” (Congregation for the Doctrine of the Faith, Doctrinal Note on Some Aspects of Evan- gelization, n. 9). “Only by being very clear that at the heart of medical and health-care assistance is the well-being of the human person in his frailest and most defenceless state, of man in search of meaning in the face of the unfathomable mystery of suffering, can one conceive of the hospital as “a place in which the relationship of treatment is not a profession but a mission; where the char- ity of the Good Samaritan is the first seat of learning and the face of suffering man is Christ’s own Face” (Discourse, Visit to the Catholic University of the Sacred Heart, Rome, 3 May 2012). Dear friends, this healing and evangelizing assistance is the task that always awaits you. Now more than ever our society needs “Good Samaritans” with generous hearts and arms wide open to all, in the awareness that “The true measure of humanity is essentially determined in relationship to suffering and to the sufferer” (Spe Salvi, n. 38). This “going beyond” the clinical approach opens you to the dimension of transcendence, for which the chaplains and religious assistants play a fun- damental role. It is their primary task to make the glory of the Crucified Risen One shine out in the rich panorama of health care and in the mystery of suffering. I would like to reserve a last word for you, dear sick people. Your silent witness is an effective sign and instrument of evangelization for the people who look after you and for your families, in the certainty that “no tear, neither of those who are suffering nor of those who are close to them, is lost before God” (Angelus, 1 February 2009). You “are the brothers of the suffering Christ, and with him, if you wish, you are saving the world!” (Second Vatican Council, Message to the Poor, the Sick and the Suffering, 8 December 1965). As I entrust you to the Virgin Mary, Salus Infirmorum [Health of the Sick], so that she may guide your footsteps and always make you hardworking and tireless witnesses of the Christian science of suffering, I warmly impart to you the Apostolic Blessing.

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Thursday 15 November I. History and Mission

Opening Address by H.E. Msgr. Zygmunt Zimowski

H.E. Msgr. ops, and with the fiftieth anniver- by a Christian anthropology, run Zygmunt Zimowski sary of the opening of the Second the risk of ‘reducing’ a patient to President of the Vatican Council, which was char- being a mere object of study and/ Pontifical Council acterised, amongst other things, or therapeutic treatment, and this for Health Care Workers, by the promotion of an increasing is not to mention extreme cases the Holy See involvement of the lay faithful in where ethically wrong experi- the life of the Church. mentation, or action for its own The three days of the meeting sake, are engaged in. untes docete et curate infir- in the Vatican, two planned for This, however, is something ‘Emos’ (Mt 10:6-8 – Go, preach the New Hall of the Synod and that can take place, to the detri- and heal the sick) is the mandate the third to be held in the Paul VI ment of respect for Life, from of Jesus on which are based two of Hall, will be dedicated to the study conception until its natural end, the fundamental and always rele- of all the aspects of hospitals in and of the patient in his being a vant to our times activities of the their essence as privileged set- person with a dignity and an ex- Church: evangelisation and care tings for the carrying out, both in- perience that are specific to him for the sick. These are endeavours dividually and collectively, of the or her and are unrepeatable. The that are always conjoined, both mandate of baptism, proclaiming ‘Christian science of suffering’, as in territories that are traditionally the Good News, and being able to the Council Fathers who met fifty seen as being of mission and in recognise and encounter the Face years ago for the Second Vatican specific institutions such as cen- of Christ and to imitate to the full Council put it, is indeed ‘the only tres for care and, more precisely, the Good Samaritan of the gospel truth capable of responding to the hospitals. Today, above all in the parable that bears his name. mystery of suffering’ and capable economically advanced countries A hospital is a reality of mis- of offering authentic ‘relief’ that is of the world, hospitals are authen- sion which is also a challenge for free of utopian solutions. tic crossroads of cultures and re- all the agents of pastoral care in This is a cardinal reality that ligions, settings for the profound health, both consecrated and oth- has to be addressed given the in- expression of healing, privileged erwise, and constitutes a unique creasing tendency that exists to places for the Apostolate of Mer- opportunity to adhere to the Word privilege management rather than cy, as they were defined by the that was made man. the affective needs of . Blessed Pope John Paul II who This is a journey that is almost On the other hand, given the in 1985 instituted our Pontifical impossible to make and main- increasing accessibility to infor- Council pro valetudinis adminis- tain in a faithful way if one does mation, which for that matter is tris, and spaces for preaching and not perceive an authentic voca- information that is not always ver- the new evangelisation. tion, if one is without faith in ified or verifiable, today it is an This is the deliberate concord- Man and Love-Charity, but also increasingly common fact that a ance of the subject of our twenty- if one is without humility that is sick person does not entrust him- seventh international conference, linked to an awareness of the hu- self or herself in a passive way to to which His Holiness Pope Ben- man condition and the finitude of an institution or a medical doc- edict XVI wanted to give the title the scientific advances that have tor. He or she has the possibility, ‘The Hospital, Setting for Evan- been achieved and which need to and wishes, to make his or her gelization: a Human and Spiritual be updated because of their con- own choices, and to interact from Mission’, with the Year of Faith, stant evolution and the advance of the first verbal exchanges, and he which was inaugurated on 11 Oc- technologies. These are advances, or she is aware, or is convinced tober 2011, just after the end of and we state the point once again, that he or she is aware, of what the thirteenth Ordinary General which if they are not ‘humanised’, is needed and of the place from Assembly of the Synod of Bish- that is to say guided by ethics and which this can be obtained. There

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follows from this a greater role for which they can be kept running. eration between the various sub- medical doctors and institutions In addition, it is impossible for jects that act in the community who, and which, have to be able to most of the health-care personnel of people where ‘the principle of communicate in an effective way to obtain full training or adequate subsidiarity should be maintained their ability to treat and to cure, professional updating. strictly connected with the prin- abstaining carefully from provok- We thus take this opportunity to ciple of solidarity and vice versa. ing false illusions where physical express our solidarity and grati- This is cooperation that tends, on recovery is in fact unobtainable. tude to all medical doctors, nurses the one hand, to provide solutions Indeed, the substance of the re- and voluntary workers, and in a to problems that cannot be solved lationship between a medical doc- special way to those who are too within individual countries, and, tor and his or her patient is im- often faced with a life that comes on the other, to address the vari- mutable. As was well illustrated to an end because of the lack of a ous needs with a shared vision. In by the Blessed Pope John Paul II, medical product. response to these needs, therefore, amongst other things the founder Their frustration is often of a human, economic and the most of our Pontifical Council, this is an daily character, and yet with cour- broadly material resources should interpersonal relationship of a spe- age and determination they con- be channelled and employed’.2 cial nature. It is, as the Osserva- tinue to assist in the best way pos- It is also of fundamental im- tore Romano of 18 October 1998, sible all suffering people, without portance that Catholic health-care reported, ‘an encounter between making distinctions based upon centres maintain their identities a trust and a conscience’, that is religion or ethnicity or origins, without compromises, welcom- to say the trust of a human being and they do this with what is avail- ing everybody without, however, marked by suffering and illness able and above all with their love. yielding to injurious forms of sec- and who is thus in need, who en- Pope Benedict XVI exhorts us in ularisation or relativism. Church trusts himself or herself to the con- the following way: ‘The Church’s health-care institutions, the Holy science of another human being health care institutions and all Father emphasised, although they who can take responsibility for his their personnel should strive to should welcome suffering people or her need and goes towards him see in each sick person a suffering without engaging in forms of dis- or her in order to assist him or her, member of Christ’s Body. Diffi- crimination, ‘need to be managed treat him or her, and heal him or culties of every kind rise up along in compliance with the Church’s her. This last is what a health-care the way: the growing numbers of ethical norms, providing servic- worker is. For him or her a sick the sick, inadequate material and es which conform to her teaching person is never only a clinical case financial resources, the withdraw- and are exclusively pro-life. They but always a ‘sick human being’, al of support by organizations must not become a source of en- towards whom should be adopted which had helped you for years richment for a few. The manage- a sincere approach of ‘sympathy’ and are now abandoning you; at ment of grant monies must aim at in the etymological sense of the times all this can give you the im- transparency and primarily serve term (from the sympathia, pression that your work produces the good of the sick. Finally, each the Greek συμπaʹϑεια, a compos- no tangible results. Dear health- health care institution ought to ite of συʹν ‘with’ and πaʹϑος ‘af- care workers, bring Jesus’ com- have a chapel, the presence of fection, feelings’). passionate love to those who suf- which will remind all who work It is specifically the relationship fer! Be patient, stand firm and do there (management, staff, physi- between a patient and a health- not lose heart! As far as pandem- cians and nurses), as well as the care worker, whether a profes- ics are concerned, while financial sick themselves, that God alone is sional or a volunteer, a religious and material resources remain in- the Lord of life and death’.3 or a lay person, that is indeed the dispensable, seek also constantly This is an exhortation which principal common denominator to form and inform people, espe- at the level of fact concerns over that is to be found in the great pol- cially the young’.1 120,000 health-care institutions yclinics and dispensaries that are The value and the profound which work in the five continents active in the remotest areas of the courage that are demonstrated by of the world and which derive planet, and ‘Western’ hospitals health-care personnel who work from the commitment of the great and those that work in economi- in the most impoverished regions religious orders, such as those cally disadvantages countries. of Africa and of the other conti- founded by St. John of God and We are referring here to na- nents of the world must absolute- by St. , but also tions that are characterised by ly be helped because, as His Holi- from the commitment of dioceses, poor economies where in a dra- ness Benedict XVI emphasised in institutes of consecrated life, and matic way there is a shortage of Caritas in veritate, the encyclical other religious and lay entities health-care institutions, in quan- at the centre of the 2011 edition and men and women of good will. titative terms, that is to say their of our international conference, An imposing network of charity, presence in local areas and access ‘the requirements of a develop- at the service of Love and Salus, to them, because of the costs con- ment that respects human life do which includes remote dispensa- nected with diagnostic examina- not only have a dimension that ries and large metropolitan poly- tions and treatment, but also in is within individual communities clinics because, as His Holiness terms of quality, because of a lack but also an international dimen- Benedict XVI emphasised, ‘Love of equipment and of money by sion. They need effective coop- – caritas – will always prove nec-

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essary, even in the most just so- Pham Minh Man, Cardinal Wil- them, taking part in the meeting, ciety. There is no ordering of the frid Fox Napier, and Cardinal will be a very large number of sick State so just that it can eliminate Willem Jacobus Eijk. people and those who accompany the need for a service of love. Various bishops and archbish- them, thanks to the efforts of UNI- Whoever wants to eliminate love ops will make their contribution TALSI as well, which well repre- is preparing to eliminate man as as well, starting with Msgr. Sal- sents the multiple realities of na- such. There will always be suffer- vatore Fisichella, the President tional and international voluntary ing which cries out for consolation of the Pontifical Council for the work that are involved in pastoral and help. There will always be Promotion of the New Evangeli- care in health. loneliness. There will always be sation, and Msgr. José Luis Re- To them and to all of you our situations of material need where drado, the former Secretary of our welcome and our gratitude, as to help in the form of concrete love Pontifical Council. many other people who because of neighbour is indispensable’.4 We also envisage a paper by of reasons of time I cannot now We have this come this year to the Italian Minister for Health, refer to but to whom goes all of the twenty-seventh edition of our the Honourable Renato Balduzzi; our gratitude for having wel- international conference which, by Prof. Enrico Garaci, the Presi- comed our invitation, agreeing to as tradition has it, will being to- dent of the Advanced Institute for interrupt their many daily com- gether personalities of an interna- Health Care with its headquar- mitments as pastors and agents of tional calibre and over 650 partic- ters here in Rome; and Fra’ Mario pastoral care, as medical doctors ipants who will come from more Bonora, a member of our Pontifi- and as nurses, and as people of than sixty-five countries to rep- cal Council and the President of good will involved in improving resent the five continents of the ARIS and of the Negrar Hospital the worlds to which they belong world. On the screen we can see of Verona. and improving themselves for the these sixty-five countries listed in Cardinal Angelo Comastri will good of mankind. alphabetical order. lead the meeting of reflection and During this inaugural day of prayer planned for Saturday morn- Notes the international conference, our ing, at the end of which is envis-

deliberations will centre around aged an address by the Holy Fa- 1 Cf. Benedict XVI, Post-Synodal Apos- the subject ‘History and Mis- ther, Benedict XVI. There will also tolic Exhortation Africae Munus n. 140. sion’, whereas tomorrow we will take part in this important appoint- 2 Speech of Archbishop Z. Zimowski to the conference on ‘Respect for Life and the address the subject ‘Ethics and ment, which will take place in the Development of Peoples’, with reference to Humanisation’, before the subse- Paul VI Hall and which will end the encyclical Caritas in Veritate of Pope quent subject of ‘Spirituality and our deliberations, those people at- Benedict XVI, Wednesday, 1 December 2010, Rome, Catholic University of the Sa- the Deaconate of Charity’. Nu- tending the European Congress of cred Heart. merous and distinguished speak- Catholic Doctors FEAMC-AMCI, 3 Cf. Benedict XVI, Post-Synodal Apos- ers will make their own contribu- which is on the subject ‘Bioethics tolic Exhortation Africae Munus n. 140, n. 141. tion and amongst these one may and Christian Europe’ and is cur- 4 Cf. Benedict XVI, Encylical Letter De- refer to Cardinal Jean-Baptiste rently being held in Rome. With us Caritas Est, n. 28b.

The Decree Ad Gentes in the Life of the Church Today

H. Em. Cardinal e think it would be appro- 1. The Situation Jean-Baptiste Wpriate to share some of our Pham Minh MA¯ n pastoral experiences in applying After 1975 the regime nation- Archbishop of the Decree Ad Gentes to the life alised all health-care/educational Thàn-Pho¯ Ho¯ Chí Mihn, of the Saigon Archdiocese in the institutions that belonged to re- Vietnam. socio-cultural-economic-political ligions. Saigon was renamed Ho Member of the Pontifical context of the Socialist Republic Chi Minh City. In adopting the Council for Health Care of Vietnam today. new name, the archdiocese lost Workers, nearly 400 health-care/education- the Holy See al institutions (elementary-sec- ondary schools and universities, hospitals and dispensaries, chari- table humanitarian care centres).

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Two decades later, the authori- News of salvation and spreading id basis of the Word of God so as ties are promoting the new policy the Kingdom of God. They should to become: of ‘socialising’ educational and be convinced that the ministry has – Church-mystery: a faith-shar- health-care services. A number of its source in the salvific design of ing community that lives wholly organisations, both of foreigners God the Father to save all people love for God the Father. and of local lay people, and some of the world. – Church-communion: living Catholics as individuals, have be- – Giving all Catholics the abil- perfectly fraternal love in unity as gun to open new health-care/edu- ity to participate in this ministry children of the one Father. cational works. Even though up to together with their fellow coun- – Church-mission: opening up now no permission has been giv- trymen by walking on the path this fraternal love to all by com- en to open schools and hospitals, and in the light of the Gospel, just passionately sharing the gifts do- various Catholic institutes such as as Jesus himself overcame many nated by God to their country- religious Congregations and par- serious problems, wickedness and men, to humankind at large, as ishes have been running nearly abuses in his human life, before brothers of the same family in the 300 new centres: reaching a new and fruitful life in globalised world of today. – Nearly 200 kindergartens, al- God’s Kingdom – a new heaven phabetisation classes, profession- and a new earth full of the light of 3c. Transforming one’s life al training courses, hostels for mi- truth, justice, peace and love. by the Gospel. The ministries of grant workers and students. evangelisation and spreading the – Nearly 100 smaller centres Kingdom of God require all mem- which are called ‘homes’ and care 3. The Formation of Workers bers of the to an- for the poorest and most aban- for Ministry swer to the challenge of Pope doned of patients, for elderly peo- Benedict XVI to evangelise their ple, for the handicapped, orphans Offering conditions to all Cath- own lives, bringing the light and and abandoned infants – help- olics to renew their ways of living strength of the Word of God into ing undesired newborn babies in as Christians: they should over- their works and words, and to im- ‘family and life protection’ pro- come certain traditional repeti- bue all their activities (religious grammes. tions as well as religion-keeping formation, Catholic education, Furthermore, the archdiocese mentalities. They should be im- pastoral care, administration…) has engaged in pastoral care for bued with the Word of God, live with the values of the Gospel Catholic health-care and educa- in the light of Christ’s love and so as to become yeast and salt: tional workers (such as doctors, truth, and themselves be evange- Christ’s light of truth and love in nurses, hospital employees, lec- lised first. all situations of today’s society. turers and teachers) by creating Furthermore, there should be in- appropriate associations for them. 3a. Renewing their spiritual itiatives in evangelising the vari- These associations unify them lives. The three main columns of ous festivals of today’s society, so as to overcome various social a Christian life are: mortification such as Woman’s Day, Valentine’s abuses, promote education for – praying diligently and receiv- Day, Father’s Day, and Mother’s poor and abandoned children, and ing the sacraments – and the prac- Day etc… introducing them to the give free health-care services to tice of sharing with a charitable Christian community programme. patients in the remotest and poor- heart. But what is more important In this way, the diocesan fam- est areas. They thus offer a Chris- is renewing the ways of practis- ily will eventually become God’s tian witness of hope and love in ing these, doing as Jesus did, fol- community, which humbly and the social context of the country. lowing the teaching of John Paul with love serves the cause of life II: overcoming the routine of the and of human development. This old man; letting oneself be trans- prospect of becoming witness- 2. Principle formed by the Holy Spirit so as es to the Good News of life and to become an entirely new crea- love would certainly, little by lit- The Catholic Church is mis- ture, following the model – Jesus; tle, blot out in the mind of many sionary by nature, therefore it re- listening to the Word of God ex- the image of a powerful Church, quests all Catholics to be aware of pressed in the Gospel and in the a fearful enemy, and thus would actively taking part in the Ministry teachings of the Church, through eventually make the Church a of Mission. This is done through social and historical events; and strong support to all men and different formation and up-dating being faithful to Jesus in his path women of goodwill in contempo- courses for priests, religious and of salvific love. rary society. lay people, and by being closely associated with the lay apostolic 3b. Building up the Church sol- associations. The Church’s lead- idly on the foundation of the Word 4. The Personnel of Mission ers should pay due attention to: of God. All the faithful should be – Creating favourable condi- united in one soul and one heart Following Christ on the way tions for all Catholics so that they in order to rebuild their families of salvation. Creating favourable can be aware of the ministry that and their communities (whether conditions for ecclesiastics, reli- Jesus has given to the Church, religious institutions, parishes or gious, lay faithful, adolescents, which is proclaiming the Good ecclesial associations) on the sol- young people, families, medical

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personnel, teachers, businessmen, tively to the building up of a civ- volunteers: more than 6,000; (3) intellectuals, professionals, im- ilisation of life and love in con- more than 1,500 choirs with a to- migrants: opening up and elevat- temporary society tal of almost 30,000 choir mem- ing their knowledge of faith and Dialogue and cooperation. bers. There exist in the archdio- better pastoral care, giving them Nowadays another means of mis- cese 26 lay apostolic associations. the ability to listen to the Voice of sionary action is dialoguing and Among them the most numer- God in all walks of life, and fol- collaborating with all other mem- ous is the Association of Chris- lowing Christ on the road of sal- bers of the society in order to tian Mothers which in 1998 had vation with four characteristics: serve life better as well as to ad- 4,000 members, but now in 2012 – Humbly inculturising them- vance the human community: in- already has 24,000. Furthermore, selves by sharing in all conditions ter-religious, inter-cultural and in- there are other groups of lay peo- of human life so as to offer to eve- ter-national actions are especially ple that spontaneously associ- ryone love and peace. valuable. Patient dialogue and ate with one another in order to – Engaging in services that bear sincere collaboration respecting do social and charitable works to witness to the Gospel of Love, by all human and religious Gospel protect human life and promote serving fellow human beings, in values as well as sound humani- development. particular those in serious diffi- tarian values that are founded in culty. the traditional culture of the peo- Centres for formation. At the – Loving generously to the end, ple would certainly make this so- present time the archdiocese has for the sake of human life and the ciety more and more sustainable one Major Seminary that needs human development. and wholesomely developed. to be extended more in order to – Opening up the road of re- receive at least 300 candidates newal that leads to the source of for the priesthood over the next life itself, the Risen Christ, to eve- 6. Situation of the Diocese ten years. Ten formation centres ryone. up to the Beginning of 2012 for men and women religious. As for the formation of lay peo- Building up the fraternity that Population. The Catholic popu- ple: in 2004, after getting back makes all humankind brothers. To lation of the archdiocese in 1998 the compound of the former Mi- promote solidarity that unifies all was 520,000; in 2012 it is 680,000 nor Seminary that had been used men – people of all walks of life – in 200 parishes, out of a total of since 1975 by the state as a Col- so as to bear witness to the Good 0.8 million, the population of the lege of Finance, the diocese has News in their condition of life: city. That is not counting 150,000 transformed it into a Pastoral and in the context of the globalized out of the total of 0.2 million mi- Formation Centre. Since 2004 world of today, there is a need to grants students and workers. 90% this centre has opened yearly in- create bridges of communion be- of Catholic go to Mass on Sunday. tensive courses for the updating tween two local Churches, two Almost 100% of children study of pastoral knowledge as well as nations, between religions... in catechism in the parishes up to faith-deepening studies, with no order to share with each other the the time of receiving confirma- less than 6,000 students every divine gifts received, and together tion and even afterwards. Secu- year. be witnesses to the Good News of lar priests number more than 300, life and love which clears the way religious priests are also 300, and Furthermore, this Pastoral Cen- for the work of evangelising this there are almost 6,000 men/wom- tre frequently runs and organises: very globalised world itself. en religious. 1. Courses of specialised train- ing for sixteen diocesan pasto- New parishes and mission out- ral commissions (Liturgy, Sacred 5. Missionary activity posts. During the last decade of Music, Holy Scripture, Cate- the twentieth century, from the chism, Vocation, Children, Young Incorporation and participa- various charitable and social ser- People, Family, Migrants, Catho- tion. In order to be genuine yeast, vices in the remote areas of the lic Education, Culture, Evange- salt and light for the world, the city missionary outposts sprung lisation, Caritas-Health Care, In- Christians should be associated up. Some of them, with a few terreligious Dialogue, Justice and more closely with the cultural-so- hundred faithful, eventually be- Peace, Social Communication). cial life of the society around them came parishes, with priests and 2. Meetings, symposiums, as- by participating in all educational religious caring for both the bod- semblies at national, inter-dioc- and health-care services that care ies and souls of the poorer people. esan, inter-religious and FABC for (in particular) those who are levels. excluded by society itself, such as Lay associations. In all 200 3. Festivals and celebrations lepers, HIV/AIDS patients, elder- parishes there exist three pasto- with a congregation up to 10,000- ly-handicapped people, orphans, ral institutions: (1) The Pastoral 15,000 participants, sometimes and poor and abandoned children. Council that has in total more than with both Christians and non- Such actions will contribute posi- 5,000 members; (2) catechists, all Christians.

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Prolusion

Hospitals: Settings for a New Evangelisation

H.E. Msgr. Sisters of the Sacred Heart. The In recent weeks the twelfth Or- Salvatore Fisichella date was 5 May 1905. In recent dinary Assembly of the Synod of President of the days L’Osservatore Romano pub- Bishops came to a close. The sub- Pontifical Council for lished this piece of a latter togeth- ject that filled its intense days of the Promotion of er with a fine piece of reporting to work was the New Evangelisa- the New Evangelisation, remember the first great American tion and the transmission of faith. the Holy See woman saint, the patron saint of In a clear way there emerged an immigrants, who engaged in work awareness that the new evangeli- which is considered from the hu- sation is by now the journey that man point of view alone of abso- the Church intends to make over lute greatness. At the beginning of the next decades with hope and de- A Historical Memory the twentieth century in Europe, cisiveness, knowing that the path the United States of America and is the work of the Holy Spirit who ‘The opening of a hospital, even Latin America she had already always guides the Church in the though it is an event of importance founded sixty-seven schools, events of history so that in history for the art of , does not works of care and hospitals. And the Church can be the living sign of usually provoke much positive in- if this was not enough, during that the presence of Christ. Awareness terest in the general public, who time she crossed the ocean at least has grown that in the new evange- vies away from such asylums of twenty-four times. We could be lisation, as well, what should take pain. Such, however, was not the astonished by the great mission- pride of place is the person of Je- surprise of His Excellency Msgr. ary action of St. Cabrini who from sus Christ, the first evangeliser of Quigley, the worthy Archbish- a small village named Codog- the Father and His mystery, but at op of Chicago, when he was sur- no was able bring her witness to the same time this should be con- rounded by a crowd of more than faith as far as the Andes. Howev- tained in our preaching which is 4,000 people who had gathered er what was said in this letter has always new because it is renewed around the chapel and the recep- for us a fundamental importance. by a faith that is incarnated in the tion hall to hear his words! Oth- The reactions of people faced with various situations of history. er people, more than a thousand certain situations were empha- However, to think that one can in number, were sent outside be- sised. She speaks about ‘asylums give a clear and exhaustive defini- cause of a lack of space and they of pain’ which did not provoke tion of the new evangelisation is a had no hope that they would be much positive interest on the part temptation from which we should granted access. Everyone agreed of people. At the same time, how- flee. Paul VI in hisEvangelii - that never in the United States of ever, there is mention of the orig- tiandi, which is always of contem- America had so much enthusiasm inality that she had put into the porary importance, warned about been expressed at the opening of construction of a new hospital: the falling into this danger when he a hospital as was the case on that choice of the location, the beauty wrote: ‘Any partial and fragmen- occasion. This was the day of the of the buildings and the first-class tary definition which attempts to Lord, the work of the Lord… The equipment, which in contrary render the reality of evangeliza- medical faculty of the city classi- fashion provoked great enthusi- tion in all its richness, complex- fied our hospital as being one of asm in the local population. If to ity and dynamism does so only at the first order. And everyone is this one adds that this hospital was the risk of impoverishing it and in agreement in saying that the called by her a ‘work of the Lord’, even of distorting it. It is impos- charming position and the beauty and we well know that it was also sible to grasp the concept of evan- of this institution make it the best the outcome of her personal holi- gelization unless one tries to keep hospital in Chicago’.1 These are ness, then the mosaic is completed in view all its essential elements’.2 the words that Francesca Cabrini and allows us to the see the great In the same way, in his address at wrote to the students of the Insti- works that believers are able to the beginning of the Synod3 Ben- tute of the Magisterium that had achieve when they allow them- edict reaffirmed in a very pro- gathered together here in Rome selves to be guided by the grace of found way: ‘In every time and to be informed about her intense the Father and in meekness to the place, evangelization always has activity and that of the Missionary action of the Holy Spirit. as its starting and finishing points

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Jesus Christ, the Son of God (cf. people who can find in the Cross ture and offer spaces for preaching Mk 1:1); and the Crucifix is the of Christ understanding and ac- that were previously unknown. supremely distinctive sign of him ceptance of the mystery of suf- This is an important suggestion who announces the Gospel: a sign fering that gives them hope in for the new evangelisation be- of love and peace, a call to con- the life to come. In the sick, the cause it must be able not only to version and reconciliation’. And suffering, persons with disabili- recognise these new settings but he immediately went on to spec- ties and those with special needs, above all else find coherent forms ify: ‘the New Evangelization [is] Christ’s suffering is present and by which to enter them. Opening directed principally at those who, has a missionary force. For Chris- towards these new forms, which though baptized, have drifted tians, there must always be place remain fundamental, cannot lead away from the Church and live for the suffering and the sick. to forgetting about the commit- without reference to the Christian They need our care, but we re- ment that believers have always life…[it is needed] to help these ceive even more from their faith. shown towards fields that are less people encounter the Lord, who Through the sick, Christ enlight- exciting and often amongst the alone fills our existence with deep ens His Church, so that every- most forgotten, such as those that meaning and peace; and to favour one who enters into contact with revolve around the great chap- the rediscovery of the faith, that them will find reflected the light ter of human suffering. The new source of grace which brings joy of Christ. This is why the sick are areopaghi are by no means rare- and hope to personal, family and very important participants in the ly marked by a wish to ignore or social life’. New Evangelization. All those in conceal these settings because As one can observe, evangeli- contact with the sick need to be they do not accept that man can sation has always been of the na- aware of their mission. We cannot experience weakness, after they ture of the Church and it is what forget when we build new hospi- themselves have had the illusion makes the Church the Body of the tals to pay attention so that we do of his omnipotence. And yet spe- Risen Christ and his presence in not lack a consoling and support- cifically because of this and our the world so as to be a mediation ive environment and a place for love for the truth we must be able of his revelation. The new evan- prayer’. to bring to the new areopaghi the gelisation is not something that One would not understand meaning of forgotten suffering is added from outside under the some of the points of this ‘Propo- and pain that is not talked about. pressure of events but a feature sition’ if one did not refer to the The fact that the Christian reli- of the very nature of the Church rich teaching of the Church on gion has as its specific feature the which emerges in a more evident suffering and illness in relation to incarnation of the Son of God is way to achieve a renewed aware- the mystery of the Cross of Christ. not without consequences for the ness of the mission that believers This teaching is to be found in organisation of its personal and have to be witnesses to the risen particular in the Blessed John social life. If God enters history Christ in a world that has radical- Paul II. In his Salvifici dolorishe and takes upon Himself the cri- ly changed its features under the wrote the following words: ‘The terion of participation in human pressure of secularism. The new theme of suffering… is a univer- life, then everything that the life evangelisation, therefore, is not sal theme that accompanies man of a person and the life of socie- a matter of placing in brackets a at every point on earth: in a cer- ty which he or she lives involves past that is always rich in testimo- tain sense it co-exists with him in becomes a space for the action of nies that changed the world, but, the world, and thus demands to be believers. Nothing is saved in that rather, it becomes an opportunity constantly reconsidered’ (n. 2). which was not taken upon by the for a serious examination of con- Word of God. The incarnation of science in order to assess whether God commits the Church to enter- the faith of believers is still able The Meaning of Pain ing the history of men and mak- to be as genuine and vivacious as in the New Areopaghi ing them participants in a plan of it should be, or whether it is sub- salvation that is not only a future jected to tiredness, obviousness, This observation allows us to promise of eternal life but is also fear…all elements that are extra- set in motion a primary analysis already, here and now, a change neous to faith and limit its sphere of our subject. The gospel does in, and transformation of, the pre- of action. not exclude any field of personal sent life. The miracles that Jesus Amongst the Propositiones that and social life. The Church, there- performed, for example, did not were presented to the Holy Father fore, can forget no place reached only have the purpose of stress- as a first summary of the work of by man and within which he gives ing his power over evil, over ill- the Synod, one in particular bears practical expression to his per- ness and over death. At the same upon the subject of the applica- sonal existence. To every one of time they were a prelude to pro- tion of the new evangelisation to its contemporaries, the Christian claiming the concrete transforma- the field of pastoral care in health. community is called to being the tion of man. What there will be It says: ‘The New Evangelization word of the Gospel which gives in the new times and on the new must be ever aware of the Paschal meaning and saves. At the present earth is made visible now through Mystery of the death and Resur- time one often hears reference to a change that the power of God rection of Jesus Christ. This mys- the presence of the Church in the works, if we abandon ourselves tery sheds light on the suffering of areopaghi that mark modern cul- to Him in faith. The body will be

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transformed and with it the whole not find a place in our homes; ing of the good news of the gospel of the creation. This idea has al- and, even less, could it be an ex- which saves, starting with their ways found space to be special- pression of the progress achieved own condition. This is not with- ly listened to at the moment of over the centuries by civilisation. out importance because it seeks the experience of suffering. The In the face of cultural forms that to look with greater intensity and apostle said this in a peremptory push towards an obsession with commitment at the formation of way: ‘When I am weak, then I am physical beauty to the point of be- believers so that in these circum- strong’ (2 Cor 12:10). The mo- ing near to the ridiculous because stances of suffering, as well, such ments of the weakness of man, of an illusion of being able to of- experiences can be lived through therefore, can become a space to fer eternal youth through surgi- in harmony with faith. One can- make evident the force of God, cal action which brings out even not improvise being evangelisers who from nothing brings every- more an old age that wants to con- and one cannot give meaning to thing to being. ceal itself, it is important to pose pain from one day to another. All It is the force of faith that has the question of the meaning of life of this requires a grounding that allowed down the centuries the and its essence. Faced with a re- grows and matures with faith in transformation of pagan plac- newed pagan cult of the body we the mystery of active and real par- es – when a sick person was de- should nourish a greater critical ticipation in the mystery of Christ ceived by myth and by his min- sense that will allow us to restore and the life of communion with isters of his real condition – into to confused man the right mean- him that is offered by baptism. centres of loving welcome where ing of things and the real meas- The journey of the Pontifical the sick person was directly tak- urement of his acts. This is a new Council for Health Care Workers en care of. What paganism direct- evangelisation which brings a has for some time now made the ed to the gods so that they would breath of oxygen by presenting New Evangelisation its priority intervene in favour of the sick, the truth and by this fact also the choice. The multiple initiatives of Christians made become a setting freedom of every person against which it is the promoter bear wit- for the direct role of the divine illusion and thus deception. ness to this. One need only re- so that the sick could touch with member here, in this sense, the their own hands the concrete near- subject of the ninth World Day of ness of God through the charitable The Sick Person the Sick of 2001 which was en- hearts of their brethren. This is the as the New Evangeliser titled: ‘The New Evangelisation first act of the new evangelisation and the Dignity of the Suffering which is imposed as an obligation There are rich and intense ex- Person’, when the Blessed John so as not to forget the human con- periences of new evangelisation Paul II himself wrote as follows: dition in all its aspects. that deserve to be participated in ‘Evangelization must be new – Indeed, we are faced with the and lived. These allow it to be new in method and new in ardour new evangelisation as a cultur- seen that the new evangelisation, – because so much has changed al expression that enters the for- beyond any form of rhetoric, in- and is changing in the care of mulation of a new anthropology volves not only those people who the sick. Not only is health care of which the culture of our days are called to be evangelisers of facing unprecedented economic has especial need. Directed as we those people who suffer, but also, pressures and legal complexities, are to give images and voice on- and primarily, makes sick people but at times there is also an ethi- ly to beauty to satisfy a by now the protagonists of the new evan- cal uncertainty which tends to ob- evident narcissism, or to the right gelisation when they are able to scure what have always been its to be healthy so as to deceive our- locate their illness and pain in the clear moral foundations. This un- selves as to an immortality that mystery of the Cross and the Res- certainty can become a fatal con- does not belong to us, the Church urrection of Jesus Christ. It was fusion, manifested as a failure to has as an obligation which is that John Paul II who, once again, re- understand that the essential pur- of emphasising the dignity of hu- membered this profound truth pose of health care is to promote man person in all of his or her ex- when he said: ‘Dear brothers and and safeguard the well-being of pressions. There could never be sisters who experience suffering those who need it, that medical a society worthy of that name if in a particular way, you are called research and practice must al- it imposed a culture which in the to a special mission in the new ways be tied to ethical impera- name of life and individual rights evangelization and to find your in- tives, that the weak and those who offered death as a condition for spiration in Mary, Mother of love may seem unproductive to the selection and discrimination. The and human pain. You are sup- eyes of a consumer society have dignity of the person applies be- ported in this difficult witness by an inviolable dignity that must al- cause of the very fact that the per- health-care workers, family mem- ways be respected, and that health son exists and bears the impress bers and the volunteers who ac- care should be available as a basic in himself or herself of the image company you on your daily path right to all people without excep- of God. Every other manifesta- of suffering’.4 The first evangelis- tion’.5 All of this is located even tion that stopped at corporeal per- ers of hospitals, therefore, are the more directly in the specific con- fection alone and discriminated sick. They are called to take upon cerns of our subject as a constant against other people on the basis themselves awareness about, and pathway that demonstrates the of age, race and language should responsibility for, the proclaim- progress that has been achieved

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and the great work that still has to her immediately back home, faith feels the deepest need. Here there be performed. must make people understand that receives greater meaning the cel- Hospitals allow a person to en- there is a need for a more solid ebration of the sacrament of rec- gage in a first basic experience: company that supports the per- onciliation as a real space where fear about the loss of a good that son and knows how to provide an- in the weakness of one’s own everyone sees as being funda- swers that are sought for in vain physical self one wants to hear mental. In these settings, an expe- elsewhere. A sick person because the voice of mercy which forgives rience of limitations and of pow- of his or her very sick condition everything and which inculcates erlessness which brings with it a personifies a request for help, for courage to look ahead with a se- form of incredulity that cannot ac- nearness, and for meaning. A new rene gaze. Here the anointing of cept that science and technology evangelisation that makes itself the sick has its privileged space do not have limits, is not extrane- strong in the new means of com- because it brings us back to the ous, if not to the patient then often munication: how can it forget value of the sacramental signs to his or her family relatives. In that there exists silent communi- which are effective because of the the face of certain pathologies it cation, made up of cries from the presence of grace which is given is only with difficulty that people heart that ask to be listened to be- and of faith which sees in them a accept the answer that one cannot cause they impose the acceptance necessary response. Anointing re- be certain. The mind immediately of questions that are often unan- minds us that we were baptised runs to alternative solutions and swered such as the courage to face and confirmed in the faith and the illusion is reproduced through up to a pathway of obstacles, the that our bodies are not extrane- a search for new diagnoses and hope of winning and a refusal of ous to the body of the Son of God new therapies. If not in one’s own resignation that has to be endured? who transformed it into the glori- country, then certainly elsewhere, A hospital can be humanised ous body of his resurrection. The in more technological countries, when it becomes a place where experience of forgiveness that is the solution will exist. Limita- one experiences that communion achieved gives trust and what in tions and, even less, pain are not that overcomes loneliness, wel- the past was mediation of sin is accepted. The mind prefers to fol- come which crushes self-interest, now renewed by the true power of low the utopia of illusion rather and readiness to engage in ser- forgiveness that destroys every- than to surrender to realism. And vice which eliminates a folding thing to enable people to perceive yet illness is a true ignition key to in on oneself. A hospital is also the greatness of love which wel- turn on the mind which wanders a church of the sick. The words comes everybody and excludes in the search for better thinking, of Jesus to the Samaritan women nobody. Faith, that is to say, helps when, that is, it is not buried by return to us forcefully: ‘the time people to overcome the inevitable the darkest pessimism. The expe- will come when people will not fears that everyone carries within rience of illness imposes on the worship the Father either on this them and, nonetheless, strength- person that he or she fixes his or mountain or in Jerusalem…by the ens human weakness which can- her eyes on the essential which is power of God’s Spirit people will not be removed, because we are often eclipsed by the ephemeral. worship the Father as he really is, all fixed in this terrain of the crea- In this process, however, it is im- offering him the true worship that tion, but can be transformed into portant that nobody is left alone. he wants’ (Jn 4:21-22). It is cer- the light of the paschal mystery. Here is imposed the commitment tainly the case that there are plac- to the new evangelisation which es that are consecrated because should form consciences in a pas- they are a sign of the sacred and Conclusion toral action animated by enthu- a special relationship with God. siasm which knows how to pro- But there are places that become Just as a new evangelisation ex- vide the company of faith. During sacred because of the celebration ists that belongs to the promotion these moments loquacious com- of the mystery of salvation that and defence of an anthropology pany is not required: what is need- is worked through people. A hos- formed in the image of God, so is ed is eloquent company. It is more pital is one of these places. Cel- it necessary for the new evange- effective when it is only company ebrating the mystery of illness lisation to take responsibility for that is the presence of a heart that and salvation, of the weakness of entering the walls of very many loves and for this reason is near- the body and the strength of love, places of suffering and pain in or- by, which takes part and has com- makes hospitals in themselves sa- der to bring those words of hope passion, carrying the burden of cred places where silence domi- that are to be found in the Gos- the other person. nates and where personal and in- pel. Where else is a proclaim- During an epoch when a sick timate prayer prevails over the ing such as this obligatory if not person is solely entrusted to medi- words of science. Here the sick in those places where weakness cal science, to technology and to person receives the visit of Christ is experienced and existential a medical doctor, and however the Eucharist which points out to questions become stronger and contradictory it might appear to a him or her the true pathway of the mind is more open to truth, health-care institution which dur- faith: this is not a conquest of man in the same way as the heart is ing rich moments speculates on who searches for God but one more ready to engage in welcom- his or her presence and during worked by God who goes to that ing? The following words of the moments of crisis sends him or person where he or she lives and Blessed John Paul II cam back

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to us full of meaning and espe- the reason for evil, suffering and Notes cial emotion: ‘Every day I go on death (cf. Gaudium et spes, n. 10). 1 In L’Osservatore Romano, 13 Novem- a spiritual pilgrimage to hospitals This is why it is important that the ber 2012. and treatment centres, where peo- skilled and significant presence of 2 Evangelii nuntiandi, n. 17. ple of every age and social back- believers should never be wanting 3 Homily of His Holiness Pope Benedict ground live. I would particularly 6 It is this pil- XVI, 7 October 2012. in these structures’. 4 ‘Message of the Holy Father John Paul like to pause beside the patients, grimage at the bedsides of those II for the IV World Day of the Sick’, 11 Oct. their relatives and the health- who suffer that the new evange- 1995, n. 2. care personnel. These places are lisation must think of in order to 5 Letter of John Paul II to the Pontifical Council for Health Pastoral Care on the Oc- like shrines where people partic- restore confidence and courage casion of the Ninth World Day of the Sick ipate in Christ’s paschal mystery. to those people who expect from (Sydney, , 11 February 2001), 18 Even the most heedless person is evangelisers words of hope so as Jan. 2001. 6 John Paul II, ‘Message of the Holy Fa- prompted there to wonder about to become, they themselves, new ther for the World Day of the Sick for the his own life and its meaning, about evangelisers. Year 2001’, 22 Aug. 2000.

The Role of the Hospital in International Health-Care Policies

Dr. Anarfi Asamoa-Baah when they were desperately ill. vented or could have been treated Deputy Director-General of Early signs and symptoms were much more easily had they been the World Health Organization usually ignored, unless they oc- detected early. curred in young children. This I I felt that, if health officials interpret as part of that universal could address risks within the t is a great pleasure to address desire of parents to do the best community, in collaboration with Ithis audience and to honour the for their children, no matter how the community, hospitals would long and noble history of work difficult and demanding. It was a be freed to do a much better job. of the Church good place to gain experience as in providing compassionate care a paediatrician, not just about dis- Excellencies, for the sick and suffering. This is eases, but also about human na- I have been asked to look at a tradition of enduring relevance. ture. the role of hospitals from the per- Today, faith-based organiza- In that mission hospital, trans- spective of international health tions provide the mainstay of es- portation was a problem. Long care policies. Now that I have sential health care in many parts waiting lines were a problem. given you my prejudices from my of the developing world. In sub- Money was a problem. Stock- younger years, let me give you Saharan Africa, for example, from outs were common. The hospital my more mature views. The role 30% to 70% of all health care is was understaffed and we were all of hospitals in the 21st century is provided by faith-based organiza- overworked. not being properly exploited. We tions. But we did save lives. People need to change some mind-sets The Roman Catholic Church came to the hospital in despera- and some policies. has been a valued resource and tion, but also with great expecta- The perceptions of hospitals partner for WHO, especially in tions, great hope. We tried our ut- and their place in internation- providing care for people infected most not to disappoint them. al health care vary greatly, from with HIV and tuberculosis. You Paradoxically, in my country OECD countries to low-income procure , deliver babies, the people also associated hospi- countries and communities. and bring doctors and services to tals with prestige. To be born in Many see hospitals as wasteful, some of the most remote and un- a hospital and to die in a hospital spending more money than they inviting corners of this earth. were status symbols. That meant should. Far and away, hospitals I have a confession to make, that the family had money. It hint- consume the lion’s share of health as a young doctor specializing in ed at luxury. care budgets. Advances in medi- paediatrics my first work was in Those early experiences were cal technologies and devices are a Catholic hospital in rural Gha- responsible for my decision to cited by many as a key reason for na. The story there was a familiar move from clinical medicine in- soaring health care costs. Some one. The hospital was the place to public health. Many of the ill- experts estimate that nearly half of last resort, where people went nesses I saw could have been pre- of the increase in health spending

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since 1960 can be attributed to the for example, was first detected in Excellencies, growth of sophisticated medical 1969 in missionary nurses in Ni- The first decade of this centu- technologies destined for use in geria. ry saw some stunning improve- hospitals. Hospitals are a mirror of how ments in world health, especially Medicine is one of the few ar- societies function, and are an es- for those diseases that keep peo- eas of technical innovation where sential element for defining the ple anchored in poverty and put a new products are nearly always public trust in the functioning of brake on development. much more costly, most sophis- the State and the society. The epidemics of AIDS, tuber- ticated, more difficult to use, and Hospitals have political impli- culosis, and peaked and more likely to break down. This cations which is seen by public began a slow but steady decline. is certainly not the case with oth- reaction to the closing of small The number of deaths in young er areas of technology, like flat- hospitals in France, the long children dipped below 10 million screen TVs or computers and waiting lists in the UK, and the for the first time in almost six dec- hand-held devices, where prod- Chinese State Council’s concern ades, and continued to drop, each ucts keep getting easier to use and about hospital reform. Politi- and every year. Deaths linked to cheaper to buy. cians often promise to build hos- pregnancy and childbirth also be- Too often hospitals acquire pitals as a way of winning votes, gan to decline after decades of the latest technologies without and not based on an assessment stagnation. a proper study of the real bene- of real needs or consideration of This is progress, impressive fits over existing technologies. In recurrent costs. Once a hospital progress, but it is by no means a many cases, new technologies do is built, even if it is underutilized victory. All of these achievements not bring significant advantages and a significant drain on public have been rendered especially for patients or improvements in funds, it is extremely difficult to fragile by another set of events health outcomes. shut it down, again for political during the first decade of this cen- Hospital can also be dangerous. reasons. tury. In fact, that decade may very Worldwide, WHO estimates that Hospitals can be dehumaniz- well go down in history as the nearly one million lives are lost ing. In their design, many hospi- time when nations came face-to- each year because of errors dur- tals show little respect for the dig- face with the perils of interacting ing surgery. These errors occur in nity of human life. They are cold in a world of radically increased the richest as well as the poorest and sterile. People are treated like interdependence. counties. a collection of specialized body Since the start of this century, Hospitals can be hotbeds of parts, and not as human beings the world has been beset by one infection. The SARS outbreak with a soul and spiritual needs. global crisis after another: a fuel of 2003 was a disease primarily There are often no inviting spac- crisis, a food crisis, a financial cri- spread by sophisticated hospitals es for family members to gath- sis, and a climate that has begun in wealthy settings. er. Friends and family may bring to change. Hospitalized patients may also flowers, but much else in the en- These crises are revealing the be exposed to super-pathogens vironment is colourless and dep- dark side of living in a close- that have developed resistance ersonalized. ly interdependent and intercon- to all mainstay antibiotics and, in On the positive side, hospitals nected world. As the past decade some cases, to all available drugs. are social institutions. When ac- has shown, the consequences are In some developing countries, cess is fair, and not dependent on highly contagious, quickly mov- the spread within hospitals of ability to pay, hospitals can con- ing through the international sys- highly contagious diseases, like tribute to social cohesion. Having tems that bind countries together. tuberculosis, is a major problem. a well-functioning hospital can be The consequences can also be Hospitals can also be dangerous a community’s pride and joy, as profoundly unfair. Developing because of faulty equipment, sub- well as a lifeline. countries have the greatest vul- standard medicines, or inadequate Hospitals are also often a stimu- nerability to adverse events and numbers of appropriately trained lus for spiritual thinking, an inter- the least resilience. They are often staff. People go to hospitals to be face between bodily ills and high- hit the hardest and take the long- cured, to heal, and not to be made er values and that deep human est to recover. even sicker. need for compassion. To repeat Globalization produces numer- Hospitals can be the senti- the title of one of your presenta- ous benefits, but it has no rules nels of newly emerging diseases. tions, hospitals are the “custodi- that guarantee the fair distribu- Many new diseases, like Ebola ans of life”. They can be a cause tion of these benefits. Today, the haemorrhagic fever, first came for celebrations, of births, cures, international systems that govern to light because they were kill- and dignified deaths. trade, capital markets, and busi- ing health care staff. Some were Hospitals are hope. Where there ness relations have more power detected only when missionary is health, there is hope. There is than a sovereign government to doctors and nurses became ill and a new breed of thinking in pub- influence the lives and opportu- were air-evacuated to countries lic health. It is this: poor people nities of citizens, including their with the facilities to run compre- deserve the very best health care chances to enjoy a healthy life ex- hensive diagnostic tests and de- available because they have been pectancy. tect new pathogens. Lassa virus, given so little else in life. Unfortunately, equity is rare-

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ly an explicit policy objective ment of cancer now carry costs to fill beds and to give appropriate in the way these systems func- that are unsustainable, even in the care at appropriate levels. tion. As a result, the world has wealthiest countries in the world. become dangerously out of bal- WHO estimates than more than Some of these shifts are already ance. Differences, within and be- 35 million people worldwide are happening. tween countries, in income levels, living with dementia. This number In this new century, industrial- opportunities, life expectancy, is expected to double by 2020 and ized countries are trying to reduce health outcomes, and access to more than triple by 2050. Already their reliance on hospitals, hav- care are greater today than at any now, nearly 60% of the burden of ing realized the opportunity cost time in recent history. dementia is concentrated in low- of hospital-centrism in terms of The difference in life expectan- and middle-income countries. effectiveness and equity, and the cy between the richest and poor- The cost of caring for demen- need to make them more fit for est countries now exceeds 40 tia is expected to rise even fast- humans. Yet, many low- and mid- years. Annual government spend- er than its prevalence, making it dle-income countries are creating ing on health ranges from as little important that societies are pre- the same distortions. The pressure as $1 per person to nearly $7,000. pared to address the social and from consumer demand, the medi- A world that is greatly out of bal- economic burdens caused by this cal professions and the medico-in- ance is neither stable nor secure. condition. The costs are already dustrial complex is such that pri- And there are other ominous staggering. In 2010, the total esti- vate and public health resources trends, again linked to the world’s mated worldwide costs of demen- flow disproportionately towards unprecedented interdependence. tia were $604 billion. specialized hospital care, at the All around the world, health is be- expense of investment in primary ing shaped by the same powerful Excellencies, care and in the human dimension forces. All these point to a number of of care. National health authori- Universal trends, like urbani- conclusions: ties have often lacked the finan- zation, population aging, and the – People want to live, long and cial and political clout to curb this globalization of unhealthy life- healthy lives. trend and achieve a better balance. styles, have sparked a sharp in- – Many people will have chron- Better balanced, and integrated, crease in chronic diseases, like ic illnesses and more than one dis- health systems will require much heart disease, cancer, and diabetes. ease at a time. better collaboration between au- Long considered the close – People want to have a say in thorities and the hospital establish- companions of affluent socie- what affects their lives and that of ments; pressure from patients and ties, these diseases now impose their families. populations is increasing and may around 80% of their burden on – People want to be treated as help force such collaboration. low- and middle-income coun- human beings, with dignity and Hospitals must become much tries. In these countries, people delicacy. more people-centred and caring. fall ill sooner, get sicker, and die – People want a reduced risk of They need to accept responsibil- earlier than their counterparts in disease, effective medicines and ity for prevention and health pro- wealthy countries. technologies, and reliable health motion, and not concentrate ex- Mounting evidence shows that authorities. clusively on cure. obesity and diabetes, strongly – Hospitals can play a big role People associate hospitals with linked to unhealthy diets, have in this. hope and healing. These expecta- reached epidemic proportions in tions need to be shaped in ways parts of Asia, where the loss of For hospitals to fulfil this role that make patients partners in traditional diets has been espe- paradigm shifts are needed to en- safe-guarding their own health. cially rapid. But no part of the sure: The Roman Catholic Church world is being spared. – emphasis on care of acute epi- has much to offer in reshaping These trends have enormous sodes of disease, to the emphasis hospital environments and value implications for hospitals and of care through the continuum of systems. Hospitals are not profit health budgets. The costs of life; centres. They are custodians of chronic care for the growing num- – responsibility for individuals, life, and that includes its spiritual ber of people with noncommuni- to responsibility for health of de- dimension. cable diseases are simply not af- fined population; As I conclude, I come back full fordable. They break the bank. – care must be people-centred; circle to an early conviction that In most low- and middle-income – services are as close to home changed my career. If health of- countries, patients with diabetes, as possible; ficials could address risks within who live on less than $2 a day, – hospital environment is as the community, in collaboration need to spend between 25% and homely as possible; with the community, hospitals 50% of their monthly income to – success is measured by the would be freed to do a much bet- buy one vial of insulin from a pri- capacity to increase hospital ad- ter job. Again, the Roman Cath- vate pharmacy. mission and capacity to maintain olic Church is well-positioned to Late last year, a study conclud- people health; undertake this kind of community ed that technologies for the treat- – the objective of a hospital is engagement.

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Recommendations and Perspectives on Pastoral Care for Health-Care Workers in Africae Munus, the Post-Synodal Apostolic Exhortation of Pope Benedict XVI

H. Em. Cardinal justice and peace. We will look at society by consumerism and ma- Wilfrid Fox Napier, O.F.M. three of these as a way of expand- terialism. ...This model of society Archbishop of Durban, ing the points raised by the Ho- bears the stamp of the culture of South Africa, ly Father in Africae Munus. What death, and is therefore in opposi- Member of the Pontifical are those points? tion to the Gospel message” (John Council for Health Care Paul II, Ecclesia in America, 63). Workers The Church through its bish- 1. Conforming to Church ops needs to ensure that health- Teaching care workers not only understand oday more than ever, the what it teaches in its pro-life ap- “TChurch is aware that her In his exhortation the Holy Fa- proach but also that this approach social doctrine will gain credibil- ther emphasizes the need “to form is adopted and actively practiced ity more immediately from wit- and inform people, specially the in our Catholic health facilities. ness of action than as a result of young” when fighting the pan- We must not fail to support them its internal logic and consistency” demics present in African coun- in their stand against the modern (Blessed John Paul II, Centesimus tries (and here he was clearly re- “culture of death” which makes Annus, n. 57). ferring to the TB and the HIV/ the life of every person subject “Be patient, stand firm and do AIDS pandemic). He specifically to political or ideological whims not lose heart!”. These are the drew the attention of bishops and and convenience, and is often words addressed to healthcare healthcare workers to two impor- promoted by governments and workers in the continent of Africa tant issues, namely, the need i) for donors. The result is that workers by our Holy Father, Pope Bene- healthcare institutions to provide are put under tremendous pres- dict XVI, in the post-synodal doc- services which conform to the sure to conform to these whims ument, Africae Munus. Church’s teaching and are exclu- or else forfeit the funding which They are important words be- sively “pro-life”, and ii) for an in- they so desperately need. We be- cause there is so much that might creased emphasis on transparency lieve that bishops have the obli- cause us to lose heart. Indeed, and ethical norms in their work, gation to speak up in defense of if we had not been sustained by so that funds would be used pri- these workers at all times and to our faith in the Lord Jesus, we marily to ‘serve the good of the support them through loving and would not have been able to re- sick’. focused pastoral care (care for the main engaged as a Church in pro- carer, to be specific). viding health care in many parts A Culture of Life versus of our continent. Our position in a Culture of Death Pastoral Care for Carers the “thick of the fight” and amidst many serious challenges does The Church’s healthcare insti- This Council has as its goal the sometimes prevent us from seeing tutions and community workers appropriate and dedicated provi- how far we have come and how in Africa serve most often in the sion of pastoral care for those in- effective our work is in reality. poorest and most deprived com- volved in the care of the sick and In May 2009 the Pontifical munities, and in regions where dying. Because by its very nature Council for Health Care Workers, disregard for the law and for the their work puts them in daily con- in conjunction with AISAC (the rights and dignity of the person is tact with illness and death, health- International Association of Cath- often manifest. “A model of so- care workers themselves stand in olic Health Care Institutions), ciety appears to be emerging in real and urgent need of pastoral convened a workshop in Rome which the powerful predominate, care, spiritual healing and guid- ahead of the African Synod. That setting aside and even eliminating ance. This could take the form of workshop put forward recom- the powerless: I am thinking here spiritual retreats, days of recollec- mendations concerning health is- of unborn children, helpless vic- tion and time to reflect and med- sues in Africa which it intended tims of abortion; the elderly and itate – to look into their hearts as a resource and framework for incurably ill, subjected at times to discover there, and draw on, understanding Catholic health- to euthanasia; and the many other those deep-seated values and be- care as a means of reconciliation, people relegated to the margins of liefs that are needed to inspire and

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guide them in their life and work. trol over others and over things” treatment that he was receiving at The AISAC workshop, men- (John Paul II, Homily, March 1, the hands of his jailors. tioned above, noted the lack of 1998). Healthcare workers are obliged pastoral care programs and peo- to bring to the attention of the au- ple dedicated to pastoral service Being a Good and Faithful thorities any cases of injustice in our institutions. Given that the Steward that they may encounter in their African peoples generally asso- work. As well as bringing relief ciate spiritual care with the heal- In Africae Munus Pope Bene- or justice to the victims, such ac- ing process, it is important that dict refers specifically to the need tion will demonstrate the spirit of health workers are well prepared for accountability. Many good in- true justice and fairness which is and trained so that the health care dividuals and organizations con- the mark of the Christian. they give can draw strength from tribute generously to the Church’s This makes it all the more in- the liturgy and prayers which are healthcare. So, especially we in cumbent on us to make sure that part of the pastoral care available Africa must show good steward- the Church cannot be accused of to them. The liturgy in particular ship in the use of resources as a pointing out the wrong that oth- is a sacred moment, especially way of acknowledging that all re- ers may be doing while ignoring when it celebrates our reconcilia- sources come from God and so what is wrong in our own facili- tion with God and with our broth- must be used for His glory and the ties. Consequently, it is necessary ers and sisters, and gives true common good. Such a responsi- that we provide healthcare work- meaning and value to suffering ble stewardship of resources will ers in our institutions with sala- and solidarity. involve advocating a just and eq- ries and working conditions that uitable healthcare system through are in keeping with or even better which every person is assured ba- than those of government. Charity 2. Transparency and sic health care and in which the must never be an excuse for allow- Ethical Norms good health of every member of ing situations of injustice to exist. the community is fostered. It would seem appropriate that I come now to the second point Therefore all administrative while African bishops take ad- made by the Holy Father, the need boards and management struc- vantage of every opportunity to for an increased emphasis on tures must ensure that wise and “promote initiatives in defense of transparency and ethical norms prudent financial decisions are justice” jointly in their countries, in our work, with funds primar- taken in handling public and do- they should at the same time en- ily used to “serve the good of the nor funds. Accountability chal- sure that their own institutions sick”. lenges us to provide credible reflect true justice in regard to “The support of the health in- information that clearly demon- working conditions, as well as an stitutions of the Church in Africa strates our relevance, our efficien- equal and fair distribution and use requires an awareness of the prac- cy and added value, our obser- of resources. tice of management (stewardship) vance of relevant legislation, and and a new internal and external the ethical conduct of our boards, partnership that will ensure the fu- management and staff. 3. A Bishop Responsible ture sustainability of services and Recommendations therefore in- for Pastoral Care in Health finances” (recommendation by clude a) the establishment of good the Pontifical Council and AISAC governance through well-appoint- The final recommendation of to the African Bishops, 2009). ed and responsible boards, and b) the Pontifical Council together Because healthcare workers in the regular provision of financial with AISAC was that, with the Catholic facilities serve people information not only to the local support of the Council, each Epis- of all beliefs, races and cultures, Bishops’ Conference but also to copal Conference should nomi- their work gives them a unique the local public health authorities nate a Bishop responsible for co- opportunity to bear witness to the and especially to donors. ordinating appropriate pastoral Gospel. care in each health region, as well That is why their actions will Promoting Justice while Caring as conducting necessary negotia- need to demonstrate a commit- for the Sick tions with government authorities ment to transparency and account- regarding health care. ability which is sorely lacking to- Finally, one of the most impor- True pastoral care for our day, where in many instances it is tant recommendations to the Afri- healthcare workers affirms, pro- “every man for himself” and “an- can Synod dealt with the promo- motes and dignifies their work, ything goes as long as I am not tion of justice through healthcare. grounds it in God and gives it true caught”. So often it is the victims of injus- value. At the same time it inspires “Christ alone can free man tice that are brought to our hos- workers to regard their work as from what enslaves him to evil pitals, dispensaries and clinics for service rendered to Christ through and selfishness: from the frantic assistance. A famous example is all that they do for “the least of his search for material possessions, Steve Biko’s doctor who was the brothers and sisters”. from the thirst for power and con- first to speak out about the unjust

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Hospitals: Temples of Humanity and Crossroads of Peoples

H. Em. Cardinal ther stresses that to achieve a pro- the fourth century, were the first to Willem Jacobus Eijk ductive re-evangelisation witness offer medical care, including long- Archbishop of Utrecht, to charity is required: ‘Faith with- term medical care, to sick people, the Netherlands out charity bears no fruit, while and to poor and oppressed peo- charity without faith would be a ple who were ill who not able to sentiment constantly at the mer- pay for their treatment.2 The foun- he Church encounters first of cy of doubt...Through faith, we dation of these hospitals was the Tall people to whom it transmits can recognize the face of the ris- consequence of a radical change the Christian faith in churches en Lord in those who ask for our that was promoted by Christiani- during various kinds of different love. “As you did it to one of the ty as regards the social position of liturgical celebrations, confes- least of these my brethren, you did sick people and the organisation sions and other pastoral encoun- it to me” (Mt 25:40)’ (PF n. 14).1 of public health care.3 ters. However, outside churches In contemporary hospitals, Christians began to see disin- there are also places of encounter, above all in hospitals in the big terested care for the sick as a task especially as regards people who cities, one can encounter because that was inherent in the imita- never go to church. This is true of of the globalisation of the world tion of Christ, primarily because many non-Christians or non-Cath- in addition to indigenous patients of the analogy that exists be- olic Christians who do not attend also the representatives of many tween the redemption of man by our churches but also of Catho- peoples and races, if not, indeed, Christ and the healing or curing lics who never practise their faith of them all. This was also my ex- of a sick person. This led a num- or practise it very little. Hospitals perience during the time that I ber of the Fathers of the Church are, without doubt, such places of worked as a medical doctor in the to bestow upon Christ the title encounter. A hospital chaplain or a hospital of the University of Am- ‘Christus Medicus’.4 This analo- parish priest or a vice-parish priest sterdam at the end of the 1970s. gy was compelled by the numer- who visits sick people from his All in all, one can describe hos- ous healings worked by Jesus and parish who have been admitted to pitals as temples of humanity and reported in the gospels. Anoth- hospital will also find there Catho- crossroads of peoples. er very important factor was that lics who perhaps never go inside a Jesus himself identified with hu- parish church. man beings who lived in poverty: A hospital, as well as being a A Look Backwards ‘“Come you that are blessed by place of encounter of non-Chris- my Father! Come and possess the tians and Christians, is also a From a look backwards it is kingdom which has been prepared place that offers an opportunity clear that hospitals worked from for you ever since the creation of to meet people who at times are the outset as temples of humani- the world. I was hungry and you more open to the Gospel than is ty and crossroads of peoples. One fed me, thirsty and you gave me usually the case. Although it is should also observe that hospitals drink; I was a stranger and you obvious that evangelisation and – as we know them were an ‘inven- have received me in your homes, in Western Europe – re-evangeli- tion’ of Christians. The Roman naked and you clothed me. I was sation concern all human beings, Empire had military hospitals sick and you took care of me, in both the healthy and the sick, the which offered emergency aid and prison and you visited me”’ (Mt rich and the poor, the elderly and rehabilitation for sick or injured 25:34-36). This provided those the young, experience in general soldiers with the primary purpose, who loved Jesus with the opportu- suggests that existential crises are if not the only purpose, of making nity of engaging in concrete acts often valuable moments of reflec- them return as soon as possible to of charity towards him, amongst tion about the meaning and the active military service. For this other things through caring for the purpose of life which can open reason, the treatment these hospi- sick, thereby recognising in them the soul to Christ and to his Gos- tals offered had utilitarian motiva- his face. A icon for all those who pel. A pastoral encounter with a tions. Christians after the Edict of work in health care was the Good patient in a hospital is thus, not Milan of the year 313 of the Ro- Samaritan of the parable that car- rarely, very productive in spiritual man Emperor Constantine had an ries his name (Lk 10:25-37).5 terms. opportunity to express themselves All of this stimulated Christian In addition, a hospital can be an publicly and to found hospitals in physicians, but also Christians in excellent setting in which to ex- order to implement the ideas that general, to care for the sick with press human and Christian charity they had as regards sick people. charity and compassion. Since in a very intense way. In his motu These hospitals, which Christians God showed us His love for us proprio Porta Fidei the Holy Fa- founded during the second half of in an unlimited way in the incar-

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nation of His Son and in the sac- had a Christian identity conserved a ‘lived theology’.8 St. Camillus, rifice of His Son on the cross, the gospel motivations of the or- who was wounded as a soldier care for the sick could also take igins. In recent decades, in ex- on the battlefield, suffered from the form of a sacrifice by treat- pressing and implementing the an incurable and festering wound ing them without asking for pay- Christian ideals of integral care, until his death at the age of six- ment in return. The icons of this that is to say medical, human, ty-four. As a patient and a work- are the martyr saints, Cosma and psychological, social and spiritual er in the hospital of St. James of Damian, whom we are told by care, in hospitals above all in the the Incurables in Rome, he saw tradition were physicians in Syria Western world, today a large num- how care for the sick during his who treated their patients out of ber of difficulties and challenges epoch was defective. The condi- Christian charity and charged no are encountered, and to this sub- tions at the level of hygiene were fee for their services. This could ject I will return later in this paper. miserable and the nurses were on even involve the sacrifice of one’s the whole unworthy people, of- own life in looking after sick pa- ten being prisoners, and they had tients who were afflicted by the An Intrinsic Evangelisation no training for their work or any plague, which was something that dedication to it. In order to im- involved the risk of being infect- A hospital as a temple of hu- prove care in hospitals, St. Camil- ed by this disease which was of- manity and crossroads of peo- lus founded the Order of the Min- ten fatal. We are told about a num- ples is a setting to the utmost for isters of the Sick, now known as ber of saints who treated people evangelisation. The reasons lie in the Order of Camillians, whose afflicted by the plague in a gen- the analogy, which I have already members – both priests and broth- erous and heroic way, amongst mentioned, between redemption ers – devoted themselves entirely whom were St. Catherine of Sien- and healing, which was empha- to care for the sick and to pastoral na (1347-1380) and St. Aloysius sised by Jesus himself, and the care for the sick. His theology of Conzaga (1568-1591). fact that care for the sick is a spe- the care of God was developed in After the decline of the Roman cial form of human and Christian part on the basis of his theological Empire, the monasteries of West- charity. studies within the context of his ern Europe offered free hospital- One should avoid giving the priestly formation, and above all ity to travellers in their guest ac- impression that one is dealing on the basis of what happened to commodation and this included here with a technique to win over him as a result of his experience medical care and treatment for souls. This would be the case of his own illness and the way in those that were ill. Thus these were one to impose the Christian which he himself and others were buildings providing guest accom- faith on patients within the con- treated in his hospital. modation were literally temples text of medical care or if this care After his conversion from being of humanity and crossroads of were to be offered only on the a wild and violent man, a slave to peoples. For more than five cen- condition that the patient convert- gambling, into an ardent follow- turies the guest accommodation ed to Christianity. This would be er of Jesus, and transfigured by of monasteries constituted the on- in contradiction with the Chris- his experience of the concern of ly organised medical care in the tian faith itself which requires that God during his illness, St. Camil- West.6 Although from the point of a person makes a free choice for lus discovered that a sick per- view of contemporary medicine Christ and his Gospel. son was ‘the altar of the exercise the level of medical science and Medical care, where the patient of his baptismal and ministerial the methods that were applied to is left free, without forcing him or priesthood’, as Favio put it.9 Sub- heal the sick were of a very low her, or putting him or her under sequently he developed a Christo- level, and many medicaments and pressure, to become a Christian, centric vision of himself and his surgical techniques of antiquity is an act whose moral object is neighbour which made him per- had been lost, the deep Christian good in itself. If carried out with ceive in a new and practical way motivation for taking to heart the a good intention, medical care is, the inalienable value of every hu- efforts of the sick remained. of its essence, an act of charity. man being even if sick. St. Camil- In parallel with the birth of cit- This is expressed in deeming the lus saw a sick person as a ‘sacra- ies, from the twelfth century on- ‘visit the sick’ the fifth of the sev- ment of the encounter with Christ wards communes built large city en works of corporeal mercy (de- and thus a way of access to God hospitals. Innocent III (1198- rived from Mt 25:35-36 and Tb and perceived and experienced 1216) stimulated wealthy Chris- 1:17). Care, if carried out without how “with the incarnation the tians to found these institutes in impositions or without concealing Son of God after a certain fashion every city. The hospital of the Ho- one’s own Christian beliefs, is, in united himself to every man”’10 ly Spirit in Sassia in Rome, which addition, in itself an act of evan- Because of his or her suffering a he himself founded, was the mod- gelisation. sick person offered a place of ex- el for these city hospitals.7 A very fine and expressive ex- periencing the kenosis of Christ Modern hospitals, which have ploration of this from the point of in his incarnation and cross. St. made a clear distinction between view of theology and of spiritual- Camillus started from tradition in medical care and pastoral care, ity is offered to us by St. Camillus recognising in a sick person the arose in the eighteenth century. de Lellis (1550-1614). Favi calls face of the suffering Christ11 but However, those hospitals which his theology of the care of God he added to this the analogy be-

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tween the above-mentioned iden- ship with Jesus in a very direct pressed in a much stronger, more tification of a sick person with and productive way in their care intense and more productive way Christ and Christ’s presence in for sick people. if it is offered in an organised and the sacraments. Apart from the Secondly, the spirituality of St. systematic way by a health-care face of Jesus, St. Camillus found Camillus for health-care workers institution rather than by an in- in the face of a sick person also prefigured in a certain sense the dividual. Thus the Christian dea- the face of merciful God who re- Second Vatican Council and its conate of charitable concern has, deems and makes participate a Christological anthropology. The inside hospitals whose workers human being in His intra-triune Second Vatican Council, in pro- are sincerely committed to imple- life. Experience of the contem- nouncing on human affairs, was menting it, a great evangelising plation of the suffering of Christ also profoundly Christological. strength. in a sick person ‘becomes a place The Son of God, who became man, for calling on solicitude for man, took on our humanity and our hu- for revelation of his mission and man condition, as a result of which The Contemporary Challenge for care for the needs of human- in Christ there is a fundamental of Maintaining Hospitals as ity. Such care refers back to the unity of all human brings, both Temples of Humanity concern with which God Himself Christians and non-Christians. through Christ bent down before Thus the Second Vatican Council After the middle of the nine- the frailty of humans in order to said in Gaudium et Spes, the Pas- teenth century and above all since transmute it into a way of hope’.12 toral Constitution on the Church in the 1930s medical science has Care for a sick person thus be- the modern world, that: ‘The truth undergone an unprecedented ad- came ‘witness to the concerned is that only in the mystery of the vance. There is no longer an ab- presence of Christ the Good Sa- incarnate Word does the mystery sence of hygiene. There are nu- maritan of humanity’ and at the of man take on light’ (n. 22).14 By merous medical products and same time the area of encounter his incarnation Christ does not on- techniques that make it possible with Christ who ‘serves, cares ly reveal God, he also reveals man to cure many illnesses and relieve for and heals a sick person with to himself. In the mystery of the many troublesome symptoms in the maternal tenderness of God incarnation there expires the dual- an effective way and for which through the solicitous action of a ism of a natural morality and a su- there was no remedy in the not Minister of the Sick’.13 Solicitude pernatural morality. A hospital, in very distant past. The diagnosis of towards sick human beings, seen performing its Christian mission cancer is no longer a ‘death sen- in this way, was seen as analogous in implementing the deaconate of tence’ although there remain today with the sacramental presence of charity towards sick people, at the many incurable illnesses. This ad- Christ and as a form of extension same time thereby bears witness to vance of medicine is a reason for and implementation of his salvif- a profoundly human charity and a gratitude. However, this does not ic-healing mission. charity that is profoundly Chris- remove the fact that illnesses, and I would like to point out two tian. especially grave and chronic ill- special outcomes of the spiritu- The theology that was lived by nesses, are also often a source of ality of St. Camillus. First of all, St. Camillus of the relationship suffering. Although we no longer the spirituality of St. Camillus, between the person who looks af- have in our hospitals the dramatic in adding to recognising the face ter a sick individual, whether a conditions that St. Camillus wit- of Christ in the face of a sick per- medical doctor, a nurse or a pas- nessed when he was alive, today, son the analogy of this identifica- tor, and the patient himself or her- as well, many sick people suffer tion of a sick person with Christ self, implied for the former a very physically, mentally, socially and through his sacramental presence beautiful and profound form of spiritually. There will always be in the Eucharist, offered a bridge spirituality. This spirituality can sick people who are abandoned by which to connect to each other awake in such workers an ap- by their family relatives. Today as the deaconate and the liturgy, es- proach of solidarity with the suf- well, and perhaps more than was pecially through the sacrament of fering individual and an empa- the case in the past, sick people the Eucharist, where Christ is pre- thetic concern for him or her in struggle with anxiety and with the sent, in his suffering, in his death the context of authentic Christian question of the meaning of suffer- and in his resurrection, amongst charity, despite his or her wealth ing and then the question of the us in the forms of bread and wine. or lack of wealth, origins, the peo- meaning of life. Like many Christians in secu- ple or race to which he or she be- However, over recent decades larised society, Christian work- longs, and his or her religion. One certain developments have taken ers in the field of health care also understands that this spirituality place which should be observed encounter difficulties in practis- is of value also for medical doc- and these concern contemporary ing their faith in their daily lives. tors, nurses or pastors in their ex- hospitals. They make the deaco- The possibility of connecting the tramural contacts with sick peo- nate of Christian charity rather deaconate with the liturgy makes ple. However, this spirituality of difficult to live. These develop- those health-care co-workers who St. Camillus, except where it is ments undoubtedly exist despite take this spirituality as a point of developed specifically in a hos- a progress which should undoubt- departure able to integrate their pital setting – and it could not be edly be appreciated. They are faith and their personal relation- developed but in this way – is ex- threats which should not be un-

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derestimated to hospitals being focus his or her attention on that products; above all they give cen- temples of humanity. organ, on that part of the body, tral place to the person’s desires First of all, secularisation does or that physiological system that and preferences, which, in a con- not halt at the threshold of hospi- concerns his or her special com- tract, meet the desires and prefer- tals. As Benedict XVI observed: petence. In this way he or she runs ences of another person. Never- ‘This secularization is not only the risk of losing the patient as a theless, these mechanisms carry an external threat to believers, human person, in his or her, total- the risk of an “idolatry” of the but has been manifest for some ity from sight. market, an idolatry which ignores time in the heart of the Church A third factor relates to the the existence of goods which by herself. It profoundly distorts the consequences of the introduction their nature are not and cannot be Christian faith from within, and of the free market economy in- mere commodities (Centesimus consequently, the lifestyle and to health care in order to control Annus n. 40).18 daily behaviour of believers’. 15 costs. This has transformed hospi- The depersonalisation caused When a large part of the workers tals into institutes that are subject by the factors that have just been in a hospital no longer share the to a managerial approach: in order listed is a serious obstacle to care Christian faith, including its mor- to calculate and control the costs based upon a Christian faith that al demands, it will become more of medical diagnosis and care and is lived. Over recent decades a difficult to express the deaconate treatment, the management uses significant number of nurses, after of charity on the basis of faith in protocols where, for example, the they finished their studies and be- Christ and thus of the spirituali- time that is necessary to perform gan to work, have felt disappoint- ty described above, which is the certain actions is prescribed and ed and by no means a few of them foundation of a profoundly Chris- this is done without reference to have decided to look for another tian solicitude. This, without the personal condition of the sick profession or another job within a doubt, weakens the evangelising person involved. This makes it hospital. Many of them, not find- witness of hospitals. difficult to spend more time on a ing in hospitals a culture in which However, even where all the person who needs such time, and they can work according to their workers are convinced Christians, as a result the culture of a hospital expectations, have the impression contemporary culture in large hos- becomes depersonalised. In addi- that they cannot live what they pitals, and especially in wealthy tion, the introduction of the free see as their original vocation.19 countries, makes the practice of market economy implies that the One disturbing question is that the deaconate of charity, which patient, often seen as a ‘customer’ in the Netherlands most of the is based upon a personal and liv- or even as a ‘consumer’, engages people who are responsible for ing relationship with Jesus, diffi- in a contract with those who come pastoral care in hospitals, and they cult. This culture is characterised to his or her aid. This contract as- are for the most part lay pastoral by a depersonalisation that attacks sumes that both parties have an workers with a pastoral mission people.16 Various different causes equal position, which in reality entrusted to them by their dioc- lie behind this depersonalisation.17 they cannot have. The position of esan bishops, are forced by man- We see manifested a strong ten- the party that provides aid and the agers to conceal their specifically dency to see professional skills position of the party that asks for Christian and Catholic contribu- and expertise, and this applies to aid are very different from each tion behind a mask of profession- medicine as well, unilaterally as other. The contract does not take alism. Indeed, they do not care for mere technical ability. This cre- into account this diversity of the the Catholic Christians of their ates an atmosphere in which the parties involved. Health care, uni- hospital. The management indi- expression of emotions, an ele- laterally guided by a free market cates to them those departments, ment that is indispensable in hu- economy, is directed more to- for example of internal medicine, man relationships, is almost the wards healing as a product than of or of surgery, where object of suspicion. The obliga- the sick person himself or herself they have to attend to all the pa- tion to confine oneself to an ap- who needs to recover. Economic tients who need them, indepen- proach of mere technical ability values thereby take the place of dently of what religion they may forces medical doctors or nurses human values. John Paul II pro- belong to: Christians of various to conceal that they are people nounced on this development in denominations, Muslims, Jews, with religious and ethical beliefs, the following way: ‘Here we find Hindus, Buddhists or non-believ- their own characters and their own a new limit on the market: there ers. The patients of other depart- feelings behind a mask of profes- are collective and qualitative ments who want to have contact sionalism. This phenomenon is needs which cannot be satisfied with a pastor of souls who be- strengthened by exaggerated au- by market mechanisms. There are longs to their religion can obtain tonomy, as a result of which there important human needs which es- this through a written request. In is a tendency to leave the ultimate cape its logic. There are goods this field use is made of the tech- decision to the patient, and this which by their very nature cannot nical professional competence of is a decision to which the health- and must not be bought or sold. a pastoral worker in the area of care workers must conform. Certainly the mechanisms of the techniques of conversation and A second factor is advanced market offer secure advantages: their the ability to assist people specialisation: a specialised med- they help to utilize resources bet- who are in a state of crisis or who ical doctor or nurse is inclined to ter; they promote the exchange of have to struggle against bad news

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as regards the prognosis for their pitals where such studies are an 7 Catholic Encyclopedia, ‘Innocent III’. 8 J.M. Favi, ‘, “te- illnesses. However, a pastoral ongoing task – one should devote ologo” della premura di Dio’, Camillianum worker must keep quiet about his especial attention to the possibility 9 (2009), n. 25, pp. 57-78, quotation p. 57. or her own beliefs, which, in real- of working with this spirituality in 9 Ibid., p. 65. 10 Ibid., p. 69. ity, concern the essence of his or the contemporary world of health 11 S. Cicatelli, Vita manoscritta di S. de her mission. This does not make care for the benefit of our sick peo- Lellis, scritta prima della morte di questo, it easy to give to pastoral care for ple. This is a ‘conditio sine qua p. 54 (edition by the Curia Generalizia dei Chierici Regolari Ministri degli Infermi, the sick a real Christian charac- non’ to be able to assure that hos- Rome, 1980). ter and prevents witness to faith pitals remain temples of humanity 12 J.M. Favi, ‘San Camillo de Lellis, “te- in Christ by those who have re- and crossroads of peoples that are ologo” della premura di Dio’, p. 70. 13 Ibidem. ceived a pastoral mission. inspired by Christian ideals relat- 14 Second Vatican Council, ‘Costituzione ing to care for the sick. pastorale Gaudium et Spes’, AAS 58 (1966), pp. 1025-1115. 15 Benedict XVI, ‘Discorso ai Partecipan- Conclusion ti all’assemblea Plenaria del Pontificio Con- siglio della Cultura (8 marzo 2008)’, AAS 100 The profound spirituality that Notes (2008), pp. 245-248, quotation p. 246. 16 J.J. Zealberg, ‘The Depersonalization was from the outset the basis of 1 Benedict XVI, “Motu proprio Porta of Health Care’, Psychiatric Services 50 care for the sick and was enriched Fidei (11 ottobre 2011),” AAS 103 (2011), n. (1999), n. 3, pp. 327-328. over time by people, and by Or- 11, pp. 723-734. 17 B.M. Ashley, J. Deblois, and K. 2 A.S. Lyons and R.J. Petrucelli (reds.), O’Rourke, Health Care Ethics. A Catho- ders or Congregations that dedi- Medicine: an Illustrated History (New York, lic Theological Analysis (Washington D.C. cated themselves in particular to Abrams, 1987), p. 272. Georgetown University Press, 2005, 5th this kind of task, is a very valu- 3 H. Sigerist, Civilization and Disease ed.), pp. 204-205; A. van Heijst, ‘Burn-out, (Chicago, University of Chicago Press, een teken aan de wand?’ in J.P.M. Lelkens, able fruit of faith in Christ. There 1943), pp. 69-70. J.A. Raymakers (eds.), Economisering en are, however, a significant number 4 H. Schipperges, “Zur Tradition des vertechnisering van de gezondheidszorg of challenges in the contemporary ‘Christus Medicus’ im frühen Christentum (Bunnik, Stichting Medische Ethiek, 2006), und in der älteren Heilkunde,” Arzt und pp. 117-129. culture of the world of health care 18 Christ 11 (1965), pp. 16-19. John Paul II, ‘Litterae encyclicae Cen- o in general, and in hospitals in par- 5 W.J. Eijk, ‘The Good Samaritan is the tesimus Annus (1 maggio 1991)’, AAS 83 ticular, to making this fruit shine Greatest Justice’, Dolentium Hominum 15 (1991), p. 843. forth. In the studies of the spiritu- (2011), n. 1, pp. 64-68. 19 S. Hewa and R.W. Hethrington, ‘Spe- 6 A.S. Lyons and R.J. Petrucelli (eds.), cialists without Spirit: Crisis in the Nursing ality of health-care workers and – Medicine: an Illustrated History, pp. 276, Profession’ Journal of Medical Ethics 16 not least of pastors of souls in hos- 283-291. (1990), pp. 179-184.

The Hospital of the Holy Spirit in Sassia: its History and Mission

Prof. Gianni Iacovelli tus. Indeed, under the hospital, the Eternal City to visit the tombs President of the Academy beneath the ‘Sistine wards’, re- of the Apostles Peter and Paul and of the History of Medical Art mains were discovered in opus to venerate the relics of the first of Rome, mixtum as well as floor mosa- Christian martyrs. Italy ics of the first half of the second The four scholae referred to century AD, together with the re- by the Liber Pontificalis (of the mains of plastered and painted Franks, of the Frisians, of the n the banks of the Tiber, in walls that certainly go back to the Saxons, and of the Lombards) Othe heart of the city, is locat- first century AD. were within the Leonine wall and ed the Hospital of the Holy Spir- In these places, which corre- accommodated travellers and pil- it in Sassia, the oldest hospital in spond to the ager Vaticanus, was grims belonging to these peoples. Rome and amongst the oldest in located one of the most important In addition to residential houses the world. scholae peregrinorum: that of the they contained shops and taverns, During the first imperial age, Saxons. The scholae, ever since places for the sick and hospitals, in this area were to be found the the fist centuries of the Christian- as well as a church and a ceme- horti of Agrippina where tradi- ity, were used for the accommo- tery to give a Christian burial to tion located the villa of the fa- dation of pilgrims who came from those people who died far from vourite granddaughter of Augus- the remotest regions of Europe to their countries. They had their

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own militiae which they mobi- dream (the life of Innocent III was Pope, who knew him and appre- lised to defend the city. full of prophetic dreams) in which ciated his works which offered The schola Saxorum was an angel commanded him to build care and assistance, by an act of founded in about 717 AD by In- a new and large hospital for the 10 December 1201 granted to him na, the King of Wessex who, on city: this was built at the point the Church of St. Mary in Saxia the occasion of his visit to Rome, where his mule knelt down, that and the adjoining hospital which had a building made to accommo- is to say in the area of the hospital had just been built or was being date the sovereigns, nobles and of the Saxons. built where at one time the ancient ecclesiastics who came from far The building work was carried hospital for pilgrims (‘hospitalitas off England. Next to it was the out very quickly and paid for by Anglorum’) had been located. Church of St. Mary in Saxia, with the Supreme Pontiff with the alms Another document, in addition attached to this a hospital (hospit- of the faithful ‘pro salute animae’. to the above-mentioned Bull of ium peregrinorum) and a ceme- By a document of 19 June 1204 1204 which contains the articles tery. This hospital (or xenodochi- (Inter opera pietatis), Innocent III of the Regula, is of fundamental um) was enlarged by King Offa of entrusted this institution to Guy importance – the ‘Ad commemo- Mercia in 794. de Montpellier and his brothers randas nuptias’. This laid down Throughout the High Middle (‘Guidoni … eiusque fratibus’) that every year the Pope, accom- Ages the schola Saxonum expand- and laid down the Rules of the panied by Cardinals and canons, ed in the area of the Borgo (from Order of the Holy Spirit. would go on a procession from the English term ‘burg’) and the Recent and accredited studies St. Peter’s Basilica to the hospi- importance of the hospital also have ascertained, in opposition tal where in memorial of the wed- grew before its decline after 1000. to certain doubts that arose in the ding of Cana there would be dis- It was precisely the area of past, that Innocent III followed tributed meat, bread and wine to the old hospital that King John the building of the hospital and three-hundred patients and an- of England, after returning from paid for it, that he established the other thousand needy people the Holy Land, gave to Pope In- rules for its management and how from every part of the city (which nocence for the building of a new it should work, and that he then at that time had a little less than hospital. entrusted it to Guy de Montpellier. 30,000 inhabitants). This act was Lothar of Segni, who became This last was an aristocrat and intended to emphasise the caring Pope in 1198 with the name of In- Templar knight who had always function (in the broadest sense of nocent III, was one of the great dedicated himself to care for the caritas) of our hospital which for of the Medieval period. sick. Since 1170 he had estab- the first time was called hospitale During his long and controver- lished in his city of Montpelier Sancti Spiritus in Saxia. sial pontificate – he died on 16 an Order of Hospital Brothers Of fundamental importance in July 1216 – he was responsible and had built a hospital named af- knowing in a detailed way about for memorable constructions such ter the Holy Spirit: in the above- the type of care that was provided as the Hospital of the Holy Spirit mentioned Bull of 1204 he was by the Hospital of the Holy Spirit in Sassia which was a model for referred to as ‘fundator hospitalis is the Liber Regulae, of which we similar institutions throughout Sancti Spiritus Montepessulanis’. have various manuscript codices Christendom. In 1198 he was in Rome where and various printed versions from One night this Pope had a he had two hospital houses. The the modern age. The oldest and most representa- Pope Innocent III Guy de Montpellier tive codices, not only from an ar- chival point of view but also be- cause of its splendid miniatures, are to be found in Italy. One, from the fourteenth century, is kept in the , in the Borghese Section (amongst the documents that Cardinal Borghese managed to move from Avignon to Rome). The other – and this is the one that will be drawn upon in this paper, is at the present time to be found in the State Archives of Rome and comes from the archives of the Hospital of the Holy Spirit. It is in a Goth- ic script, with illuminated head- ings, and was drawn up, according to the most recent and accredited analyses, at Avignon roundabout the middle of the fourteenth cen- tury. It is attributed, because of its stylistic and iconographic features,

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to the atelier of the Master of the relation to other hospitals (Santa During the ‘captivity of Avi- St. George Codex. Maria Nuova in Florence, Santa gnon’, for about seventy years, a The Regula was approved de- Maria della Scala in Sienna). decline was witnessed, not only of finitively by Gregory IX in 1228 But hospital health care was the city of Rome but of all health- and affirmed the following fun- not the only task of the Hospital care institutions of the city, includ- damental principle: ‘the patient is of the Holy Spirit. The Rules of ing the Hospital of the Holy Spirit. the master and he who assists him Innocent III of 1204 had declared The old building constructed dur- is his servant’. Within this general expressly: ‘reficiuntur famelici, ing the twelfth century by Mar- rule, some distinctions were made pauperes vestiuntur, necessaria chionne di Arezzo was by now di- as regards the approaches to be en- ministrantur infirmis’ (the hun- lapidated, the internal organisation gaged in towards patients: towards gry will be fed, the poor will be of the hospital was in a state of ru- the poor, ‘libenter ed caritative’ clothed, and the sick will be given ins, and the income of the hospital (willingly and in a spirit of char- the necessary treatment and care). was at a low level and insufficient. ity); towards religious, ‘benigne, In addition, Pope Innocent III, Eugene IV (1383-1447), amidst quasi servus Dei, et caritative’ though the creation of the ‘wheel the stormy events of his pontifi- (with affection and willingness to for the foundlings’, sought to pro- cate, had an opportunity and the help, as is appropriate to a servant vide care to newborn children time to rebuild the hospital from of God, and in a spirit of charity); whom inhuman mothers, pros- its foundations, to fill its emp- and towards the rich and the pow- titutes or of other kinds, used to ty funds by an income that was erful, ‘speciale hospitium et rev- abandon or even to throw into the paid directly by the Pope, and to erenter serviatur (they should be waters of the River Tiber. restore its operations by giving served with a special willingness The ‘Constitution’ of Innocent new strength and vigour to its re- to help and with reverence). The III had an influence on health care ligious Order. He created, accord- three adverbs libenter, benigne in Europe for a number of centu- ing to the customs of the time, the and reverenter express clear dif- ries until the fifteenth century and Brotherhood of the Holy Spirit ferences in terms of social class beyond. Indeed, many hospital in- which was made up of lay people and treatment: they also express stitutions adopted the Rules of the who were rather well-off and to the spirit of the times and the spe- Hospital of the Holy Spirit. whom ‘indulgences’ were grant- cial features of the place but also ed: in the Liber Fraternitatis were the practical necessities connected The ‘wheel’ for the foundlings written the names of the brothers with the working of the institution who had made over funds or left and its survival, given that admis- legacies to the hospital. sion, care and treatment were free. Nicholas V and Callixtus III The people who needed to be were other Popes who dedicated admitted arrived at the hospital themselves to the Hospital of the or were taken there (others were Holy Spirit during this troubled picked up in the streets, once a period. But the Pope who was re- week, by a kind of ambulance sponsible for a decisive turning cart) and left their belongings in point in the reconstruction of the a special office. They had to un- Hospital of the Holy Spirit was dress before they were assigned Sixtus IV. Francesco della Rovere a bed and had to engage in con- was Pope from 1471 to 1484 and fession and take holy commun- his pontificate has received from ion. Dressed in the special clothes historians rather controversial of the hospital, they lay in their judgements. As regards the sub- beds assisted by the confratres. The sisters had the task of chang- The Sistine Hospital ing the bedclothes once a week, if they were dirty, and to wash the feet of the patients every Tuesday and their heads every Thursday. There is no reference in the Regula to physicians, surgeons or apothecaries. One may as- sume that the brothers had special health-care knowledge and expe- rience and that the sisters and the servants made their contribution to the usual practices involving care and assistance. The presence of physicians in special cases cannot, however, be excluded, as is borne out by documents of the same period in

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ed, and the buildings for accom- only at the level of health care and modation and the services were assistance but also at the level of restored. It was an authentic ‘city the economic-financial context of of the sick’, an ideal setting for Rome and Lazio. conjoining religious piety with In the middle of the seven- the mechanisms of healing. teenth century the Hospital of the The sixteenth century witnessed Holy Spirit had acquired a strik- extraordinary events. The Catho- ing size: in 1657 4,014 sick peo- lic Counter-Reformation and the ple and 932 foundlings entered Council of Trent established new the hospital and a year later 6,505 rules for hospitals and for all care- sick people and 1,101 foundlings providing institutions, more rigid (by means of the special wheel) regulations as regards the way crossed its floor. In 1625 on one they worked and were managed, day alone there were 1,587 peo- more careful administrative con- ple in the dining hall, and of these trols, and a greater level of techni- 380 were patients, 118 were chil- cal/health-care qualifications. dren, 560 were spinsters, and But at the same time a new re- there were also , sisters, men ligiosity pervaded the whole of and women nurses, servants and the sector, worked an evolution people who worked in various from within, shook consciences jobs for the hospital. and transformed institutions. John The institution enjoyed im- The wards of God, Filippo Neri and Camillus mense prestige, not least because de Lellis were expressions of this of the ‘value of the men great deep renewal at the level of men- in medicine, surgery and herb- ject of this paper, he reconstructed talities and customs. The Hospital al medicine’ who worked in it. ex novo the Hospital of the Holy of the Holy Spirit received the last Amongst these there was Giorgio Spirit which had been destroyed two – Filippo Neri and Camillus Baglivi, a man of an open mind by the disastrous fire of the Borgo de Lellis – into its wards amongst who was ready to use in the treat- of 1471. He involved in this pro- the patients, and gave them the ment of sick people all the new de- ject ‘skilled architects’ whom he rudiments of the art of medicine velopments, such as music thera- called to Rome from all parts of and placed them in contact (an or- py, which in our hospital achieved Italy. The building work was com- ganised contact) with pain, illness incomparable heights. When Car- pleted between 1477 and 1482. and death. dinal Juan de Lugo introduced The façade was renewed (this is Over the next two centuries the in Rome the elixir of China, a a façade that appears in the paint- Hospital of the Holy Spirit was a new miraculous medical product ing ‘The Temptations of Jesus’ by forerunner of the transformations against fevers, the sisters of the Botticelli in the Sistine Chapel that were underway in the field of and in the seventeenth engraving treatment and care for sick people. by Giovanni Battista Falda), the Alexander VII established a St. Filippo Neri two huge wards with at their cen- ‘small hospital for the wound- tre the dome cladding were creat- ed’, a sort of emergency depart- ment that was open day and night The home of the sisters to deal with the victims of brawls and attacks which at that time in Rome were very frequent. Once again under Alexan- der VII, in the year 1644, Com- mendatore Vai laid down that eve- ry Thursday the managers of the hospital – the administrators, the medical doctors, the apothecaries, the ecclesiastics and the other ‘of- ficers of charity’ – were to meet in the room containing herbal rem- edies to discuss the problems and the needs of the moment. And pe- riodic meetings of this kind were also established subsequently. The presentation of tables, infor- mation and comparisons attested to engagement and study in the correct management of an insti- tution, and this was important not

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elements for this operation which Bibliographical Notes in the future would undergo a ma- On questions of a general character, only jor development. some essential recommendations for the his- He transferred teaching to in- tory of hospitals, see, for everyone, the old side the hospital and still today, at but always valuable A. PAZZINI, L’ospedale nei secoli, (Orizzonte Medico ed., Rome, the Historical Museum of Health- 1958); for the history of Roman hospitals Care Art, is kept the teaching A. CANEZZA, Gli Arciospedali romani chair from which he taught at La nella vita cittadina, nella storia e nell’arte Sapienza. The remains of the an- (Rome, 1933); and for juridical-institutional questions cf. E. NASALLI ROCCA, ‘Il di- atomical theatre are also kept at ritto ospedaliero nei suoi lineamenti storici’, thus museum: the obstetric wax- Biblioteca della ‘Rivista di storia del diritto es of Manfredini (1785), the little italiano’, vol. XX, Milan, 1956. On the Hospital of the Holy Spirit there is skeletons of the monstra, and the a broad and high-level literature. During the anatomical models – all elements 1950s and 1960s a important ‘corpus’ of stu- that were useful in the prelimi- dies was constructed, in particular the work of P. DE ANGELIS, L’Arciospedale di San- nary teaching of medicine. to Spirito in Saxia nel passato e nel presente The Popes of the Restoration (Rome, 1952); La spezieria dell’Arciospedale dedicated especial care to the di Santo Spirito in Saxia e la lotta contro la malaria nel terzo centenario della nascita di Giovanni Maria Lancisi Hospital of the Holy Spirit. Lat- Giovanni Maria Lancisi (1654-1954) (Rome, er, Pius IX added a ‘pars nova’ to 1954); L’architetto e gli affreschi di Santo what was still, legitimately, the Spirito in Saxia (Rome, 1961); L’ospedale di Santo Spirito in Saxia in Roma e nel mondo Hospital of the Holy Spirit made hospital of the Popes: this new (Rome, 1961): these texts were published in a concoction of exceptional effi- wing was used as a military hos- the series of historical studies on the Hospi- cacy which was extremely useful pital for the treatment of the sick tal of the Holy Spirit in Saxia and the Roman hospitals. in countering malaria, which at and wounded of the French con- In part some of the research of Enzo Ber- that time was very widespread in tingent stationed in Rome. gami and A. F. La Cava on the Liber Regu- Rome and its hinterland and came When in 1870 Rome, after the lae has been superseded; still valuable are the studies of Bergami in the internal regulations from the Pontine marshes. breach made in Porta Pia, was of the hospital (E. BERGAMI, ‘Influenza del Between the seventeenth and annexed to Italy, the situation regolamento dell’Ospedale di Santo Spirito the eighteenth centuries there of our hospital was aligned with nella evoluzione della sanità in Italia’, in Atti e Memorie dell’Accademia di Storia dell’Arte emerged the figure and the work the health-care legislation of the Sanitaria, 1, 1989. of Giovanni Maria Lancisi, a new State and the Hospital of the Of very great interest for the history (but medical doctor of mercy and a Holy Spirit became (was consid- also for the present state of the buildings and the frescoes) of the whole historic site of the scientist of exceptional value. He ered) one of the many hospitals of Hospital of the Holy Spirit are the Atti del taught at La Sapienza but argued Rome. Convegno Internazionale di Studi (Rome, that the teaching of the tradition- There thus ended at this mo- 15/17 May 2001): L’antico ospedale di San- to Spirito. Dall’isitutzione papale alla sani- al texts of Galen, Avicenna and ment the special character of a tà del Terzo Millennio, 2 vols. (Il Veltro ed., Mesue the Elder was insufficient hospital (a place for admission Rome, 2002). in the training of a good physi- and care) in which faith and rea- The move from papal Rome to the troubled post-unification period is described very well cian: theoretical teaching had to son, piety and science, relics from in the recent S. MATTONE, M. MONGAR- be conjoined with direct examina- the past and hopes for the future, DINI, and M. SCARNO’, L’Arcispedale San- tion of the sick. And the Hospital found their most complete syn- to Spirito in Saxia (Aracne ed., Rome, 2011). of the Holy Spirit provided all the thesis for many centuries.

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The Historical Genesis of Hospitals

Fra’ Pascual Ancient India: its data tell us of Job, that he was just, took place Piles Ferrando, O.H. about certain centres where medi- during a time when because of ill- Emeritus Prior General, cines were distributed and which ness and calamity he and his fam- the Hospital Order had personnel who were trained ily were seen as sinners. This was of St. John of God, in treating sick people. something that he did not accept Spain The Egypt of the Pharaohs: and against which he fought with sanctuaries existed where sick resistance and cries of protest un- people who were seeking help til there came, through nearness could reside and there were ‘phy- to God, proof of his goodness. sicians’ who practised magic. In this context, more than plac- 1. Introduction Ancient Greece: in its temples es of care there were social atti- there were kinds of private clinics tudes that promoted the distanc- I think that one should approach with the best physicians who lived ing of sick people from cities and the subject that on this occasion I there so that they could examine towns: lepers, the mentally sick, have been asked to address with those who asked for their help and the obsessed etc. were led to live reference to its broadest definition. also rest. Later they treated peo- in fenced off areas where very lit- This is something of which I have ple in halls where the ‘incubatio’ tle was done to heal them. More practical knowledge given that I took place: a series of therapeutic than care and treatment, they re- have had the possibility of know- sleeps and baths, physical exer- ceived exclusion, which for cer- ing about many hospital institu- cise and diet. These temple were tain categories of sick people has tions in various parts of the world. places of pilgrimage. continued until the present day. I have not been a person dedicated Ancient Rome: sorts of military The Bible offers us accounts to the field of history: I have been camps were created for wounded of initiatives that were taken to much more directed towards the soldiers. In Italy the great land- help infected people. We have management of the people who go owners began to construct build- a description of the healing of to make up hospitals, both the users ings that they called ‘hospitals’ in Naaman the leper who came and the professionals, and I have order to keep their slaves in good from Aram to Israel and was sent done this with a specifically pasto- health. by the prophet Elisha to the Riv- ral outlook because I am a Brother None of these four peoples had er Jordan (2 Kings 5:1-15). Them of St. John of God, a priest. hospitals for the poor and the sick. there is the healing of the para- On the other hand, seeing the The spirit of antiquity towards the lytic at the pool of Siloam by Je- programme of this international sick and the needy was not based sus (Jn 9: 1-12), a pool that had conference, with subjects based upon compassion. The custom of a curative power when the waters upon what is covered by the title, helping people in need to a great moved. Chapter 38 of Sirach en- everything in my paper will be extent began with Christianity. gages in a praise of the physician about the action of hospitals, their and his learning; it speaks about professional, human, and curative medicines and the prudent man (on many occasions) action, or 3. The Light that Came from who knows how to use them, and action involving accompanying the Word of God and also about the healing power of when treatment cannot be given, Steadily Grew in the Church the spirit of God and the need for and always with evangelising ac- prayers for healing. tion according to the context or The traditions of antiquity ad- In a progressive way the word the creed of the people involved. dressed the subject of evil and ill- of God illuminates us about the The title of my paper is ‘the his- ness and the reason for their exist- reason for evil in history and the torical genesis of hospitals’. ence. The most known and most action of God and men in favour profound tradition is that of the of others, above all in the case of Bible. Illness, suffering and death those in need. Four characteristics 2. The Contributions were the outcome of sin and as a are emphasised: a different view of Antiquity consequence they were a punish- of sick people; a way of engag- ment of God. We find ourselves in ing in human relationships which As it is impossible to engage in very precarious and primitive con- is based on love; a broadening of an exhaustive study, I will offer texts and ones with few founda- care for the incurable and the dy- a trajectory with various dates as tions in knowledge about reality. ing; and the appearance of organ- testimony. In antiquity there was The Creation myth by which the ised care for the whole of the pop- overall action which was reflected appearance of man and woman ulation. in religious or cultural traditions in history is explained has need- Modern hospitals have their ori- which were different from those ed theological explanation during gins in the houses for the sick and to be found in the Bible. the modern era. The knowledge in the hospitals that were built by

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the Catholic Church during the received from Christianity their welfare continued through an in- Roman Empire. Christianity asked idea of a hospital as such, a fact crease in the control exerted by its faithful to help the sick and that it is advisable to know about the state and because of the policy those in need. The principal con- given the increasing interreligious of the state of reducing and con- sequence of this change in values component that we have and be- centrating services and centres as was the appearance of organised cause of the importance that our part of a project of greater insti- care for the whole of the popula- Islamic patients have today for us. tutional rationalisation. This was tion and this led to the creation of During the medieval period the achieved by strengthening the the hospital as a specific institu- word ‘hospital’ began to be used quality of care within the pub- tion. and every category of hospital ap- lic domain. Vitality was lost and peared, developed by the military difficulties appeared as regards Orders during the crusades. But the appreciation of care provid- 4. The Historical Evolution there were also civil and episcopal ed within the context of so-called of Hospitals hospitals in the cities which were charity. really such, as well as hospitals of The Enlightenment had the vir- During the fifth century the the nobility for pilgrims and hos- tue of giving a decisive impulse Christian Churches of the East pitals for the crusaders which then to the medicalisation of hospitals created charitable institutions became of general use, for lepers, and to converting them into plac- which were later called ‘hospi- the mentally ill, and so forth. es where scientific medicine and tals’. The authors of greatest au- With the hospitals of the Re- its academic acquisition increas- thority see the Hospital City of St. naissance there began the secu- ingly developed. The dark side, Basil as the first hospital in histo- larisation of hospitals, structures however, of this stage lay in the ry. In 370 he founded in Caesarea which had previously been organ- fact that advances in the organi- an establishment for sick people ised by institutions of religious sation of hospitals and in medi- who were treated and cared for by character. This was the natural cal science were not accompanied physicians and nurses. St. John consequence of a secularisation by a better and more worthy and Chrysostom did the same later in of society which led to a greater more attentive care for those pa- Constantinople. St. Basil was the involvement of public authorities, tients who had been admitted to first to begin by fusing two genu- which promoted them and con- hospital. inely Christian institutions, name- trolled them. The municipal and During the eighteenth century ly a monastery and a hospital, and state authorities allowed hospitals changes in scientific ideology ac- this union was consolidated in the to be their own responsibility. The centuated the importance of em- West by St. Benedict of Norcia. state began to take responsibility pirical studies and the produc- We are provided with the first for what was is known as public tion of knowledge on the basis information about the appearance welfare. A specifically hospital of observation of the facts. Af- of various centres in the West at architecture appeared and there ter the French Revolution, medi- the end of the fourth century and was also the presence of special- cal doctors in these countries be- during the fifth century by St. Je- ised hospitals: for the contagious, gan a new strategy of professional rome. Subsequently, St. Benedict incurables, convalescents, lepers, and social progress through what in his Rules spoke in chapter 36 the mentally ill, etc. was generally called ‘observa- about how sick brothers had to tion medicine’. With the notable be cared for, about how illness number of patients that could be had to be experienced, and about 5. The Increase in Autonomy obtained in hospital wards, medi- behaviour towards those people cal doctors had an opportunity to who cared for the sick. Chapter From roughly the middle of observe from the outset the indi- 52 refers to guests and defines the the seventeenth century onwards, vidual development of illnesses character of hospitality. A prolif- hospitals entered their stage of de- and the diagnoses of many more eration in infirmaries stands out. velopment when their control by patients than was the case in their The Byzantine hospitals were the state increasingly grew to the private practices. a natural and immediate devel- point of placing them at the ser- The increasing presence of doc- opment of the work of St. Basil vice of its political, economic and tors and surgeons in European and his successors. They began military goals. This approach led hospitals made these institutions a trajectory of care that was in- to the replacement of motivations increasingly attractive as places creasingly marked by the use of and goals based upon charita- for the instruction and training of scientific medicine and then by ble criteria, as had been promot- physicians. Special teaching halls Hippocratic-Galenic medicine. ed by the Church, by a search for were looked for where lecturers The Byzantine model of hospitals greater efficacy in the achieve- and assistants, followed by their was transferred to the medieval ment of ends. Medicine was like students, made regular visits to and modern Islamic world. It was this in a decided way and this was patients. The teaching of educa- also transferred to the Christian then promoted by Enlightenment tion became more active. and Roman world starting in the thinking. General hospitals be- Hospitals during the nineteenth twelfth century. gan and these have continued un- century present a paradox as re- Between the eighth and the thir- til today. gards their historical evolution: at teenth centuries Islamic hospitals The secularisation of hospital a scientific level they were praise-

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worthy but at the level of care they most important health-care re- that took place at home, now took were deplorable. Medical doctors source – with the incorporation place in hospitals. From the be- came to be seen as authentic sci- of scientific medicine hospitals ginning of the nineteenth centu- entists but in the same institutions were transformed into institutions ry a depersonalised approach to hospitalised patients became a of primary reference. Thanks to illness influenced the nature of higher field of scientific observa- diagnostic and therapeutic pro- the relationship between medi- tion, but this was done with the cedures such as radiology, elec- cal doctors and their patients be- most crude enlightened despotism trocardiograms and clinical lab- cause professionals played a cen- and the conditions offered by hos- oratories, the ability to produce tral role in successfully solving pitalisation were often below the diagnoses greatly improved. Hos- the diagnostic problems of human minimum necessary for elemen- pitals increasingly concentrated pathologies. The moral author- tary human decency and dignity. on the treatment of acute illness- ity of medical doctors, which had es. A new generation of vaccines hitherto been based on personal and therapeutic chemical sub- qualities, was now based on sci- 6. Hospitals for all stances improved the chances of entific competence. Clinical ex- Social Classes success in the battle against cer- perimentation became aggressive tain illnesses. With anaesthetics and abusive because of the few The last years of the nineteenth and antiseptic procedures, hos- guarantees that existed to safe- century can be seen as the mo- pitals were transformed into the guard patients. ment when the evolution of hos- most important centres for sur- pitals received a new impulse gery. which continued into the first half New occupational illnesses 7. The Presence of the Church of the twentieth century. The form – to treat patients, hospitals ab- during this Whole Stage this took was as follows: sorbed more and more genera- There was a move from charity tions of women nurses who came The Church has had, and has, to insurance against sickness – for from the middle classes and who a preponderant role in the provi- the first time in history hospitals had been trained with educational sion of health care for the good were used to diagnose and treat programmes based upon the mod- of patients. Many Hospital Or- patients from all social classes. In el established by Florence Night- ders came into existence, amongst 1882 insurance against sickness at ingale (1820-1910). These hospi- which that of the Brothers of St. work was introduced for employ- tal women nurses took the place John of God which was approved ees and their family relatives, with of the religious personnel who by in 1571 by Pope St. Pius V and a concomitant expansion of the tradition had provided service to that of the Fathers of St. Camillus, market as regards health because patients. The women nurses of the Ministers of the Sick, which this included medical treatment, Florence Nightingale were trans- was approved by Pope Gregory the costs of medial products, and formed into valuable assistants of XIV in 1591. admission to hospital. Medical the medical profession in the pro- There were a large number of doctors and insured workers had vision of care and treatment to pa- religious foundations for women a duty to decide between the need tients. which consolidated the very im- to treat the patient and his or her Hospitals as centres for re- portant role of the presence of the capacity to work. The medicalisa- search and specialisation and Church in hospital care. tion of medicine had arrived. medical teaching. During the sec- The action of the Church has Hospitals functioned according ond part of the twentieth century been to do good to others, rely- to the needs of the urban and in- hospitals were transformed into ing in turn upon the support of dustrial context – the new mission the primary laboratories of med- governments in those areas where of hospitals was the result of a ical doctors. Their objectives, foundations were made, and also convergence of ideologies, politi- which included specialisation, upon the support of the local pop- cal strategies and welfare needs. training and research, were trans- ulation, solving the health-care Religious values and donations formed into institutional priori- and social needs of very many to charity still had an important ties. Hospitals underwent a major people through the major sacri- role to play at the beginning of development in specialised care fices of people who joined these the twentieth century because the with the creation of clinical de- institutions, following the spirit of needs of economic development partments and an increase in the the men or women founders. based upon capitalism indicated number of medical students. In the spirituality of these insti- that the health of workers in the Other aspects of the new hos- tutions the paschal mystery of Je- industrial world was of great im- pitals. After hospitals were trans- sus Christ, who took on suffering portance both for the state sector formed into a point of preferred of a redemptive character for oth- and for the private sector. Urbani- attention for the application of er people, as well as the approach sation advanced at an accelerating scientific principles in medicine, of the Good Samaritan who was rhythm. In addition, industrialisa- new ethical problems emerged. sensitive and compassionate to- tion created a new panorama of The processes of the medicalisa- wards the wounded man he en- occupational illness and also ones tion of life increased the level of countered on the road, were very caused by accidents. life experiences. Birth and death, present. Hospitals became the first and which previously had been events

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8. Observations provide Catholic religious assis- centres for all people and although tance services in hospitals. they are the work of Catholic insti- History tells us that the Church g. For this reason one should tutions we cannot force their users created care centres and has had a state again vigorously and clearly or the professionals within them to decisive influence on their devel- that the Church must be faithful to adopt our beliefs. We must always opment over the last six hundred her Tradition and for this reason be evangelisers through our lives years, from St. Basil until the pre- must give to hospitals the atten- and we will do this to the extent sent time. tion, the people and the pastoral that we embody the Gospel in our Starting with the modern era, instruments that they need today; religious experience lived in the hospitals moved from being the the Church must be faithful to Je- sacraments and in service. responsibility and property of sus Christ, the Good Samaritan We are given a great deal of light the Church to belonging to vari- and Physician for all people; the by the Second Vatican Council, as ous secular institutions, and this Church must maintain her faith- indeed was the wish of that Coun- underlined the power of political fulness and make hospitals a fun- cil, the fiftieth anniversary of the authorities, and, later, of medical damental instrument of encoun- beginning of whose synodal as- culture and medical science. ter with sick people, their family sembly will take place over the This has not been an imped- relatives and those who work in next few days. With prudence but iment because until now the them providing care; in dioceses with audacity we must look to the Church has continued to pay pref- people should know about and future with hope so as to bring that erential attention to hospital insti- appreciate more the efforts made light that centres of care and hospi- tutions. The proof of this is to be by Catholic hospitals to meet the tals need today, with the sensitivity found in: new challenges of hospital care of their professionals, with support a. The large number of religious and to form with them closer rela- for life and with dying with dig- Orders and Congregations which tionships of pastoral cooperation; nity, so that they are truly places from the sixteenth century on- and given secularisation there is a of evangelisation, because of the wards have had as their charism need to review and renew the doc- deeds we engage in and where they the provision of a service of care trine of Catholic hospitals (Spain are performed. and of pastoral care in hospitals, 1981). We trust that during this year of and the foundation of their own faith that we are living through and institutions to express this hospi- the Synod of the New Evangelisa- tality. 9. Conclusion tion whose celebration we are now b. The foundation of hospitals ending, these two events will be in lands of mission, from the six- In this technical, secular, plu- a stimulus for us and as we have teenth century onwards as well, ral, scientific world the Church been reminded openly on various as action inseparable from the of Christ, the Good Samaritan, occasions our faith should be unit- evangelising work of the Church. must act in the world of health and ed to works of charity, especially According to the latest data pro- health care in the way that has al- for those who suffer because of ill- vided by the Holy See in the An- ways characterised her, doing good ness or marginalisation. May they nuarium Statisticum Ecclesiae, to others, especially when they are help us to be a solidarity-inspired there are 120,826 Catholic health- most in need. and renewed presence of Christ care structures in the world and The Church must do this being that is not alarmed but, rather, il- of these 5,236 are hospitals in the aware of the global world in which luminates, and like Christ knows true sense of the term. she lives with its cultural diversi- how to say things that are clear, c. The number of hospital foun- ties, being in mind the constan- are alive with transparency; and a dations which are still owned by cy of gospel principles, amongst presence that proclaims a year of diocesan churches. which the great mercy of Jesus grace for everyone, shares life with d. The number of hospital beds Christ towards those who suffer, the least and with sinners, and al- at present provided by the institu- with whom he identified, as is ex- ways tries to bring a message of tions of the Church in the various pressed in the account in chapter salvation for everyone! sectors of health care, amongst 25 of the Gospel of St. Matthew of May we do this through our pres- which beds for psychiatric cases the Final Judgement. ence in hospitals which are places without which, in by no means The contemporary context is the of physical and moral healing; may few cases, the adequate provision outcome of a secularisation that in we accompany the pain and deaths of secular health care would not some aspects is exaggerated but of people; may we make these in- be possible. which in others has been necessary, stitutions forces for humanisation e. The active and productive and we must strive to be light and where people in their own way contribution of contemporary salt of the earth through witness, encounter the mystery of the one hospitals to new and pioneering knowing how to welcome, illumi- God, a healing presence in our initiatives such as ethical commit- nate, respect and accompany every lives! tees, palliative care units, units for situation of suffering and death in I will end this paper of mine with people with brain damage, etc. our apostolic activity, in the belief a quotation from a paper given by f. The agreements and under- that God saves, in addition to eve- H.R.E Msgr. Zygmunt Zimows- standings with public authorities rything that we can achieve. ki, the President of the Pontifical and private health-care bodies to Centres of care are universal Council for Health Care Workers,

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at the recent Synod for the New their families to pastoral care in Aspects of Evangelisation’, n. 9): Evangelisation. He reminded us parishes etc. In practical terms hos- an evangelised hospital is ‘a place that ‘pastoral care in health has a pitals must be seen as privileged in which the relationship of treat- field of action which has many de- settings for evangelisation be- ment is not a profession but a mis- tailed and complementary expres- cause where the Church becomes sion; where the charity of the Good sions which go from hospitals to a ‘bearer of the presence of God’ Samaritan is the first seat of learn- relationships with the various pro- she is transformed at the same time ing and the face of suffering man is fessional figures of the health-care into an ‘instrument for the true hu- Christ’s own Face’ (Benedict XVI, world; from personal encounter manisation of man and the world’ Address to the Catholic Universi- with people marked by the mystery (Congregation for the Doctrine of ty of the Sacred Heart of Rome, 3 of pain and from dialogue with the Faith, ‘Doctrinal Note on Some May 2012).

The Centuries-Old Religious Role of the Sisters of Charity of St. Jane Antide Thouret in Roman Hospitals

Sister Anna with her and we thank the Lord for ‘God alone’ is the motto of the in- Antida Casolino the incalculable number of peo- stitute – embraces the pains of the The Sisters of Charity ple that have been met, loved and world: poverty as regards bread, of St. Jane Antide Thouret, healed, to whom we have sought health, culture and freedom. This Italy to bear witness to the tenderness, is the charism of charity which is the gratuitousness and the liberal- always of contemporary relevance ity of God the Father who is near and importance and which through to those who suffer and in a par- the untiring and audacious work of ticular way to the sick, to the poor the Sisters of Charity, and their lay Introduction and to children. friends, seeks to be, today as well, The boundaries within which a propulsive centre of evangelisa- The historical outline in this we travel on our journey through tion and service. brief survey brings out a fine fea- time are those of the city of Rome Our Founder stayed in Rome ture of the civil, social and eccle- in the years that go from 1844 to during her trips from France to Na- sial history of Rome and takes us today. We are the Sisters of Char- ples which took place on a num- back to the flow of the river of ity of St. Jane Antide Thouret, our ber of occasions and for almost love for our suffering neighbours Founder who in 1799 in Besan- two years between 1818 and 1820 which led my religious family to çon, in France, created our Con- when she sought pontifical approv- take root in Rome and to make its gregation which then soon spread al for the Rules of the Congrega- mission of charity always contem- to nearby Savoy and Switzerland. tion. At that time the organisation porary, in line with the charism of Its arrival in Italy goes back to the of care was the task of the govern- the founding Mother, St. Jane An- year 1810. She swiftly answered ment and the pastoral care of the tide Thouret. the request to care for the poor of Supreme Pontiff himself through Our sister wrote: ‘if suddenly the city of Naples which was made the work of a chairman of a com- one could reveal to human eyes all by the Empress, Madame Letizia, mittee responsible for various in- the tasks of heroic education, now the mother of Napoleon Bona- stitutions. Thus she nourished the enveloped in a dear and sweet si- parte, who had entrusted the King- wish to make herself available to lence, carried out by all the male dom of Italy to his brother-in-law, the Pope for a service of charity. and female religious Congrega- Murat. She made this request a number of tions, we would be certain that Hitherto the Congregation has times in letters that she sent from Rome is not only ‘Caput mundi’ reached thirty countries in the Naples between 1824 and 1826, and the capital of Italy but also, and world. ‘Love Jesus Christ, love the year of her death. Because of above all else, the capital of Char- and serve the poor, who are his the interceptions of the letters and ity’ (Raffaella Perugini, La nostra members, express to them the love because of a lack of understanding stella, Rivista trimestrale delle Su- of the Father’ (RdV 1.1.1.) is a between certain Cardinals and of- ore della Carità, 1962). We agree charism that in the sight of God – ficeholders of the Vatican, nothing

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came of this. But there would be plemented it: calling on the young himself appointed Gen- a flowering of works of charity in women to be involved in work, eral, to look for another location Rome later on. the acquisition of a sense of re- in Rome for the novitiate and to sponsibility, and with the wish to move the general curia there from The First Call of the Sisters acquire a more luminous identity. Naples. The political, social and of Charity to Rome Their approach was marked by strongly anti-clerical climate was great welcome and friendliness, heavy and lucidity was required Eighteen years after the death the wealth that they had available. so as not to succumb, as well as of our Founder, Sister Rosalia The inhabitants of the neighbour- prudence in order to defend the Thouret, her niece and secretary, hood did not forget this… young aspirants against complica- who at that time was the Provin- In the history of Italy and of tions, dangers and confusion. On cial Superior in Modena, after re- Rome, 1848-49 was a moment of 13 June 1869 an act of a public no- ceiving a request from Pope Greg- revolutionary movements and ri- tary was drawn up for a building ory XVI, responded to that request ots which wanted to overturn the in the north-east part of the Aventi- for a service of charity with two existing political regime. They no which was surrounded by land communities at the Hospital of were moved by liberal anti-cleri- and a large garden. Here, after this the Holy Spirit in Sassia, in agree- calism and by the dream of a new transfer took place, young women ment with the General Superior political order. The unity of Italy were received and given formation Sister Guinevere Boucon. The ser- was wanted, even to the detriment so that they could be ready for the vice began on 23 September 1844 of the . The secularist mission of charity as a response with six sisters. In what spirit? The climate and the establishment of to the appeals of the Vatican, the same as that of the Rules written the Mazzinian Republic in Rome town council of Rome, some no- by the Founder: the mission of brought about the distancing/ex- ble families and benefactors for charity is ‘to do in part what the pulsion on the grounds of pub- the provision of care to the sick Saviour of the world came to do lic peace on 23 February 1849 of and the education of young people on earth, to work to establish the the sisters and the religious of St. in schools, orphanages and con- Kingdom of God’ (S.G.A. Discor- Camillus de Lellis, who had re- servatories. so preliminare alla Regola) with cently arrived in the capital city. the ecclesial definition that was so Pope Pius IX himself was forced St. Agostina Pietrantoni dear to her: ‘I am a daughter of the to flee to Gaeta. at the Hospital of the Holy Spirit: holy Church, be the same with me’ Once the republic had fallen the a Martyr to Charity (S.G.A., Circ. 11-4-1820). Pope returned to Rome and called The sisters were entrusted with back the Sisters of Charity. H.E. In 1882 a young woman called the Conservatory for Unmarried Msgr. Carlo Luigi Morichini was Livia Pietrantoni arrived at the Women for young women rejected chairman of the committee for generalate house: ‘one of those by their families and by society, charity, which also had lay mem- little and humble sisters of whom and the Orphanage for Abandoned bers. In 1850 he established an- one can ask anything, especially Children, which were both con- other community in the Hospital what one cannot ask of the others, nected to the hospital. The recep- of the Holy Spirit to which he en- with the certainty of a ‘Yes’ which tion was good but immediately the trusted the nursing care provided comes from the heart and aware- two communities had to deal with in the Sistine Ward. Later, Pius IX ness that only in this way can one a confusion that had spread to all invited the creation of a novitiate express gratitude to God for being levels: the economic, the organisa- in the buildings of the same hos- called and to the Congregation for tional and the moral. However, the pital and this was inaugurated on being accepted’. (Perugini, Storia sisters managed to unite in love 2 January 1852. These commu- della provincia religiosa di Roma, and with this widespread energy nities were at the service of the 1989). soon the atmosphere was marked poor, their needs and their health, In 1884 this young sister was by calm, order and respect. in a climate of relationships which invited as a nurse to the Hospital Two years later (1846) it was were always marked by affection of the Holy Spirit, first in the de- once again Pope Gregory XVI and an educational purpose. Af- partment for children and then in who through Msgr. Morichini, the ter assimilating the spirit of the the ward for tuberculosis patients. Director of the Pontifical Charita- Founder, the primary purpose of Prof. Achille Ballori, a grand mas- ble Works, made a second pontifi- the sisters was that of bearing wit- ter of the freemasons, was the di- cal request, this time for the run- ness to faith and charity even in rector of the hospital. He ordered ning of the Refuge for Penitent the most difficult places, such as all of the crucifixes in the wards to Women in Piazza Santa Maria in the psychiatric wards of Via della be removed, sent away the chap- Trastevere, where what was pro- Lungara and those for people with lains, the Conceptionist Fathers, posed was a work of rehabilitation bad sight. and had hung in the Sistine Ward a and mental and physical care for slogan in square letters – ‘Freedom young women who had emerged But at the Hospital of the Holy of Conscience’. While waiting to from the most squalid experienc- Spirit the Waters did not Calm send away the sisters as well, he es, troubles and rebellions. What prohibited them from speaking was the therapy for these prob- In 1860 Pius IX asked Sis- about God to the patients. It was in lems? The sisters found it and im- ter Caroline Chambrot, whom he this climate that Agostina worked.

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She served the sick whom she de- could not look after those of their works that helped the very poor. In fended saying that they were not members who fell ill. Hence the 1875 a home for blind poor peo- bad but only suffering. Her motto advance of the social need to open ple was opened: it was named af- was ‘For the Lord everything is a large number of hospitals with ter the Queen and financed by leg- not very much’ and she was told large structures or small centres acies given by aristocratic families that she had to take some rest. for treatment, and the constant re- who were connected with the roy- Having contracted tuberculosis quests made to our Congregation al family. Its task was to provide she wanted to stay in the ward so for hospital sisters for the sick accommodation and care to blind that another sister would not be- and the elderly and for sisters in- poor people. This home was made come ill, and she went on with volved in education for girls and a charitable institution by the roy- her service always smiling, full of young people. al decree of 18 April 1875 which care and without tiring. Her nurs- A hospital that has left a deep approved its statutes. These stat- ing of life may be codified in mark on the memories of the Ro- utes were subsequently modified. ten rules for behaviour in a hos- mans is the hospital founded in The service of this home ended af- pital environment: her decalogue. 1400 and called the Hospital of ter the Second World War because She revealed all her awareness St. Mary of Consolation, which is the funding had come to an end. that she was serving the person of under the Rupe Tarpea at the foot The town council of Rome took it Jesus Christ in the sick, the impor- of the Campidoglio. This place over and fused it with the Institute tance of the delicacy of small acts enjoyed great popularity together of Sant’Alessio sull’Aventino. To- of kindness, the search for better with the Hospital of the Holy Spir- day it operates elsewhere with ap- care even to achieve a little relief, it. The Sisters of Charity entered it proaches in line with existing laws and caring accompanying until the in 1871 and remained there until and regulations. final encounter with God. 1936. The Superior, Sister Loreta The relationship between Pope Agostina died one morning, Marcoz, called the ‘veteran’ by Dr. Pius IX and the Sisters of Charity stabbed by a patient whom she Alessandro Canezza, is remem- was a special one. He had known had cared for in her ward and who bered with veneration. She died in the communities of the diocese had challenged her the whole time. the hospital in 1928 after 38 years since when he had been Bishop of The day was 13 November 1894 of untiring service to the sick. Imola. He was on very good terms and she was thirty. She was in time When in 1930 the Hospital of with some of them and in partic- to forgive the murderer who him- St. Camillus was opened, the Hos- ular with the vicar general, Sis- self subsequently converted. Be- pital of St. Mary of Consolation ter Irene Buzio, whom he called cause of her virtuous life Agosti- remained an emergency unit for his most tender daughter. She had na was beatified on 12 November a few years. Today the building is asked him to be a missionary in In- 1972 as a martyr to charity, in the the headquarters of the High Com- dia. ‘My daughter, your Indies are words of Pope Paul VI, and can- mand of the Municipal Police of at the Hospital of the Holy Spir- onised on 25 April 1999 by the the Campidoglio. it’, was his reply. And it was pre- Blessed John Paul II. Since 29 In 1870 some sisters of the Hos- cisely in this hospital that this sis- April 2003 the Italian Bishops’ pital of the Holy Spirit were called ter engaged in a hard struggle to Conference, through the Vatican by the military section of the chief defend the patients and the sisters Congregation for Worship and the of the occupation of Rome after from the attacks of anti-clerical- Sacraments, has issued copies of the storming of Porta Pia in order ism, violence, and abuse of power. the decree that declares her Patron to care for the wounded of the Ital- Unfortunately, she witnessed the Saint of the Nurses of Italy, when ian army and the papal soldiers in martyrdom of one her daughters: this is requested by medical doc- the district known as Gianicolo. Agostina Pietrantoni. tors, nurses, volunteers, patients The sisters hurried to help. They and various kinds of associations. had to dress wounds but they were The at Celio also engaged in listening to the The Journey towards Other problems of these soldiers, listen- In 1871 the sisters were at the Hospitals and Places of Care, ing to them, and alleviating their military hospital, which had pre- Assistance and Treatment for longing to be with their relatives viously been a pontifical hospital, those who Suffer who were far away. at the Hospital of the Holy Spirit The Queen of Italy, Margherita which was transferred to the ar- In the meanwhile, governments of Savoy, had been the classmate ea of Santa Maria Maggiore and , and town councils during the sec- of Sister Loreta Marcoz, the Gen- later on, to the Celio Hospital, the ond part of the nineteenth cen- eral Councillor and Superior at military polyclinic that was built tury became increasingly aware the Hospital of St. Mary of Con- between 1885 and 1891. Here still of their duties within society to- solation. Once the Queen came today a community provides ser- wards those who could not take to Rome the contacts were re-es- vice in some parts of it. This mili- care of themselves. A sick patient tablished between the two friends tary world dear to our Founder as moved away from his or her vil- and the custom was established of well is especially sensitive to the lage in order to obtain treatment visits to the generalate house and presence of the sisters. Here the ill- in a city if he or she did not want the various charitable works that nesses of young recruits or of men to stay at home and die: families the Queen supported. It appears who have served the State with were forced to work hard and that she was very much inclined to honour and dedication are treat-

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ed. Here a delicate nearness to the sent to run the St. Mary of the An- tion there also worked sisters who wounded or the mutilated, those gels Orphanage for Girls in the were paediatric nurses and sisters who have been in war, humanitar- Palazzo delle Terme di Diocle- who were social workers who had ian or cultural missions in various ziano, near to the central railway above all the delicate and complex countries of the world is needed. station. In 1896 another eight sis- task of arranging adoptions. Laws Here the coffins of the victims of ters for boy orphans were sent to transformed this institution for the attacks, wept over by relatives, are Via XX Settembre and then to the immediate taking in of children received as a work of mercy that Istituto San Michele, on the right with difficulties. Today it is direct- the sisters have often engaged in bank of the Tiber, which had been ly managed by the town council of recently because of acts of terror- founded in the seventeenth centu- Rome according to new rules. The ism or deleterious events in the ry by Pope Innocent XII to take in Sisters of Charity left this service places where the various missions and help poor people, young peo- on 28 February 2002 after dedicat- have been carried out. ple and elderly people of the Papal ing all of their efforts to making up Linked to the Celio Hospital is States. After the building was pur- for parental absence with tender- also the Cecchignola, a military chased by the state railway com- ness, dedication, smiles and medi- nursing home, in the neighbour- pany, the girl orphans were sent to cal care and treatment. hood of Laurentino where another the Istituto San Michele where the community worked from 1954 to sisters had already been providing The Treatment of Infectious 1991. a service to elderly and sick people Diseases since 1898-99. The orphanage was Care for the Elderly, Teenage in existence until 1960. At the end of the nineteenth Mothers, Orphans and When the Fascist government century infectious diseases were Abandoned Children in 1938 wanted to turn the Istituto spreading. In Rome a centre for San Michele into an institute of art, those suffering from them was in To go back to the chronology, all the sections were transferred to operation from 1884 onwards in in 1875 the town council of Rome the neighbourhood of Tormaran- Aventino but in 1896 the Gover- wanted a home for poor and sick cia, in Garbatella, where the sis- nor of Rome called the Sisters of elderly people at San Gregorio ters remained until 1994 to take Charity of Santa Sabina for all al Celio. The Sisters of Charity care of elderly and sick people and emergencies. They were ready to agreed to serve them. A little later children who were in difficult situ- give themselves and were always there was the transfer to the Um- ations. The elderly were then tak- full of courage, Nothing stopped berto I Home, in San Cosimato, in en in at San Cosimato in Traste- them, and nothing frightened Trastevere, where other sisters of vere. But there were very many them during the cholera outbreak the Order were already working. of them: a very large number of of 1910, the measles outbreak They remained there until 1958. individuals who lived alone, had of 1910, and the out- been abandoned and in bad health break of 1920. It was the boldness The Savetti Maternity Ward but who next to the sisters found learned from St. Jane Antide that warmth and recovered a meaning animated them. The town council of Rome, to their lives. through the ONMI (the National The Lazzaro Spallanzani Hospital Work for the Protection of Mater- The Provincial Foundlings nity and Children), in 1887 had Hospital The Hospital of Santa Sabina already asked for a kind of assis- was closed in 1936 when the Laz- tance that have never before been In 1896 there was a request to zaro Spallanzani Hospital, which entrusted to the Sisters of Charity: establish a provincial foundlings specialised in infectious diseases, nearness to, assistance to, and care hospital in Rome. This was after began operations. All of us know for, teenage single mothers. There the revolving wheel in which ba- how high the level is of this hos- were two hundred of them in the bies were placed at the Hospital of pital and how it is in the forefront Savetti maternity wards of San the Holy Spirit so that they would as regards scientific research, the Francesco a Ripa, in Trastevere, be taken in was abolished. The idea treatment of infectious diseases and they stayed there until 1956. was to create a work independent and the fight against AIDS. Still Their task was to help these of the hospital which would also today, a community of Sisters of young women to defend their take in single teenage mothers. Charity works here providing a health, to appreciate life through The central buildings were four in nursing service, together with a motherhood, to and to lead them to number: in the district of Giani- service of social assistance for look to the future with positive in- colo, on the basis of the illnesses drug addicts and people who are tentions as regards self-fulfilment from which the children suffered: terminally ill with AIDS, and as and a positive and effective reinte- in Via Poerio, Via Garibaldi, at workers in the chaplaincy. gration into society. the Fontana Paola, in Via Fratel- li Bandiera and in Via Pamphili A Nursery School and Centre The St. Mary of the Angels where in 1955 the central build- for Single Teenage Mothers Orphanage for Girls ing was established with about fif- ty sisters who were nurses. With In Rome, from 1901 to 1927, And in 1894 four sisters were the passing of time in this institu- the Sisters of Charity worked in

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the ‘Maternal Home’ named after sors with whom the sisters were felt and more pressing because it Princess Iolanda of Savoy who, able to work in an excellent way was spreading with greater facil- like Queen Margherita, was very in the practice of medical and sur- ity through increased contacts that sensitive to the world of the needy, gical science for the benefit of pa- were generated by progress and the poor and the abandoned. And tients. In 1961 the sisters joined social emancipation. in 1902 five sisters were sent to the university obstetrics clinic The Sisters of Charity were a work that looked after children and in 1965 its eye clinic. called in Rome, as had already without a family, the so-named One cannot but record the pro- happened and would happen else- ‘Home of Providence’ which ductive effects and the efficacy of where, to provide their service in a was located between Via Salaria this very capillary presence. These work of a new social kind: the pre- and Via Arno. This was the first were years that were full of good vention of tuberculosis. nucleus of a large complex. The because of the dedication of the One aspect of the therapy was next year, indeed, because of the sisters, their concern, and their prevention in the case of children interest in the project of Prin- cooperation with the consultants in families where there was a case cess Mary Massimo-Colonna, a and with the personnel so that eve- of infection. Very many of them nursery school for single teenage rything worked to the benefit of were removed from the terrible ac- mothers was annexed to this insti- the patients, around whom out of tion of the disease and placed in in- tute and this was entrusted to four faithfulness to their profession and stitutes where the air was healthy, . This work was their charismatic mission revolved and their food and hygiene were completed in 1925 with the St. all the reasons for being and act- attended to. One of these preven- Anne Maternity Clinic which had ing of each sister and the commu- tive institutions was in Rome, the eight sisters. A certain Sister Ma- nity as a whole. Unfortunately, the Queen Helen Residential School, ria Borghi dedicated to this work community left service at the pol- in Via Ferruccio, half way between of Via Amo her fine capacities yclinic on 14 November 2011 be- the Basilica of S. Giovanni and the for human relationships and she cause of a lack of turnover of its Basilica of S. Maria Maggiore.­ It left upon it an impress of intelli- members. had fifty girls between the ages of gent solidarity with the poor, with two and fourteen. The sisters went children, with their mothers, with On the Hospital Trains there in 1912 and remained there medical doctors and with the civil until 1963. and religious authorities. One of the first tasks of the The honorary president was the The sisters left the whole of this Superior General, Sister Anna Queen of Italy and the executive service in 1977 when the medical Lapierre (1915-1936), was to take president was her lady in waiting, team of the clinic openly declared to heart the organisation of the Countess Gu­glielmina Campel- its support for abortion and be- presence of the Sisters of Char- lo-Buoncompagni, who was very gan to receive from other hospital ity near to those who suffered present in the life of the school. mothers who did not want to con- because of the war. During the Very poor children and orphans tinue with their pregnancies. Great War of 1915-1918 the sis- went there. ters worked very hard to care for In Rome were created: The Umberto I Polyclinic the wounded, the mutilated and the sick. They left for the fronts The Marchiafava Institute In 1905 the Umberto I Poly- and as soon as the sisters had re- clinic was born in the neighbour- turned from the first expedition This was the ‘Marchiafava’ hood of San Lorenzo. It was Prof. on hospital trains of 1915, Mother anti-malaria sanatorium institute Achille Ballori himself who had Anna organised, together with the which was created in 1918 with so opposed them at the Hospital of sisters of the Province of Rome, its central buildings in S. Egid- the Holy Spirit who asked for the nursing care in four hospital trains io, in Trastevere, which derived Sisters of Charity. Forty-eight sis- which left for the central railway from a section of the Hospital of ters were immediately sent to the station on 15 January 1917, the S. Sabina and was to begin with various departments of the hospi- most disastrous year of the war, only for malaria patients but was tal. With the opening of other de- for the Russian and French fronts. later dedicated to the prevention partments and specialist clinics, In each train there were four sis- of tuberculosis. A marble com- the sisters would come to num- ters: the mission of eight of them memorative stone at the entrance ber 112. In 1933 the sisters also lasted for the whole year; anoth- to the building, which today is a began to work in the dental clinic er eight returned home after two museum, records the date when of Eastmann (they left in 1975). years. the sanatorium was dedicated to In 1957, with another twenty-four Dr. Ettore Marchiafava, a distin- sisters, the IA university surgery The Prevention of Tuberculosis guished doctor and a senator of clinic was opened within the pol- the Kingdom of Italy, as well as yclinic and was named after Prof. The first decades of the twen- being an expert on malaria, and Pietro Valdoni, a great figure of tieth century were marked by in 1918 the head of the commis- modern surgery with whom the the discovery of the tuberculosis sion of the town council of Rome Sisters of Charity had a special re- bacillus by the scientist Robert for hygiene. These were years lationship, as they did with Prof. Cock. The hope that such a dis- when malaria caused many vic- Paride Stefanini and other profes- ease could be cured became more tims amongst the workers of the

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Roman rural region. In 1925 he had previously been entrusted to of the neglect of the management organised the first international lay personnel. and because of a shortage of sis- congress on malaria. He was al- If one goes through the names ters, the institute moved towards so the Vice-President of the Ital- of the sisters, and those who knew closure and this took place in the ian Red Cross and the promoter of them when they also looked after year 1983. The certainty remained numerous initiatives for the pro- disabled children, there comes to that the work of the sisters had tection of hygiene and the treat- be invoked the witness of a service sowed in the hearts of very many ment of people with tuberculosis. under the banner of charity, sacri- girls and boys love of a healthy At this sanatorium the young peo- fice, forgetting about oneself, pru- life, serenity and hope for a more ple remained on average for two dence and hard work. It was the welcoming and supportive world. months and were entrusted to the primacy of love and the Kingdom care and treatment of the medi- of God that guided their work. The Day Home for the Prevention cal doctor of the governorate and of Tuberculosis the Sisters of Charity, who were The Vittorio Emanuele III called the Sisters of St. Vincent Permanent Anti-Tuberculosis The day home for the preven- de Paul before the canonisation of Residence at the Lido of Rome tion of tuberculosis, conceived the Founder. In the institute there and created in 1920 by the mu- was also an orchard/garden and a The town council of Rome well nicipal government of Rome, had small school. When the hundred knew the capacities of the Sisters its buildings first in Via Galilei plus children afflicted by malaria of Charity who were working in and then in Via Ario­sto, within decreased in numbers to the point the institute. Therefore in 1920 the large complex of the Hygiene of disappearing, the service of as- they entrusted them with the per- Office. In this home, as in all the sistance continued with a chil- manent residence in Ostia where others, the children not only re- dren’s and vaccination clinic. The in addition to health care the chil- ceived care and treatment but al- Sisters of Charity left this service dren were provided by them with so had available an internal pri- in 1963. nursery and elementary education mary school: a nursery school and Another work of the period and gymnastic activity which took elementary classes which were immediately following the First place on the beach in front of the taught by the sisters. In 1951 the World War (1919) which Mother institute. Roundabout 1932 there children were transferred to Villa Anna Lapierre undertook for the emerged the plan for the union of Glori, which was fused with the Province of Rome was that named the new building with the pre-ex- day institute which was already after the person who originally istent one through an underground located there. Since 1988 the proposed it, ‘Gina Mazza’, and passage under Viale della Mari- complex of the day home is today this was for women who had pre- na so that the children would not the location of the Casa Famiglia viously been in prison. The house have to cross the street. The old di Villa Glori, run by the Roman was at the corner of Via Monte Fa- building was then used exclusive- Caritas for the provision of care rina and Via del Falco near to St. ly for accommodation with balco- to people with AIDS, and which Peter’s Square in the Vatican. In nies overlooking the sea and fenc- arose from the idea of giving back 1926 it moved to Monteporzio, es around the beach. The children to the park its function of being a near to Rome, and the sisters left reached the number of five hun- place of collective memory and of it due to incompatibilities with the dred and there were thirty sisters social aggregation and solidarity. management. involved in education, nursing and general services. During the The Opera S. Vincenzo for The ‘Maraini’ Institute summer the work and the num- Children without Families and ber of sisters increased with oth- Abandoned Children: 1921 From 1920 onwards the er groups of children, the children ‘Maraini’ institute for prevention of state employees, and guests to The San Vincenzo Institute for took in breastfed children who take the sea air and swim. children from the foundlings hos- were the children of mothers with The home/school of Ostia was pital and for other unfortunate tuberculosis and it was therefore a model as regards organisation, children without families owed a kind of preventive nursery. The the readiness of the personnel to its existence to Countess Anna Al- sisters were entrusted with a group help and the availability of re- berghetti-Merolle, an elderly lady of wet nurses who had an urgent sources, and hygiene and disci- in waiting of the court of Queen need to be trained in a sense of re- pline. It was often a place of visits Margherita­ of Savoy. It was lo- sponsibility and personal morality and study for Italian and foreign cated in Monteverde, in Via Fed- in their service to those poor chil- figures who wanted to learn about erico Torre, and was admired by dren. Theirs was a very delicate modern works for the provision various agencies because of the task and the sisters with discretion of care to children. This home be- values of humanity and charity and patience managed to have a gan to decline in the 1970s: the that were implemented within its certain comforting impact on them town council of Rome had oth- walls. Four years after its creation, all. The management of the insti- er urgent needs as regards social this house became the responsibil- tute made an assessment and also policy. Care to families was pro- ity of the Children’s Nurseries of entrusted to the sisters the days vided by means of other instru- Rome. The Sisters of Charity left and the care of the children, which ments. By degrees, both because the service in 1956 because the

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provincial council was not able to ber 1927. Twenty-five months lat- The Residential School of St. provide replacements. er, on 27 October 1929, the hos- Vincent de Paul for Nursing pital was solemnly inaugurated in Sisters and Ward Sisters Casa Vittoria the presence of Benito Mussolini and took the name of the Hospi- Just a few notes on the residen- Another request came from the tal of the Littorio. At the time of tial school for nurses named after governorate of Rome on 13 Sep- the inauguration about a thousand St. Vincent de Paul. Training in tember 1929. Mussolini wanted to beds were ready and operational. nursing for the sisters at the be- clean up the streets of Rome and It should be realised that the de- ginning of the twentieth centu- free them from beggars, former partments of Marchiafava and ma- ry depended on direct practice in prisoners, people who had come ternity (1935) and the heart centre wards and the experience devel- out of lunatic asylums and hospi- (1957) were not finished. The staff oped with older sisters, together tals and had no home, no families was made up of eighty-six medi- with some summary knowledge of and no jobs. cal doctors, four pharmacists, 194 anatomy, medicine and emergency In Via Portuense there were nurses, sixty sisters who later be- aid. It happened afterwards that the buildings of an old workshop came eighty, two chaplains and the directors of the hospital them- for the production of oils for eat- 105 auxiliaries. Later, following a selves created an examining board ing, where the comestibles arrived referendum organised by the Pius when training took place outside. from San Cosimato. This place Institute of Hospitals of Rome In other cases theoretical training was called the ‘beggars’ centre’ amongst the health-care staff, took place privately and the exams and later the ‘beggars’ asylum’. In on 20 October 1946 the hospital were taken at the prefecture of the 1970 it was called Casa Vittoria in changed its name to the ‘Hospital nearest city, with the authorisation honour of Sister Vittorina Tudini, a of St. Camillus’, and its inaugura- of the Ministry for Internal Affairs Sister of Charity who was decorat- tion took place on 24 November or the High Commission for Pub- ed for her merits at the Theatre of 1946. lic Hygiene and Health Care. the Opera of Rome and who dedi- We can read in the newspaper But new scientific research, the cated her entire life to those abject Il Quotidiano of 27 November advances in medicine and surgery, people and for whom shacks gave 1946 the following words: ‘The new therapies and the large num- way to pavilions in the greenery large hospital of Monteverde Nuo- ber of people admitted to hospital with suitable arrangements and vo, previously of the Littorio, has led the sisters to have a more suit- with shared buildings which were been given, as we reported, by a able training to carry out their mis- centres for aggregation. unanimous wish of the health-care sion with sick people. The town council of Rome fol- personnel, the patients and the It was the Congregation itself lowed this institution attentively nurses, the augural and holy name which took responsibility for es- but the daily devotion of the sis- of Camillus de Lellis, the precur- tablishing a residential school for ters who worked in it as nurses and sor of the Red Cross, the reform- professional nurses and ward sis- as co-workers for the various ser- er of hospital care’. This general ters. With the agreement of the vices went well beyond what the recognition of the saint – which health-care authorities the Hospi- internal rules required. It was said joined others that in the past Rome tal of the Holy Spirit in Sassia was that if for some absurd reason all had given him as a sign of peren- chosen as its location because the the works of the Province of Rome nial gratitude and admiration – support of a hospital was required. of the Sisters of Charity were to took place at the same time as the The inauguration took place on 6 end, this work in Via Portuense, centenary of the canonisation of February 1933. Its management, in line with what the Congregation Camillus de Lellis. apart from a very short spell, was upholds, should be the last to dis- The Sisters of Charity joined always in the hands of the Sisters appear… the Hospital of St. Camillus, be- of Charity. Attended by a large ing wanted and proposed by the number of Sisters of Charity, be- The Hospital of St. Camillus consultants who had known or ex- cause of the pressing requests perienced their hard work and the it was also opened to other reli- After the First World War had spirit with which they worked in gious Congregations (at least thir- come to an end and while a vio- other Roman hospitals. The pasto- ty in number) and to lay women. lent epidemic was devastating Eu- ral care in health was carried out At the level of facts, the training rope, the decision was taken to in cooperation with the Camillian that it provided was always excel- build a new hospital complex on Fathers, the Ministers of the Sick, lent. In 1974, although it was at the outskirts of the city of Rome. with whom there had always been a high point in its existence, this The area of Vigna S. Carlo in nourished an understanding, a uni- school was closed because of new Monteverde, held to be one of the ty of intent, generous dedication economic burdens which could no healthiest in the city, was decided in favour of suffering people ad- longer be met and which had been upon. After the project had been mitted to hospital and their fami- imposed by the laws on non-state approved, on 28 April 1919 the ly relatives, dialogue with medical nursing schools. building work began. Because of doctors, and practical cooperation For the Sisters of Charity the a lack of funds the work was sus- with all the personnel. This ser- Hospital of the Holy Spirit has al- pended for a number of years and vice ended completely in the year ways remained a point of affec- was only begun again in Septem- 2005. tionate reference because it was

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from there, for the Church, that voice of admiration and gratitude Since 1989 a sister has worked there began the Roman life of the comfort you during hours that at the Spallanzani Hospital for Congregation; in this hospital re- are not easy and continue to sup- drug addicts, terminal AIDS pa- mains the presence and the sacri- port you so that you can write new tients and their families. In the fice of St. Agostina who watches luminous pages of your history, same hospital other Sisters of over the hospital world, medical which are already rich in immortal Charity provide their service at the doctors, nurses, staff and patients. glory!’ (Vita ospedaliera, August side of drug addicts and those af- I think it is incumbent upon me 1963, monthly review of the Fate- flicted by various infections. Thus to remember His Eminence Cardi- benefratelli – Province of Rome). services continue today with six of nal Fiorenzo Angelini, President them, of whom two are at the side Emeritus of the Pontifical Coun- Thirty Years of Nursing Service of sick people as volunteers. cil for Health Care Workers and at the Central Clinic of Roman We can understand the delicacy before that of Prisons with which relationships at a hu- Rome from January 1977 to Feb- man level and a Christian level ruary 1985, the delegate for reli- In response to a request made must be nourished with sick peo- gious assistance in hospitals and by the Ministry of Justice, from ple and how much pastoral pas- places of health care in the capital. 1979 onwards the Sisters of Char- sion is needed to accompany them His rigour and his tenacity always ity were a part of the infirmary of during the final passage of life, saw him present, a participant, at- the prison of Rebibbia and the cen- above all if they are young. tentive to the quality of service tral clinic of the prison of Regina for the sick and to the beauty of Coeli. These are communities that At the Nursing Home of the Jesuit the charism of St. Jane Antide remained outside the prisons and Fathers Thouret. nursing sisters who worked eight- hour days, always ready to act in For we Sisters of Charity to be The Gold Medal for Public the medical centres, in the operat- at the side of sick or dying priests Health Care ing theatre or during admissions or religious is not a unique expe- to hospitals, in full harmony with rience of its kind in other parts of During the history of our Con- the chaplains, medical doctors and Italy. Thus the answer was in the gregation we have received nu- prison police. Their withdraw- affirmative when we were asked merous awards for the apostolic al from this activity due to a lack to provide nursing at the nursing action of our sisters with the sick of replacements took place in the home for elderly and sick Jesuit in Italy, in Europe, in the East and year 2010. Fathers at the House of Jesus: to be thus also in Rome. One exam- with them, to be concerned about ple amongst many brings out the The Service for Drug Addicts their diagnoses, their medicines, shared intentions and actions, al- their natural or artificial alimenta- beit in diversity, of religious Or- In the large hospitals of Rome tion, their physiotherapy, to give a ders and Congregations of differ- the sisters by degrees left the gen- caress or smile to those who have ent inspirations: on 23 July 1963, eral services to lay people and dedicated their lives to the Church in the chapter hall of the general remained as ward sisters or pro- in terms of culture and evangeli- curia of the Fatebenefratelli, on the fessional nurses in a few depart- sation. The testimonies to beauty, Tiberine Island, the Hon. Angelo ments. In the meanwhile the new delicacy, serenity, and the bear- Raffaele Jervolino, the Minister signs of the times were studied and ing of pain which the Fathers are of Health, officially awarded the it was asked to which answers and capable of have become precious gold medal for public health care which challenges should be given pearls of appreciation of which has to the Hospital Order of St. John of priority. no limits. Since 1980, when we be- God, to the Order of the Ministers In 1978 a sister was as the ser- gan, we have reached the month of of the Sick, to the Company of the vice of drug addicts at the SAT March of this year, when the Fa- Daughters of Charity of St. Vin- (service of social assistance) in thers were brought together at the cent de Paul and to the Congrega- the clinic for drug addicts of the General Curia of Pizza Borgo San- tion of the Sisters of Charity of St. Hospital of St. Camillus. This was to Spirito and we greeted them! Jean Antide Thouret, in the pres- a matter of forming relationships ence of and civil servants at a human, health-care and legal of the Ministry for Health. level with drug addicts, with their Conclusion These four religious Orders families, with therapeutic com- have in common the fire that burns munities, with tribunals, with the The whole of this holy story, in hearts, the fire that becomes local health units and with the threaded through with humanity, love and concrete action for our various offices involved in the re- gospel tenderness and social con- brethren who are in pain: ‘This covery of the victims of drugs. tributions, makes us praise the event seeks to place in their due In 1984 two sisters were at the Lord, for the grace of ‘Romanity’ light the high human and social CEIS (Italian Centre for Solidar- as well, in the sense of the place merits of four religious families… ity) of Don Mario Picchi with pre- and the ecclesial awareness of our The Republic of Italy commends cise roles and tasks connected with service of charity which contin- most solemnly and confers a most the welcoming, the accompanying ues, in addition to some places in sought-after distinction…may the and the recovery of drug addicts. the historic centre, also with Cari-

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tas and parishes on the outskirts of a new style of life that is an alter- Sources Rome, as evangelisation and hu- native to that of contemporary so- man and spiritual mission. ciety which strongly feels a cri- Correspondence, minutes, diaries and photographs kept at the archives of the Gen- We feel emotions of nostalgia sis of values and of resources and eral Curia of Rome. for this past of so much work in which has the sensation that noth- Correspondence, minutes, diaries and Rome. We are certain that the fu- ing can be retrieved. photographs kept at the archives of the Pro- ture will not cancel the past. To- We believe and we hope that vincial Curia of Rome. day we feel that we are involved in this front of death, of an end, con- a process of transformation that is tains those seeds of life that only Texts closely bound up with the world. love of charity for God and for our Hence the analysis, the discern- brethren is able to generate. It is Storia delle Suore della Carità di Santa ment and the choices that lead to on the beauty of charity, our fourth Giovanna Antida Thouret dal 1826 al 1915, by Madre Antoine de Padue Duffet, Rome. a search for a new deaconate of vow, that we want to stake our- Storia della provincia di Roma – Suore charity! This for us means adher- selves, in our time as well, seeking della Carità, by Raffaella Perugini, Rome, ing to history which moves us to- to recognise what should be trans- 1994. 150 anni da raccontare – Le Suore della wards new international and mul- formed and what is already full of Carità di S. Giovanna Antida nell’Ospedale ticultural relationships, towards the future, of life and of hope for di S. Spirito di Roma, Rome, 1994. new forms of poverty, and towards everyone!

On the Pathway of Learning and Charity: the Human and Spiritual Accompanying of Medical Students

Prof. Cav. ter when they are still incapable of daily life modern, secular and Benoit Lengelé, MD, PhD of alleviating their pain because multicultural, the Catholic Uni- Full Professor, their knowledge is just beginning. versity of Louvain (UCL) remains the Chairs of Human Anatomy Following the initiation of carry- faithful in each of its teaching and and of Reparative Surgery, ing out of a dissection, they final- research missions to Our Lady of the Catholic University ly engage in the concrete experi- Wisdom, under whose protection of Louvain. ence of nearness to death, which is the Church has placed our Alma Brussels, Belgium a source for them of fundamental Mater ever since its foundation in questions about the meaning of hu- 1425. It is within the context of a man life, the reality of transcend- proposal involving the rooting of rom the beginning of their uni- ence, and the relevance of faith. Christian roots that we therefore Fversity courses, young medical All of these breaks are equally strive, with humility and perse- students find that they have to ad- life events where their older col- verance, to perform the duty of dress a large number of existen- leagues can guide them in their framing our students during the tial and symbolic breaks which spiritual journey, being supports existential trials of their long ac- can make them, in personal terms, as regards identification and bear- ademic pathway. The encounter more frail, or then deviate them ing with them a Christian mes- with death during the dissection into the practice of a materialis- sage which, later on, will be of courses, which are indispensa- tic and dehumanised medicine. fundamental importance for their ble in acquiring intimate knowl- First isolated from their families, personally expressed medical edge about the human body, form they are then left to themselves, practice; for the ethical choices a decisive part of the events that at times without reference points, that they have to make at the bed- are a foundation for their becom- in an adventure that takes place side of their patients; for the sin- ing aware of the value of life and on the frontiers of life and death, gularities of human relationships; of the respect that its mystery in- in a universe that is in a pedagogic and for the different therapeutic spires. It is, therefore, at the heart way totally dominated by science options that modern medicine of- of this intense emotional loss that and reason. They then discover fers from the moment of the con- we hope to anchor their primary the uncertainty, the doubt and the ception of life until its final point. ethics and direct their spirit to the suffering that are brought by their Although belonging to a soci- meaning of self-giving and re- first patients whom they encoun- ety that has become at the level spect for the other.

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Incarnating Death so as to tients. The students see the faces The students answered this Consecrate Life of the deceased with whom they wonderful and sensitive message have come into contact alive in in the following way: ‘To give Dissecting a dead body, vio- the looks, full of tears, of the rel- one’s body, after death, so that lating the skin of its surface, and atives who loved them and who others may live: does this not per- separating its structures in the resemble them. Dissection, one haps mean, if we consider the mat- wise tangle of muscles, intestines, of the most coldly material and ter in its true light, to take part in vessels and nerves, is an initiat- transgressive of medical rituals a community of life that goes well ing trial that prefigures the medi- thus becomes, nobly, a Eucharist. beyond death? It means to prepare cal mission and the curative activ- And without difficulty it then be- oneself to live better, inasmuch, as ity that will penetrate and invade comes possible for us to make our Spinoza said, ‘a free man thinks the flesh of patients in order to of- students understand that the bro- of nothing less than death and his fer them relief for their maladies. ken body under their arms, armed wisdom is a meditation not on This exercise leads many of our with forceps and knives, is not di- death but on life’. The blessed liv- students to have silent admiration vided but multiplies, inasmuch as ing, in offering their moral clothes and wonder. For those who live in it generates in their expressions to the unknown, have defeated faith, this secret enthusiasm, this and their spirits, though what we death well before it takes them respect that is faithful to the wish- call metaphorically ‘The Miracle away! Love, Christians say, is es of the deceased to be a source of of the Multiplication of Bodies’, a stronger than death. Is there a finer knowledge beyond the shadows, living knowledge that overcomes illustration of self-giving that that is transformed into a natural act death and which will be through of abandoning, as Christ did, not of prayer and an action of grace. them an inexhaustible source of only one’s own life but also one’s However, there are a large number benevolent care for the living. own death to others? If our body of students who experience these In the golden book of this an- is the temple of our spirit, if our febrile feelings in a confused way, nual ceremony, amongst innu- eyes are the look of the soul, then with a certain sense of guilt, a merable testimonies, the family this deed which in appearance is source of doubt or a strengthen- of a deceased woman, who had as foolish as that of the Cross, is ing of the materialistic beliefs of offered her body to science, wrote nothing else but the best way of be- those who do not share in hope. In as follows to the students: ‘Here ing alive amongst the alive…May order to offer a spiritual anchor- is our mother, in her body deteri- these few words that we address to age for these deeds carried out on orated by old age and by illness, you, dear family, being you com- dead bodies and the fragile human our ‘good’ mummy…Please, treat fort and above all hope in the pain feelings that they generate, the her with respect, sweetness and of the mourning that you are expe- lecturers and the chaplains of the tenderness…May she bring an- riencing. In the heart of your good Faculty of Medicine every year swers to your endless questions. mother we have found a thousand invite the students at the end of This was her dream: to serve, to thanks and we do not doubt that in this first exercise, and roundabout love, to give without asking any- the secret of the stars, which she All Saints Day, to meet at a Mass thing in return…if, thanks to her, has certainly been amongst, she is where they encounter the fami- you can find out how to relieve watching over each one of you and lies of the people they have dis- suffering, this will make her hap- is waiting for you, at the end of sected. From this meeting, from py! Know simply that her brain your silent journeys which lead to which each student emerges with was nourished on the writings her. Keep alive in yourselves the a heavy and uncertain heart, an of Theilhard de Chardin, and the memory of her smile and be cer- incredible light is born. Readings good words of all her children and tain that, in the silence of our re- and the Gospel are shared. In si- grandchildren to whom she taught spect, every vow of hers and every lence, the families call to their de- faith in eternal life…That her eyes wish of hers has been humbly hon- ceased loved one whose body is admired with the same enchant- oured’. absent from its grave, like that of ment, without limit and without To parents who have lost a Christ at Easter, simply saying his usury, all the wonders of nature, child at birth the students offer or her name. The students answer from the noblest to the simplest a white sheet of paper on which, and the emotion, each time, fills and the most imperfect…That her with emotion, they put a coloured the assembly, creating a commun- lips unceasingly sang of her joy to print of the feet of that child. ion. From both sides of the win- be alive and whispered the most Thus, at the other extreme of ex- dow of the invisible, each person tender words of encouragement, istence, this trace of an ephemeral touches the soul of the other. The consolation and love, not only to passage on the earth indicated that families of the deceased discover us, her family, but to all the sick the world conserves in memory of generous young people who, far people that she met during the that child a indelible sign of the from being neglectful, nourish a long hours that she helped them moving on of every life, albeit respectful and infinite gratitude in the hospital. Therefore, when fleetingly, in the human commu- for the gift they have received you open her noble body, draw on nity. To embody death spiritually, and feel, by way of gratitude, that it with generosity: it is filled with- means to consecrate human life in this is something that they should out end with an unshakeable trust the clinical practice of our future take advantage of when they are in the beauty of life and in the be- medical doctors. We hope in this at the bedsides of their future pa- nevolence of God’. way to ensure that in their daily

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experience the prospect of the in- act of care. A cancer patient, for nevolent medicine derived from eluctable deaths of their patients example, is no longer a suffering the art of healing that is opposed is no longer lived as a failure from person. His or her clinical sheet is to a rigorous and factual medicine which to flee through being absent organised by now into stages indi- that is increasingly governed by or something which is reduced to cated as being from 1 to 4 accord- science, is, however, such as to the use of technical equipment. If ing to a classification of T (for tu- send them off course in two op- they have understood everything mour), N (for nodules) and M (for posing directions. The first sees that is intertwined with this mys- metastasis). The higher they are, them take refuge too often in the tery that edifies, then perhaps lat- the more the illness has advanced dogma of a normative and mate- er they will decide to accompany and the prognosis is unfavourable. rialistic medicine. This tendency it with sweetness and patience. The forms of treatment that are becomes so accentuated that in ‘Nothing troubles you, nothing chosen depend on these degrees the current economic framework frightens you’, wrote St. Theresa and follow rules from which it the constrictions of economic re- d’Aville, ‘everything passes, on- is not at all easy to distance one- turns are often added – reinforc- ly God remains. Patience obtains self. The same occurs in the ma- ing it – to the pragmatic pathway everything’. jority of almost all other illness- outlined by scientific reason. The es which are enclosed within the dehumanisation of the action of reductive framework of a factual treatment is unfortunately the Drawing Near to and Living analysis and the therapy that has price to pay for this loss. The sec- Suffering in Order to Learn been imposed. In these schemata ond pathway is that where, dom- Mercy of normative forms of treatment, inated by affection, the medical the human dimension of the pa- doctor is made extremely frag- After the experience of near- tient and his or her illness is of- ile by a sensitivity shared with ness to death, the encounter with ten seriously compromised. In be- the suffering of his or her patient human suffering and the feel- coming a science, contemporary that dwells inside him or her, and ing of injustice that accompanies medicine partially divested itself to such an extent that every ther- it are the second interior test that of its soul. In being voluntarily apeutic choice becomes for the the young future medical doctors made autonomous by the princi- medical doctor an insurmounta- have to address. Faced with the ple of benevolence – which is now ble source of dismay and doubt. challenge of those who treat, who seen as a obsolete residue of the There derives from this a paraly- have to heal a malady, comfort medical paternalism of the nine- sis at the level of decisions that suffering flesh and relieve pain, teenth century – it has become can lead to a pre-judging of the science teaches students reasoned material at times to the utmost, patient and even, out of inertia, to recourse to an arsenal of medical forgetting that before being a sci- a deflection of the medical doctor or instrumental techniques, the ence it was an art. ‘Be unemotion- into alternative practices that are choices about which have to be al!, we were constantly enjoined without any scientific foundation. thought through. The treatment by a great American teacher when Teaching the middle way to our that is proposed must be based up- a decision had to be taken about students is not at all easy. But the on a real analysis of the situation an operation to be imposed upon a essential reference to humanity of the patient and the therapeutic patient with cancer of the face that and to Christian values is a pow- choices that derive from this are would have disfigured him. As re- erful good in an educational initi- naturally deduced from the so- gards medical treatment and care, ative that goes beyond the simple called objective elements – which he was right. As regards the form transmission of a savoir faire and are often in code – of the medi- of the holistic approach to the pa- reaches the teaching, through si- cal picture. This kind of norma- tient we continue to think that he lent example at the bedside of the tive reasoning, which is specific was wrong. To add emotion and patient, of a savoir être. Through to evidence-based medicine, has compassion to the mutilating act an identification with his or her today been imposed as the golden that has to be engaged in out of teacher, the young trainee learns rule to follow in every medical ac- duty takes nothing away from its above all else that the destiny of tion. It is certainly very useful and efficacy or the ability to do it per- the medical doctor is located, with performs an indispensable guid- fectly. Now, what shared suffering sweetness, in an ideal of struggle ing role, not to speak of its being often brings to this act is priceless against suffering and against the a protective barrier, and thus pre- for the patient who through sim- injustice of illness. As is the case vents, through guidelines that are ple facial expressions or a hand with everything, this duty to strug- approved by one’s peers, those placed on his or her hand perceive gle to raise up a weakened patient therapeutic adventures that are the benevolent care of this com- from his or her wounds is situat- the most damaging for the patient. munion with his or her pain. In- ed in the immediate continuity of But to place a cold analytical dis- tuitively, in the ingenuousness of the knightly values of the Chris- tance between the patient and his their youth, our students feel this tian West of which St. Martin of or her medical doctor dangerously easily: like Simon of Cyrene they Tours was a hieroglyphic witness. compromises the human relation- are ready to offer their shoulders Those who fight cannot hope to ship on which are based the gen- to carry a cross. be spared all wounds: in agree- erosity and the benevolent atten- Their posing of questions in the ing to receive them and bear them tion that are indispensable to the face of what is at stake in a be- they share in the dignity that they

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restore to those to whom they pro- will undoubtedly invade him or Founding Research and vide medical treatment and whose her as regards the other that med- Progress on the Duty of wounds are eliminated: ‘The true icine can no longer help, aban- Humanity measure of humanity is essential- donment to Providence through ly determined in relationship to prayer transcends the act of treat- To consecrate one’s life to the suffering and to the sufferer. This ment and provides it with a hu- bedside of a sick person so that holds true both for the individual man density that is irreplaceable. humanity and transcendence dwell and for society’, writes His Holi- According to the epitaph of Par- in, and relieve, interior suffering, ness Benedict XVI in Spe Salvi. acelsus, all medicine is love and, just as clinical therapy itself re- To paraphrase the Holy Father we when it can no longer offer heal- lieves or eliminated physical pain. could add: ‘A medicine that does ing. it can always still give, with To embody death so as to accom- not manage to accept suffering mercy, love and compassion. This pany it and not flee from it or bring people and which is not able to effort, however, requires a funda- it on. To fight against the evil that contribute through compassion to mental humility as was observed weakens the wounded flesh and ensuring that suffering is shared by Ambroise Paré, a surgeon to not to bend but to persevere. To and also borne inwardly by those four kings of France and the in- act in all things with compassion who treat is a cruel and inhuman ventor of bindings for vessels, in and mercy. To remain humble be- medicine’. his famous motto: ‘I have treated, yond one’s knowledge and to dare To prevent this lack we should God has cured’. to offer one’s own powerlessness educate people in contact with In a personal capacity we do to what overcomes us. These are the emotions that are provoked not hesitate in individual conver- the guidelines for spiritual conduct by suffering Otherness, the look sation to bring to our students the that we propose to our students to of the heart at what we call the testimony that prayer has often be integrated into their future med- visible and invisible presence of come to our help in the riskiest ical practice so that, beyond the the Figure of Christ in the ex- surgical situations and that aban- competence that is offered, it has perience of a sick person: in the donment to God or the holy pro- real added human value which, in daily life of a hospital the exam- tection of the Virgin Mary has the end, will be its fertility. All of ples of this are innumerable and it allowed our hands to save many these precepts, absorbed by sensi- is enough to pay attention to this patients who were condemned. tive hearts, shape their daily lives. for the young student to discov- To give an example of this, some But are they enough to illuminate er empathy, compassion and also months ago we tried to save the the existing pathway that con- mercy, a value that we consider to foot and the leg of a little girl aged structs the future of medicine ac- be essential. The question that the six which had been accidentally cording to scientific advances? person who provides treatment is cut by the blade of a lawn mow- Medicine is a science that is in constantly invited to pose to him- er. After hours of microsurgery, perpetual movement. Progress is self or herself is thus the follow- all the attempts to re-establish the a part of its essential duties. One ing: ‘do you see the invisible im- blood flow, which was necessary cannot accept the perennial fail- age of Christ in the features of the to the survival of the limb, had ure to understand the mechanisms person who is suffering in front failed. The young student who that govern certain illnesses, or of your very eyes?’ This image was my assistant during the oper- are powerless in terms of treat- is tenuous, certainly, like the im- ation, a frequent attendant of the ment in face of others, as an inev- press of the face of Jesus left on Mass to which I referred above, itable fact. It is therefore right to the veil of Veronica; but for those watched me with consternation investigate on a molecular scale, who agree to allow themselves repeat gestures of hopelessness. A until the infinitely small, the little to be inhabited by his persever- pause then opened up in our ex- mechanisms of life so as to under- ing presence it is the foundation change of looks. A momentary stand them and treat their failings, of ethics that are safe and lasting. break in the operation gave way, in the same way as it is legitimate And it is starting from this that the in the silence of us both, to prayer. to explore a dead body in order to pathway of the therapeutic choice, After the silent saying of the filial alleviate the suffering of the liv- if it shows itself to be outlined, is prayer, the surgical clamps were ing. The noble task that medical imposed on the evidence in the removed from the foot of the girl: research sets itself is to push be- face of the question that follows she had regained life. When a few yond the limits of knowledge and the previous one and provides the weeks later she asked us how she at times the limits of the possible answer to it: ‘do you see the work could thank us for having saved so that all the resources that life of God accomplished under the her leg, we answered her simply itself and the world that surrounds deeds of your hand which medi- that she should express her grati- us offer can be rightly utilised to cates the flesh and the spirit of tude to her mother in heaven be- treat illness and restore to man this wounded body?’ Faced with cause without her benevolent his autonomy and his integrity. personal powerlessness in rela- help it would not have been pos- Pushed as far as the use of the tion to every situation of incura- sible to overcome the impossible. multiple potentialities of primary bility, a young medical doctor in ‘We must pray as though every- cells, this logic, however, is not the end will have, like his older thing depended on God and act without its risks. Indeed, it threat- colleagues, the ultimate experi- as if everything depended on us’, ens to close up scientists within ence that, in the sense of loss that wrote St. Ignatius. a dehumanised materialism com-

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parable to the situation of medi- human appearance whose wound- Whereas the great majority cal doctors who are prisoners of ed face had become a cranium, we of our colleagues of the medical the narrow and reductive corri- understood, in the shelter of re- world were amazed by the fact dors of evidence-based medicine. flection, that this symbolic gesture that we did not attribute this tech- Scientific progress, which lives was not a work that was preten- nical advance to science alone, to through the objective and sym- tious: it was humble. Where our our purported intelligence and to bolic transgression of the barri- experience had taught us, indeed, our collective talent – ‘Why such ers of knowledge, must therefore that all of our surgical art was un- Christianity?’ (one of them, in- be tempered, in the nascent spirit able to reproduce the genius of deed was indignant that in a scien- of young researchers, by its own nature and thus of the Creator, tific film on the event we associ- ethics founded upon the same uni- we had to accept, with modesty, ated a discreet sound of Lauds with versal values as those referred to that only a loan from that genius the filming of consequences of the above in order to make them the would have been able to advance face transplant), our students, in- reference point for choices as re- our art, benefiting our disfigured stead, easily understood that this gards therapy. patients alone. Heaven, in which adventure, about which we gave Our university has always res- we believe, inspired us in this no- them testimony, had for us an ethi- olutely adopted the duty of pro- ble experience: to treat means to cal and spiritual dimension that gress. From its foundation on- experiment, wrote Vésale. And it was deeply anchored in respect for wards, André Vésale established then guided us with benevolence otherness and the human. This fact the bases of modern medicine on the unknown pathways of crea- is for us a real source of enthusi- and surgery at the price of a fun- tion and discovery. For every story asm, encouragement and hope. damental overturning of anatomi- shared in faith the visible and in- The hospital in which we have cal knowledge. In the same way visible faces of the gospel are dis- chosen, through our curative mis- the presbyter Lemaître, father of creetly revealed to us, constituting sion, to perform our duty as Chris- the theory of the Big Bang, de- after a certain fashion, during the tians, remains, through the human fined the physical limits of the uni- course of our scientific and spiritu- suffering that constantly calls on verse. Nearer to us in time, Chris- al journey, the chapters of a gospel our consciences that bend over the tian de Duve, who won the Nobel until the stations of a Good Friday. destinies of those who have been Prize for medicine, described lys- A morally inconceivable and tech- made frail by illness, a perfect set- osomes. This past of ours obliges nically improbable operation be- ting for humanisation and embod- us to assist our patients to the best came a Eucharist. From a broken ied evangelisation. The hold that of current knowledge but also to body, shared on the first Sunday reason and science have today over contribute to creating, for their sal- of Advent, was born, for the pa- life and the decisions of people re- vation, new knowledge or know- tient who received the transplant, sponsible for treatment do not nec- ing how to act that conduce more a new life. The act of taking or re- essarily render their hearts arid, to their dignity. Transgression is ceiving the face of a dead person hearts which remain ruled by sen- not excluded from this duty, on the was inhuman. The act of giving sitive souls that aspire to charity. condition that it is based on man, one’s own face, this part of our- Even if the young medical doctors faithful image of the Creator, and selves that we hope will survive of future generations will never be does not pursue other ends than in the memories of those we have able to abandon the irreversibly the retrieval of his humanity. In loved, was superhuman. But also established normative constraints no case can the principle of pre- human, profoundly human and of an evidence-based medicine, caution be opposed, as an obsta- rooted in Christian hope, was the which in philosophical terms de- cle of inertia, to the carrying out act of agreeing to be, with one’s rives from the post-humanist cur- of this imperative duty. Our jour- own hands, the humble ferryman rent of thought, we continue to be- ney was thus long when, on the of this mysterious exchange in lieve with trust that, in the face of constant lineage of our research which was worked, like a transub- the duty to create new knowledge on the development and nature of stantiation, a symbolic passage of at the boundaries of what consti- the human face, destiny called us life from one human being to an- tutes the essence of life, they will to think about, conceive and then other. The initial experience of this understand, from a new transhu- carry out with our students the first re-figuration, repeated about thir- manist philosophical perspective, face transplant ever implemented ty times by us and by many oth- that science is work that certainly in the world. The idea of having er medical teams in France, Spain elevates the human spirit but which to engage in this innovative action and the United States of America, also draws near the attentive soul was imposed on us by the evidence forms a part today of common sur- to God. ‘A little science’, wrote and also, we would have to say, al- gical practice: by now accessible Pasteur, ‘distances from God, but most by illumination. Previously to everyone, it has but one noble much science leads back to him’. frightened by such an undertaking mission – to restore, in those who Medical progress will thus re- which required us to go and re- have been gravely wounded in main a gift from heaven, a grace move from a clinically dead wom- their faces, the essential image of which, through a beneficial, char- an her life features before death the human whose face they bear, itable and merciful will, brings carried them away, even though the mirror of the soul, the tran- Christ to the side of the bed of with the intention of restoring a scendence of the visible. every patient.

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Military Hospitals and the Evangelisation of Peace

Gen. Vito Ferrara fact that most of operations in the In the telemedicine mobile cen- Brigade General field are in nations whose official tre there are the same services and of the Carabinieri, religion is not Catholicism. the possibility of sending to Italy Vice-Director of Health Care from abroad the results of various of the Carabinieri, clinical tests carried out by para- Italy Military Field Hospitals medic health-care staff and hav- ing them referred to military hos- We will now consider some ex- pitals that are located in Italy. pparently, to speak about amples of Italian military field As you can see from the pic- Amilitary hospitals and peace hospitals in the various theatres tures, through these mobile clin- could seem to be a contradic- of operations where our coun- ics, used for example as you can tion. However, during this paper try is involved in peace missions, see in Iraq, we have reached the I will try to illustrate how in war namely Afghanistan, the Leba- smallest villages in order to pro- territories and wearing a uniform non, Chad, Iraq, East Timor, Ko- vide them with our services (the one can also engage in ‘evange- sovo and Bosnia. mobile clinic, medical examina- lisation’, bearing witness to one’s As you can see a military field tions, vaccinations, etc.). love for God and one’s brothers hospital has different names ac- and sisters. cording to its role at the level of admissions and surgery (Role 1, Evangelisation Role1 plus, Role 2, Role 3) and it Operations in the Field is organised with a waiting room, But what has all of this got to an emergency aid section, medi- do with the ‘evangelisation of In missions in the field medical cal sections, a surgery section, an peace’? The important thing, it officers and the nursing staff of analysis and x-ray laboratory (in- seems to me, is to see how things the Carabinieri, in addition to as- cluding TC), and an admissions are done; that is to say how our ac- suring health care for the military and treatment room. As you can tivity as medical doctors in these personnel on service operations, see from the pictures, this is a special areas and in war situations also engage in the following ac- hospital that is fully equipped at a is engaged in. If what we do is on- tivities: clinical and surgical level and this ly done out of philanthropy or to – Intelligence (study of the en- means we can carry out surgical respect the rules of our commis- vironment and the health-care operations of a certain difficulty sion and to carry out the simple structures of the local area, en- and importance. Here are some tasks of our work, then we cannot demic diseases). pictures of surgical operations. speak about evangelisation! But if – Health care for the civilian in every thing we do, and if in the population (mobile clinics and people we help and treat, we see medical visits at home for the The Mobile Clinic the face of Christ, then the situa- population, visits to support the tion changes. local hospitals). The Carabinieri in particular, My personal experience has in addition to their normal am- taught me that even with the great On these occasions medical bulances which are able to reach difficulties due to differences of doctors have an opportunity to the most severe and difficult ter- religion, if the person who is in visit a very large number of peo- rains, also have a mobile clinic front of us realises that what we ple, men, women and children, and a mobile telemedicine cen- do we do with love and with pas- and to enter into contact with a tre. These are two very fine ve- sion then we manage to make a reality which is particularly pain- hicles that I have worked with on breach even in the hardest hearts ful but which fills the days of each various occasions, for example in and to enter into harmony with one of us, we medical doctors, Nassirya, in Iraq, and also during the most hostile and difficult peo- with very high moral and profes- aid missions for the civilian vic- ple as well. sional meanings. tims of earthquakes in my home- For example, the photographs Professional – but even more land, Italy. that you will are of an autopsy human – contact with these popu- The mobile clinic provides that I carried out in Nassirya after lations that are devastated by war services relating to cardiology; the killing of an Iraqi interpreter and hatred can certainly be an ex- otorinolaringoiatry with audiom- following a violent exchange of cellent opportunity for evangeli- etry and endoscopy; gynaecolo- small arms fire. The fact that I sation for Catholics such as our- gy; eye-care; and a laboratory for washed, cleaned and then dressed selves, above all because of the analyses. the bloodied body of the dead man

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in the presence of a large number sation and of witness for these lo- the phenomenon of obedience; of his family relatives, as well as cal peoples as well. what discipline means, what the the respect that I demonstrated to- These last photographs, on the fundamental canon of military wards their relative, enabled me other hand, are of the Patriarchate life is: that of offering one’s own to touch and work with the body of Pec, in Kosovo. One can see life for the good of others. Sacri- of a Muslim and even to be invit- this very beautiful and enormous fice… having this energy of mili- ed to take part in the funeral. mulberry tree: it has shared roots tary men of knowing how to use We can see another way of but the trunk has divided in two, the energy and the fullness of evangelising in these photo- one towards the east and the oth- moral manliness which the sol- graphs: creating nursery schools er towards the west. According to dier makes his own and professes for children and orphans; making tradition, the splitting of the trunk for good, for faith, for charity and a crib and a Christmas tree; cre- took place when the schism took for civilian life as well’. ating school classrooms and pro- place between the Church of the I offer this conclusion from viding exercise books, coloured East and the Church of the West. what emerges from the pictures pens, and toys for children; and The branches, however, go back that we have seen and my expe- going to orphanages and pris- together and intersect and this is rience as medical officer, taking ons to treat people and distribute the hope that we Christians have: up the words of the prophet Isai- food. And doing all of this after to return to Unity in Christ. ah. We must hope and believe that being attacked with mortars or To end this paper of mine, I ‘swords will be made into plough- having gone through an exchange would like to quote the words of shares’ and we must work so that of small arms fire and making Paul VI who on Sunday 17 May every civilian and military hospi- people understand that our pas- 1964, during his visit to the Mil- tal takes this fecund opportunity sion for our work as medical doc- itary Hospital of Celio in Rome, to achieve brotherhood between tors and our love for our broth- although he stressed the need for the peoples of the world, spiritu- ers and sisters is stronger than the lasting peace between the peoples ality and evangelisation. fear that grips you while they are of the world, also made the fol- The penultimate picture is for shooting at you and while you see lowing statement: ‘the Pope is an those of us who have fallen and a fellow countryman wounded or admirer, from this point of view, bore witness through their lives dying. of the soldier; he knows what the to their love for their sisters and Another fine picture that I al- human organisation of a military brothers, and the last image is for ways bring with me to meetings unit, of an army, is; how much our protector, the Virgo Fidelis, of this sort is the following: you expenditure of moral energies, and the prayer that every day in can see a group of Iraqi women of high concepts it brings with it. Italy or in the field the Carabinie- dressed in black veils with their One need only observe how great ri address to Mary: in this prayer faces completely covered. Next and human is the phenomenon of peace, love and brotherhood are to them in the street there are two command, which is matched by talked about, not war. girls who are about ten years old and who are wearing aprons that we Italians gave them, and they Prayer of the Carabiniere are carrying exercise books and other books under their arms and Most Sweet and Glorious Mother of God, our Mother, are going to school! This image is We Carabinieri of Italy, apparently normal and banal but To you reverently raise our thoughts, we should remember that we are With trusting prayer and fervid in heart! in a fundamentalist Muslim place where women, and that includes You who our legions invoke, girls, must always be covered and Comforter and protector, absolutely must not go to school. With the title ‘Virgo Fidelis’, Through these little things, as You accept all of our supplications for good, well, one can achieve evangelisa- And give vigour and light to our country. tion and peace. Women of all peo- ples, and above all Muslim wom- You accompany our vigilance, en, are a fundamental channel for You advise us on what we should say, evangelisation and peace between You animate our action, peoples. Your sustain our sacrifice, Lastly, you can see here some You inflame our devotion! small churches built by members of the armed forces with the help And from one end of Italy to another, of military chaplains and in some You provoke in each one of us, areas (Chad, East Timor) with the The enthusiasm to bear witness, help of missionary priests who With faithfulness unto death, work in those local areas. Bearing To love for God and our Italian brothers and sisters. witness in a kind but decided way to one’s faith is a sign of evangeli- Amen!

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Hospital Management Between Rationalisation and the Defence of the Right to Health

Dr. Anthony R. Tersigni, ered branches. if the healing min- per 100,000 lives, while it is fache istry of the Church is to bear fruit 744.7 for white males. So too, as President and it must remain in Christ, remain reported on the 2011 national can- Executive Director, true to its Catholic identity. Like- cer institute fact sheet, while the Ascension Health Alliance wise, if a health care system, par- incidence rate of breast cancer is Office, ticularly the fragmented system higher among caucasian women USA of the United States, is to bear than for African-American wom- fruit, we must trim away and burn en (132.5 vs. 118.3 per 100,000), the withered branches that result the death rate is much higher for ood afternoon your eminenc- in waste, inefficiencies and sin- African-Americans (33.8 vs. 25.0 Ges, excellencies and invited ful social structures that prevent per 100,000). These discrepancies guests. It is a pleasure to be here. the fulfillment of the right to ad- reflect injustices and sinful social The Pontifical Council for Health equate health care for all. structures that will require more Care Workers International Con- There is little doubt that the than simply expanding insurance ference is always a thought-pro- health care system in the United coverage to correct. voking and exciting gathering. States is in need of such atten- While expanding health insur- It is important work that is done tion. At this time, the United Sates ance coverage is a starting point, here. All the discussions center is still the only wealthy, industri- there are many additional efforts on thoughtful reflection of the in- alized nation which does not en- that must be undertaken in de- creasingly complex challenges sure that all its people have 100% fense of the right to health care. that we face in health care today. coverage or 100% access to high- Being of the created world, we The theme of this Workshop is quality, cost effective health care. have no choice but to recognize “The hospital, a place for evan- While the recent passage of Pres- and call others to accept the real- gelization: a human and spiritual ident Obama’s Affordable Care ity that if all persons are to have mission.” My particular topic is Act will expand both private and access to some health care, no one ‘Hospital Management: Between public insurance to many of those can have access to all available Rationalization and the Defense individuals who currently do not forms of care. Whether you call it of the Right to Health’. As the have adequate coverage, it will not the transformation of health care, United States Bishops state in fix all of the problems. The social health reform, or maybe even ra- their Pastoral Letter on Health injustice that has resulted from the tioning, one of the most impor- and Health Care, “From the earli- failure to recognize and respond to tant tasks leaders of the Catho- est traditions of the Church to the the right of all people to adequate lic health ministry in the United present day, the mission of evan- health care has taken its toll on the States can undertake is to ration- gelization to which Jesus sent his American system. Barriers to ac- alize the delivery and financing followers has included healing as cess experienced by the uninsured systems. a major part.” In Luke, Jesus says, and underinsured in the United There are two ways to concep- “Into whatever city you go, after States have contributed to poor tually understand the term ‘ra- they welcome you... cure the sick overall health outcomes. Accord- tionalization’. One way which we there. Say to them, ‘the reign of ing to the World Health Organiza- rationalize is to devise self-sat- God is at hand” (10:8-9). tion, the United States health care isfying but incorrect reasons for As I began to reflect on the task system is highest in cost, and still, our behavior. This type of ration- before me, another scriptural pas- the U.S. system is 37th in overall alization already occurs far too sage came into my mind, the Gos- performance and ranks 72nd by frequently in today’s health care pel of John, Chapter 15, Verses overall level of health. system. The other way, in which 1-5: “I am the true vine and my Compared to ten European I use for our purposes today, is father is the vine grower. He takes countries, the United States has to make rationale or structure ac- away every branch in me that a much higher prevalence of can- cording to principles of reason. In does not bear fruit, and everyone cer, heart disease and stroke in its the context of the healthcare sys- that does he prunes so that it bears population 50 years of age and tem, then, this means restructur- more fruit... I am the vine, you are over. ing or redesigning the delivery the branches; whoever remains in Moreover, there are significant and financing processes to create me, and I in him, will bear much discrepancies in health related a coherent system that is ordered fruit, because without me you can outcomes for racial minorities in – not according to the constraints do nothing.” If we are to bear fruit the U.S. As reported in 2011, the of markets, the demands of poli- we must remain in Christ, and the age adjusted mortality rate for tics or even the needs of health vine must be trimmed of its with- African-American males is 942.6 care providers – but according to

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the needs of persons who come to necessary for the proper develop- the same as the Ethical and Re- us for healing in its fullest sense, ment of life and thus are essential ligious Directives for Catholic caring for their body, mind and elements of the common good. Health Care Services of today. spirit. Only by eliminating the in- Included in these basic goods are For thousands of years, then, the efficiencies in the delivery of care a decent minimum of health care, guiding norms of the practice of in the United States will we be and the means of livelihood in the medicine and of the Catholic mor- able to give our brothers and sis- event of ill health, the death of a al tradition were like two different ters the care to which they are en- loved one, and old age (cf. Pope branches of the same vine. Until titled, by right, having been made John XXIII, Pacem in terris, 6). the 1960s, no health care profes- in the image and likeness of God. The corresponding vision of dis- sional would ever seriously have Only by eliminating the en- tributive justice requires that eve- considered performing abortions demic social injustices and sin- ryone has sufficient access to or helping patients to kill them- ful social structures that cause healthcare, not simply health in- selves much less performing an the branches to wither on the vine surance coverage. This vision is act of euthanasia. Today, the pres- can we ensure that they receive the basis for the social responsi- ence of the healing ministry of this care in a way that truly re- bility of Catholic health care ser- the Church is of ever greater im- flects Jesus, healing ministry in vices as articulated in Part One portance than before, and the op- the world today. Like the vine and of the Ethical and Religious Di- portunity for evangelization ever its branches, the rationalization rectives for Catholic Health Care more present. of health care delivery and the Services: “The first right of the As a public ministry that touch- right to health care share common human person, the right to life, es the lives of those it serves when roots. This shared root system is entails a right to the means for the they are at their most vulnerable, in fact God’s , revealed proper development of life, such the Catholic health ministry can to humanity through both scrip- as adequate health care” (see also, be a powerful instrument of the ture and reason. USCCB, Health and Health Care Church’s prophetic voice for the Just as our inherent human I, pp. 5, 17-18, and the Catechism good of all persons. More than dignity has as its sole source the of the Catholic Church, nn. 1928, simply the refusal to provide cer- fact that we are made in the im- 1936, 1937, 2211, 2239, 2446, tain procedures that are contrary age and likeness of God, so too it 2820). The fulfillment of this vi- to human dignity, the strength and is by virtue of this origin that we sion requires us to recognize that, transforming vision of the Catho- share in God’s dominion – that like the vine and the branches, lic health ministry lies in its op- we participate in God’s ongoing the right to adequate health care portunity, role and ability to act as act of creation – through the gift and the imperative to rationalize a positive influence on the prac- of reason. While reason itself is healthcare share the same roots, tice of medicine and the culture of not the source of our inherent hu- the inherent dignity of all human health care. Most of all, the trans- man dignity, we must use our rea- life from conception until death forming power of this prophetic son in service of both the works due to our being made in the im- voice lies in the Catholic health of mercy and the works of justice. age and likeness of God. In this ministry’s abiding commitment As Pope John Paul II has said, way, the rationalization of health to continue Jesus’ healing pres- “The Church cannot remain in- care and the defense of the right to ence in the world today. To truly sensitive to whatever serves hu- health care do not stand opposed rationalize the healthcare system manity’s true welfare, any more to one another as opposite ends we must remain in Christ. We than she can remain indifferent to of a continuum; rather, the ration- must seek to live out our Catholic whatever threatens it” (Redemp- alization of health care is a nec- identity as we lead the transfor- tor Hominis, 13). I believe that the essary and appropriate means for mation of health care in a rational failure to recognize and respond responding to the right to health way, so that we may respond to to the right to adequate health care care and, thereby, contributing to the most basic rights that all peo- for all persons is such a threat, and the common good and promoting ple share in common. the rationalization of health care and defending human dignity. I would like to share with you can serve humanity’s true welfare. The moral norms which flow what I see as the top five manage- Thus, everyone who is engaged in from the fundamental belief that rial priorities for leaders of Cath- the healing ministry of the Church all human life is inherently valu- olic health systems in the United shares a responsibility to involve able and deserving of protection States with respect to the ration- themselves in the sustained strug- and which guide the Catholic alization of the health care deliv- gle to rationalize the health care health ministry are truly univer- ery system. These five priorities system and correct any unjust so- sal. Since the beginning of the are like branches on the vine that cial, political and economic struc- Hippocratic tradition of medicine, will ensure that our efforts to ra- tures that interfere with our ability some 500 years before Christ, the tionalize health care stem directly to heal the wounded world as Je- universal fundamental norm of from our identity as a ministry in sus taught us by his own example. medicine has been “Primum non christ and bear fruit by leverag- As John XXIII taught in his en- nocere,” “first, do no harm.” Prior ing the strength and transforming cyclical Pacem in terris, the fun- to the 1960s, the Code of Ethics vision of our Catholic identity in damental human right to life im- of the American Medical Asso- responding more adequately to plies a right to the basic goods ciation would have been virtually the right to health care. In no par-

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ticular order, these five priorities derserved, sometimes economi- sential component of the healing are: 1) Theological and spiritual cally devastated areas, even when ministry, the current model iso- formation programs for lay lead- we know it will not be profitable. lates such care as separate and dis- ers; 2) Solidarity with those who The ability to make such diffi- tinct, that is, as ancillary. live in poverty and experience the cult decisions requires that lead- What is needed is a new way injustices that accompany social ers and directors be confident in of thinking about the delivery of marginalization; 3) The exercise their ability to exercise our third care that treats the whole person of a robust concept of responsi- priority, the responsible steward- in an integrated way, that rec- ble stewardship that goes beyond ship over the limited resources of ognizes the multifaceted causes merely doing more with less; 4) their health systems. To be certain, of illness, that meets the person Developing a new model of health such stewardship entails minimiz- where they are rather than requir- care that delivers truly person-cen- ing resource consumption, elimi- ing them to come to us, and that tered care; and 5) Living a faithful nating waste, and healing without aligns the goals of the healing re- commitment to the Church’s vi- harm while maximizing outcomes lationship in accord with human sion of human life and the moral and providing the highest quality – not simply medical – values. norms that flow from that vision. care. In this context, medical util- Palliative Care is perhaps the best Regarding the first priority, for- ity and operational efficiency are example we have today of such an mation programs for lay leaders essential to remaining sustainable approach. As His Holilness Ben- of the Catholic health ministry, I even when one willingly chooses edict the XVI noted in his mes- have personally chosen to make to remain in a particular market for sage for the fifteenth world day of this a priority for our organization reasons other than economic ben- the sick, “there is a need to pro- Ascension Health Alliance. In to- efit. Though such decisions must mote policies which create con- day’s social morality of choice, be made with the greatest amount ditions where human beings can consumerism and consequential- of prudence and caution, an ade- bear even incurable illnesses and ism, leading a health ministry re- quately robust notion of steward- death in a dignified manner. here quires more than just sophisticat- ship within our tradition includes it is necessary to stress once again ed business acumen. Our leaders an inherent element of justice. Jus- the need for more palliative care must possess a spiritual-centere- tice that requires attention to eq- centers which provide integral dness and an alignment with our uity, fairness and the basic human care, offering the sick the human tradition that informs an abiding rights of all understood in light of assistance and spiritual accompa- commitment to the mission and the universal destination of goods. niment they need. this is a right identity of the organization. An In the context of rationalizing belonging to every human being, essential component of ministry healthcare, stewardship which one which we must all be com- leadership is a virtuous character merely results in doing more of mitted to defend.” that predisposes us to do the right what we already do while us- Yet, palliative care is a model thing even when it is difficult, un- ing less resources falls short of that is limited to those living with pleasant or entails less than desir- meeting our obligations; steward- chronic and/or terminal illness able consequences. ship must enable us to radically and while it should remain a top Within our tradition, our sec- change what we are doing and priority, we need to continue to ond priority solidarity can be un- how we are doing it in light of an seek out new models of care deliv- derstood both as a virtue and as a appropriate understanding of why ery that place the person, with all principle. As a principle it guides we are doing it in the first place. their needs for healing, at the cent- our distribution of material goods Simply stated, the reason the er of everything we do. Only then for the sake of a more just social Catholic health ministry exists at will we be able to deliver on our order. As a virtue, it goes beyond all is because of our fourth prior- promise to continue Jesus’ healing a concern for the material goods ity the human person, the image presence in the world today and of the created world and orders of God made manifest. As you bring about health, understood in the sharing of spiritual goods. are aware, anytime Jesus healed the biblical sense as wholeness, While a “preferential option” for the sick or wounded persons, he and proclaim the kingdom of God the poor and vulnerable is often healed them not only physically on earth by healing our wounded considered one of the primary, but spiritually and socially as well. humanity as Jesus did. distinguishing characteristic of As Pope John Paul II reminded us, Finally, I would like to address Catholic health care, something we must not let the technical as- the importance of our fifth prior- more than that will be required to pect of medicine overshadow the ity, fidelity to the church’s vision meet the economic challenges of fact that the patient in the bed of human life and the moral norms tomorrow’s healthcare environ- is a person in need of healing in that flow from that vision. For us in ment. We must also respond to many dimensions. Once we even the United States, these norms are those whose right to health care refer to the person as a “patient,” summarized in the ethical and reli- goes unseen and unmet in today’s we have already reduced them in gious directives for catholic health environment. Solidarity, under- our minds to being an object of care serivices, currently in their 5th stood as both a virtue and a prin- the healthcare system and conse- edition. I have saved these for last ciple, must guide our operational quently given priority to medical because they are the summation and strategic planning at ensuring values over human values. While of the other priorities. I believe a vital presence as needed in un- Pastoral Care Services are an es- that, taken as a whole, the Ethical

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and Religious Directives provide A Health Care System that de- poor and vulnerable, and imple- a roadmap for the rationalization livers high quality, safe, efficient ment the Church’s social teaching. of health care. While some in the care to all persons consistent with While the current model of health U.S. see the Ethical and Religious their most fundamental human care in the u.s. is one of compe- Directives as a source of criticism rights. To be sure, however, the tition, the model of tomorrow, in- against Catholic health care, and Catholic health ministry cannot deed of a raTionalized health care even some within the Catholic do this on its own. If we are to ra- system, is one of collaboration. health ministry might be tempted tionalize the healthcare system in So, in closing, I would like to to view them as an obstacle to new defense of the right to healthcare, thank you for your time and atten- business ventures, the opposite ac- we must form new partnerships tion this afternoon. I hope I have tually holds true. By faithfully liv- with other providers and organi- been able to provide you with ing out our mission in accord with zations who respect our funda- some information for your con- the whole of the Ethical and Re- mental beliefs. Those who respect tinued reflection regarding the ra- ligious Directives, we can create our need to realign local delivery tionalization of health care so that a health care system based on ra- systems, provide a continuum of we, as a healing ministry of the tional principles, centered on the care to our communities, witness Church, may respond to the right human person understood as made to a responsible stewardship, pro- of all, and thereby proclaim the in the image and likeness of God. vide more equitable access to the Good Word through our actions.

Biomedical Research in Hospitals

Dr. Ornella Parolini Although, on the one hand, re- ferred to with the felicitous expres- Director of the E. Menni search appears to be the setting sion of St. Augustine: ‘We search Research Centre, for approaching and organising with the desire to find, and we find The Hospital Polyclinic Institute the potentialities of human ration- with the desire to search further’. of Brescia, ality, which is a gift of God, it is Indeed, man, and the researcher as Italy also offers to our eyes a virtuous man, is marked by a yearning for circularity in which a researcher the infinite which is placed in his follows the inverse pathway and heart by Mystery. This dynamic, goes back, through a correct use like a void that asks to be filled, of this gift that has been received, cannot completely emerge at the Short Introduction from the creation to the Creator, in certain levels of the human path- the undertaking of exploring real- way. It can, indeed, remain still I will seek in this short introduc- ity and in the taking of responsibil- confused about its ultimate End: tion to outline a framework within ity for all people. unaware, therefore, although per- which, in referring to my personal ceived and present. Theologians experience, the fundamental fea- speak about ‘self-transcendence’, tures of research activity emerge. 1. Research and the Desire that is to say the capacity to go be- I would then like to narrow my fo- for Knowledge yond ourselves, perceiving that we cus and concentrate on biomedi- find our ‘meaning’ and our ‘home’ cal research and its specific as- The desire for knowledge forms not in ourselves but in something pects in order, lastly, to place the a deep part of the nature of man; that is greater, more fundamental analysis in its context, within the it has accompanied him since the and more original than ourselves. hospital world, which is marked by dawn of history and in all latitudes This experience is well portrayed strong special features: first of all and it is a constant from the ear- by the notion of amazement: we the daily relationships with people ly childhood of every individual. are amazed, that is to say we are who are ill and suffering, which Faced with the real and provoked stunned, in the face of something research activity certainly shares, by the real, man feels the need to that surprises us and goes beyond although perhaps in a not immedi- understand the world and himself. us, that we do not fully understand, ately perceivable way. It is not sufficient for our reason something, rather, which we more In reality, research activity is to list the most shallow and evi- intuit than know about. profoundly bound up with all those dent aspects of reality. This de- It is precisely this openness that elements that characterise the nor- sire, which is never fully satisfied, is the greatness of man, who, while mal living, thinking and acting of corresponds to our deep nature, he acquires increasingly complex man and thus it takes part in every a desire that Pope Paul VI, in his truths, does not forget to keep the dimension of his existence, includ- Message to Men of Thought and door open to Truth, thereby avoid- ing the dimension of Faith. Science of 8 December 1965 re- ing a reduction of the real to his

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own limited scale. ‘The supreme asks us to walk along its pathways II: ‘Scientists, precisely because step of reason lies in recognising with audacity, with generous com- they ‘know more’, are called to that an infinity of things rise above mitment, with an approach of free- ‘serve more’. Since the freedom it’ (Blaise Pascal, Pensées, frag- dom and confidence, adopting the they enjoy in research gives them ment 466). Awareness and accept- recommendation that the Holy Fa- access to specialized knowledge, ance of their own finitude, and at ther offered as a fundamental ele- they have the responsibility of us- the same time of a Greatness that ment for theology which knows ing that knowledge wisely for the goes beyond us, are the sign of that how to relate to the contemporary benefit of the entire human family’ intelligence that is specific those world, that is to say ‘the courage (Address of His Holiness Benedict who know how to enjoy and love to engage the whole breadth of rea- XVI to the Members of the Pon- things, and leads us to the emotion son, and not the denial of its gran- tifical Academy of Sciences, 6 No- of knowing, to that experience of deur’ (Address of Benedict XVI at vember 2006). wonder in which, for that matter, the University of Regensburg, 12 A researcher can, in addition, the ancients recognised the origins September 2006). experience on his own journey that of philosophical thought. How- In research that is guided by an unexpected and surprising insight ever, it is not sufficient for the re- upright use of reason that is not in- which, commonly defined as the searcher to acquire knowledge. It duced into a positivism that denies ‘madness of the researcher’, I my- would remain a small thing if won- dignity to what cannot be meas- self prefer to read as the enlight- der did not create the desire for ured empirically and is not abso- ening gift of He who is Truth, of sharing, an approach of openness lutised into a dehumanising self- that Wisdom that guides small and and of gift. The ability to sound referential system, a scientist is a large discoveries, at times reaching out reality at a deep level makes participant in the grandeur of the unexpected inspiration, at times a researcher an authentic authori- creation and is led in a safe way stimulated by the circumstances: tative witness to the amazement to truth: ‘reason is by its nature ‘To assist reason in its effort to un- provoked by the creation. In him oriented to truth and is equipped derstand the mystery there are the the wish to know is at least on the moreover with the means neces- signs which Revelation itself pre- level of the wish to make known, sary to arrive at truth’ (Fides et Ra- sents’ (Fides et Ratio, n. 13). to contribute to the history of hu- tio, n. 49). manity in the knowledge that in In the modern acquisition of un- his own work he makes produc- measured power by science and 2. Biomedical Research: a tive the efforts that have preceded technology we find implicit the Concrete Expression of him as well. For this reason, an au- risk that a healthy and reasonable Scientific Research thentic researcher, while he reaps autonomy as regards method, ob- what others have sowed, is called jectives and instruments is misun- Technically speaking, the term to make himself available to plac- derstood and transformed into an ‘biomedical research’ covers dif- ing seeds once again in shared land illusion of omnipotence in which ferent branches of medical re- in a free way, without making any the limited scale of the human is search: ‘basic research’, which distinctions, so that others can ben- lost from sight and there is the dan- seeks to understand the mecha- efit from them. ger of being guided by the desire nisms that underlie various pathol- In the way that a researcher pro- for dominion. This was a phenom- ogies; ‘applied research’, which ceeds there is his own style which enon that was already perceived seeks to give answers to clinical is constant during all the stages of by the Second Vatican Council. research; and ‘translational re- his work, whose principal charac- Gaudium et Spes observed that search’, which is based upon con- teristic is a capacity to be critical. man ‘especially with the help of stant circle between basic research Here there is an authentic need for science and technology…has ex- and clinical research, ‘from the reason, a vocation to research with tended his mastery over nearly bench to the bed of the patient’. All the exercise of doubt. the whole of nature and contin- of these three kinds of approach Avoiding the hard work of test- ues to do so…Hence many ben- are carried out with the goal of ing, of critical discussion, is an efits once looked for, especially increasing knowledge in the sec- indicator of shallowness, of intel- from heavenly powers, man has tor of medical research with the lectual laziness, and of a rejection now enterprisingly procured for aim of improving diagnosis and/or of one’s own responsibility to jus- himself’ (GS, n. 33). A research- therapy. tify what is proposed. A capacity to er finds himself in this sense faced be critical has nothing in common with a crossroads: to feel himself 2.1 An example of with presumption or prevarication; stronger by glorying in his con- state-of-the-art biomedical indeed it is the exact opposite. Ex- quests or to be aware of his own research: research plaining oneself with a readiness to state of being a creature, recognis- on stem cells discuss one’s advances and those ing a greater hand that creates and of other people involves a rejec- regulates reality and calls him to Basic research on stem cells is tion of anchoring oneself in con- serve Truth and humanity with the continuing to make great strides cepts and knowledge that are taken greater responsibility that derives every day thanks to the important as given and the humility always to from greater knowledge. results that have been obtained. In allow oneself to be subject to dis- As Benedict XVI observed, the field of so-termed advanced cussion. A high idea of research quoting his predecessor John Paul cell therapies numerous clinical

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trials have been conducted. It is hitherto, both because of their that are achieved. In the case of by now well known that all post- characteristics of being similar to stem cells, the greatest clarity is birth adult tissues, from placenta embryos and because of the genet- essential as regards the source tissues and foetal tissues to those ic manipulation used to produce from which they are isolated, the that make up an adult organised, them, the possibility of causing tu- applicability of the discoveries in are mines from which it is possi- mours remains high. therapeutic approaches, and the ble to isolate stem cells. The pos- fundamental difference that ex- sibility of isolating stem cells from 2.2 The researcher ists between clinical experimen- blastocysts, the so-termed embryo as an individual tation and consolidated treatment stem cells, is equally well known and his responsibility as was recently emphasised by and has been the subject of a live- Prof. Augusto Pessina (‘Le cel- ly debate. These are characterised, This short introductory frame- lule staminali adulte tra mito e re- as can be imagined, by a high po- work as regards research on stem altà’; ‘Adult Stem Cells Between tentiality of differentiation into cells enables us to engage in some Myth and Reality’: L’Osservatore cells of different tissues. Recent- reflections about the researcher as Romano, 27 November 2011). ly, because of the attention given an individual and his responsibil- In the sector of the applicability in the mass media to the award of ity. of stem cells in therapeutic ap- the Nobel Prize to the researchers Linked to the reflection of point proaches, we have had, unfortu- who first established the strategy 1) about research as an expres- nately, during recent years, an ex- by which these could be obtained, sion of the thirst for knowledge ample of incomplete information, the so-termed Induced Pluripo- implicit in man, it is clear that a information that is not very clear tent Stem cells (IPSC) have com- researcher is not a mere and im- or even manipulated. One can manded attention, that is to say personal technician who has some thus generate in patients and their the pluripotent stem cells obtained skills and abilities. He is first of all families false hopes which pro- from adult cells following their a man, and this humanity of his en- voke bitter disappointment, lead- genetic reprogramming through ters legitimately into the pathway ing to the drawing of risky con- the introduction of genes that can of research. In this sense, the neu- clusions when one is still at the bring them to a state similar to that trality of science does not exist. stage of clinical experimentation, of an embryo, recovering both the The freedom and the responsibil- if not indeed pre-clinical experi- interesting characteristics of dif- ity of the researcher, who does not mentation, and presenting as safe ferentiation towards all three em- only belong to an institution but and effective therapies for which bryo layers (ectoderm – for ex- also has a social dimension, must experimentation could in the end ample the epitelium, the digestive direct his action at every step of produce results that are very dif- and pulmonary cavity; the meso- his pathway of research beginning ferent from those expected. It is derm – for example muscles, bone with the choice of the lineage that irresponsible not to take into ac- and blood; and ectoderm – skin he intends to follow and the crite- count the impact that incautious tissues and tissues of the nervous ria to which he should adhere in announcements can have on peo- system) and the characteristic, al- order to identify it. That of simple ple who suffer and who await, so common to embryo stem cells, technical practicability? That of with trepidation, an answer from of forming teratomas after inocu- material reward? That of the pres- science to their illness. Patients lation into animals. tige that may derive from it? That have the right to correct infor- The methodology by which to of the needs of those who suffer? mation, to receive attention and obtain IPSC was greeted by many That of justice in the allocation of care from medicine and research as an ethical victory because it al- resources? which with healthy realism and an lows the obtaining of cells ‘similar A whole series of factors, to- awareness of limits do not prom- to those of embryos’ without the gether with an ethical assessment ise what they cannot deliver. need to create or destroy human of the consistency between ends Scientific seriousness and hon- embryos. From a biological point and means, comes into play. This esty require humility in drawing of view, the IPSC are undeniably was observed by the Holy Fa- teachings from negative results as of great interest and this consti- ther on the occasion of the inter- well and going back with realism tute a discovery of notable impor- national conference organised by on one’s steps when the observa- tance. However, I believe that the the Pontifical Council for Culture tions that have been made indicate noise surrounding this discovery (12 November 2011): ‘In addition that there are no well founded rea- has been rather lacking in a criti- to purely ethical considerations, sons for continuing on the pathway cal sense and also risky in relation then, there are issues of a social, that was envisaged on the basis of to the clinical potentiality of these economic and political nature that a hypothesis. Just as it is not eth- cells, at least in the short term, in- need to be addressed in order to ically acceptable to destroy em- asmuch as some genes correlated ensure that advances in medical bryos, and thus human lives, with with pluripotency are recognised science go hand in hand with just a view to a possible future bene- as having a cancer-inducing capac- and equitable provision of health- fit, so it is not ethical to abandon ity. It should be recognised that lit- care services’. The responsibility a healthy prudence and underes- tle or nothing is known about the of the researcher also comes into timate the potential dangers of a biology and the real potential of play as regards the communica- therapeutic application that has not these cells, in relation to which tion and dissemination of results been sufficiently examined.

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3. Biomedical Research in In a certain sense hospitals are ther Benedict XVI to the Catholic Hospitals: Respect for Life the setting where the researcher University of the Sacred Heart in and Providing Care Starting as an individual enters into a re- Rome on the Occasion of the Fif- with Research lationship, albeit in a very special tieth Anniversary of the Faculty of way, with the patient as an indi- Medicine and Surgery). I often use the following exam- vidual, and in a specific way that Starting with these words of ple to bring out the aspects which, is his responsibility places himself Pope Benedict XVI, I will now on the one hand, liken, and, on at the service of that patient. The seek to offer some reflections on a the other, differentiate, the expe- challenge certainly remains that of relationship that is often wrongly rience of a medical doctor with/ solving the problems of the illness portrayed as being one of conflict. from that of a researcher. The ob- but the context of hospitals pro- In referring to my experience, I jective of both is to engage in the vokes and educates the researcher would like to share with you the best diagnosis and then the best in the goals of his activity, offer- perception that the domain of sci- therapy. A medical doctor pursues ing him the possibility of being an ence and the domain of Faith, al- this objective by entering into ac- integral part not only of the treat- though they are distinct, are two tion in an immediate way, applying ment but also of taking care of, and different but not separate sides of the knowledge and the instruments also helping him to live his scien- my being which are to be found in that he has available in order to tific dedication as an actuation of my unity as a person, giving them solve, treat and alleviate the prob- the great commandment of Christ breadth and depth. lems encountered in the patient. to work hard to serve one’s breth- In the field of the recognised An inability to provide forms of ren, with whom, indeed, he iden- autonomy of earthly realities it is treatment that solve the problem tified: ‘as you did it to one of the certainly the task of the individu- certainly does not indicate surren- least of these my brethren, you did al fields of human activity to con- der by a medical doctor whose vo- it to me’ (Mt 25:40). struct their own pathways so that cation involves the task not only of To keep one’s eyes fixed at the they are suited to the subject of healing but also of treating and of level of ideals on the patient as inquiry. I believe that the point of taking care of. However, the una- the recipient of the results of one’s departure for the construction of vailability of effective therapies own work sustains a researcher in a fruitful dialogue is recognising leads him back in a strong way to a his daily hard work and difficul- that each of the two dimensions – sense of his own limitations. ties, and becomes a way of pro- science and Faith – has methods, On the other hand, a researcher claiming the centrality and the ir- instruments, domains, subjects of looks at an illness that can still not removable dignity of every life. research and goals that are specif- be cured as a challenge that pro- Indeed, the Pope when speaking ic to each one of them. Each one, vokes him to channel the efforts of about the sick person declared: therefore, requires respect for its experimentation in that direction. ‘His transcendental dignity gives own specificity and the legitimate In a certain sense, where a medical him the right to remain the ulti- possibility of autonomous exer- doctor is faced with a closed route, mate beneficiary of scientific re- cise according to its own princi- a researcher sees outlined a route search and never to be reduced to ples. to follow. One could, however, its instrument’ (Address of the Ho- This legitimate autonomy does think that the challenge becomes ly Father Benedict XVI to the In- not, however, imply the raising of the illness in the abstract, without ternational Conference Organised scientific research to a final and ab- having the patient as an individu- by the Pontifical Council for Cul- solute value which is without any al present. Although it is in reali- ture, 12 November 2011). limitation: ‘One can therefore say ty medicine in general that is ex- that the autonomy of the sciences posed to the risk of concentrating ends where the upright conscience in an exclusive way on resolving 4. Scientific Research and Faith of the scientists recognise evil – the clinical expressions of illness, the evil of method, outcome or ef- on parameters that are not normal, ‘Experienced fully, the search is fect’ (John Paul II, Address to the this risk is even stronger for a re- enlightened by science and faith Rectors and the Lecturers of the searcher, who does not come into and from these two “wings” draws Universities of Poland, 30 August direct contact with the patient but dynamism and an impetus, with- 2001, n. 3). dedicates all of his energies to the out ever losing its proper humili- All of the creation is ordered to search for the solution to a prob- ty, the sense of its own limitations. the Good of man and every human lem. In this way the quest for God be- activity must tend towards this And yet never as much as during comes fertile for the mind, a leav- same end. The Catechism of the this historical period of biomedical en of culture, a champion of true Catholic Church observes: ‘It is an research has the rediscovery of the humanism, a search that does not illusion to claim moral neutrality centrality of the individual been of stop at the surface. Dear friends, in scientific research and its appli- such fundamental importance, and always let yourselves be guided cations. On the other hand, guid- this specifically to assure that tech- by the knowledge that comes from ing principles cannot be inferred nical knowledge and strategies are on high, by knowledge illuminat- from simple technical efficiency, for the good of man, of each and ed by faith, recalling that wisdom or from the usefulness accruing to every man, and not only for some demands the passion and effort of some at the expense of others or, men. seeking’ (Address of the Holy Fa- even worse, from prevailing ide-

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ologies. Science and technology Faith, in leading man to pose The Church is entrusted with the by their very nature require un- questions to himself and to dis- important task of fostering and cre- conditional respect for fundamen- cover the full meaning of his exist- ating conditions so that in dialogue tal moral criteria. They must be at ence, is a support for the researcher and in mutual respect science and the service of the human person, of in acquiring knowledge about the Faith can benefit from their mutual his inalienable rights, of his true meaning of his activity and helps contributions. The Church also has and integral good, in conformity him to understand it anew in the a further responsibility in being a with the plan and the will of God’ broader dimension of the integral mater et magistra: that of looking (CCC, n. 2294). vocation of man. In the recognition at the scientific world with a caring It is this reference to service to that he is a creature, the research- gaze and special attention, offering the human person, to his true and er who is a believer is in addition her own message to these ‘pilgrims integral good, that ensures that sci- stimulated to keep alive awareness marching towards the light’ (Paul ence and Faith are not obstacles to of his own finitude and his limits, VI, Message to Men of Thought each other but can, on the contra- which is also transmitted in his ac- and Science, 8 December 1965). ry, offer each other mutual support tivity in the scientific field: scien- In this sense, it seems to me that I in pursing the same objective, to tific knowledge is not an ultimate can point to certain concrete needs. which, indeed, they draw near fol- end, nor is it able to meet all the First of all, since an ability to inter- lowing different routes. needs and questions of men. It vene in the contemporary debate in The Fathers of the Second Vati- is faithful to its vocation when it an authoritative and effective way can Council observed: ‘Therefore places itself at the service of the pre-supposes the capacity to act at if methodical investigation within Good of man and contributes to the high levels of competence, it is es- every branch of learning is carried creation of a more human world, sential that attention is paid to the out in a genuinely scientific manner thereby cooperating with the King- formation of consultants who have and in accord with moral norms, it dom of God. In this way the world a solid training, above all in the never truly conflicts with faith, for of research can make its contri- field of the biosciences, and also earthly matters and the concerns of bution, which is achieved in vari- to a commitment to the dissemina- faith derive from the same God. In- ous ways, available to the Church. tion of scientific knowledge which deed whoever labours to penetrate It teaches faithfulness to what is is entrusted to qualified experts. the secrets of reality with a humble true, which is the fundamental el- It is also important for the and steady mind, even though he ement of scientific inquiry, and of- Church to work to promote the is unaware of the fact, is neverthe- fers an opportunity for dialogue birth of networks of communica- less being led by the hand of God, with the contemporary world. In tion and activities involving co- who holds all things in existence, addition, it allows participation in operation between Catholic schol- and gives them their identity’ (GS, achievements inspired by interna- ars. Lastly, specifically because n. 36). tional solidarity, thereby achieving research is a human activity, there It is evident at this point that be- a concrete and specific actuation of is a great need for a pastoral care tween scientific knowledge, the man’s lordship over the creation, that nourishes the spirits of scien- other forms of (philosophical, ethi- in the imitation of the example of tists, cultivating in them that intel- cal, theological) knowledge and the Divine Samaritan, who ‘came ligence and that wisdom that will Faith there is no reason for the not to be served but to serve’. make them able to be present as existence of oppositions. When Amongst scientists there is a witnesses to the Truth and to Love these arise they are a clear sign of widespread awareness that tech- in the challenges of modern sci- some contradiction on the path- nological-scientific knowledge ence. way of knowledge, of an error on and skills place great power in the pathway that should be identi- their hands. This calls on them to fied, explored in depth and healed take upon themselves with greater 5. Conclusions by resorting to critical testing, to awareness and a greater sense of dialogue, and as far as I am con- responsibility the fate of the whole During the Year of the Faith cerned, as a believer, by bringing of humanity. Amazement in front all of us have the task of return- to bear divine illumination. of the infinitely small and the in- ing to embodying the Faith in the In interaction and dialogue be- finitely large that is revealed by various contexts of life. I believe tween Science and Faith each in the scientist also helps everyman that scientific research must re- reality has a great deal to offer to to raise his eyes from the narrow discover and continually discov- the other. Taking up the words with space of his own immediate expe- er its true origins, it true mission, which the Blessed John Paul II riences, obtaining for him horizons so that in the life of a researcher opened his encyclical letter Fides of universal beauty and truth. Last- a greater commitment to scientific et Ratio, when describing the rela- ly, in unveiling the mechanisms research does not weaken Faith, tionship between Faith and reason, that govern the world, scientific but strengthens it, and the research of Faith and science as well we culture comes to the aid of Faith, laboratory can be not only a setting could say that they ‘are like two purifying it and freeing it from en- to be evangelised but also a setting wings on which the human spirit crustations and elements of super- in which evangelisation is actively rises to the contemplation of truth’. stition. worked for.

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The Vocation of a University Hospital

Dr. Sandro Caffi The pre-requisites for these and human growth, as well as in- Director General of the AOUIs are: an ability to provide tegrated structures for teaching, Integrated University Hospital care designed to meet the need for research and health care; assuring Company (AOUI) of Verona, health of citizens; the presence of an exchange of experiences be- Italy care processes for those patients tween the different generations; with more severe and complicat- and valuing the cultural heritage ed clinical profiles; attention paid of professionals of the regional he relations between faculties to, the analysis of, and the solu- health-care system Tof medicine and hospital insti- tion of ethical problems connect- The research must be devel- tutions go back a long way in It- ed with care provided in a clinical oped in a scientific-biomedical aly and they were almost contem- context; engagement in activity pole that is characterised by: ed- poraneous with the establishment involving health-care research ucational areas organised within and spread of the modern system and basic research; the use of the hospital area; structures dedi- of teaching medicine based on benchmarks to measure the quali- cated to applied research; the inte- clinical observation. tative levels reached by the care gration of research in the field into The law of 17 July 1890, n. 6972, procedures and by the use of the innovative organisational models, was the first legislation to address resources of health-care technol- of a local-area kind as well; and in an overall way the question of ogy; and the adoption of innova- contacts with institutions dedicat- the relations between universities tive technologies. ed to basic research. and health care. It clarified that co- At a more detailed level, the In the introduction to the doc- operation between universities and characteristics of care in this field ument establishing the AOUI of hospital institutions in cities where are: being qualified and adequate Verona, some key words are indi- there were faculties of medicines as regards periods of time, knowl- cated which are indispensable in was necessary. edge and needs in a way that is achieving the goal of full integra- The reform of 1992 (d. lgs. compatible with the resources tion between the university and 502/1992 art. 4, and 4-6) envis- available; being designed to re- the regional health-care service aged university clinics or poly- spond to and meet the need for and between care, teaching and clinics managed directly by uni- health in relation to hospital care; research: ‘innovation’ – grasping versities for their own purposes, working in structures that have with intelligence and speed the also acting as the providers of high volumes of services being points that come from the world health-care services on the ba- provided and a high specialisation of science in the biological, clini- sis of agreements with agencies of the activities engaged in; using cal, organisation and ICT field; that owned services and hospital advanced technologies; privileg- ‘culture’ – basing oneself in every companies – public centres that ing any initiative that improves act of research on rational logic provided health-care services – continuity in care in services and based upon scientific demonstra- which had agreements with uni- the local areas from which pa- tion and the capacity to mediate versities providing (wholly or by tients come; and conceiving and between these and the facts of ex- individual departments) a service implementing pathways for the perience; ‘justice’ – responding to of teaching and research. admission and discharge of frail the requests for the protection of The d. lgs. 517/1999 envisaged patients. the weakest individuals inasmuch the transformation of polyclinics The characteristics of the teach- as illness is the gravest cause of and hospital companies into inte- ing are: fostering the teaching/sci- the creation of differences be- grated university hospital compa- entific supply specific to the mis- tween people and medicine is a nies (AOUI) in which universities sion of a university and having privileged instrument for the rec- and regional governments togeth- specific teaching areas; assuring reation of a condition of clinical er would create a new organisa- access to the world of work for equality; and ‘clinic’ – using in a tional model able to assure train- young people by offering them harmonious way the sets of tech- ing and research while health care training experience directed to- nical and relational acts that char- was being provided. wards their cultural, professional acterise care for sick people.

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Telemedicine: a Medical Reality that Calls on Ethics

Dr. Giovanni Putoto ject starting with an empirical ap- updating of health-care person- Head of the Planning proach, looking that is to say at nel which is today indispensable of Doctors with Africa-CUAMM, reality as it is in the field and al- in countering the obsolescence of Italy lowing questions to arise from it. knowledge; research which more This paper is divided into two than ever before takes advantage parts. In the first I describe what of the contribution of centres and telemedicine is and what its ex- expertise; and programmes for pected benefits are. After this public health and administration. Introduction there is a rapid look at the appli- The benefits expected from the cation of telemedicine in Africa applications of this technology re- The explosion of internet and and the obstacles that impede its fer to some of the most relevant the new communications tech- widespread application. In the dimensions of the working of the nologies has helped to ensure second part two practical ethical health-care system, such as the that in many parts of the world, dilemmas are presented: the first possibility of improving access to including Africa, telemedicine concerns the relationship between essential health-care services (in- is seen with growing interest as telemedicine and the allocation of creasing their quality and effica- a possible response to the very resources; the second raises the cy) and mitigating situations that many problems that afflict health question of fairness in its use in involve a scarcity of personnel care, especially at a hospital lev- favour of poor people. This is fol- through cooperation, networking el. Google has almost five million lowed by an analysis of telemedi- and formation. hits under the heading of ‘tele- cine and frugal technologies and, These benefits are especially medicine’. Many meetings fol- lastly, by conclusions. relevant in Africa where in many low one another on the various cases the population lives in ru- applications of this new branch ral and remote areas that are very of medicine while there are some Telemedicine: What is it?1 far from health-care centres, and thousands of research articles health-care workers, if they are published on this subject in spe- By telemedicine one means the present, work in a context of great cialist scientific reviews, both exchange at a distance of medi- isolation without opportunities medical reviews and ones on ap- cal information between points for professional growth and ex- plied engineering. that are distant from one another. change. If one considers that al- In contrary fashion, little is This exchange can take place in most a half of the African popu- known and even less is docu- real time of after the information lation does not have access to mented about the ethical impli- has been collected, stored and for- essential services, and that there cations connected with the use waded. Texts, audios, videos or is a shortage of almost a million of telemedicine. And this applies fixed images can be transmitted. health-care workers in this sector, in a particular way to develop- The technologies that are used are one can understand how telemed- ing countries where resources are very varied in character, from cell icine could make a fundamental limited and where needs are many phone to satellite systems, but in contribution to filling this gap. and in competition with one an- substance all of them share the other. Hitherto, indeed, only four use of internet. Given the rapid countries in sub-Saharan Africa progress of information and com- Telemedicine in Africa: and one international association munication technologies (ITC), What is it?2 have developed ethical guide- there has also been a proliferation lines; only one article has been of names and acronyms such as Indeed, an in-depth look at published in the prestigious re- telehealth, e-health, m-health, and how this technology is penetrat- view Philosophy, Ethics, and Hu- with this, also, a loss of the termi- ing Africa highlights a rapid, al- manities in Medicine, and there nological consistency of the very beit informal, spread of telemed- are very few publications that ap- term ‘telemedicine’. icine in many sectors. There are pear on the research engine Pub- The applications of telemedi- very many examples of this.3 The med under the headings telemedi- cine in the medical sector are continent of Africa is the conti- cine, Africa and ethics. many in number. The most fre- nent where there is the most in- The aim of this contribution by quent relate to the diagnosis and tensive use of the HINARI pro- Doctors with Africa CUAMM is treatment of illness, in order to gramme which makes freely to provide some elements of dis- obtain a second opinion by spe- available 11,440 scientific re- cussion in this very complex sub- cialists as well; the formation and views and over 8,000 books in

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electronic form in 30 languages. have been applied to support the of telemedicine in Africa is fully Once again in the field of the for- registration of life events such as represented in what is today de- mation of medical doctors and births, deaths and the causes of fined as ‘frugal technology’.5 This nurses, amongst the various glob- death. Despite these positive de- is an attempt to develop techno- al networks that use telemedi- velopments, a large number of logical instruments in order to cine for humanitarian purposes obstacles continue to exist to the contribute to solving the health reference should be made to the spread and use of telemedicine in and health-care problems of the SCART (short course on antiret- Africa. Amongst the most impor- poorest populations in the world. roviral therapy) initiative of the tant one may list: an insufficient There do not exist univocal an- Institute of Tropical Medicine technological infrastructure; the swers to the question whether tel- University of Anversa which al- inadequacy of national develop- emedicine is a priority but, rather, lows many people in the field, ment policies and strategies; leg- decisions connected, as the occa- above all in Africa, to be updated islative uncertainty as regards the sion requires, to the context and on this subject through an inter- subjects of privacy and informed the finalities of its use and the active training course which is at consent; and a shortage of studies benefits that it brings. done at a distance through inter- on cost/efficiency and financial net. This is an example of a vir- sustainability.4 Is telemedicine for the poor? tual community which gathers around a complex subject such as It has been amply documented that of treatment for HIV. Anoth- The Ethical Dilemmas that those who use the new tech- er similar experience is UNFM/ nologies in the health-care field RAFT which involves a network Is telemedicine a priority? are in large measure the highest of European centres and eighteen social classes in terms of income African countries, in large meas- The cost of a telemedicine sys- and education. One is dealing ure francophone ones, around the tem by satellite connection is here with the so-called ‘inverse subject of diabetes. Specialist around 15,000 euros. With the care law’,6 according to which the courses are offered online as well same sum of money one can em- availability of high-quality health as debate forums, updating on the ploy two or three obstetricians care tends to be inversely vari- literature in the field, exchanges in a Ugandan district hospital able to need. To give a practical of clinical experience and epide- where the maternity wards are the example connected with the Af- miological data. most crowded, in need and short rican context: access to a caesar- In the field of diagnoses by im- of qualified personnel. What are ean operation, which constitutes ages, the chronic shortage in Af- the criteria for choosing between a complex technological and life- rica of specialists in radiology and these two options for a hospital saving service, is the prerogative pathological anatomy is, in part, management? The allocation of of women who belong to the most overcome thanks to the projects resources in medicine constitutes well-off social groups.7 The ethi- respectively of teleradiology and one of the ethical points that is cal problem that underlies the in- telepathology. Amongst the vari- most difficult to solve, even when troduction of new health-care ser- ous examples given in the litera- they are of an organisational char- vices, such as telemedicine, lies in ture in the field as well, mention acter, as in this case. The few re- the risk of creating explicit or im- should be made to the district hos- sources that are available should plicit forms of inequality and thus pital of Thyolo, in Malawi, which be directed towards meeting pri- of social injustice. a year ago was able to receive ra- mary needs, the financial sustain- What are the implications for diology equipment for carrying ability of the hospital, and the or- the management of a hospital? A out diagnoses from the United ganisational implications that all first observation concerns the fee States of America, and this has new technology involves. policy of a hospital. A fee policy benefited 158 patients with tu- One the other hand one should as regards hospital services based berculosis. Or the cooperation also consider the potential bene- exclusively upon the capacity of between the hospital of Mulago fits that telemedicine involves at patients to pay would raise many in Uganda and that of Fuerth in a clinical level and the level of di- questions about ‘contributive jus- thanks to which 92 bi- agnostic services and treatment, tice’. With the same fee, the con- opsies have been analysed and re- and as regards the subject of the tribution of the most economical- ferred at a distance. In the field of updating and advance of profes- ly disadvantaged people would be public health care, as well, ICT sional skills and expertise, the re- greater and this would help to in- instruments such as SMS are be- cruitment of new health-care fig- crease inequality amongst the pa- ginning to be applied: in South ures, and the attraction of new tients. Africa, for example, SMS are patients. In this case as well, this is used in some programmes in the The assessment of benefits and not a problem confined to tel- fight against HIV, against TB and costs, however, should not be lim- emedicine: it concerns the ethi- sexually transmitted diseases, in ited exclusively to the institution cal approach to the subject of the order to support primary preven- of a hospital but should in addi- financing of hospitals. The own- tion, the regular taking of medi- tion include the perspectives of ership and the management of a cal products, and the surveillance patients and of society more gen- hospital, especially if a Catholic of epidemics. In other cases they erally. This overall assessment hospital, should draw up, apply

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and assess, constantly, a policy or pointed out as regards its correct that single answers do not exist guidelines for the social defence use. These are the dilemmas con- for all contexts and for all situa- or protection of the poorest and nected with the allocation of re- tions. most marginalised categories so sources and thus the assessment that access to the hospital and to of telemedicine as a priority as the services that it offers, as in the regards other needs, and the di- Notes case of telemedicine, are not ex- lemma concerning the fair use clusively conditioned by the fi- of this technology by the poor- 1 R. Wootton et al., Introduction to tel- emedicine, (The Royal Society of Medicine nancial capacities of individuals. est parts of the population. These Press, London, 2006). are dilemmas that are typical of 2 P. Howitt et al., Telehealth in the de- the organisational ethics of such veloping world (Royal Society of Medicine 8 Press, IDRC / 2009-01-01). Conclusions and Prospects an important reality as hospitals. 3 Special theme: e-health, Bull. World The answers to these dilemmas Health Organ., 2012; 90:321. Telemedicine offers many and require from management oper- 4 WHO, Telemedicine: opportunities and developments in Member States: report on promising potentialities for the ational guidelines that are based the second global survey on eHealth (2010). improvement of health-care ser- upon clear criteria of moral phi- 5 P. Howitt et al. , ‘Technologies for vices in developing countries. In losophy and, at the same time, Global Health’, Lancet, 2011 Ag 1; 380 (9840):507-535. sub-Saharan Africa it is already that are based upon a process 6 J.T. Hart, ‘The inverse care law’, Lan- present and being used, even that is participated in and open cet, 1971 Feb. 27; 1(7696):405-12. though in a very informal and not to discussion, dialogue and the 7 C. Ronsmans, S. Holtz and C. Stanton, ‘Socioeconomic differentials in caesarean structured way. Side by side with concrete testing of the decisions rates in developing countries: a retrospec- the political, technical and organ- that have been taken. It would be tive analysis’, Lancet, 2006, 368:1516–23. isational problems which have to interesting here to foster the ex- 8 R. Pegoraro, G. Putoto and E. Wray (eds.) Hospital Based Bioethics. A Europe- be addressed in order to secure change of good practices so that an Perspective (Padua, Piccin, 2007). systematic and effective diffusion one can learn from good expe- of telemedicine, two dilemmas riences that are available in this [email protected] of an ethical character should be field, remaining aware of the fact www.mediciconafrica.com

Healing Spaces: The Science of Place, Spirituality and Wellbeing: Implications for the Hospital Environment and Health

Prof. Esther M. In our modern world, hospitals this, one must define the con- Sternberg, M.D. have too often been stressful plac- cept of ‘stress’, first popularized Research Director, es. The modern field of neuroim- in the way we understand the Arizona Center for Integrative munology provides ample scien- word by Hans Selye who bor- Medicine, tific evidence that stress can make rowed the word from physics in University of Arizona, one sick and that belief can help the mid-20th century. Stress has Tucson, USA heal, and the research to prove many parts ­– the initiating event, how this occurs. For that reason the brain’s physiological stress alone, it should be incumbent up- response, and the effects of the ow do we make hospitals on us to change the hospital set- hormones and neurochemicals Hplaces of healing of the spirit ting from a stressful place to a released during stress on the im- in addition to the body and mind? healing one, which supports both mune system and other organ sys- This is the central question posed emotional and physical health and tems in the body involved in the by this 27th Pontifical Council helps the body to heal rather than healing process. A key mediator conference. It is also the central worsening illness. that links the stressful event with tenet of the emerging medical The knowledge of the many the brain’s stress response is per- fields of integrative medicine and ways in which the brain and im- ception. An individual must per- pain and palliative care, and the mune system communicate, have ceive an event as stressful in or- architectural and design field of shed light on how stress makes der to react to it. Once an event is evidence-based design.1,2 one sick.3 In order to understand perceived as stressful, the brain’s

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stress center, the hypothalamus same brain regions and brain out- in patients with different forms of releases the hormone corticotro- flow pathways.14,15 Surveys of depression. Those on the sunny pin releasing hormone (CRH), patients in intensive care units side of the ward had significant- which in turn causes adrenocorti- and those facing terminal ill- ly shorter hospital stays (2-4 days cotropic hormone (ACTH) to be ness show that large proportions shorter) compared to those on the released from the pituitary gland seek religious observance and shady side.17, 18 and cortisol to be released from desire prayer, even if they previ- Part of the beneficial health ef- the adrenal glands. Cortisol is ously had not practiced their re- fects of windows may come from an anti-inflammatory hormone, ligion. Such times in a person’s light. Full spectrum sunlight is which when present in excess, as life can become “teachable mo- known to enhance mood and re- occurs in chronic stress, impairs ments”, when he or she may gain duce symptoms of depression immune cells’ ability to fight in- self-insight and find healing or in persons with seasonal affec- fection, heal wounds and protect wholeness through such practic- tive disorder and other forms of from cancer. Indeed numerous es. Health care providers should depression.19 Color can also in- studies show that chronic stress be trained and prepared to assist duce emotional responses, most- is associated with more severe patients and their families achieve ly through learned associations and frequent viral infections4,5; such healing experiences, and the – blues and greens are generally reduced take-rate of vaccines4,5; physical hospital setting should calming and reds and yellows ac- slowed wound healing5; speeding be such that it can facilitate and tivating.1 of cancer growth6; and speeding support rather than hinder such Other beneficial effects may of chromosomal aging.7 moments. come from the view of nature it- More recent studies also show The modern hospital has self. Certain scenes are universal- that salubrious activities such as evolved over the centuries as ster- ly preferred across cultures, ages meditation, exercise, yoga, tai ile, stressful, noisy mazes –­­ def- and all segments of the popula- chi and prayer reduce the brain’s initely not conducive to healing. tion.20 These tend to be views of stress response and activate pos- These physical changes started nature, sweeping vistas in particu- itive emotional brain pathways out as positive advances in pub- lar. Complex scenes are processed involved in anti-pain perception lic health, in which all foments of in the brain in a region called the and desire – the brain’s opioid and infection were removed and soft parahippocampal cortex, which dopamine ‘reward’ regions.8,9,10,11 homey surfaces and coverings is rich in endorphins, those anti- In addition the vagus nerve is ac- were replaced with shiny, easy-to- pain, feel-good molecules. Irving tivated and releases acetylcholine clean tile and metal. This was very Biederman at the University of and neuropeptides, which put a effective in controlling infections Southern California has theorized further damper on the stress re- but resulted in the emotionally that the reason we all like to look sponse, slow the heart to a more sterile and noisy atmosphere that at beautiful views is that we are healthy rhythm and enhance the we associate with hospitals today. releasing endorphins when we immune system’s healing proper- Hospitals more and more became look at them.20 Nature is also rich ties.12 Deep slow breathing is an places to house expensive diag- in fractal patterns: geometries that important common mechanism nostic machinery and attention to are identical at every scale. It is in all these activities, which acti- the emotions and spiritual life of not understood why people prefer vates the vagus nerve.13 the patients and their families was to look at fractals,21 but computer Many of these same brain pro- overlooked.1 analysis of such patterns in a 15th cesses are activated during the Many recent studies have Century Japanese Temple garden placebo response: the belief that shown that thoughtful changes (the Ryonji Temple, Kyoto) indi- a medicine or medical interven- in the hospital environment can cate that the lines of fractal sym- tion will heal. Although often dis- speed recovery, reduce pain, re- metry pass directly through the missed, the placebo effect is ac- duce medical errors, and improve most peaceful viewing spot in the tually a very powerful effect: it the moods of patients, their fami- Temple.22 is the brain and body’s own heal- lies and the hospital staff. Roger Similarly, other sensory expe- ing mechanism. Thirty to fifty Ullrich first showed in a landmark riences can have positive effects percent or more of the effect of study published in Science Maga- on emotions and healing. Laven- any cure can be attributed to the zine in 1984 that patients recov- der is calming and inhaling lav- placebo effect. It is so powerful ering from gall bladder surgery ender scent can actually induce that the benefits of placebo must whose beds were beside windows slow wave sleep in animal stud- be subtracted from the effect of with a view of a grove of trees left ies.1 Frankincense, given by the any active drug in placebo-con- hospital on average a day earlier, Queen of Sheba to King Solomon trolled trials in order to determine required less pain medication and and one of the gifts of the Magi, the magnitude of the active drug had fewer negative nurses’ notes was so prized by the ancient Ro- or intervention. Prayer, includ- that patients with a view of a mans that they assigned sentries ing Franciscan prayer, Carmelite brick wall.16 This launched a field to guard the bushes that produced ’ mystical experiences, and called evidence-based design. this resin. Frankincense resin Buddhist mantra repetition, sim- Subsequent studies in Italy in the was carried into battle by Roman ilar to prayer, have been summer and Canada in the win- Legion soldiers for its healing shown to activate many of these ter have shown similar findings properties. Indeed modern stud-

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ies show that this aromatic resin tures in the hospital setting – fea- the evidence needed for the health does have anti-bacterial and im- tures to reduce stress and support benefits of modifications in hos- munostimulatory properties that emotions, social support and heal- pital design and also for the ben- could help in wound healing.1 ing? We are entering an era when efits of integrative interventions Sound can have a double- more and more is being done to combining attention to the emo- edged effect – with music re- the physical environment to re- tional and spiritual needs of indi- ducing stress and inducing calm, duce stress and support the emo- viduals together with convention- and even reducing dose of pain tions, and the benefits on health al medical care. In today’s world medication required post-opera- outcomes are supported by scien- we must use these scientific prin- tively. In contrast loud noise is a tific evidence. The Pebbles Pro- ciples and evidence rigorously powerful trigger of the stress re- ject coordinated by the Centers gathered through careful research, sponse. Noise levels in intensive for Health Design in the United to design healing hospitals. With care units can reach as high as States has gathered evidence from proper design, the hospital can be- 95 decibels – the same level as a renovations of dozens of hospi- come a spiritual place where indi- motorcycle firing at close range. tals across the United States and viduals, even “in the Valley of the Swedish studies have shown that has shown that design measures Shadow of Death” can find their an intervention as simple as at- such as including gardens, views place of peace and healing. tenuating sound with absorptive of nature, diffuse and appropri- ceiling tiles, reduces stress and ate lighting, noise attenuation, results in better sleep quality in warm and welcoming home-like patients and nursing staff in in- décor, social spaces for families, References tensive care units.1 and step-down units together re- 1 Sternberg EM. Healing Spaces: The Another important factor in sult in shorter hospital stays, less science of place and wellbeing. Harvard the hospital environment, which infections, lower pain medication University Press 2009. contributes to healing is social use, better patient and staff satis- 2 Sternberg EM. The Balance Within: The Science Connecting Health and Emo- support and positive human in- faction, less nursing turnover, and tions. W.H. Freeman Publishers, New York. teractions, including love and fewer medical errors.23 Cost cal- Hard cover 2000. Paperback (Holt) 2001; compassion. This is one important culations show that the addition- Dutch translation, 2001; Chinese translation 2002; Japanese translation 2006. element that is present at Lourdes, al money spent up front to design 3 Marques-Deak A, Cizza G, Stern- the Healing Sanctuary in South- such hospitals can be recouped in berg E. Brain-immune Interactions and dis- west France where the Blessed the first year of operation because ease susceptibility. Molecular Psychiatry, 24 10(3):239-250, 2005. Virgin appeared to Bernadette, a of these health benefits. 4 Cohen S, Tyrrell DA, Smith AP. Psy- poor peasant girl in 1864. There Advances in non-invasive mo- chological stress and susceptibility to the altruistic compassionate love is bile health monitoring devices are common cold. N Engl J Med. 1991 Aug 29;325(9):606-12. abundant between the ‘malades’ allowing the sensitive detection 5 Glaser R, Kiecolt-Glaser JK. Stress- (the sick) who come there to be of stress and relaxation responses induced immune dysfunction: implications healed and their friends, fami- in real-time as individuals move for health Nature Reviews Immunology, 5:243-251, 2005. lies, strangers and pilgrims. The through their environment. In a 6 Thaker PH, Han LY, Kamat AA, physical aspects of the place – the study in office workers we have Arevalo JM, Takahashi R, Lu C, Jennings beauty of the mountains and the shown that improvements in of- NB, Armaiz-Pena G, Bankson JA, Ravoori stream, together with the long his- fice space, which take these fea- M, Merritt WM, Lin YG, Mangala LS, Kim TJ, Coleman RL, Landen CN, Li Y, Fe- tory and fervent belief associated tures into account reduce physi- lix E, Sanguino AM, Newman RA, Lloyd with the site, facilitate a sense of ological measures of stress in M, Gershenson DM, Kundra V, Lopez-Be- restein G, Lutgendorf SK, Cole SW, Sood deep spirituality for all who visit, workers in the new compared to AK. Chronic stress promotes tumor growth regardless of religion or culture. old office space lacking these fea- and angiogenesis in a mouse model of ovar- Those who visit cannot help but tures.25 We have also developed ian carcinoma. Nat Med 12(8):939-944, 2006. feel better once they have experi- a method to measure stress and 7 1 Epel ES, Blackburn EH, Lin J, Dhab- enced this totality of spirit there. immune biomarkers in sweat, to har FS, Adler NE, Morrow JD, Cawthon How do we capture these ele- avoid the need for blood collec- RM. Accelerated telomere shortening in re- 26,27 sponse to life stress. Proc Natl Acad Sci U S ments of healing in a modern hos- tion to detect immune status. A. 2004 Dec 7;101(49):17312-5. pital? Most hospital rooms today These new devices in combina- 8 Ornish D, Lin J, Daubenmier J, Weidner do not feature beautiful views, tion can detect patterns of bio- G, Epel E, Kemp C, Magbanua MJ, Mar- gardens, pleasant quiet sounds, markers that reflect the health lin R, Yglecias L, Carroll PR, Blackburn EH. Increased telomerase activity and com- diffuse light and have not been and emotional status of individu- prehensive lifestyle changes: a pilot study. designed to accommodate fami- als in naturalistic settings and can Lancet Oncol, 9(11):1048-57, 2008. lies. Indeed in the previous centu- be used in future to help design 9 Sternberg EM. Neural regulation of in- nate immunity: a coordinated non-specific ry visiting hours were often kept healthier hospital environments. host response to pathogens. Nature Rev. Im- to a minimum, exactly at a time Understanding the brain im- munol., (invited review) 6(4):318-28, 2006. in patients’ lives when such social mune connection in scientific 10 Engstrom M, Pihisgard J, Lundberg P, Soderfelldt B. Increased hippocampal support is most needed. The vast terms can thus explain how stress activity mantra meditation, fMRI. J Altern majority of hospitals are not de- makes you sick, how belief can Complement Med, 16(12):1253-8, 2010. signed in a way that might help help heal and how place and space 11 Dusek, J et al. Genomic Counter- Stress Changes Induced by Relaxation Re- healing. around can contribute to illness or sponse 3(7):e2576, 2008. So why not include such fea- health. Such data are providing 12 Tracey, KJ. Understanding immunity

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requires more than immunology. Nature Im- refractory depressions. Journal of Affective Health Services Management, 21(1):3-24, munology 11:561–564, 2010. Disorders, 40(1-2):49-51, 1996. 2004. 13 Peng CK, Henry IC, Mietus JE, Haus- 19 Desan PH, Weinstein AJ, Michalak 25 Thayer JF, Verkuil B, Brosschot JF, dorff JM, Khalsa G, Benson H, Goldberg- EE, Tam EM, Meesters Y, Ruiter MJ, Horn Christie I , West A, Sterling C, Abernethy er AL. Heart rate dynamics during three E, Telner J, Iskandar H, Boivin DB, Lam D, Cizza G, Marques AH, Phillips T, Heer- forms of meditation. International Journal RW. A controlled trial of the Litebook light- wagen J, Kampschroer K, Sollers, JJ & of Cardiology 95,19– 27, 2004. emitting diode (LED) light therapy device Sternberg EM. The Effects of the Physical 14 Newberg A, Pourdehnad M, Alavi A, for treatment of Seasonal Affective Disorder Work Environment on Circadian Variations d’Aquili EG Changes in blood flow, parietal (SAD). BMC Psychiatry, 7:38, 2007. in Heart Rate Variability and the Morning & mPFC Buddhist visualization & Francis- 20 Biederman I, Vessel EA. Perceptual Rise in Cortisol. European Journal of Car- can nuns’ phrase repetition. Percept Mot Pleasure and the brain: A novel theory ex- diovascular Prevention & Rehabilitation Skills. 97(2):625-30, 2003. plains why the brain craves information and 17(4):431-439. 15 Beauregard M, Paquette V. EEG & seeks it through the senses. American Sci- 26 Marques-Deak A, Cizza G, Eskandari brain blood flow changes in Carmelite nuns’ entist, 94, 248-255, 2006. F, Torvik S, Christie IC, Sternberg EM mystical state. Neurosci Lett. 444(1):1-4, 21 Taylor RP. Reduction of physiologi- and Phillips T. Measurement of cytokines in 2008 cal stress using fractal art and architecture. sweat patches and plasma in healthy wom- 16 Ulrich RS. View through a window Leonardo, 39(3): 245-251, 2006. en: validation in a controlled study. J. Im- may influence recovery from surgery. Sci- 22 Van Tonder GJ, Lyons MJ, Ejima Y. munol. Methods, 315:99-109, 2006. ence 224, 1984. Visual structure of a Japanese Zen garden. 27 Cizza G, Marques AH, Eskandari F, 17 Benedetti F, Colombo C, Barbini B, Nature 419, 359-360, 2002. Christie IC, Torvik S, Silverman MN, Phil- Campori E, Smeraldi E. Morning sunlight 23 R. Voelker. Pebbles Cast Ripples in lips TM and Sternberg EM. Elevated neu- reduces length of hospitalization in bipolar Healthcare Design. JAMA 286(14):1701- roimmune biomarkers in sweat patches and depression. Journal of Affective Disorders, 1702, 2001. plasma of premenopausal women with ma- 62(3)221-223, 2001. 24 Berry LL, Parker D, Coile RC, Hamil- jor depressive disorder in remission: The 18 Beauchemin KM, Hays P. Sunny hospi- ton DK, O’Neill DD, Sadler BL. The Busi- POWER study. Biol Psychiatry. 64(10):907- tal rooms expedite recovery from severe and ness Case for Better Buildings. Frontiers of 911, 2008.

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Round Table Hospital Workers: Evangelisers of Life

1. The Administrator

Dr. Orochi (Mt 10:7-8). Health-care workers the sick both physically and spirit- Samuel Orach are people called to continue and ually, thus missing opportunities to Director of the UCMB, bear witness to that work of the emulate Jesus in the healing minis- (the Uganda Catholic first Apostles commissioned by Je- try. Various levels of physical ab- Medical Bureau), sus before he ascended into heav- senteeism of health workers have the National Office for Pastoral en: “You will be my witnesses not been reported. A World Bank study Care in Health, only in Jerusalem but throughout in Uganda, for example, reported Kampala, Uganda. Judaea and Samaria, and indeed to absenteeism of health-care work- of the Pontifical the ends of the earth” (Acts 1:8-9). ers in government facilities (after Council for Health Care How well health care is managed two visits) of up to 37%. (3) Anoth- Workers and provided indicates how well er study in the Bushenyi district of the good news of love is passed on. Uganda (after seven unannounced In many counties Catholic health weekly visits) recorded an aver- care still constitutes a sizable pro- age aggregate level of absenteeism portion of the national health care of 47.9%. (4) Besides physical ab- Introduction system at both institutional and senteeism, health-care workers are non-institutional levels. This is often also in great and unmet need The Greek noun “euangelion” definitely the case in many Afri- of spiritual support, making it dif- means “Good News” and is liter- can counties including Uganda, ficult for them to use the opportu- ally translated as “evangel” or gos- as will be seen later. It is report- nity of clinical care to support spir- pel. Thus “evangelism” originates ed that even in the United States, itually patients and their relatives. from the word “euangelizomai” away from Africa, Catholic health In many instances spiritual care is which literally means “I bring care forms the largest proportion thus sought separately from clini- Good News.” The old Greek al- of not-for-profit care. (1) But how cal care. so used it to mean “bringing good do we or can we use the big num- 2. Restoration of the confidence news of victory”. The good news bers to influence health care so that and dignity of the sick was a fea- is that God loves us so much that it reflects the healing ministry of ture of Jesus’ healing ministry. He He gave His only begotten Son, Christ? (2) identified closely with them and Jesus, to die for our sins and to touched them and allowed them bring salvation to us. Jesus himself to touch him (Lk 4:40; 5:13; Mk spread his Father’s good news of What was Characteristic 1:40-42). Instead, today health- love. One of the ways he used was of Christ’s Healing Ministry? care workers are widely perceived the healing ministry. He combined to be detached from patients and the preaching of the Word with What were some of the key fea- often separated from them by at- the practical healing of diseases tures of Christ’s healing practice? titude and technology, thus miss- and sicknesses (Mt 4:23). In oth- What opportunities are we missing ing an opportunity to touch them er words, healing was one way of to be evangelizers and inheritors of physically and spiritually and to be preaching the good news or show- the ministry? How can we revive touched by the patients. Emotion- ing God’s love. He passed this on or strengthen our role as evangeliz- al and spiritual detachment is also to his disciples “and gave them au- ers? At least seven characteristics one of the factors leading to some thority over unclean spirits with may be identified in Christ’s heal- health-care workers carrying out power to chase them out and to ing ministry which we can exam- abortions or calling for the legal- cure all kinds of diseases and sick- ine against, or compare with, cur- ization of abortion as they do not ness” (Mt 10:1). “And as you go rent health-care practices. feel for the life of the unborn. make this proclamation ‘the king- 1. Jesus expressed the good 3. Jesus did not segregate. The dom of heaven is at hand’. Cure news not only in words but also a people he treated ranged from the the sick, raise the dead, cleanse the great deal in deeds. Today’s health- poorest like lepers (Lk 5:12-14), a lepers, and drive out the demons” care workers are often absent from man with a withered hand (Lk 6:6-

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9) and a blind man (Mk 8:22), to “You received without charge, lic Medical Bureau which is the healing the servant of a centuri- give without charge. Provide your- health department of the Ugandan on, a rich man (Lk 7:1-10). Today, selves with no gold or silver, not . Thirty of most of our health-care systems are even with a few coppers for your these are designated as hospitals inequitable and segregating. Even purse, with no haversack for the while others are health centers or “social health care” systems favor journey or spare tunic or footwear clinics of varying levels with some the rich more. Corruption has not or staff, for the workman deserves soon to be formally recognized as spared the health sector in a num- his keep” (Mt 10:8-9).1 This does hospitals. The growth pattern ap- ber of countries. Poor patients suf- not mean Jesus downplayed the pears at some stage consistent with fer the final effects of corruption fact that health care has a cost to be responding to the vacuum created as they fail to receive the services met, including the human-resource by years of conflict and instabili- they need when they need them or cost, and that health-care workers ty coupled with economic collapse services of a required quality. deserve fair pay, but he was stress- and a poorly functioning govern- 4. The faith of the person to ing that money should not be the ment health-care system (Fig.1). be healed or of those taking care primary barrier. Together, Catholic health facili- of the sick is as important as the 7. But “touching” and healing al- ties had 8,043 health-care workers physical touch of a doctor or the so meant reaching out to the souls in June 2012, about one quarter of administration of medicines. This of the people he served. “Crowds the combined government/Catho- spiritual aspect is seen in many ex- were amazed when they saw the lic health-care workforce. amples of Jesus’ healing ministry mute speaking, the deformed made The private-not-for-profit PNFP( ) as was the case with the healing whole, the lame walking and the hospitals, almost all of which are the centurion’s servant when he blind able to see, and they glorified religious-founded, make up 43% said: “I tell you, not even in Isra- the God of Israel” (Mt 15:31). In of total hospitals (with 43% of el have I found faith like this” (Lk this sense he did not only touch the available capacity). 7:9-10) or when he healed the par- sick: he also touched and healed Catholic hospitals alone make up alytic (Lk 5:17-25). the minds of the crowd who then 23% of the total in the country and 5. Jesus allowed the quality of believed in him. 28% of the hospital bed capaci- his work to speak for itself. He Opportunities Available for ty (calculated from the MoH data told his patients not to tell others Evangelization through the Physi- of Dec. 2009). Catholic hospitals what he had done (Lk 5:14-16; Mk cal Presence of Health Facilities make up 53% of the PNFP hospi- 1:44) and yet his reputation contin- and Health-Care Workers tals. Out of 32 institutions training ued to grow by the day through his First, the case of Uganda is here nurses and midwives, 20 are PNFP good work without any advertis- presented simply to exemplify (over 60%). Of these, 13 are Cath- ing. Health care is today increas- such opportunities and to share olic-founded training institutions ingly commercial. In many coun- some of the attempts being made and make up 40.6% of all insti- ties the rise in the cost of health by Catholic health care to evange- tutions training nurses (and mid- care is disproportionately faster lize. wives) and 65% of all PNFP health than the expected rise in quality of The first Catholic health facil- training institutions in the country. care. In poor communities this of- ity, Rubaga Hospital, was opened So, the Catholic Church has a size- ten leads to the marketing of poor in 1899. Since then the number able presence in Uganda. It has the products or poor quality health has grown to 284 health facilities largest non-state health care and care to unsuspecting and desper- distributed across the country and training role in the country. ate people. The poor, who are of- accredited to the Uganda Catho- Most of the 8,043 employees in ten uninsured, end up struggling to pay catastrophic costs out their Fig 1: Trend of growth in number of Catholic health facilities pockets and thus get poorer. by region in Uganda 6. Jesus preached and demon- strated compassion. Healing by touch demonstrated a high lev- el of compassion because under Jewish law touching the sick was a sign of impurity. Unfortunately, today more and more health-care workers are seen to be “aggres- sive” with little or no love shown to the patients. The sick are often poor or made poor by their illness- es. Christ’s compassion for them is also reflected in his directive that the presence or absence of mon- ey must not be the primary deter- minant of access to care. At their commissioning to heal and cure the sick Jesus told the disciples:

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Catholic health facilities are Cath- terventions or approaches”, “hu- Improving governance olics. But besides those working in man rights to health care includ- and management Catholic-founded facilities, there ing the call to legalize abortion,” are several Catholic health-care etc. The easiest force to blame Weak leadership and manage- workers in non-Church employ- for the stagnation and the rise in ment have been blamed for many ment like government hospitals, prevalence of HIV is the Catholic of the problems faced by the various non-governmental organi- Church for being against these so- health-care sector. The Catholic zations dealing in health or health- called “evidence-based interven- Health Department, the UCMB, related work or in private practice. tions like promotion and distribu- has for its part made strengthen- This means that the opportunity tion of condoms”. The pressure ing of corporate governance in its for Catholic health-care workers to is even increased by the donors. network one of the top priorities evangelize exists both in the large The US government, for example, in its system strengthening strat- contribution the Church makes to has now severely cut off PEPFAR egies, something for which it has the country’s health-care system funds to programs promoting ab- gained respect within Uganda’s and outside Catholic health care. stinence and faithful marriage for health-care sector. The UCMB first the control of HIV, despite these ensures that its own governance having been the hall-mark of suc- structures function. It supports and Challenges cessful HIV prevention in Uganda strengthens the governance and in the past. Catholics in positions management of the health institu- Jesus and his early disciples of responsibility in government tions accredited to it through the carried out evangelization amidst health care and other non-Catho- training of individual managers, of many challenges, including perse- lic owned organizations find them- Boards of Governors and collec- cution. The healing ministry today selves between Catholic teaching, tive workshops. It also carries out also faces a number of challenges, on the one hand, and having to support supervision and provides but probably of a different nature. comply with priorities of organiza- scholarships. Catholic health-care They are challenges that also affect tions employing them, on the oth- facilities use the national Health the wider health-care system in the er. Some of them feel some level Management Information System. country and are mainly economic of intimidation and an “identity The UCMB hitherto has made this or economics-related and spiritual crisis”. These Catholic health-care HMIS very functional in its net- in character. workers need to be supported to work, thus strengthening its capac- The widely acknowledged high maintain their confidence and be- ity for planning and advocacy. level of corruption in the country come evangelizers of the system. has not spared the health-care sec- tor. There is a policy of free health Deliberate efforts to increase care in government facilities but What is the Catholic accessibility for the less in fact there is a lot of bribery in Health-Care System Doing? privileged of society access even to basic care. Health- care workers are frequently ac- Amidst all these challenges, The problem of inequity is not cused of having lost their moti- Catholic-founded health institu- unique to Uganda or to develop- vation to serve and are often seen tions and other faith-based health- ing countries. Michael Sheedy as not caring enough for the sick. care facilities have endeavored to gives an interesting description of More and more health-care work- bear witness to the presence of a graphic representation of such ers, especially in government insti- Christ among Ugandans. They inequity even in the United States. tutions, are also seen as not mani- have remained a beacon of hope for In Uganda (and other similar coun- festing their religious beliefs and many people in regions affected by tries) the rising cost of health care ethics in their health-care practic- armed conflict for over three dec- at the same time as declining ex- es. A shortage of medicines and ades. At such moments they have ternal donation to Church-founded medical supplies is common yet lived Jesus’ teaching: “The great- institutions (which are often ru- the government is reluctant to in- est love a person can have for his rally placed among the poor) puts crease the health-care budget. friends is to give his life for them” pressure on raising user fees which This means that even those who (Jn 15:13) and are largely still per- in turn threatens to reduce access have the inner joy to serve may fail ceived as being more compassion- to care for the poor. The Catho- to translate that message of love ate than government facilities. lic health-care facilities under the and compassion into practice be- However, Catholic health-care UCMB have struggled amidst all cause of the broken health-care institutions and workers in Ugan- these developments to keep fees system. da and elsewhere would still do as reasonably low as possible Despite the fact that Catholics better if they emulated even more while advocating for more subsi- are the single majority religion Christ’s way by integrating medi- dies from government and donors. in the country, Catholic health- cal care with spiritual care. Christ The UCMB monitors the trends of care workers, particularly in non- as a healer of the body was also a cost and user fees and the gener- Catholic institutions, are increas- healer of the soul, thus using the al economic trends in the country ingly facing intimidation because occasion of healing to evange- and offers advice to the network of their faith. There is a great deal lize. The following are some of the to ensure that economic accessi- of talk about “evidence-based in- things being done in Uganda. bility for the poor remains the ba-

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sis of all management decisions in professionals, to strengthen hos- Christ’s healing practice. The fol- responding to external challenges pital chaplaincy. Training a health lowing thirteen recommendations while remaining true to the reali- professional in pastoral care offers are made: ties of the economic environment. a perfect opportunity to respond 1. The work of evangelization In this way we try to show concern to the medical as well as spiritual starts with us, the people entrusted and love towards the poor. needs of the patient and of care- with the leadership and manage- takers in an integrated manner. ment of Catholic health facilities. The demand for them has grown We need to evangelize ourselves, Building a spirit of compassion so fast that the over seventy peo- other leaders and the people we and service ple trained so far are not enough serve by demonstrating good lead- for the thirty hospitals as they are ership and stewardship of our in- The report of absenteeism of often drawn into the health centers stitutions. Jesus already had au- health workers in Uganda’s pub- as well as into out-of-hospital care thority but decided to earn respect lic facilities as being between of the sick. The UCMB’s strategy instead of demanding; he demon- 37%-49% is disturbing. We do not is to have a team in the chaplaincy strated servant leadership and in have figures for faith-based facili- and not only an ordained chaplain. fact emphasized that “The greatest ties, including those of the Catho- among you must be your servant” lic Church. However, health-care (Mt 23:11). We are called to strive workers in faith-based facilities Increasing awareness of to serve as leaders but also to leave are still perceived as being the health-care workers about what was entrusted to us better most physically present despite Catholic social teaching than we found it (1 Pt 4:10). This their lower pay and they tend to means we must put good systems shoulder both formal and self-re- To try and address the increas- in place so that the institutions live ferrals from the public facilities ing pressure from pluralistic soci- beyond us. where high absenteeism is expe- ety, the UCMB is trying to create 2. To do the above we need to rienced. This physical presence, awareness in Catholic health-care have leadership and management even amidst economic difficulty, workers about Catholic social positions occupied by people ap- is quite consoling to the communi- teaching so that they understand propriately trained in knowledge, ty. People who qualified in Catho- the basis of certain positions tak- skills and attitudes for the job. This lic health training schools are gen- en by the Church. This is done applies to both hospitals and oth- erally considered more kind and during the annual general assem- er health-related institutions like compassionate and hard working. blies, during technical workshops medical schools and other training In this way they show the love of and during the induction of new institutions of the Church. We need Jesus to the patients. But the com- staff in some cases. For this pur- to strengthen health leadership and bination of a heavy workload and pose the UCMB spearheaded the management training by Catholic low salaries makes faith-based formulation of a guideline for the universities by making them spe- facilities have high annual staff induction of new staff both at the cial and able to impart the sort of turnovers, reaching 50% for some national headquarters (the Uganda attitude required of servant lead- cadres, although these are quickly Catholic Secretariat) and for hos- ers. replaced. pitals and diocesan health offices. 3. We need to make a hospi- tal not only a place for consulta- tion and the practice of medicine Seeking and responding to Recommendations to Catholic but also a place of prayer and the patients’ feedback health hospitals, clinics and strengthening of faith. Chaplaincy health-care workers should be strengthened by train- The UCMB, together with the ing both priests and profession- respective hospitals, carries out an- The above are all examples al health-care workers as clinical nual patients’ satisfaction surveys. of Christ sharing the good news pastoral care givers (thus forming This information is shared within with the sick and the crowds that a team: the chaplaincy), enabling the network so that Catholic health brought them. Today these are pa- pastoral care to be an integral part facilities try to remain relevant to tients and the communities among of the general care of the patients. the communities that use them by whom they live. Having been cre- In Uganda the Catholic Medical trying to address patients’ concerns ated in the image of God (Gen Bureau is at the moment the only where possible. 1:26-27), we as health-care work- organization training people for ers must let patients and commu- hospital chaplaincy. It is expen- nities see that image of Christ in sive and difficult to sustain single- Training in clinical us. Hospitals and clinics need to handed, but it needs to be contin- pastoral care be seen not only as places of high ued. medical professional practices but 4. Catholic medical schools The Catholic Medical Bureau also and first of all as living tes- or training institutions need to (UCMB) is at the moment the on- timonies to the healing Ministry strengthen and integrate ethical ly institution in Uganda that trains of Jesus. Health-care workers can teaching and spiritual mentoring clinical pastoral care givers, many do this by emulating, among other into routine training irrespective of of whom are already health-care things, the above characteristics of the training specialization .

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5. Leaders and managers need to the same objectives of serving ing national health and econom- put a special focus on improving the population, including govern- ic policies. There are policy de- both the physical and the function- ments, is one way to go. But we cisions that sometimes make the al presence of health-care workers need to be firm on the rules of the health-care system destructive of amongst patients and their imme- partnership game. We also need human dignity. Examples include diate communities in times of con- to explore other probably more the legalization and procurement flict or peace and in times of eco- sustainable resource mobilization of abortion, the promotion and dis- nomic boom or difficulties. Again, mechanisms within the different tribution of artificial family plan- this has a lot to do with attitudes national contexts. ning pills, the under-funding of the and work ethics and appreciating 10. We should aim to provide health-care sector resulting in poor that in serving there is the opportu- quality health care that “markets” health-care systems, among others. nity to give, as Jesus himself said itself as exemplified by Jesus’ own “It is more blessed to give than to healing ministry. receive” (Mt 20:35). 11. Kindness and compassion Conclusion 6. In addition to the above we should become the hallmark of our can further increase the participa- health-care practices. We need to The Catholic Church has the tion of religious Congregations in show more love to the people who mandate to provide health care as a health care. Religious Congrega- come to us for care. This requires fulfillment of Holy Scripture, thus a tions need to be stimulated to once attitudes and practice that should continuation of Christ’s spreading again become innovative and pro- be built both during training and in the good news through the healing vide more health care especial- service. ministry. Health-care workers are ly outside the traditional systems 12. More attention should be people called to individually and (hospitals) and also move into paid to the spiritual and emotion- collectively continue this evangeli- home care and other community- al needs of health-care workers zation. In many countries Catholic based services that make them take themselves than is currently the health care still forms a significant the “face of Jesus” directly for the case. A sick doctor or nurse can- part of national health care. More community. not administer well to another sick needs to be done to evangelize 7. A more human face can be person. We need support in train- both within Catholic health care given to patient care. Technology ing clinical pastoral care givers in and by Catholics working in gov- is fast reducing doctor-patient in- “provider-oriented” pastoral care ernment and non-Catholic health teraction. More and more the doc- in order to support the health-care care. Challenges to Catholic health tor knows the patient’s illness bet- providers as well as patients and care seem to be worldwide, though ter while knowing the patient less communities. However, the long- to varying extents. More innova- and less. Jesus touched and knew term solution lies in strengthen- tion will be needed to help miti- the people he healed. Patient-cen- ing the foundation of one’s faith. A gate the effects of the challenges tered health care that also reflects new evangelization targeting fam- faced by Catholic health care in the social teaching of the Catholic ilies, creating stronger Catholic emulating Christ and showing his Church needs to be emphasized in families where future health-care presence among the sick and their training and in practice. workers will grow might be the so- communities. Health-care workers 8. As health leaders, managers lution. Focus should not only be on themselves need to be evangelized and health-care workers we must health-care workers in the Catho- and spiritually supported so that be or become defenders of human lic-founded hospitals, clinics and they may evangelize better. dignity and respect for life and community-based programs. Cath- without shame fight against all the olic health-care workers wherever crusades that dehumanize the sick they may be in the country should Note and the unborn, for example the be reminded of the duty to evan- pro-abortion campaigns. gelize from where they are and 1 The African Bible has been used. 9. Catholic health-care workers helped to be proud of their identity should champion the fight for eq- and to take care of their own spir- References uitable or non-segregative health itual lives.

care that can be accessed by even 13. Health-care workers, espe- 1. Martien A. M. Pijnenburg, Bert Gor- the poorest in our societies, with- cially those in leadership and man- dijn, Frans J. H. Vosman, and Henk A. M. J. in the context of the realities of re- agement positions, need to move ten Have, ‘Catholic Healthcare Organiza- tions and the Articulation of their Identity’ ducing resources and increasing closer to and be present where pol- (HEC Forum. 2008 March; 20(1): 75–97. costs in health-care facilities. The icy is formulated in their respec- Published online 2008 April 19. doi: 10.1007/ principle of “distributive justice”, tive countries or at least find ways s10730-008-9063-8). 2. Michael Sheedy, ‘Catholics: Access to especially for basic care, should of influencing policy. Tradition- Health Care a Right’ (http://www.flaccb.org/ be central in our planning and pro- ally doctors and other health-care healthcare/accesstocare/oped_120304.htm). vision of care, as well as advoca- workers have kept to their places 3. Peter Okwero, Ajay Tandon, Susan Sparkes, Julie McLaughlin and Johannes cy actions. But with the econom- in hospitals, fearing that they will G. Hoogeveen, ‘Fiscal Space for Health in ic challenges raging on, this calls be seen as becoming political. This Uganda’, World Bank Working Paper No. 186 for some health-care financing in- needs to change. Catholics even (2012). 4. UNHCO, Prevalence and Factors Asso- novation even within the Church. outside the health system need to ciated with Absenteeism of Health Providers Partnership with those who have play a stronger role in influenc- from Work in Bushenyi District (2010).

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2.The Medical Doctor

Prof. Daniela Terribile Western world with the Hippocrat- contents with time have been en- Researcher in Breast Surgery, ic tradition, adhered to a precise riched by Christian thought. Its The Catholic University order: the duty of the physician is most recent edition in Italy was of the Sacred Heart, to do good to the patient and the on 23 March 2007 as edited by The A. Gemelli University duty of the patient is to accept this. the National Federation of Doc- Polyclinic, This was a relationship of a pater- tors, Surgeons and Dentists. Rome nalistic kind where the moral re- sponsibility of the physician lay in The modern concept of the hos- the certainty that he worked for the pital goes back to 331 AD when irst of all, I would like to ex- absolute good of his patient. the Roman Emperor Constantine, Fpress my sincere and keen- The famous Hippocratic Oath who had converted to Christianity, ly-felt gratitude to the Presi- entered history and still today set in motion a new kind of hos- dent of the Pontifical Council for has its validity, even though its pital. Hitherto illness had isolated Health Care Workers, H.E. the Most Reverend Msgr. Zimovs- The Hippocratic Oath ki, and its Secretary Rev. Msgr. Mupendawatu and all those who Aware of the importance and the solemnity of the act I perform and the work with them for having be- commitment I undertake, I swear: stowed upon me the honour and • To practise medicine in freedom and independence of judgement and the privilege of being present at conduct, rejecting all undue influences. this important event for health- • To pursue the defence of life, the protection of the physical and care workers and for having al- mental health of man and the relief of suffering, on which I will lowed me to take part in this initi- base, with responsibility and constant scientific, cultural and social ative of an international character commitment, my every professional act. on the defence of health through • To treat every patient with equal scruple and commitment, without carrying out the human and spir- reference to ethnic grouping, religion, nationality, social condition itual mission of evangelisation or political ideology, promoting the elimination of every form of through hospitals. discrimination in the health-care field. • To never engage in acts designed to deliberately bring about the A Religious Matrix death of a person. has Always been Present • To abstain from all forms of diagnostic and therapeutic exaggerated in the Relationship of Man treatment. with Illness • To promote the therapeutic alliance with the patient based upon trust and reciprocal information, with respect for and the sharing The has its of the principles on which the art of medicine is based. roots in antiquity and as a result • To adhere in my activity to the ethical principles of human thousands of years before Christ solidarity against which, respecting life and the person, I will in India, in Ceylon and in Egypt never employ my knowledge. the temples were seen as places • To make my knowledge available to the advance of medicine. of healing by the divinities of the • To entrust my professional reputation exclusively to my skills and my time. moral qualities. It was thanks to Hippocrates, • To avoid, outside professional practice as well, every act and all the father of medicine (460 BC), conduct that can damage the decorum and the dignity of the that the art of healing began to profession. be based on rational foundations. • To respect my colleagues even when there is an opposition of The Hippocratic physician was at opinions. first an itinerant professional. • To respect and facilitate the right to free choice of a medical doctor. The ethics that the father of • To provide emergency care to those who need it and to make myself, modern Western medicine hand- in the case of public disasters, available to the competent authorities. ed down reflected the ideal of the • To observe professional secrecy and to defend privacy as regards physician as a philanthropist at everything that is confided to me, that I see or have seen, understood the service of the whole of hu- or intuited in the practice of my profession or because of my status. manity, and above any division • To work in learning and conscience with diligence, skill and prudence between men. according to fairness, observing the deontological rules that govern Ever since its origins, the rela- the exercise of medicine and those legal rules that are not in tionship between the physician and opposition to the tasks of my profession. his patient, as it developed in the

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sick people from the community to teenth century there existed both in order to base on Christian ide- which they belonged. The Chris- in Europe and in the United States as knowledge, university teach- tian tradition, on the other hand, of America numerous hospitals ing and connected operational stressed the close relationship be- that were publicly or privately ad- institutions. Article 1 of the stat- tween the sick person and his or ministered. utes reads: ‘The Catholic Univer- her neighbour, and found in that re- During the nineteenth and the sity, according to the spirit of its lationship the obligation to provide twentieth centuries the experienc- founders, adopts the goal of as- care and treatment. Illness thus be- es of St. Giuseppe Cottolengo, St. suring a presence in the university came a question of priority impor- Giuseppe Moscati and Don Carlo and cultural world of people com- tance for the Christian Church. Gnocchi, who left behind them an mitted to addressing and solving, From a historical and experien- unending legacy to the Church and in the light of the Christian mes- tial point of view, therefore, there the civil community, were unfor- sage and moral principles, the is a profound link between the re- gettable. They were luminous wit- problems of society and culture’. ality of hospitals and the gospel nesses to loving care for the ‘least’ And articles 9 and 10 read: ‘The message: this relationship marked who could not find treatment in Catholic University promotes the the various stages of the subse- hospitals as they were then con- theological and moral education quent development of care for the ceived: they had a function of pub- of its students, including that re- sick. There were the so-termed lic utility which is a great conquest lating to the problems of profes- ‘hôtel-Dieu’, ‘God’s hostels’, but which cannot be sufficient to sional deontology, through other centres attached to monasteries, meet the emergencies and needs educational initiatives as well’; where monks learned the art of that emerge in every epoch from ‘The Catholic University is a medicine with a more rational ap- suffering humanity. In the lives community of lecturers, students proach. A lack of distinction be- of these great figures the authen- and administrative, technical and tween poverty and illness (pau- tic spirit in which hospitals were health-care staff marked by re- pertas and infirmitas) lasted for born emerges with all its clarity: spect for the fundamental rights the whole of the Middle Ages and to bend down before suffering of man and personal and collec- hospitals in the West remained for man, placing him at the centre of tive freedoms, as well as the prin- a long time charitable institutions. attention, without forms of dis- ciples of solidarity. The lecturers, During the eleventh century crimination, and directing towards the administrative, the technical hospitals spread in Europe. They him every possible effort in order and the health-care staff work to- were placed along the principal to meet the thousand situations in gether to maintain and strengthen routes, in cities as well as in the which human life should be pro- the Catholic unity and identity of countryside, and were institutions tected. Their witness introduced the university’. with a religious matrix, organised into the Church the ‘added’ value For us, working as medical doc- in a structural sense like monas- of creative voluntary work to flank tors and researchers inside this teries and in a legal sense like re- hospitals, which were by now cod- Catholic university community, ligious brotherhoods. Their head ified in their canons, in order to the words of Giuseppe Moscati was usually a ‘spedalingo’, who keep alive care for the person and ring out with great contemporary was nearly always an ecclesiastic. his or her needs and the freedom relevance: ‘Remember that in fol- The medical school in Salerno, of free and not planned initiatives. lowing medicine you have taken Italy, was the first and the most While the large and prestigious on the responsibility of a sublime important medical institution in medical schools were created mission. Persevere, with God in Europe during the medieval peri- and the largest hospitals began to your hearts, with the teachings od, and its first exponents and ani- gravitate to the nascent universi- of your father and your moth- mators were Benedictine monks. ties, St. Giuseppe Moscati, a med- er in your memories, with love During the Renaissance great ical doctor and university lectur- and pity for the abandoned, with figures of saints stood out who er, appealed through the force of faith and with enthusiasm, deaf to created hospital Orders, that is to his life witness to the great human praise and criticism, immune to say communities of religious who and Christian value of the medical envy, disposed only to good’. in hospital service, carried out in profession. ‘The sick are the figures of Je- a spirit of gospel charity, found The rise of the great profit-mak- sus Christ. Many unfortunate peo- their life task. This was the case ing hospital chains was a phe- ple, delinquents and blasphemers with St. John of God, the founder nomenon of the late-twentieth end up in hospital by will of the of the Hospital Order known as century. In Italy hospital institu- mercy of God who wants them to the ‘Fatebenefratelli’, and with tions and local social and health- be saved! In hospitals the mission St. Camillus de Lellis, the founder care units (ASL) became compa- of sisters, of medical doctors and of the Order of the Regular Cler- nies in 1992. of nurses, is to cooperate with this ics Ministers of the Sick (Camil- infinite mercy, helping, forgiving lians). From the Renaissance on- and sacrificing themselves’. wards the hospitals in Europe The Catholic University of the ‘Let us remember that we have were usually built and maintained Sacred Heart in front of us, in addition to a with public funds, even though body, a soul, a creature of God’. there remained the link with re- In 1920 the Catholic University ‘Do not fail to cultivate and re- ligious bodies. During the nine- of the Sacred Heart was founded view every day your knowledge.

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Progress lies in a constant criti- In a recent communication clinic, as well as being university cism of what we have learnt. One of the Catholic University one lecturer in degree courses (medi- science is unshakeable and un- reads: ‘Faced with the growing cine and surgery, nursing, ob- shaken: that revealed by God, the complexity of a university institu- stetrics) and specialisation at the science of the beyond!’ tion and its daily life, the Catho- same university. ‘Not science but charity has lic University has decided to re- I am also engaged in the coor- transformed the world in certain affirm its fundamental principles dination of national work groups periods; and only a very few men and values, defining more func- and scientific societies for the have entered history through sci- tional rules in order to achieve dissemination and standardisa- ence; but everyone can be im- the efficacy and the transparency tion of methods of diagnosis and perishable, a symbol of the eter- of the whole institution. An im- treatment of breast cancer and the nity of life, where death is only portant stage in this process is the drawing up of documents for con- a stage, a metamorphosis for a introduction, starting on 1 No- sent and guidelines to improve ac- higher ascent, if we dedicate our- vember 2011, of the Ethical Code cess to treatment throughout Italy selves to good’. and Organisational Model of the as well. We find the central thread of Catholic University of the Sacred At the level of voluntary work this witness which is so near to us, Heart’. I am the Vice-President of Su- as with so many other things that One perceives in these words a san G. Komen Italy, a non-profit have followed one another down moment of testing and self-exam- making organisation for the fight the centuries, in the words of the ination that an institution of this against breast cancer, being the Gospel which, lapidary and resist- kind must engage in so as to redis- head of its educational and mis- ant to the wear of time, remains a cover and reacquire motivations sionary activities which principal- fixed point on which to base the that should always be renewed ly involve: educational and train- wishes, the will and the works of and never taken for granted. ing initiatives for students of high generations of believers involved Evangelisation is the soul of schools, general medical prac- in an authentic medicine that is medicine on the human scale. titioners, nurses, obstetricians, impregnated with humanity. This is a value for the whole of pharmacists, the general popula- In the third millennium, going humanity which yearns for good tion and women who have had back over the history of hospitals and it is an inescapable duty for breast operations, and initiatives in general and our university in- those who work at the side of offering health care through vis- stitution in particular, we are led those who suffer in the name of its for the prevention of cancer in to ask ourselves how it is possi- the charity of Christ. women for disadvantaged wom- ble to achieve to the full the goals When thinking of the many oc- en, missionary sisters and women of such a noble but so difficult a casion when I have found myself, prisoners (health villages). profession as the medical profes- as a specialist in senology, in front sion, without hearing sound out of a woman in a state of anxiety in our hearts those words that after learning that she has breast My Personal Experience call upon us as believers: ‘Truly cancer, I realise how much Mosca- I say to you, as you did it to one ti’s statement, the outcome of his My first strong impact with suf- of the least of these my brethren, experience as a medical doctor fering, solidarity and the need for you did it to me (Mt 25:40); ‘a Sa- and a believer, is true: ‘What can relief and care of the sick took maritan, as he journeyed, came to men do? What can they oppose place at the age of thirteen during where he was; and when he saw the eternal laws of life with? Here a visit to Lourdes that had been him, he had compassion’ (Lk there is the need to take refuge in organised by the school of the 10:33). These words have deeply God. But, however, we medical ‘Marcelline’ which I attended in touched men of every epoch and doctors must strive to alleviate Milan. On that occasion my wish every ideology, inspiring initia- suffering’. ‘Pain should be treated to involve myself at a social, hu- tive, behaviour, deontological and not as a dart or as a muscular con- man and Christian level as a med- civil codes for the protection of traction but as a cry of the soul, ical doctor was confirmed. the weakest, solidarity, universal to which another brother, a medi- During my years of formation brotherhood and free giving. cal doctor, runs with the ardour of at the Catholic University there There are universal values in- love, charity’. were other stimuli and encour- scribed in the heart of every man agements as regards the pathway that cannot be disappointed with- I had chosen. In attending the sur- out running the risk of betraying Self-presentation gery department I remember the his humanity. figure of the ward sister who was Today in a socio-cultural real- I am a medical doctor who spe- dedicated to her mission as an im- ity that is very much marked by cialises in oncology and general portant reference point not only ethical relativism, by materialism, surgery and a researcher at the for the patients and their family by the logic of the market and by Catholic University of the Sacred relatives but also for the young individualism, often these values Heart of Rome. I am a breast sur- medical doctors and students. can pass by unobserved or be for- geon and the head of the Unit for My subsequent decision in fa- gotten, even where they should be Integrated Therapies for Breast vour of specialisation in surgery defended and borne witness to. Cancer at the A. Gemelli Poly- in the cancer and breast cancer

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field arose in an instinctive way in are actively involved in the multi- tres in over 80% of cases there order to resolve in a radical way ple roles of contemporary society. is the possibility of operations a disease that even today many Breasts, the organ that is af- which are increasingly limited years later is held to be fearsome flicted, constitute an important and conserve the female body and and as aggressive as ever, and co- symbol at any age (motherhood, respect the physical integrity of incided with the personal impact breastfeeding, beauty, femininity, the woman as well as the aesthetic of the contemporary diagnosis of the image of the body). dimension, albeit fully observing the breast cancer of my mother. The possibility of mutilation, oncological criteria. When an op- This family experience further al- the important consequences of eration which removes part of the lowed me to develop a sensitivity chemotherapy treatment, with the breast is required, it is extremely on the side of those who receive further loss of physical image, al- important to have available the treatment. beit temporarily, and the possi- possibility of an immediate re- I remember how many times ble loss of a procreative capacity construction using different tech- my mother after tests or visits generate major difficulties in re- niques through close cooperation made me observe the lack of sen- lationships with family relatives between the plastic surgery team sitivity towards, or respect for, the (husbands and children) and col- so as to avoid the psychologi- patient on the part of medical doc- leagues, with frequent phenom- cal injury of mutilation. The de- tors who were in a hurry or dis- ena of isolation, flight, rejection scription of the subsequent stages tracted, and she exhorted me not and excessive apprehension. should take place in a climate of to do the same in my profession. In contemporary society the empathy within a spatial and tem- increase in the age at which the poral context that is suitable to the first pregnancy takes place makes importance and the critical char- The Scale of the Problem more probable a situation where acter of the moment, with it being the appearance of breast cancer ascertained that the need for the Breast cancer is a social prob- takes place in a woman who wises treatment, and what the treatment lem. Every year in the world for motherhood which has not yet consists of, has been understood. 1,400,000 women are afflicted by taken place or with children of a The Breast Unit is character- it and in Italy 47,000, with about pre-school age, with a consequent ised by the constant presence of a 11,000 deaths every year. The in- further grave malaise or suffer- complete multidisciplinary group cidence of this pathology is on the ing experienced by the woman in- of medical doctors (radiologists, increase and it is estimated that volved. surgeons, anatomy pathologists, at the present time one woman For a medical doctor special- radiotherapists and oncologists), in every eight during the course ised in senology there is a need psychologists, nurses, physiother- of her life will encounter this ill- to act on various fronts: sensi- apists and often voluntary work- ness. In parallel with this increase tisation and prevention for the ers who help to spread the burden in incidence it should be observed healthy population (communi- of suffering caused by an illness that over the last ten years the ties, places of work and schools) that is so multifaceted as is the death rates have fallen because with a publicising of the impor- case with breast cancer. of a series of factors. On the one tance of correct lifestyles; forms In our country and in the mem- hand, we may point to increasing of early diagnosis such as breast ber States of the European Com- health-care education and sen- scans etc; and the use of increas- munity there is underway a col- sitisation as regards prevention ingly prompt and targeted diagno- lective effort by medical doctors, which has allowed an increasing ses and integrated therapies. women’s associations and gov- number of prompt diagnoses and In recent years at a national ernment institutions to ensure that thus better prognoses, and, on the and international level there has this model of diagnosis and treat- other, there has been the availabil- developed the concept of the in- ment is implemented on a large ity of increasingly effective forms tegrated diagnostic-therapeutic scale in order to assure uniform- of treatment and ones that respect pathway which is based upon ac- ity and fairness of treatment for the functional and aesthetic integ- companying the woman along the women who have this pathology. rity of women, something that has whole of that pathway with a sin- led to a greater acceptability of gle centre of reference (the Breast such treatment. Unit). This form of action allows The Dimension of Listening At the present time the possibil- the setting in motion of more suit- ity is emerging of acting in terms able examinations with a clear re- Down the centuries the rela- of primary prevention through the duction in the time that is needed, tionship between the medical adoption of correct lifestyles (cor- of bureaucratic procedures, and an doctor and the patient has certain- rect diet and constant physical ac- optimisation of information with ly changed from being paternalis- tivity). Given that the age band the patient being ‘guided’: for ex- tic to having more informal and that is most afflicted is that of 45- ample at the moment of diagno- cooperative tones with the goal of 75, one can understand how this sis it is important that information achieving a therapeutic alliance. is an illness that affects people that does not involve divergences For a long time, however, com- who are the fulcrum of society in is provided by a single health-care munication in the therapeutic- their capacity as workers, wives, worker. As regards treatment, at care context was seen as a sponta- mothers and grandmothers and the present time in qualified cen- neous process that was connected

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with the features of the personal- and professional work, part of the ing him or her as free and able to ity of the individual health-care necessary equipment of a com- choose. In this being present, with worker or the individual patient. plete medical doctor. reason and the heart, in this open- In other terms, the problem was And to listen means to direct ness, is achieved the cognitive ex- not posed of the meaning of com- oneself to welcoming the other, perience and the relational expe- munication and its value was ig- in his or her irreducible otherness. rience. nored as regards the recovery of The body and the mind are like In recent years people have health or clinical improvement. prostheses on the threshold, ready come to acknowledge the advan- At the present time a large number to be reached by what will come: tages of effective communica- of researchers have addressed the this is total listening to looks, to tion in the relationship between question of communication with- voices and to emotions. the health-care worker and the in the health-care relationship and Open listening requires a readi- patient, starting with very differ- have stressed the importance of ness to encounter the other where ent approaches: from the strictly this dimension in the wider con- he or she finds himself or herself, clinical approach to the ethical text of health and illness. If every in suffering, in fear and in lone- approach, and from the economic illness is an uprooting, a loss of liness. It assumes a natural incli- approach to the organisational and belonging, then every patient can nation to freedom which is trans- managerial approach. The qual- become a refugee who loses his or lated into an approach without ity of communication today con- her certainties, the usual and safe temptations to engage in domi- stitutes an ineluctable objective spaces of his or her daily life. nation or judgement about the which does not ask to be justified When a patient turns to a medi- other. It assumes the courage to or illustrated but solely explained cal doctor to ask for help, he or set out on a journey towards un- through forms and strategies, she intentionally looks for the known lands through unexplored measured with increasingly sen- possibility of a meaningful en- pathways, aware of one’s own sitive indicators and translated counter in order to calm his or her fears and frailties, with memories into guidelines that mark the be- anxieties, to find new answers to of one’s own fallibility, aware of haviour of all health-care work- questions that are not only clini- being alone and at the same time ers at their respective levels. ‘It is cal in character. This is a search dependent on the other. Attention no chance, as the literature in the that takes place amongst unfore- to the dynamics of communica- field has for some time stressed, seen fears and new insecurities. tion coincides with attention to, that the variations in the process- It is precisely in this no-man’s- and care for, the relationship in es of communication influence in land that the encounter between its multiple aspects: it involves a relevant way some outcomes in the medical doctor and the patient not only a consideration of ver- the behaviour and attitudes of pa- can take place. bal messages but also attention to tients, such as satisfaction as re- It is striking that in the face of the non-verbal communication of gards the medical examination, illness even men of success or the patient. Open listening is al- following the therapeutic indica- culture, who are very self-con- so, indeed, listening that is in par- tions (compliance) and a reduc- fident and confident about their allel with a number of channels tion in their worries’. own decisions, display a disquiet that have been opened up: from Once again the problem is not that delegates to the medical doc- the channel of perception to that whether to do it but how to do it: tor responsibility for complex and of the emotions and on to that of how to take responsibility for the demanding decisions. To receive logic and reason. A medical doc- need of the patient for communi- a patient being aware of this dis- tor is thus engaged at different cation, which takes the form in quiet means for a medical doctor levels that belong to his or her practice of a need for informa- to cross a threshold, to forgo his interiority and to the relationship tion: knowing more, about one- or her language, and to construct contemporaneously. The micro- self, about one’s illness, about its with the patient who is his or her elements and the macro-elements, management, and a need for edu- interlocutor a new language. On- facial expressions and looks, like cation: how to manage one’s ill- ly this approach puts the medical body posture and gestures, allow ness in a better way, but also how doctor in a condition to listen to an understanding of congruencies to manage oneself in relation to a history and not only a story of and discrepancies as regards the the illness, how to reorganise the symptoms; not an anamnesis but contents of verbal messages and complex network of social-famil- a narrative. at the same time are indicators of ial ties which are troubled by the However, knowing how to cre- the quality of the relationship, in- illness. This is a relational sphere ate a climate of empathetic lis- dicating what is taking place here where the medical doctor, the tening, of trust and of security; and now. nurse, are called to act above all knowing how to avoid excessive Having a cooperative and non- on the educational front, acquir- normative attitudes; being able to judgemental approach, a capac- ing an increasing awareness of the manage emotional dynamics and ity to feel with another without therapeutic value of non-pharma- communicative processes; and, becoming lost or confused (em- cological aspects. This is the mo- lastly, knowing how to be pre- pathetic understanding but not ment to adopt the role of being a sent for the other, are not innate confusing identification), means counsellor or to take advantage of and natural capacities, but, rath- being able to respect the self- the competence of a counselling er, the outcome of long personal determination of the other, see- service that is strictly integrated

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into the medical area of reference. pany the will to go on living and harsh and unpredictable no man’s In our reality, at the Gemelli thus to receive treatment. land where anything can happen, Polyclinic, the Breast Unit avails The change in the image of the where a different language is spo- itself of the support of a team of body, indeed, passes not by way ken. To listen without a memory psychological/cancer women of the illness in itself but by way and without wishes, as Bion says, health-care workers who are es- of the treatment: the operation, the means for the medical doctor to pecially dedicated to the prob- chemotherapy and the reconstruc- be able to listen to the other and lems of cancer in women and who tive surgery. What is changed is to what is taking place in the re- are at the side from the very con- not seen and does not deform, lationship with the patient, rather tacts onwards of the pathway of at least initially, the body. What than allowing himself or herself the patient both at the diagnosis treats is what modifies the body. A to be deafened by the noise of stage and during the subsequent mastectomy operation: a devital- theories about the illness, by di- stages (admission and/or helping ised body, a fragmented body: the agnostic concerns and by the ur- therapies). patient thus finds that she has to gency of therapeutic decisions. In the case of breast cancer the face up to mourning, losing a part To cross one’s own frontier means feeling of a loss of fixed points of herself, losing the self-object. for the medical doctor to discov- and of exile is even more accen- That modified body represents the er that dynamic towards what is tuated because of the innumera- absence of the malady, the emp- concealed, towards what needs ble symbolic and cultural mean- tiness that was previously occu- to find a voice and an interpreta- ings correlated with the part of the pied by the tumour, the piece of a tion. To interact with this reality body that it afflicts. sick body that remains constantly means to forgo the cold and safe Breasts in every culture are in the memory. Losing oneself in thinking of the technical in favour seen as a characterising element the hope of surviving; the antith- of affection-thinking that allows of the female identity, a symbol esis of what happens, at the lev- an understanding of the reality to the utmost of affectivity that el of imagination, to the cancer of the relationship with the other nourishes and welcomes, of the cells: so as not to kill, these kill; who is in front of one. It means capacity of women to give and this (chemotherapy) kills so as understanding how one feels in- to give of themselves. At a more to allow the person to live. Other side this illness, what it means unconscious and archaic level, corporeal changes are also caused for that patient to be what he or breasts are the symbol of crea- by the therapies. Chemotherapy, she is, what it means, for exam- tivity and affectivity, indeed they in particular, is the other side of ple, to suffer in a cardiac illness are the basic symbol of creativi- cancer, to the extent that it reveals and have stomach cancer, what it ty. The breasts and the heart are what is hidden: the falling out of means to have lost one’s father at objects that are often seen as the hair, the swelling of the face. an early age perhaps because of same and interchangeable, not on- the same illness or to have been ly because of their closeness but abandoned by one’s parents or to also because they share the char- Illness as a School for Life have a physical malformation or acteristic of an analogous emo- to have grown up without the pos- tional meaning (indicated as sym- How often is it the case that a pa- sibility of hearing sounds or see- bols of affective life). tient comes out of an illness trans- ing colours. It means to interact We can affirm that the breasts formed, not only because he or with a sense of powerlessness, of are the authentic system of val- she is clinically cured but because anxiety and of loneliness: and this ues that are reflected both in intra- his or her outlook on things, in the is not easy or painless. But only in psychic terms (the relationship facts that concern him or her, has this way can the patient be helped with one’s existential identity and been changed. And this changes to tolerate in a better way his or gender identity) and in relational the person involved, it makes him her pain, the suffering that he or ones. or her different: he or she appre- she is experiencing. In this sense A women with breast cancer ciates different things, attributes can one educate the patient, giv- is doubly wounded in her iden- different levels of importance to ing him or her the possibility of tity: wounded in her possibility them, tolerates some things bet- acquiring experience. One ought of thinking in female terms and ter and does not in the least tol- to be or become, to use the words in portraying herself in relational erate others. Essentially, the per- of Godamer, a wounded healer, and social terms; wounded in her son involved has passed through a person, that is to say, who is possibility of thinking about her- a school for life, in which some- able to provide care but also able self in unconscious terms as the one has taught him or her many to feel that he or she is a patient, bearer of creativity: the breasts, things about his or her illness but able to feel wounded. This does that good and creative part that above all about the person who not mean to eliminate the asym- are so intimately linked to femi- has had that specific illness. But metry of roles, of knowledge or ninity and maternity, become, this assumes, as regards the medi- even less the existential Healthy- because they are struck by the cal doctor, a courage to go beyond Sick asymmetry, but it does mean, illness, bearers of a message of his or her own boundaries, to go rather, to be able to draw near death, of negativity and of de- beyond his or her cultural and ex- and welcome diversity. struction. New self-images and istential certainties. To cross the A medical doctor is constantly images of one’s own body accom- frontier means to venture into that in contact with sick people who

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are reaching the end of their ex- tients and their family relatives frequently made: lack of time and istences. Faced with a dying per- rarely believe that everything that lack of specific training. son, beyond the more strictly pro- is possible has been done and the Learning to communicate with fessional aspects connected with doubt that the medical doctor has the patient at such delicate mo- medical care and treatment, a se- not been able to correctly man- ments means reviewing one’s own ries of questions are often posed age the situation because of a way of informing, removing it both which involve him or her at an lack of skill or negligence is al- from a brutal schematic approach emotional, ethical and spiritual ways ready to spring out. Thus is of data and from a general dilu- level. Although the prognosis for nourished a dispute well known tion of information in a conver- many illnesses which until a short to recent developments in legal sation that is as cut back as it is time ago were seen as incurable medicine which has to face up to fleeting. Informing means bearing has changed, the prospect of death an increasing level of distrust to- well in mind the emotional reso- is always present in the evolu- wards the medical class which is nance that the data can generate in tion of some of them and anyway very often guilty of not knowing the patient right away and also af- death remains a destiny that is in- how to transform the successes ter a period of time when, perhaps evitable for everyone. Removing of technology and science into on his or her own, he or she will the idea of death is not materially guarantees of immortality. One reason about things and their dra- possible given that man is called consideration that one can draw matic character will emerge. The to integrate the idea of death into from this fact is that nobody has medical doctor and the patient his existence as a debt that sooner adequately helped patients and can both try to flee from this very or later he will have to pay. Thus their family relatives as regards onerous stage of knowing and it is not ethically licit to remove the encounter with death. For this making known about, but certain- the idea of death, given that eve- reason, in some institutions, such ly an approach of this kind trou- ry man must necessarily experi- as hospices, counselling in ac- bles all the other aspects of the re- ence it. But the dominant culture companying death has been cre- lationship. The medical doctor in of contemporary society tends ated. saying a truth of this nature fears to mask the reality of death, as The encounter with death that he or she will have to admit though in avoiding thinking about could become less complex if his or her powerlessness and his it and understanding it on one’s people were habituated to seeing or her defeat, but the same situ- own personal horizon, in defini- death as a natural and inevitable ation can arise for the patient as tive terms ignoring it, it is also event to which one should give a well, and thus one can generate possible to defeat it. meaning according to one’s per- a circle of distrust where the pa- It is not surprising, therefore, sonal beliefs and for which one tient seeks alternative solutions to that when one cannot help speak- should prepare oneself because the relationship with that medical ing about it our culture chooses one does not know where, where doctor whose answer he or she the most spectacular and dramat- or how it will take place. A sick does not see as satisfactory. This ic forms and ways of doing this, person should be helped to die, is a risk that the medical doctor as though whatever the case it teaching him or her how to die as has to run, but nonetheless assur- wanted to distance it from daily well, with full respect for his or ing the patient his or her support experience. It is no accident to- her anxieties and fears, expecta- and reassuring him or her about day that people are much less tions and hopes. Beyond the un- the fact that he or she will not be prepared for addressing an event doubted professional competence left alone to fight this very diffi- of such importance. Many of the with which a medical doctor cult battle. The patient, or his or human, moral and spiritual val- must demonstrate in all of his or her family relatives, may also ac- ues with which in past years one her conduct that everything pos- quire other information in order to prepared oneself for welcoming sible has been done to ward off check what has been said by the death on one’s own existential death, there is a relational aspect medical doctor but if they find a horizon have been lost. In a cul- that has totally special configu- concordance they will know how ture of success, the value of life is rations. Involving the patient so to find in his or her intellectual measured by the categories of ef- that he or she participates know- honesty and his or her availabil- ficiency and productivity, as a re- ingly in the process of his or her ity at the level of the relationship sult of which the drawing near of death is an explicit recognition of what they really need in order to death is seen as a defeat, a failure his or her dignity and his or her face up to death and dying. that is personal but also scientific right to be defined as a protago- Honest and courageous in- and professional in character. De- nist of the medical choices that formation, with the admission spite the availability of very so- concern him or her. In some cas- of one’s own limitations and the phisticated technology, medicine es, the levels of anxiety increase proposal of an alliance can allow retains its limitations which also and can be controlled only by a pain and suffering to be faced up becomes accentuated because the dual pharmacological and psy- to in all their expressions, through level of the expectations of man chological/educational interven- a wise use of medical products for increases more rapidly than it is tion from which the medical doc- the treatment of pain. The patient possible to satisfy them. Faced tor cannot withdraw, not even by should be helped to understand with death, even when it is only placing to the fore the two argu- that although the battle against suggested as a hypothesis, pa- ments to which reference is most the illness has in a certain sense

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been lost, that against quality of course about death and life, about ready difficult situation. Actual life during this very delicate stage the meaning of both, which is experience has been rather dif- is still fully possible and involves open to recognising the meaning ferent and in general people who the greatest possible reduction in of the life that has been lived and for many years have been distant pain, the possibility of keeping the meaning of life that remains from their faith and the practices alive the network of family affec- to be lived with that person or of piety also receive with serenity tions, and an intense exchange of in those circumstances. Counsel- and with peace this last cateche- requests and answers between the ling that expresses confidence in sis. But in a completely surprising patient and the medical doctor. the capacity to understand and to way one may observe that sick Day by day, and at times moment forgive, if this is necessary; in the people appreciate even more the by moment, the patient is called capacity to be grateful and in sim- action of the medical doctor who upon to talk about his or her pain plicity to express what, however, when seated next to them does and the efficacy of the drugs and has been an occasion for suffer- not withdraw from this dialogue medicines, about his or her wish- ing and a lack of comprehension. about death, an authentic dialogue es and the possibility of meeting Counselling where, of the patient about the highest systems. It is in them. There is a continuous moni- so requests, one can speak serene- the face-to-face encounter with toring that expresses a process of ly about God and heaven which another person that fear gradual- negotiation in which the medical awaits not only those who have ly loses its dark tonality, closed to doctor is an interface between the lived an upright and generous life any possibility of a future devel- pain and the patient, in order to but also those who have not man- opment. reduce the former to the complete aged to live in this way because advantage of the latter. they were weighed down by neg- Counselling should also in- ative experiences which they had Conclusions clude the family relatives who not been able to work through and most closely take responsibility resolve. For them, as well, a mo- The drawing up of this paper for the patient and who add to the ment of rest and abandon arrives proved a very important, unex- psychological stress which any- in a divine justice that goes be- pected and extremely useful mo- way involves them in the spiral yond human justice, in the love of ment of reflection on my work as of loneliness and abandonment: God who will know how to amply a medical doctor inside a large those who remain can feel terribly compensate for a lack of love that Catholic university polyclinic. A alone, almost betrayed by those has been lived through or wrongs moment of assessment and also who pass away, and they can al- that have been endured. Coun- of self-criticism as regards my so feel all of the physical stress of selling at this stage is nourished initial ideals rich in enthusiasm, the relationship of care, above all by hope, a human and supernatu- of a wish to contribute to allevi- when the patient is at home. Phys- ral hope, which will grant to eve- ating human suffering until a ma- ical assistance, the organisational ry man in practical terms what turing of an awareness of human burden of caring for the sick per- he needs, what he wishes for, in and professional limitations and son and the continuation of other a perspective of life that endures the need for a constant reference family and professional respon- beyond time, that heals injustices, to faith. sibilities, create situations which fills gaps and places us in the con- My work has allowed me, and often lead to authentic forms of dition of those will find lost affec- allows me, the opportunity and burn out. Good counselling in this tions and more simply will wait the privilege of helping to train case can act beforehand, predict- for affections that they are now young health-care workers, med- ing reactions that are completely leaving. ical doctors and nurses. In this natural and strengthening indi- For many years a part of this field, side by side with the possi- vidual defences, through calls on counselling has been engaged in bility of providing technical no- a broader family network of sup- by the chaplain of the hospital, by tions directly in the surgical field, port as well. But it should cer- the parish priest or by the priest. in a clinic or in a department, the tainly be set in motion as soon as Today these figures have been no- fundamental effort has been to the first signs of giving way are tably reduced in number and in a understand the importance of ex- identified, which are that much certain sense the barriers have in- treme attention paid to the sick more grave the more one is deal- creased which separate the sick woman and her context. For ex- ing with situations that tend to be- from a personal encounter with ample, women patients with a tu- come chronic and where at times the Grace of God, whatever their mour at an advanced stage who the family relative can also have faith may be, not least because arrive still today in a large city to feelings of guilt when the mental/ fear of death and separation leads be placed under our observation physical hard work that he or she family relatives to delay – often to are the result not so much of ig- does not manage to deal with re- the point of making it impossible norance about the illness but of- quires spaces of relief and a break – the encounter of their sick rela- ten of a grave psychological ma- for that person. tive with a priest. The explanation laise which at times they have Counselling that prepares for this is that the patient could preferred to go through in isola- someone to die is counselling become frightened and thus the tion in order to conceal their ill- for that person’s family relatives: intention is to avoid anything that ness our of a fear of facing up not with a clear and courageous dis- could render heavier his or her al- only to the treatment but also to

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the judgement of the medical doc- tients whom I had an opportu- Bibliographical References tor. It is therefore fundamental to nity to meet and whose illnesses learn how to intervene helping but I have been able to follow. I am Macellari G., Pluchinotta A., and Ter- ribile D., Senologia pratica (Edizioni Min- never frightening or judging. however still convinced that the erva Medica, 2007). My experience in hospitals has evolution of technology, a funda- Orlandelli E., Palazzoni G., Terribile been enriched in recent years by mental instrument for the medical D., and Ferrarese D., Seno buono-seno cat- tivo (Alpes, 2009). new knowledge relating to tech- doctor and for the optimisation of Bruni R., ‘La prospettiva emotiva nel- nological advances and knowl- care and treatment, cannot be sep- la relazione con il paziente’, in Binetti P., edge about man (anthropology, arated from a careful dimension Bruni R. et al., Persona, paziente, cliente (SEU, Rome, 1999), pp. 79-128. psychology), at times changing of ‘listening’ and of ‘presence’ in Binetti P. and Bruni R., Il Counseling what I thought were rooted con- relation to the patient. From this in una prospettiva multimodale (Edizione victions. Suffering has been a point of view, Evangelisation is Magi, 2003). Bruni R., Sentieri sensibili: per una great teacher with its reverbera- truly the soul of a medicine on the fenomenologia del dolore (AUS-l’Ancora tions in the lives of various pa- human scale. nell’unità di Salute, 2007) n. 1, pp. 50-57.

3.The Nurse

Sister Alžbeta Bc. Jana to the full their Christian powers sation? I was especially touched Galgóciová which are often buried and suffo- by the words of the Holy Father Sister of the Congregation cated, the more these realities will Benedict XVI to be found in his of St. Elisabeth, be at the service of the kingdom encyclical : ‘In- Bratislava, of God and therefore of salvation dividuals who care for those in the Slovak Republic in Jesus Christ’.¹ need must first be professional- To be full of the spirit of the ly competent: they should be Gospel means to draw upon the properly trained in what to do and t the outset I would like to words of the Lord, to know them, how to do it, and committed to Athank His Excellency Mon- to make oneself shaped by them, continuing care. Yet, while pro- signor Zygmund Zimowski for and to spread them. This means fessional competence is a prima- his kind invitation to me. It is a inviting Jesus into every activ- ry, fundamental requirement, it is great honour for me to be here in ity that we are engaged in for not of itself sufficient. We are de- front of the distinguished guests sick people, to be rooted in Christ aling with human beings, and hu- and participants of this interna- so as to bear personal witness. man beings always need somet- tional conference. Thanks to this fact we know the hing more than technically proper The evangelisation of the reason for our work because ‘the care. They need humanity. They health-care world concerns all love of Christ controls us’ (2 Cor need heartfelt concern. Those those of us who work in hospi- 5:14). From this personal rela- who work for the Church’s cha- tals as medical doctors, nurses or tionship with God we draw the ritable organizations must be dis- health-care assistants. It does not strength and the love to serve the tinguished by the fact that they do concern only priests, consecrat- sick. God touches the sick person- not merely meet the needs of the ed men and women or volunteers ally but also through health-care moment, but they dedicate them- who come to hospitals, but, rath- workers such as ourselves. We are selves to others with heartfelt er, all of the lay faithful who by instruments in the hands of God. concern, enabling them to expe- their baptisms became witnesses In order to be able to carry our rience the richness of their huma- to the love of Christ. work we need significant training nity. Consequently, in addition to An especially suitable con- or so-called ongoing apprentice- their necessary professional trai- text for evangelisation is, without ship in the health-care field. Side ning, these charity workers need doubt, a place of work where peo- by side with the professional part a “formation of the heart”: they ple live in suffering. Pope VI in of things, the human approach is need to be led to that encounter his Apostolic Exhortation Evan- the inseparable part which is re- with God in Christ which awa- gelii Nuntiandi observed: ‘The quired above all of we health-care kens their love and opens their more Gospel-inspired lay peop- workers. But what should a hos- spirits to others. As a result, love le there are engaged in these re- pital assistant who is at the same of neighbour will no longer be for alities, clearly involved in them, time also an evangeliser be like? them a commandment imposed, competent to promote them and Is one dealing only with profes- so to speak, from without, but a conscious that they must exercise sional care or also with evangeli- consequence deriving from their

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faith, a faith which becomes ac- lifestyles and because of their ad- feeling of loneliness produced by tive through love (cf. Gal 5:6)’.² mission to the clinic they live far his or her uphill journey. 9 Love for neighbour as a conse- from their families. For this rea- A health-care worker/evange- quence of our faith. son, from us is expected empathy, liser is a worker full of the Spirit I live in the Congregation of respect and welcoming. If we ded- of the Gospel, he or she is rooted the Sisters of St. Elisabeth, whose icate time to them, listen to them in Christ, attends to the formation principal charism is assistance to with commitment and attention, of his or her heart, serves God the sick. Our patron saint is St. they open their hearts and allow through man, enters the world of Elisabeth of whose feast us to enter into their needs and the values and the needs of oth- day we will celebrate in the next help us to mobilise their strength.5 er people, and gives altruistically few days. Elisabeth was a Prin- A serious illness leads a person to everything that he or she has re- cess and the daughter of Andrew reassess all of the values in which ceived gratuitously. II, King of Hungary, who forwent hitherto he or she has believed. If I would like to end my paper her inheritance, founded hospitals this moment is perceived correct- by paraphrasing the words of our and personally served the sick. In ly, it can become one of the most Founder: ‘All great acts of love this way, she carried out the great valuable and fruitful periods of his are nothing but a constant de- mission of love to which all of us or her life.6 It can be transformed crease and extinction in order to are invited by the Gospel: ‘as you into a period of personal prayer, make Christ grow. This depends did it to one of the least of these research, and a closer link with only on the spontaneous sacrific- my brethren you did it to me’ (Mt God. Many people have found re- es and obedience of the servants 25:40). This message during the lief, help and liberation through of God, who in response to His seventeenth century touched our prayer, and have been able to bear call plant and water. However, the founder, Apollonia Radermech- the burden of illness and to accept words of St. Paul always apply: er. Following the example of St. what they would otherwise not “So neither he who plants nor he Elisabeth, she completely dedi- have had the strength to accept. 7 who waters is anything, but only cated herself to service to the We must help sick people to dis- God who gives the growth”’ (1 sick. Mother Apollonia said: ‘God cover the true meaning of suffer- Cor 3:7).10 gives to man the capacity and the ing so that they accept it and unite Specifically for this reason, we necessary graces for the tasks He their suffering to the suffering of must give gratuitously what has calls him to’.³ Christ. 8 It is difficult to find com- been given to us gratuitously! From the Gospel we know that forting words in suffering but this Christ paid especial attention to can be compensated for through Notes the sick. God has called us to en- attention, personal interest and gage in a service that draws us prayer for the patient or prayer 1 Pavol VI, 1992. Evangelii nuntiandi. near to Him. This is noble work directly with him or her. At first Zvolen: Združenie Jas, 1992. 45 s. ISBN 80- 900548-4-6. which Christ has given to us sight these are small things. How- 2 Benedikt XVI, 2006. Deus caritas est. through his words: ‘As the Father ever, they become for patients Trnava: SSV, 2006. 48-49 s. ISBN 80-7162- has sent me, even so I send you’ great expressions of love. Meeting 594-9. 3 Brosch, Jozef. 1997. Apolónia Rader- (Jn 20:21). In caring for the sick the needs of the souls of people mecherová. Bratislava: vydavateľské druž- we carry out the message of God who are seriously ill has a rath- stvo LÚČ, 1997. 62 s. ISBN 80-71-14-215-8. by which we health-care work- er important role. Here I would 4 Ján Pavol II.: Talianskej federácii pra - covníkov ortopedickej techniky, 19.11 1979. ers become ‘merciful Samaritans’ like to stress the importance not In: Insegnamenti II/2 (1979), 1207, č.4. Po- (Lk 10:30-37). Our work becomes only of oral communication but rov.: Ján Pavol II.: K účastníkom vedeckého a service to life by which by way also of non-oral communication kongresu, 21.5.1982. In.: Insegnamenti V/2 (1982), 1792, č.5. of man we serve God and in this by which we create a relationship 5 Ďačok, Ján. 2000. Človek, utrpenie, ne- way become his co-operators’.4 with the patient which allows us mocnica. Trnava: vydavateľstvo Dobrá Kni- Women nurses, who engage in to communicate at the level of ha, 2000. 75 s. ISBN 80-7141-300-3. 6 Svatošová, Marie. 1995. Hospice a ume- complex care, spend most of their feelings. The patients speak to us ní doprovázet. Praha: ECCE HOMO, 1995. time with patients. Specifically about their families, their wishes, 38 s. ISBN 80-902049-0-2. for this reason they should be the their plans and their unanswered 7 Krivohlavý, Jaro. 1991. Kresťanské péče o nemocné. PRAHA: ADVENT, 1991. 52 s. first, if not the only, people with questions, often, however, they 8 Hatoková, Mária a kol. 2009. Sprevá- whom a patient can speak about speak to us about their spiritual dzanie chorých a zomierajúcich. BRATI- his or her spiritual needs. I work lives. To take care of a sick person SLAVA: vydavateľstvo DON BOSCO, 2009. as a woman nurse in the cancer means to bend down before him 122-123 s. ISBN 978-80-8074-095-5. 9 Ďačok, Ján. 2000. Človek, utrpenie, ne- clinic and I meet patients who or her in order to make him or her mocnica. Trnava: vydavateľstvo Dobrá Kni- live in fear and anxiety because feel better, to remain silent in or- ha, 2000. 125-126 s. ISBN 80-7141-300-3. 10 Brosch, Jozef. 1997. Apolónia Rader- of the uncertain prognosis about der to share in his or her suffering. mecherová. Bratislava: vydavateľské druž- their illnesses. Patients often have This is a personal approach which stvo LÚČ, 1997. 74-75 s. ISBN 80-71-14- to fight with the changes in their helps the patient to go beyond the 215-8.

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4. The Volunteer: Volunteers in Hospices, Hospitals and Home Care for the Elderly in Poland

Ms. Anna Janowicz all these elements of interdisci- minally ill and dying with great Poland plinary care. Helping the patients support from the Church. It be- in their activities, leading discus- came a model for creating more sions, helping solve everyday is- than a hundred home care pro- sues and responding to the vari- grammes in Poland which were ous needs of patients and families based on the voluntary work of 1. Volunteering as a Part of are the tasks of volunteers. A re- physicians, nurses, chaplains and Caring Teams in Health-Care duction of anxiety, of uncertain- others5 [p. 253]. The Church was, Institutions and Home Care ty and a feeling of loneliness are and still is, a very strong sup- important elements in non-medi- porter of hospice programmes in Volunteers play an important cal care. The volunteer offers the Poland. In 1987 Pope John Paul role in the caring process. Accom- patient his or her time, listens, II recognised the great amount panying patients and their fami- and can respond (personally) or of work done by hospice volun- lies and listening to their needs inform professionals of the car- teers when he used these words without a professional distancing ing team when this is needed. Of- during the meet­ing with the sick are the values that are added by fering time to listen to concerns, and disabled, health-care work- suitably trained volunteers. Pa- sharing prayers, favourite read- ers and volunteers: ‘I admire the tients usually feel a greater dis- ings, and assisting the patients hospice, which has undertaken its tance from a doctor, nurse or and their families could be the service in Gdansk and is spread- chaplain. A volunteer often be- precious gift of a volunteer.1 The ing into other cities. It was born comes a friend of the patient and importance of these aspects of out of the common concern of the family and can help in responding care was stressed by the Found- chaplaincy and doctors standing to their needs.1 Volunteers should er of the Modern Hospice Move- by their patients’ beds about the not take the place of professionals ment, Cicely Saunders. She said: proper place and conditions for and in their training they are in- nothing else matters because you patients at the end of their lives. formed that they are not allowed are who you are. Nothing else This concern is expressed in their to enter the realm of responsibility matters to the last moment of shared attention­ and nursing of ill of professional figures. However, your life. We will do all we can, people in their homes, in heartfelt there could be a valuable ‘link’ in not only to help you die peaceful- and disinterested self-sacrifice’5 various areas of care. This should ly, but also to live until you die.4 [p. 37]. be used in institutional and home In the twenty-first century, the care only when it is accepted by professional and well-established professionals and adequately co- 2. Volunteering and its hospice-palliative care system in ordinated by the volunteer coor- Development in Hospice Poland started to lack volunteers dinators. Such training has been Palliative Care in Poland in caring teams. The involvement prepared, conducted and pub- of society was promoted as a part lished by the leaders of hospice- Volunteering for hospice-palli- of a nationwide campaign enti- palliative care volunteering teams ative care was crucial in the crea- tled ‘hospice is life too’. One of in Poland.2 It can be adapted to all tion of the hospice movement in the purposes of the annual nation- the institutions of health care and Poland. During the difficult peri- al campaign is to educate the gen- home care where the help of vol- od of political changes and ‘Sol- eral public and to encourage peo- unteers is accepted by the caring idarity’ the first home care hos- ple from different social groups teams. pices were created with the major and different age groups to volun- Holistic hospice-palliative care support of the Catholic Church teer in hospices. In 2007-2010 the tries to respond to the different and they were based fully on the National Chaplain for Hospices needs of the patients, offering voluntary service of medical and and the Hospice Foundation con- medical, psychological, social non-medical staff. In Gdansk, the ducted a nationwide programme and spiritual care which is im- birthplace of Solidarity, health- for hospice-palliative care volun- plemented by various profession- care workers and students used teering which led to the develop- als of the caring team.3 The time to gather in churches. In 1983, ment of voluntary involvement in offered to patients and families during martial law in Poland, the home care and institutional care by volunteers in hospice-palli- first home-care hospice team was for people towards the end of ative care is a valuable help for formed, giving help to the ter- their lives.6 Promoting volunteer-

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ing among different social and could have a little rest during my 3. Volunteering in Pastoral age groups, providing training presence...Today I cannot imag- Care Teams in St. John of and giving educational materials ine that I would not be here. Giv- God Helping Institutions for volunteer coordinators meant ing my heart and time I feel that that each of the hospice-pallia- I receive double. The joy of be- This initiative, which focused tive care centres that participat- ing with ‘our’ patients cannot be on transferring good practices ed in the programming reported compared with anything. My life and experiences in the provision an increase in the number of vol- has such a meaning with volun- of quality care to terminally ill unteers and their lasting cooper- tary service!’ (Teresa). patients to other health care in- ation with the caring team. The The nationwide programme stitutions, was undertaken by the quality of care for the patients calling for volunteering in hos- National Chaplain for Hospices and their families improved and pice-palliative care has been suc- in 2009. The Polish Province of more people towards the end of cessful. It has promoted voluntary Order of St. John of God, cele- their lives received adequate care activi­ties in schools and universi- brating its 400 years of service in because of the support of volun- ties, trying to reach out to young Poland,9 decided to mark this an- teers in care teams. The social in- people who are (always) willing niversary by creating voluntary volvement of many people who to help and take up the challenge pastoral care teams in its health directly supported hospice-pallia- connected with hospice service. and social care institutions. It in- tive care as volunteers, or helped Hospice workers and volun­teers vited experts in order to train vol- indirectly (organisational and fi- have created promotional and ed- unteers and their coordinators. At nancial support), showed that the ucational programmes with teach- the same time there were moves programme was successful. More ers and tutors, educating them to create a postgraduate school for patients in hospice-palliative care about end-of-life issues.8 A spe­cial team pastoral care for priests, re- institutions had assistance to- message was sent to the group of ligious or lay assistants and vol- wards the end of their lives and adults called the ‘volunteers 50+’ unteers. International conferences that was the most important goal group. Hos­pice-palliative care helped people to learn from oth- of this programme.7 centres have reached out to local ers how important a pastoral care What encouraged the volun- parishes and to organisations for team can be in various health and teers to help hospice patients with pensioners, showing people the social care settings.10 With the the ‘I like to help’ project? ‘My possibilities of volunteering. The valuable help of Monsignor Zi- simple path to being a volunteer involvement of this group, often mowski and the Pontifical Coun- hospice was led by my terminal- connected to parishes and prayer cil of Health Care Workers, a ly-ill friend Christine and my se- group, has been very successful, selection of articles from the Vati- riously ill mother, who along with changing the stereotype of vol- can journal Dolentium Hominum my husband (a hospice volunteer unteering as an activity for the was published for the first time in as well) looked after them for two young and the students, and pro- Polish, giving scientific support years...For over two years I have viding a solid and faithful group for the promotion of team pasto- been a hospice volunteer in the of reliable assistants for caring ral work and volunteering.11 group ‘volunteers 50+’. I identi- teams2 [p. 35-38]. Pastoral care teams, based on fy my service with the words of All the actions taken by the Na- volunteers and cooperating with Mother Teresa of Calcutta: ‘You tional Chaplain for Hospices and chaplains, have been created in can do what I cannot. I can do more than a hundred hospice-pal- ten of the John of God helping in- what you cannot. Together we can liative care teams in Poland have stitutions. In 2011-2012 a series of do something quite wonderful for been described, together with ac- training initiatives were taken, in- the Lord’ (Jola). tion at the level of research, and cluding lectures, workshops, study ‘My own illness, helpless- show how important a role volun- visits to every place where there ness, complete dependence on teers can play in caring for those were pastoral care team activities, others…and the enormity of hu- in need. We read: ‘It is a unique and the international exchange of man kindness and help, which record of efforts made by coordi- good practices. At the end of two allowed me to stand on my feet nators and voluntary workers in years of preparation and training, again, were the foundation of my Poland, above all at a local lev- study of the activities of pastoral decision to volunteer. So how el, to raise social awareness to care teams and assistance in their could I not give back to others responding to the needs of peo- needs, all the volunteers and their what had been given to me in the ple towards the end of their lives. coordinators went on a study vis- difficult days of sickness?...I do Life stories, written over the years it to Granada, Spain. Meeting in not know if I have enough en- by many people from across the the sacred place of the Order of ergy to work in a hospice car- country and published as a part John of God, prayers and practi- ing team. I have started with the of past projects, have been the cal knowledge exchanged with child home-care team. Such suf- source of inspiration for public volunteer coordinators and caring fering and yet a huge request for education in end-of-life care, as teams confirmed actions taken by presence and love. I could not well as for this paper which pro- pastoral care teams in Poland.12 help them in sickness, but I could vides an account of social educa- The first of this kind of initiative give them my time: stories, fun, tion activities in hospice-pallia- in Poland was shown to be suc- hugging, listening. Their parents tive care7 [p. 170]. cessful in clinical-pastoral prac-

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tices as well where the students of voluntary based teams in parish- daily to ensure that the incurably the postgraduate school for pasto- es and local communities to help and terminally ill, together with ral team care worked as interns in the elderly and the chronically ill their families, receive adequate cooperation with the Bonifratres was published.15 More steps need and loving care. The Church, fol- Volunteers pastoral care teams. to be taken in order to develop lowing the example of the Good The results of these initiatives, these forms of charitable activi- Samaritan, has always shown which try to enrich pastoral care ties which are present in many lo- particular concern for the infirm. for patients, assisted mostly by cal communities. Often their ac- Through the individual members busy chaplains, will be the sub- tivities could be improved by the and institutions, they continue ject of research and further studies professional training of volun- to stand alongside the suffering (the author’s PhD dissertation will teers and volunteer coordinators. and to attend the dying, striving study the involvement of volun- In this way the level of compe- to preserve their dignity at these teers in the pastoral care of health tence, and a motivation to serve significant moments of human ex- and social institutions in Poland). those in need (from local commu- istence. Many such individuals – nities), could increase.16 health care professionals, pastoral agents and volunteers – and insti- 4. The Development of Parish tutions throughout the world are Volunteering for the Elderly 5. Conclusion tirelessly serving the sick, in hos- and Patients at the End pitals and in palliative care units, of Life With the growing number of el- on city streets, in housing pro- derly, handicapped and terminally jects and parishes’.18 May these Since the initiative with hos- ill people in Poland and Europe, words help us build and support pice-palliative care volunteering we are facing new challenges. volunteering programs in neigh- has proved to be a success, these The example of hospice-pallia- bourhoods and parishes where experiences may serve as a mod- tive care volunteering in Poland the good practices and experi- el for the development of end-of- is a realistic example of the possi- ences of hospice-palliative care life care for patients living in their bility of cooperation between the may be transferred to other insti- own homes or in long-term resi- Church, the health care system tutions and care providers! More dential care institutions. In 2010, and volunteers, who are of great research is needed to understand the textbook for informal carers help for those in need. The mis- the role of team pastoral work and (families, volunteers) was pub- sion of the Good Samaritan con- the coordination of volunteers lished as a practical tool for those tinues and the assistance of volun- in order to provide better care in who need to care for their loved tary pastoral teams in health/social institutions and home-care set- ones at home.13 At the same time care institutions is an answer to tings. The Church and other faith the ‘I like to help’ Foundation was the spiritual and emotional needs groups, health/social care organi- established to transfer good prac- of patients, their families and car- sations and NGOs with volun- tices in volunteering in hospice- ers. The encouraging words of teers, through a joint effort, could palliative care to other kinds of Cardinal Stanislaw Dziwisz give prove that elderly and terminally institutional and home care. The hope that pastoral care teams will ill people in Poland might be able demand for this educational tool help chaplains to meet the various to enjoy higher quality end-of-life encouraged the authors to invite needs of patients and help them to care7 [p. 171]. the principal Christian charitable meet Jesus in the sacraments17 [p. organisations in Poland (Caritas, 7-11]. We are facing the reality of Diakonia, Eleos) to endorse the a growing number of chronically Bibliography new edition of this textbook and ill and elderly people amongst us. propose workshops for families The Church should be present in 1 Krakowiak P., Modlińska A. (red). (2008), Podręcznik wolontariusza hospicyj- and volunteers. Consequently, in discussions and actions addressed nego, [Hospice volunteer’s handbook], Via 2011 the second, enlarged edi- to the needs of the terminally ill Medica, Gdańsk. tion was published and widely and the handicapped. Cooperat- 2 Krakowiak P., Modlińska A., Binnebe- 14 sel J. (red.)(2008), Podręcznik kopordyna- distributed in Poland. These en- ing with health-care structures, tora wolontariatu hospicyjnego, [Hospice deavours constitute a good start supporting volunteers in differ- volunteer’s coordinator handbook], Via but there is a need to implement ent services and giving religious Medica, Gdańsk. 3 Binnebesel J., Janowicz A., Krakowiak further means of mobilising and and spiritual support is a part of P., Paczkowska A. (red.)(2010), Pozamedyc- recruiting people in Poland to be our Christian and human mission. zne aspekty opieki paliatywno-hospicyjnej, active partners in end-of-life care. Apart from the chaplains and pro- [Non medical aspects of hospice – palliative care], Via Medica Gdańsk. Since 2011 and this textbook fessionals in health and social 4 du boulay S., Rankin M. (2009), Okno and educational film, a series of care, inspired by Christian values, nadziei. Cicely Saunders – zalożycielka ru- workshops have been engaged there is a great deal of space for chu hospicyjnego, [Window of hope. Cicely 5 Saunders – Founder of the Hospice Move- in for the Catholic institutions of volunteers [p. 255-256]. ment], Znak, Kraków. Caritas and the Protestant centres Pope Benedict XVI encouraged 5 Krakowiak P. (2008), Dzieje of Diakonia. In the Annual Pas- all professionals and volunteers in pallotyńskiego hospicjum w Gdańsku, [His- tory of pallottine hospice in Gdańsk], Via toral Programme for the Catho- his message for the World Day of Medica, Gdańsk. lic Church for 2011/2012, a re- the Sick: ‘I would like to encour- 6 Krakowiak P., Janowicz A., Woźniak port on the urgent need to create age the efforts of those who work O. (2010), Lubię pomagać. Programrozwo-

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ju wolontariatu hospicyjnego 2007-2010, [I Conference Record, March 14, 2009 La- naszym domem. Program duszpasterki na like to help. Hospice volunteer development giewniki], Medycyna Praktyczna, Kraków. rok 2011/2012, komisja Duszpasterka KEP, program 2007-2010], Fundacja Hospicyjna, 11 Muszala A., Binnebesel J., Krakow- [Care for the chronically ill, the elderly and Gdańsk. iak P., Krobicki M. (red.) (2011), Dolentium dependent in the parishes as a way to im- 7 Krakowiak P. (2012), Edukacyjne I spo- Hominum, Duckowni i świeccy wobec ludz- plementation of “Church as our home”], leczne funkcje opieki paliatywno-hospicyj- kiego cierpienia, [Dolentium Hominum, Poznań. nei. Badanie w dzialaniu 2002-2010, [Social Clergy and laity in front of human suffer- 16 Bocheńska-Seweryn M, Kluzowa K. and educational functions of hospice-palli- ing], Prowincja Polska Zakonu Szpitalnego (2001), Motywy I formy pracy członków pa- ative care św. Jana Bożego – Bonifratrzy, Kraków. rafialnych zespołów charytatywnych. [Mo- Action research conducted during 2002- 12 www. Bonifratrzy. Pl (10.2012). tives and forms of work of members of par - 2010], Fundacja Hospicyjna, Gdańsk. 13 Krakowiak P., Krzyżanowski D., ish charitable groups]. 8 Binnebesel J., Janowicz A., Krakow- Modlińska A. (2010), Przewlekle chory “Caritas Scientific Yearbooks”, V. War- iak P. (2009), jak rozmawiać z uczniami o w.domu. Poradnik dla rodzin I opiekunów, szawa. końcu życiai wolontariacie hospicyjnym, [Chronically ill at home. A guide for fam- 17 Dziwisz S. (2011), Wstep, [Introduc- [How to talk with students about end of ilies and carers], Fundacja Hospicyjna, tion], w: Muszala A., Binnebesel J., Kra- life and hospice volunteering], Via Medica, Gdánsk: kowiak P., Krobicki M. (red) (2011), Dolen- Gdańsk. 14 Krakowiak P., Kryżanowski D., tium Hominum, Duchowni i świeccy wobec 9 Bujak A., A., Klag W., Orman A. Modlińska A. (2011), Przewlekle chory w ludzkiego cierpienia (2009), Bonifratrzy. Z Andaluzji do Pols- domu. [Chronically ill at home. Second Edi- [Dolentium Hominum, Clergy and laity ki, [The Bonifraters, from Andalusia to Po - tion], Wyd. II zmienione I rozszerzone, Fun- in front of human suffering], Prowincja Pol- land], Bialy Kruk, Kraków. dacja Lubię Pomagać Gdańsk. ska Zakonu Szpitalnego św. Jana Bożego – 10 Kapelan szpitalny I zespoly medycz- 15 Krakpwiak P. (2011), Opieka nad prze- Bonifratrzy, Kraków. ne we wspólnej posludze przy chorym. wlekle chorymi, starszymi I niesamodziel- 18 Benedict XVI (8 December 2006), Zapis konferencji, Lagiewniki 14 marca nymi w parafiak jako sposób realizacji ha- Message of his Holiness Benedict XVI for 2009 (2010), [Hospital chaplain and medi- sła roku duszpasterskiego ,,Kościół naszym the Fifteenth World Day of The Sick, Vati- cal teams in a common ministry of the sick. domem”, w:Sułkowski S. (red.) Kościół can.

5. The Chaplain

Don Werner Demmel lation of boundaries and contents out by sisters and monks and they Chaplain, amongst the confessions makes determined the climate of the in- Germany many of our Christian brothers stitution. and sisters very insecure or even Secular people, naturally pushes them into the arms of vari- enough, shared the spirit of eccle- our Eminences, Your Excel- ous substitute religions. They do sial support, carried out pastoral Ylencies, Reverend Sirs, ven- not find clarity and reliability in tasks, and in their health-care ser- erable sisters, ladies and gentle- Christian doctrine and actual ex- vice had eyes and ears that were men! perienced realities. attentive to the spiritual needs 3. Often a terrible indifference of the gravely ill and the dying. to religion is encountered. They built humanitarian bridges, 1. Preliminary Observations 4. Religious extremism increas- helped to overcome anxieties, and ingly prevails over a healthy cen- opened up the road to the admin- At the outset in my reflections tral position. istration of the sacraments. I would like to formulate certain It was equally natural to organ- basic thoughts on the situation of ise a religious choir in the clinic, pastoral care in Germany and not 2. Professional Beginnings regularly engage in Biblical con- on the major part of Church reali- versations after the service, have ties. 1. Ecclesial socialisation co-workers, for example for the 1. The Reform of Martin Lu- liturgical services, such as sing- ther, secularisation and the re- When, thirty years ago, I began ers or readers, or for the adoration unification of Germany, as well, my priestly service in the hospital of the Eucharist during the Easter inflicted wounds on the German world I encountered a context that triduum. Church, weakening it, in part was still socialised in the main in gravely as well. a Christian-ecclesial sense, and 2. The administration Pastoral care in Germany, this notably facilitated the en- of the sacraments against this background, has to trance of a – and I use the phrase address major challenges, be- – ‘fresh priest’, that is to say one My work was clearly and prev- cause of the contemporary pro- who had just been ordained, to alently directed towards the ser- cess of an increased foreign pres- carry out his task. vice of the sacraments. Indeed, at ence in our society as well. In the clinics that we worked in that time there was a wish to re- 2. To this should be added the at that time directive and health- ceive the sacraments and pastoral fact that the confusion and cancel- care work was often still carried accompanying was much more

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natural and frequent that is the response to the ‘multi-faith’ soci- this fact this sacrament has by case today. ety. now been transformed into a kind The administration of viaticum, Considerations or visions of an of death ritual rather than a ritual extreme unction and the service ecclesial character or inherent in of life. of reconciliation were still to the pastoral care are no longer taken forefront. into account; indeed, they are of- Short visits were fostered by ten extraneous to the management 5. Hospital Pastoral Care in a the long stays in hospital because of what is a company. Team real accompanying was still al- The average stay in hospital at lowed. the present time has been reduced 1. At the present time, togeth- Thirty years ago I still lived in a to 4.5 days. First a previously er with two lay workers who are context in which 80% of the peo- planned diagnosis takes place pastoral assistants, I look after a ple were Catholics, Today, Cath- and the treatment follows imme- general clinic with 490 beds and olics make up only 40%. 30% of diately afterwards. Rehabilitation a specialised phthisiology clin- them are Protestants and the rest treatment is also planned before- ic with 300 beds. The partners are Muslims or members of mi- hand. which support these are respec- nority groups, as well as people Pastoral accompanying of a tively two limited companies that who do not profess any religious longer time period is by now al- have shareholders. confession. most impossible and short visits 2. Our work is also supported have been reduced to what are ab- by women who engage in pasto- surd lengths of time. ral care as volunteers. They were 3. The Contemporary Situation Hospital pastoral care, there- trained beforehand by myself and of Pastoral Care in Hospitals fore, has shifted into the waiting then accompanied and directed rooms of the services (for exam- towards specialisation. They of- 1. The transformation of clinics ple the x-ray rooms!). fer regular visits and report to me the wish of a patient to receive a Against this background, com- sacrament. They are an important paring my situation of current 4. The Regression of Ecclesial bridge between the patients and work with that of that time, it is Socialisation those of us who engage in full- licit to speak about an authentic time hospital pastoral care. system and/or paradigm change. Christian-ecclesial socialisa- 3. Because of the notable short- Because of this change in gen- tion ha strongly diminished at a age or lack of priests, it is increas- eral conditions, over the years personal level and at the level of ingly the case that lay theologi- my service has also been strong- patients as well. This should also ans provide hospital pastoral care ly changed and this has required be understood as a secondary ef- and they are often not flanked by a change of direction and a reor- fect of the reunification of Germa- a priest in the exercise of this re- ganisation. ny as a result of which we were sponsibility. This was also the Clinics have gradually been invaded by a mass of fellow cit- reason why I was entrusted with a transformed, in the sense that they izens who had not been baptised second clinic as a priest. have become suppliers of services and who were indifferent to reli- 4. As regards the administra- and economic enterprises. gion. tion of the sacraments, the lay Economics and technical com- The ascertainment of a con- theologians need a basic priestly petence have become priority el- fession and/or membership of a service. However, when a priest ements to the detriment of a pro- creed is by now done only spo- is not available, a lay person can fessional ethos. radically. On the one hand, this only do what he or she is allowed The patient is seen as a custom- is because of the fact that one is to do, namely accompany, pray er to whom is sold a ‘health pack- dealing with information that is and bless. age’. provided voluntarily by patients and, on the other, because such 2. Consequences for pastoral information has been practically 6. The Possibility of a New care in health in hospitals obliterated by the defence of pri- Evangelisation vacy and to such an extent that for All of this cannot fail to have the parish it is by now almost im- 1. Encounter as a way towards consequences for pastoral care in possible to organise a service of evangelisation health in hospitals. hospital visits. The chapel of the clinic, for The administration of the sacra- Whereas in the past it was more reasons of costs, is now available, ments has been strongly reduced my ecclesial approach and my ac- something that would have been and it is only rarely requested tions involving the sacraments unthinkable previously in Catho- spontaneously. In the daily reality that marked my being and my lic Bavaria. of the hospital only extreme unc- work, today I would be inclined In its place the supporters of tion is something of importance. to understand my service as that the hospital prefer a ‘space of si- Unfortunately, however, in gen- of being a builder of human and lence’, without Christian sym- eral this is requested when things spiritual bridges, acting constant- bols, open to all faiths and thus a have gone too far and because of ly between two worlds in a situ-

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ation of condensing life within me as a human accompanier who regards religious meetings and the context of the clinic and with has time, who can listen and help needs. reference to the decay of values the situation to be borne, allowing The immense changeover in within society, creating thereby a reconciliation with God or with personnel and the employment of network of relationships between his or her family relatives, or as temporary staff makes it extreme- co-workers, patients and their someone who can help in dealing ly difficult to organise continual family relatives, and between with things that remain unsolved. pastoral care because one almost God and man. Given that I have always had cannot observe any longer a real In my frequent meetings, in the the habit of going up to a patient identification with the clinic as an rooms of patients, in my office, in whoever he or she may be, with- institution. corridors or in the chapel, despite out first being informed about his As regards hospital pastoral all the changes that have taken or her religion or confession, nat- care, in general I can no longer place in my situation, I see myself urally I never know beforehand rely upon personnel that are fa- and my work as the guarantee of whether the patient is a Catholic, miliar to me and who can play another reality, albeit always en- if he or she had left the Church an important role of mediation in dowed with a great advantage in or whether he or she has another pastoral care. terms of trust. faith. The conversations, whether Simply, I accept the encounter. 4. The person as an exponent of they are planned or take place Hitherto I have never been reject- evangelisation naturally, are, as a rule, marked ed. Even Muslims are grateful for by mutual respect and are open a visit, for an edifying conversa- The transformations that have to a deeper analysis, to a religious tion. taken place in society and in the exchange or to the receiving of a This openness allows many Church have made evident the sacrament. co-workers, even when they do role that the personality of the Just by being there, but also spe- not have a concrete point of ref- priest in general and/or in evan- cifically through my sacramental erence in the Church, to ask me gelisation should have, and how service as a priest, I allow people or to inform me in my capacity as important are my faith and my in the hospital, whether they are a priest, thus allowing a number spirituality in addressing all the patients, their family relatives or of prejudices towards the Church difficulties that are to be found co-workers, to open themselves to and some wounds inflicted by the in pastoral care, taking into con- another dimension. Church to be forgotten. sideration the respective individ- By no means rarely these meet- On the agenda are in-depth con- uals that I meet: for example the ings, which are often ‘only’ ap- versations and/or exchanges of a image of God and of man that I parently human, are transformed religious nature with the co-work- carry within myself; my open- into religious moments where ers, whether they are involved in ness and transparency in relation people’s outlook opens up once health-care assistance, in the ad- to God; my readiness to relate to again to the presence of God. ministration of the hospital, or other people; and my reliability in The accompanying of grave- even only employed at a techni- meetings with people who entrust ly ill people or of the dying, of cal level. themselves to me. people in mourning or of people A priest, in addition to the task who are in a state of hopelessness, 3. Offers of specialisation as aids that he performs in relation to pas- through a human encounter opens for evangelisation toral care, is increasingly becom- up access to life, to faith and to ing a advocate of humanity and a God. For a number of years now, in person who warns about the need my hospital, I have offered my for respect for man who is made 2. Humanisation as a preparation co-workers a specialisation in in the image and likeness of God. for evangelisation professional ethics and I have To be present, to be ready to constantly encountered great in- help, as a man and as/or a priest: In my service as a hospital terest in this project. this is what is becoming increas- chaplain, the principal aspect is However, unfortunately I am ingly important in today’s hospi- the service of answering calls, also obliged to observe a trou- tal world, where one increasingly that is to say a readiness act day bling loss of identity as regards feels that there are fundamental and night for emergencies of all knowledge about Christian values failings in a human but also in a kinds. Often hopelessness and and the contents of the Christian religious sense, where often an anxiety dominate a room, a pa- life, as well as a fall in the eccle- institution loses its natural role tient and very often family rela- sial dimension in general. of mediation, and where the rel- tives as well. As a consequence, I see as even evance of individuals has in- Every day, above all during more important those offers that creased. the night, I find that I intervene allow me to transmit messages in situations where at the outset and values in a manner that is 5. Liturgical offers to support one does not understand wheth- not captious, bringing to people’s evangelisation er the person concerned needs memories attitudes that are typi- me as a priest or needs spiritual cally Christian and reawakening As regards the daily offer of li- help, or whether he or she wants a sensibility that has been lost as turgical celebrations, one should

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not underestimate the importance the Masses, the , the med- field of pastoral care in a hospi- of the way in which the liturgy itations and good readings near tal, rather than having such pas- is celebrated, of when the sacra- the bookshelves with their publi- toral care entrusted to lay theolo- ments are prepared and adminis- cations are and remain important gians who are entrusted with it on tered, as well as the fact that spir- aids and instruments that manage the basis of an employment agree- ituality that is experienced opens to open many hardened hearts, of- ment. up pathways that allow people to ten bringing back men to the open A hospital chaplain on his own accede once again to God, in ex- arms of the Father. is without doubt overburdened treme life situations as well. with requests and responsibilities The hospital chapel offers many that arise from his situation. The people, in addition to the limits 7. Final Remarks chaplaincy requires qualified and imposed by confessional mem- engaged support, for example that bership, to enter the tranquillity Your Eminences, Your Excel- provided by a post-catechumenal of a holy area, to once again turn lencies, ladies and gentlemen! group. their faces to God, and to have 1. For me a hospital constitutes Differently from what happens a place where they can pray and from many points of view a re- in pastoral care that is provided give thanks, weep and ask. flection of society and a certain in a parish, where by now I only I believe that the existence of condensation of life’s relation- reach the active core of the faith- a chapel is very important, above ships which after a fashion are re- ful, in carrying out pastoral care all in clinics for drug addicts or duced and concentrated to the es- in my hospital I encounter many rehabilitation, and I regard it is sential, until a person’s breathes people of different backgrounds as a great loss for sick people that his or her final breath. Everything and different characteristics: peo- this opportunity is precluded or that does not matter here loses its ple who have been distanced from removed for reasons of cost. value. the Church or are interested in it, A ‘space of silence’ the size of 2. Pastoral care and evangeli- people who practice their religion a room can never take the place of sation in a hospital have anoth- or who are outside the Church, a consecrated chapel. er priority value as regards what people who are Catholics or peo- Receiving a sacrament or tak- takes place, for example, in the ple who are Protestants. ing part in the holy Eucharist in varied reality of pastoral care in a 5. For this reason, it has become a hospital – during the course of a parish. indispensable to link hospital grave illness – can bring out many 3. However, and perhaps specif- pastoral care with local pastoral things that often have been con- ically because of these challenges, care, that is to say with the pasto- cealed for years, allowing the re- pastoral care in a hospital for me ral care that is provided in a par- turn of relationships of faith that constitutes a special opportunity ish. And this not only to retrieve seemed for a long time to have for the Church and for evangeli- those contacts that have been lost been forgotten (for example, “Fa- sation because man in a hospital but also, and specifically, to sen- ther, I have not confessed for is made more sensitive than usu- sitise once again the members more than thirty years. Can you al, more receptive to, and grate- of a parish to be aware about its help me?”!). ful for, messages of comfort and sick members and to transmit to Often an illness can become hope, and above all the love of the these sick people the feeling that an opportunity to once again rest Son of God who was made man. the parish community has not for- one’s life and one’s faith on new 4. For these reasons, I believe gotten them but is thinking about bases. that it is very necessary to have them and praying for them be- As regards hospital pastoral a service of volunteers who are cause they are a part of the local care, in addition to visits to the well-trained at an ecclesial and church and are valuable members patients, the liturgical services, religious level specifically in the of the body of the risen Christ.

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Friday 16 November II. Ethics and Humanisation

Health Care between Being and Acting: a Balance of Charity

Fra’ Mario Bonora, cred ministry specifically care for value which, while being a confir- P.S.D.P. the poor and above all care for mation of the traditional exercise President of the Don Calabria those sick people who, as Luke ob- of charity towards our brethren as Sacred Heart Hospital, serves, Jesus commends to his dis- a natural expression of Christian Negrar-Verona, ciples when he sent them out ‘to faith, would also raise such activ- National President of the ARIS preach the kingdom of God’, con- ity to the dimensions of the evan- (Religious Association of Social/ necting this supreme mission with gelising work itself of the Church Health-Care Institutes), the mission of caring for the sick: and the defence of religious free- Italy, ‘and heal the sick’ (Lk 9:2). Since dom, which are neither marginal Member of the Pontifical then, until our contemporary mod- nor secondary in the contemporary Council for Health Care ern health-care complexes, there world, a world that is increasingly Workers, has been a flowering of care initi- multi-confessional, more techno- the Holy See atives which drew inspiration and logical and more equipped both at nourishment specifically from the the level of ideology and of behav- values of the Gospel. iour. our Eminences, Your Excel- Today, in a society that is I have deliberately used the con- Ylencies, reverend priests, dear marked by fundamental technical ditional tense because in the practi- brothers, Ladies and Gentlemen, and legislative developments that cal health-care world, and the Ital- ‘He did not come to be served nonetheless encounter difficulties ian health-care world in particular, but to serve’ (Mt. 20:27). I would in identifying with that globalisa- there are by no means few obsta- like to begin with this phrase from tion that is so much wished for but cles to the implementation of a the Gospel according to St. Mat- which is difficult to attain, the pres- Christian synthesis between being thew. It has been my companion ence of social/health-care institu- and acting in the approach of char- during the longs years of my re- tions that are managed by religious ity. At the level of principle, there ligious profession; it inspired my agencies and Congregations bears is nothing that can be criticised. vocational choice; and it has com- witness to the permanent ideal of But when one descends to a practi- forted me during the many, the the Church to offer to sick people, cal level one then has to take into very many, hard moments of a life together with a generous and tiring account a reality in which increas- that has been spent in the wards of service that is impeccable from the ingly a language is spoken which a hospital. In particular, however, health-care and humanitarian point is held dear by the dominant logic this phrase of Matthew’s seems to of view, above all else also a con- of the market. In the field of health me to be able to capture the mean- crete sign of the extension of the and health care, or to put it better ing of what we are reflecting up- love and solicitude of Christ for in the field of human suffering, as on: the Christian synthesis of being suffering people. well, this is not the language of and acting in and for charity. Memory of what has been the Gospel. So what is happening? achieved with hard work and sac- One need only listen to the cry rifice during these years of moving of alarm which by now has been Christ Came not to be Served between the end of an epoch and raised from the world of health but to Serve the birth of the third millennium care of the Church – because these allows us to see future pathways are the social/health-care insti- In the Acts of the Apostles there and pathways for projects that con- tutions managed in Italy and the is without any shade of doubt a firm the vitality and dynamism world by religious Congregations pointing out of the recipients of of the presence of the Church is and agencies – to understand what this service: the poor and the sick. this break in our age. Namely, the is taking place. Cuts, a lack of ap- Ever since its origins, the Church opening of our beings to a pano- preciation, closures, and the trans- has privileged and raised to a sa- rama of programmes of very great fer of management to non-Church

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agencies, seem to drain this not ly people, is the person. Therefore the fact. They tell us that we can marginal part of the mission of what is ethically positive is not one overcome this crisis. But it would the Church – namely healing the euro less or one euro more but the be a terrible thing if solidarity en- sick – of meaning. This is a mis- person, what he or she does, his or tered into a state of crisis. With sion which if interpreted in a liter- her organisation directed towards his innate prophetic sense, Bene- al sense, that is to say treatment of improving the use of the hours that dict XVI, in Caritas in Veritate, at the body, cannot be confined to the he or she makes available in his or number 21, writes: ‘The different albeit indispensable forms of spir- her service to the sick. aspects of the crisis, its solutions, itual and moral assistance, shar- This is our great resource: if it is and any new development that the ing and accompanying, but which invested well it obtains unimagina- future may bring, are increasingly naturally requires the use of works ble results. We are convinced, that interconnected, they imply one an- with buildings, technological re- is to say, that the ethical charac- other, they require new efforts of sources, agreements through con- ter of health care is to be found in holistic understanding and a new tracts, and respect for the rights of minds and hearts; it passes by way humanistic synthesis’. He shifts, workers. And it is this that in plac- of relationships between all those that is to say, attention onto the ing so many institutions in a state people who make up the think- anthropological question. Man is of difficulty. ing brain, the laboratory of pro- frightened in the face of the crisis. But it is not specifically about jects, the generator of creativity, Instead, in face of a crisis, even this that I want to speak when in- the mechanism that is constantly the most burdensome crisis, we voking ethics in the management tested to assure that an institution must learn (the Pope continues in of the relationship between being has wealth at the level of human, his encyclical) to ‘adopt a realistic and acting in health care. Nor do moral and psychological resourc- attitude as we take up with confi- I want to demonstrate the dispro- es, and to assure that patients re- dence and hope the new responsi- portion between costs and income ceive readiness to help, a swift bilities to which we are called by or the injustice that discriminates response, smiles, support, tender- the prospect of a world in need of Catholic health care that is put on a ness, welcome and accompanying. profound cultural renewal, a world level with state health care, where In a word: love. that needs to rediscover fundamen- this latter, even though it has the It is clear that to obtain such tal values on which to build a bet- same obligations as the former, results one has to act on our be- ter future’. And he goes on to add: benefits from state subventions and ing. We need a real conversion of ‘The current crisis obliges us to re- aid from which, indeed, the institu- hearts – something which amongst plan our journey, to set ourselves tions of the Church are excluded. other things should not be surpris- new rules and to discover new And I do not even want to speak ing in a Catholic hospital – but al- forms of commitment, to build on about health-care ethics to defend so humility which would be useful positive experiences and to reject Catholic institutions from accusa- in the search for cooperation and a negative ones’. Benedict XVI urg- tions, which for the most part are possible understanding, which are, es us to revive the secret yearning of a rhetorical character, that they indeed, indispensable for an en- for rebirth that is in each one of us suffer from a lack of transparency deavour which should involve the so as to overcome all of our fears. as regards their budgets. We are the excellence of team work. These We must stake all of our capacities first to be responsibly convinced of would be the first steps towards a for change in order to open up the the need for such transparency. renewal that would be capable of road to a new journey. I would like to speak about the helping us to avoid that an exag- This is a journey that begins ethics of health care by referring to gerated business climate ended up with a rediscovery of the fact that people who by the nature of things by being transformed into disinter- man is made for giving, for self- spend money in health care in or- est as regards the real problems of giving. The Pope, however, also der to act. I want, therefore, to ask a hospital institutions, into a non- writes that: ‘The logic of giving myself in what human context the respectful use of the things of a does not exclude justice and does expenditure of material resources hospital, and into a treatment of not follow afterwards’. And he is carried out; with what style of patients that was without human- then defines solidarity, which is behaviour and existence it takes ity. This could also lead unknow- above all else ‘feeling responsible place; and what the other resourc- ingly to a passive approach, to a for everyone’. And the Pope goes es are that contribute towards, sup- lazy creativity, and to a sense of ir- on to declare that ‘Without gratu- port and justify financial expendi- responsibility or non-involvement itousness not even justice can be ture. in the face of a search for a future. achieved’. Perhaps it is worthwhile And a future that was perhaps dif- remembering that our holy men ferent. and women Founders placed stress The Human Person is the True specifically on gratuitousness and Wealth solidarity. Their only resource was The Crisis should not charity. During ages when every- It should immediately be made Frighten us thing was uncertain or inexistent, it clear here that the first resource of was specifically charity, the resolv- an institute of health care, whether This crisis exists and it is cer- ing force of love, the only certain- it is a large hospital or the small- tainly worse that what we imag- ty that could be counted upon. For- est health-care residence for elder- ine it to be. It is no use concealing tunately, still today there are very

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many testimonies to giving, to free perhaps fatigued or perhaps dis- Unity-Communion personal engagement. orientated by the noise that sur- rounds him, and this to the point And if this were not enough, we of making him lose direction and should look for strength amongst The Good Samaritan no longer feel even the hand of us, in unity. A unity that cannot the master who guides him. The be only proclaimed at the level This is the figure that emerges Lord, and we should be certain of of words but which must become most often in the thinking of Pope this, continues to guide our steps a daily practice of solidarity be- Ratzinger. We should not see the so that we continue to carry him tween institutions. Hitherto, a self- unfortunate traveller on the road where he is most needed, wherev- referential approach has hindered to Jericho as a symbolic figure of a er a man is suffering. ‘God’s love’, us from constructing authentic and dated parable, and the Samaritan, Benedict XVI tells us, ‘calls us to effective networks with each other the person who gave of his own move beyond the limited and the and with others. The crisis is dem- time and money to help the suf- ephemeral, it gives us the courage onstrating all of the short-sight- fering man, as the only figure who to continue seeking and working edness that has brought us to this still has true, authoritative and for the benefit of all, even if this point. We will thus rediscover that salvific words to proclaim to our cannot be achieved immediately unity which, as a reflection of the society of consumption; the only and if what we are able to achieve, unity which in Christ connects us figure, whether physical or moral, alongside political authorities to the Father and the Holy Spirit, is that gives hope to the world. We and those working in the field of called to become visible commun- cannot allow his beast of burden, economics, is always less than ion and to have explicit missionary which carried him on the road to we might wish. God gives us the reflections. Then we will finally be Jericho, to fall ill and stop carry- strength to fight and to suffer for able to achieve a state of charity ing him to where the Lord calls love of the common good’ (Cari- that is a reflection of our being and him. We are that beast of burden, tas in Veritate, n. 78). of our acting.

The Humanisation and Fairness of Care and Treatment in Health-Care Institutions

Prof. Enrico Garaci to account a fact relating to age. In the Western world this ques- President of the Higher Institute The part of the population of Ita- tion becomes more evident when of Health Care ly which is over 65, which at the we consider social developments and the Higher Council of present time is about 20% of the and technical-scientific progress. Health Care, overall population, is destined to Indeed, the concept of welfare, Italy. become 28% in 2030 and 34% in understood as giving everything to 2050 if the present level of increase everyone without limits, has been in maintained. This involves an in- superseded and we have entered irst of all I would like to thank creased risk as regards illnesses to the full the stage of post-wel- FH.E. Msgr. Zygmunt Zimoski that constitute the principal causes farism. The patient is no longer a for inviting me to take part as a of death: cardiovascular diseases, passive subject who receives med- speaker of the twenty-seventh in- tumours and cerebral haemorrhag- ical products but an active ad exi- ternational conference at this im- es. These are illnesses, therefore, gent subject who wants to know, to portant meeting on ‘hospitals as which are different to those to be be informed and to take part in the settings of evangelisation: their hu- found in the South of the world, process of treatment. man and spiritual mission’ which which are principally AIDS, ma- In addition, we have lost the addresses a subject which is so rel- laria and tuberculosis. idea that although medicine only evant to the defence of the dignity Independently of the various ap- at times treats, it must, however, of suffering patient. proaches and various therapies, one always provide relief and com- An analysis of the humanisation should ask how medical doctors fort. The concept has been lost that and fairness of care and treatment behave when faced with the vari- ‘providing comfort’ and ‘taking in contemporary health-care insti- ous illnesses that exist. Is medicine care of’ cannot be separated from tutions cannot be separated from directed solely towards the whole the therapeutic and improvement the prevalent pathologies of this illness as a conceptually abstract process. epoch and in this area of the world. nosological entity or is it directed As regards these last purposes, First of all, we should take in- towards the person as a whole? medicine has failed and one should

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therefore understand the reason for ty. He or she has a social network health; to improving inadequate this failure. of affections and friendships, re- structures; to fostering the right The greatest cause that one can lationships with his or her family distribution of health-care resourc- ascribe is the loss of a holistic vi- and friends, and with institutions, es; and to ensuring that the health- sion, which is a direct consequence which cannot be de-contextual- care policies of the world have as of scientific reductionism, in the ised. their goal only the good of the hu- face of a problem of increasing In order to achieve a journey of man person’. complexity as regards these pa- humanisation we need the direct In Italy there have been impor- thologies. commitment not only of medical tant health-care policies directed The medical act cannot be deper- doctors but also of all health-care towards fairness in health such sonalised; it should always have at workers in order to promote activ- as those outlined by the National the centre of its activity the person ity and conditions whose exclu- Health Plan (NHP) of 1998-2000: and the relationships that he or she sive goal is the good of the patient. combating inequalities in health as manages to establish. Specifically Patients must thus be treated with a principal objective to be achieved because the lack of integration of dignity and must be aware of the through the strengthening of the ‘taking care of’ with ‘therapy’ con- decisions that concern their health. capacity of people and communi- stitutes a not very effective model The definition that Pope John ties to adopt healthy behaviour and of clinical practice, one must pro- Paul II gave at a famous confer- improvement in access to services. mote a holistic model of treatment ence on ‘The Humanisation of The NHP of 2001-2003 and the and care that takes into considera- Medicine’ which was held in Rome NHP of 2003-2005: an approach tion not only the technical-scien- in 1987 is detailed and stimulating: confined to certain weak subjects tific dimension but also the social a) ‘Within the context of the in- (immigrants and drug addicts). dimension, the anthropological di- dividual relationship where hu- The NHP of 2006-2008: the re- mension. manisation means openness to affirmation of the universality of Scientism in medicine impedes everything that can help to un- services and the promotion of fair- the adoption of a correct holistic derstand man, his interiority, his ness in the system to achieve the vision. Scientism with its dogmatic world and his culture. Humanising overcoming of social and local in- position, which sees the methods this relationship means both giv- equalities. of inquiry of the physical sciences ing and receiving, creating that is One must continue down this superior to all the others, seeks to to say communion which is total path by strengthening and promot- explain everything that happens in participation’. ing the processes of humanisation. relation to the patient, the meaning b) ‘At the social level the need Religious hospitals, which are of human life, of suffering and of for humanisation is translated in- very much present in Italy and death. to the direct commitment of all the whole world, could be the first The patient, on the other hand, health-care workers to promoting, forces and leaders in this process, needs attention, benevolence and each in his or her own field and ac- with the experimentation of mod- dignity and constitutes overall an cording to his or her competence, els of care that are closer to the inseparable psycho-physical uni- conditions that are suitable for needs of patients.

Hospitals: Bioethical and Biopolitical Problems

Prof. Francesco amongst the ten truths of medi- ronment. For my part, I would D’Agostino, cine, the lapidary statement ac- like to add that they are dangerous Full Professor of the Philosophy cording to which hospitals are from a bioethical and biopolitical of Law and of the General dangerous places. This apho- point of view as well because they Theory of Law, rism was not explained further by activate questions to which the University of Tor Vergata, Smith, not least because an expla- culture that is now dominant does Rome, Italy nation was superfluous: this ob- not seem to be able to provide an servation, although elementary in answer. character, makes us rapidly un- 1. In an editorial which right- derstand that hospitals are dan- 2. It is well known that in the ly became famous in the review gerous for the health of people ancient world the institution of of which he was the editor, the who have been admitted to them; the hospital was completely ab- British Medical Journal, Richard dangerous for the health of visi- sent. In vain do we look in the Smith placed at the top of the list, tors; and dangerous for the envi- Greek-Roman lexicon for a term

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that could be translated by the have towards their fathers. In a Orders, became intertwined in an modern word ‘hospital’. The xe- famous passage from De ben- almost indissoluble way with the nodochium, as is well indicated eficiis (VI.16), Seneca reminds practice of medicine and became by the etymology of the word, was us that it is not possible to extin- an extraordinarily eloquent aspect simply a house to accommodate guish a debt to our physician sim- of Christian piety, with its conse- foreigners: a hostel, therefore, ply by paying him: this is because quent practices of charity. a hotel, which was perhaps also friendship does not have adequate characterised by a special colour payments. The physician should 4. Albeit without taking from and warmth (if, for example, the have our gratitude, and gratitude, it the whole of the characteristic foreigner was a ‘pilgrim’). But I as is known, is inextinguishable. of being an art and of having a will speak of this subject no more. warm interpersonal relationship, Medical practice was seen as a rig- 3. Hospitals began to come in- the modern epoch worked to make orously dual relationship between to existence in late-antiquity with medicine a rigorous science, in the the physician and his patient and the Christianisation of the Medi- context, which was ever broader, the place of treatment was ar- terranean world. But they did not of the biological sciences and the ranged to be the same place, and arise as an institution that was pri- natural sciences tout court. The with absolute naturalness, as the marily intended for the optimisa- modern hospital could not but feel house of the physician: that house tion of therapies, but, rather, as the effects of this new direction, outside of which one engaged in a place to admit the poor, the el- which was at one and the same public life and within which, for derly, the abandoned and thus al- time epistemological (because it the ancients, one engaged in pri- so the sick. Hospitalitas was the was founded on the principle that vate life, the naked life, which response that Christianity gave only scientific knowledge was au- was marked by its characteris- at the level of practice, with slow thentic knowledge) and ideal (be- tic rhythms: births, procreation, but decided and aware progres- cause it was founded on the belief illness, ageing and death. These sion, to the teaching channelled that only through scientific med- rhythms, especially for the well- by the parable of the Good Sa- icine was a physician able to as- off classes, were penetrated with maritan. This parable evidently sure a patient the greatest likeli- immense authoritativeness by the has a pre-eminent theological- hood of defeating that illness that physician, who was animated not doctrinal value by alluding to a had attacked him or her). Through only by his knowledge but also by fraternal love which – modelling complex historical processes, but his benevolence towards the suf- itself on divine love – does not ones that are not difficult to recon- fering of sick people and in gen- exclude anyone, does not know struct, hospitals became machines eral towards all those who looked limits of rank, does not engage à guérir, being transformed into for his help. This benevolence in any calculation of conveni- specialised systems of care which was alluded to by the Greeks ence, and expresses itself as pure were indifferent to the social di- when they used the term philan- gratuitousness. At the same time, mensions of illness and attentive thropia or when they spoke about however, the parable activates in exclusively to their clinical di- the warm bond that had to link the the mind of the listener the im- mensions. The separation of hos- physician and his patient and thus age of a man who, finding him- pitals from lunatic asylums, from used the phrase philia iatriké. self in a state of the most absolute places for the chronically poor Hippocrates taught, prefiguring need and almost near to death, and for elderly people, and from Pascal, that only he who loves finds someone who takes care of institutes providing care to chil- knows well: only when there him, pours oil on his wounds, and dren, became rigid and found its was philanthropia could there helps him on a journey of conva- justification in the weakening of be in the physician an authen- lescence and recovery. To the inn- the philanthropic vocation and the tic love for his profession, that is keeper, to whom is entrusted the spread of medical professionalism to say philotechnia. This linking body of the victim of the robbers, in the world. In parallel, the im- of the physician to his home (in the Samaritan gives precise or- age was consolidated of hospitals the broad sense of the Greek term ders of care. In this way in his- as places not only of care but al- oikos which referred more to the tory an absolutely new horizon so of scientific research to which set of people who lived in a build- was opened up: the xenodochium were entrusted the formation of ing than to its walls) produced the ceased to be a place to receive the the new generations of medical paternalistic paradigm: the physi- xenos, the foreigner, and became doctors: as a functional part of cian related to the patient not only the Hôtel-Dieu, the place to re- this task we witness the dynam- with the authority of a father but ceive a neighbour, following the ic towards the most complete ra- also with that of a good father (as impulse of those who, like the Sa- tionalisation of hospital structures all fathers should have been, even maritan, make themselves neigh- (one may think, for example, of though they are not always such). bours. Hospitalitas ceased to be a the birth of ‘wards’), accompa- In his turn the patient, perceiving noble, but subjective, psychologi- nied by an inevitable process of that the physician gave him not cal attitude: it became the objec- bureaucratisation. The separation only his professionalism but also tive foundation of the care home of charity and assistance from after a certain fashion his friend- and of the hospital, as an authentic treatment was consolidated in a ship, returned it with that trust spiritual force it activated confra- definitive way when the definitive and gratitude that sons ought to ternity, created rules and religious systemic structuring of hospitals

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and the consequent creation of an lems that manifest themselves in theran, Adventist, Presbyterian or authentic governing class with- a systematic way as dilemmas. Methodist hospitals, or ones con- in them brought out their busi- If hospitals could be reduced to nected with Jehovah’s Witnesses. ness dimension. To this phenom- solely functional structures, these enon was added another, which problems would not be perceiv- 7. Naturally enough, it is not the was also a consequence of the able. To think of them, however, religious reference as such that new systemic character, which ir- exclusively in this way turns out creates the problem. Indeed, this reversibly characterised the mod- to be impossible because this is is increasingly invoked as the op- ern hospital: it became a place unduly reductive. Hospitals have timal solution by which to direct where, in a difficult balance be- always inevitably had a multiple the patient to identify that place of tween the public and the private, or at least a dual identity. They are treatment which is most coherent dying was managed. Eloquent sta- at one and the same time places of with his or her vision of the world tistics demonstrate the constant scientific and technological inno- (this has been expressed, and with decline of death at home and the vation and places for the provision great vivacity, by Tristram Engel- continual and steady increase in of social services: they receive hardt Jr.). The problem lies in the deaths in hospitals. The caus- salaried personnel and person- tension that inevitably comes to es of this phenomenon are many nel moved by a spirit of volun- be established between the iden- and they are certainly not difficult tary service; they receive public tity of a religious hospital and its to identify: on the one hand, the funds and private funding; and vocation, what is in general today hope that high-technology treat- they have the purposes of a com- expressed by the term ‘mission’. ment – which could be done on- pany and humanitarian purposes. Those who believe that illness, ly in hospital contexts – could, if In their setting are expressed, in medicine and healing are funda- not lead the individual to avoid the most extreme forms, the most mental anthropological experi- death, then at least give him or characteristic bioethical dilem- ences, undergone in a fundamen- her further chances of survival; on mas. The impossibility, for hos- tally homogenous way by all men the other, the crisis of the family, pital institutions, to address these and worthy of being addressed which made terminal assistance dilemmas with their own internal in an equally homogenous way by the family relatives of the dy- resources and with their internal whatever the religious identity of ing person (an assistance, for that professional skills and expertise the patient, will see in religious matter, and obviously, completely explains the presence within them hospitals the simple manifestation impossible for families that made of independent ethical commit- of the purest Hippocratic spirit, up of a single individual, which tees. It is, however, specifically in marked by a noble ideology and was a spreading phenomenon in hospitals that are expressed in the always, and whatever the case, the great metropolitan centres most extreme forms the problems directed towards the good of the throughout the world) almost im- of desisting with treatment ac- sick person. Those, instead, who possible. We should not underesti- quired by the nature of exagger- believe that the experience of ill- mate the paradoxical relationship ated treatment, the problem of the ness, of medicine and of healing with death that characterises con- allocation of (inevitably scarce) are culturally directed and anthro- temporary man and which is based resources, the problem of the pologically differentiated, start- upon its removal, and this has be- treatment of minors, and the prob- ing with visions of the world that come the more effective the more lem of conscientious objection on are held to be irreducibly multiple death in a home context has been the part of health-care personnel and mutually irreducible, will see excluded. Hospitals thus acquired or anyway of the refusal by such in religious hospitals the definitive the characteristic of being a set- personnel to engage in practices proof of the irreversible fragmen- ting in which one may perhaps die that are held to be scientifically tation of modern medicine, which but in which one should not die not indicated or ethically contest- has become by now definitively and which thus has the duty to re- able, etc. etc. The list could go on post-Hippocratic and structurally move death from being visible in for a long time. defined by a mere functional ori- any form. Hence one of the most entation. In this approach a phy- typical characteristics of hospital 6. The problem of problems is sician, from being a healer, be- institutions today, which can be that of hospitals ‘under religious comes a technician of the body, perceived to the full only in the sponsorship’, to employ a typi- and his or her action acquires a most advanced hospitals, namely cally Anglo-Saxon phrase: hos- justification that does not start the extreme attention that the ac- pitals which both because of their from an incumbent attention to commodation dimension receives, ownership and because of their the good of the patient but from a which was conceived from the management or anyway because formal request for a service based outset as being directed towards of their image can have a reli- on a contract, a request which can a non-terminal admission, an ad- gious label. In Italy, obviously come to him or her from the pa- mission that was always tempo- enough, they refer back, with a tient himself or herself or – when rary and transitory. few rare exceptions, to the Catho- this is the case – from the health- lic Church, but in other countries, care system by law, for reasons of 5. It is here that a new series and most markedly in the Unit- a social character. In this second of bioethical problems of today’s ed States of America, one much approach, there is no qualitative hospitals have their roots, prob- more frequently finds Islamic, Lu- difference between medicine that

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treats the body and medicine that day a (probably) decisive battle is a varnish of being ethical but that strengthens it, between therapeu- being fought for those who hold of bringing out within science and tic surgery and aesthetic surgery, dear the Hippocratic paradigm, technology themselves the dimen- and between sterility treatment with everything that this paradigm sions of being ethical, and these carried out to assure so-called brings with it, as regards princi- are dimensions which continue to ‘reproductive rights’ or even for ples that are not only bioethical be systematically marginalised, if mere eugenic purposes. The very but also, and above all else, an- not rejected. From this point of category of ‘medicine’, comes in thropological in character. In the view as well, therefore, it appears fact – always in this last approach view of many people, indeed, the that one can observe that at the – to lose its identity, coming to be hour has now come to recognise roots of hospital bioethics there identified (without any problems that hospitals, because of the exag- are the same problems, which are of an epistemological or ethical gerated functional characteristics widely unresolved, that torment kind) with the category of ‘ma- that increasingly mark them out in general bioethics: these are unre- nipulation’. modernity, are demonstrable proof solved problems because they are of the superseding of Hippocratic meta-bioethical in character, be- 8. We can return at this point to medicine and the triumph of func- cause in large measure they are the beginning of my analysis. Hos- tional medicine. Those who gen- anthropological. These are prob- pitals today are dangerous places, erously seek to counter this dy- lems that concern our identity and not only for medical reasons – be- namic with generous attempts to which arose when the possibility cause, that is to say, unexpect- make hospital institutions ethical was seen of proceeding to a total ed pathologies can be developed probably do not perceive that the and extreme manipulation of the within them – but for ethical rea- core of the question is not that of living, whether human or non-hu- sons: they are settings in which to- giving to science and technology man.

Hospitals as Guardians of Life

Prof. Riccardo Marana In a publication of 2008 of the a university community, is called Director of the Paul VI European Observatory on Health to make a contribution of excel- International Scientific Institute Systems and Policies and the lence in service to man and to sci- – ISI – for Research into Human World Health Organisation en- entific progress. To achieve these Fertility and Infertility for titled ‘Assuring the Quality of objectives, constant cultural en- Responsible Procreation, Health Care in the European Un- richment is required in interacting The Catholic University of the ion’, emphasis was laid on the with the social context in which it Sacred Heart, various basic criteria which can works and with the international Rome be used for a suitable assessment scientific community, as well as a of the quality of services that are careful management of resources offered in the health-care field ac- in order to value them but also to cording to the highest standards: identify the priorities as regards the availability and allocation of their allocation. When one adopts Hospitals Suited to resources; fairness and care in the the perspective of a hospital that the Defence of Life choice of expenditure; the organi- works within a Catholic universi- sation and efficiency of the use of ty, its commitment to the defence When one speaks about hospi- resources; the suitability of clini- of life must be very precise be- tals and their function in caring for cal conduct derived from interac- cause of the deep motivations that public health, reference is made to tion with the scientific evidence; underlie its existence. One is deal- the criteria for assessment that are the efficiency and safety of treat- ing with making a contribution of indicated: by the organisations at ment; care for the patient: conti- excellence which, even before be- an international level, and con- nuity in the gathering, reliability ing expressed in terms of statis- nected with emerging countries, and transparency of information; tics of efficacy or surplus budgets, that constitute points of reference; the impact on public health; satis- is expressed in practical terms in by a comparison of experiences faction of the expectations of the state-of-the-art health services di- connected with health-care man- general public and workers in the rected towards the defence of hu- agement in various countries; and sector, etc. man life from its origins to its nat- by the evidence of medical-scien- All of this is asked of a hospital ural end. tific literature. such as ours which, as it belongs to The defence of unborn life con-

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stitutes a priority commitment for becoming arbiters of its destiny tion and intrinsically autonomous a Catholic university. For years and disposing of it without res- in his or her continuous, gradual our university has stood out for ervations, opened the field to one and coordinated growth. The em- the attention it has paid to preg- of the most controversial and dis- bryo, therefore, is a human indi- nancy at various stages and in turbing debates that the history of vidual starting with fertilisation the treatment of any pathologies man can remember and which can (Carrasco, 2010, Ventura Juncà, that may interfere with its normal be captured in the following ques- 2011). physiological processes. tion: when does human life begin? In preparation for fertilisation, Our School of Obstetrics and two highly specialised cells, one Obstetric Pathology has a consoli- derived from the man (the sper- dated tradition and a capacity for The Origin of Life: matozoon) and the other derived innovation which means that it is Fertilisation from the woman (the egg soul), esteemed at a national and an in- are subject to a series of modifica- ternational level. Biology, development embryol- tions which have two specific ob- Today, however, the interna- ogy and genetics have agreed for jectives: to prepare the spermato- tional context has presented us over forty years that an individual zoa for fertilisation (capacitation) with challenges which are in- of the human species begins to ex- and to reduce in both germinal creasingly difficult as regards our ist at the moment of fertilisation, cells the number of chromosomes commitment to the defence of un- as was declared by the famous and to a half of the number of the so- born life. never contradicted Chamber’s En- matic cells, that is to say from 46 25 July 1978 is a date that en- cyclopaedia: ‘Pregnancy is a time to 23 chromosomes (the process tered history because of the birth when the foetus develops inside of meiosis). This reduction is nec- in Great Britain of Louise Brown, the womb of the mother, between essary otherwise the fusion of the the first child ‘produced’ in a test fertilisation and birth’ (Jeffcoate male cell with a female cell would tube (the first ‘test tube baby’) us- 1969) and by a famous work of have as its result an individual ing the technique of in vitro fertili- medicine: ‘For the new individual with a number of chromosomes sation, which was the work of the life, begins in the ampoule of the that would be double the normal physiologist Robert G. Edwards in uterine tube with the act of fertili- (Savada, 2010). cooperation with the laparoscopist sation’ (Scothorne, 1976). The broad variability assured in Patrick Steptoe. What is a human embryo? The the gametes by meiosis is provid- By a fortuitous coincidence, on human embryo is an individual ed by two kinds of ‘remixing’ dur- the same date the Catholic Church who belongs to the human spe- ing the first meiotic division. had promulgated ten years previ- cies, as the geneticist Angelo Firstly, the chance distribution ously the encyclical Humanae Vi- Serra and the biologist Roberto of the paternal and maternal ho- tae on the transmission of human Colombo write: ‘the logical in- mologous chromosomes: during life, in which, starting from the duction from the data provided by the first stage of the metaphase, very nature of man, the personal the experimental sciences leads to the maternal and paternal chromo- and relational nature of human the only possible conclusion, and somes have the same likelihood of sexuality and its intrinsic procre- that is that – apart from chance being aligned on one side or the ative finality were affirmed, as a events involving disturbance – at other, with the possibility, there- result of which in the conjugal act the fusion of the two gametes a fore, of a ‘remixing’. of a man and a woman by nature new real human individual begins Secondly, recombination with there exists an indissoluble link his or her existence, or life cycle, an exchange of portions of ge- between its unitive and its procre- during which – given all the nec- netic material between couples of ative meanings. essary and sufficient conditions – maternal and paternal chromatids Humanae Vitae proclaimed that he or she will realise all of the po- (the sub-units of which the chro- human nature, by nature, has its tentialities with which he or she is mosomes are made up) through origins, according to the creative endowed. The embryo, therefore, the phenomenon of meiosis called design of God, in the act of love from the time of the fusion of the ‘crossing-over’ which further in- that unites a man and a woman. gametes is a real human individu- creases the potential genetic var- Today we can understand in a al and not a potential human indi- iability of the gametes and the better way the prophetic value of vidual’. children that come from this. The this encyclical which proclaimed It is with the act of fertilisation, potential of the genetic variability the dignity of procreation in an that is to say at the moment of the generated by meiosis is astonish- epoch when nobody would have union between the male germi- ing. The possible number of dif- imagined that one day human life nal cell and the female germinal ferent combinations for the inde- could originate outside the warm cell at the level of the third distal pendent segregation of 23 pairs nest of conjugal love and become of the fallopian tube, that a sub- of chromosomes in spermatozoa a product of a manipulation in the stantial mutation takes place and or oocytes is 223= 8,388,608 dif- hands of biologists and the techni- a new human being is constituted ferent germinal cells (Klug 2007, cians of reproduction. with an individual and unrepeat- Cain, Discover Biology, third edi- The possibility of individuals able genetic inheritance which tion, W. W. Norton & Co., 2006). outside a couple appropriating to allows him or her to be an active Thanks to such a genetic vari- themselves the mystery of life, subject of his or her own constric- ability between the gametes at the

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moment of fertilisation, an enor- that had been created. Article 2 of manifestations of the emergency mous number of combinations that law reads: ‘Resort to medical- that is expressed by bioethics. of chromosomes is made avail- ly assisted procreation is allowed When we compare the proce- able. Given that in a human in- when there are no other effective dure of FIVET (‘Fertilisation in dividual (diploid), the genetic in- therapeutic methods to remove Vitro and Embryo Transfer’) with formation is contained in the form the causes of sterility or infertil- the process of natural reproduc- of couples of homologous chro- ity’. Sterility caused by patholo- tion, substantial differences are mosomes, one coming from the gies of the peritoneal tube is the highlighted: only 5-7% of oocytes mother and the other from the fa- first of these conditions. obtained during the FIVET proce- ther, at the moment of fertilisation In reality, in daily practice, the dure produce a pregnancy and on- one can obtain 223= 8,388,608 x tendency prevails to by-pass any ly 10-15% of the embryos lead on 223=8,388,608 = over 70,368 mil- sort of diagnostic examination to the birth of a child. This means liard possible genetic combina- of a sterile couple and to see so- that for every ‘babe in arms’ ob- tions, to which should be added termed ‘medically assisted pro- tained through FIVET, 80-85% the effect of crossing-over. This is creation’ as a first option. of the embryos produced are lost a practically unlimited variability Article 13 of the same law pro- (Kirkegaard, 2012). The transfer which constitutes the highly so- vides the rules for the defence of of more than one embryo has had phisticated biological mechanism the embryo: a prohibition on clin- the intention of improving the re- on which is based the uniqueness ical and experimental research sults but it has led at the same time and never to be repeated char- which is only allowed for the pur- to a marked increase, over the acter of each human individual, poses of the health of the embryo, last ten years, of levels of multi- as well as the variety and natural as well as a prohibition on the eu- ple pregnancies, with consequent turnover of the population. genic selection and manipulation complications for the mother and A recent sentence of the Euro- of embryos and gametes. also for the foetus. pean Court of Justice (ECJ) of 18 In article 14 Law 40 prohibits The tendency over time has October 2011 in Luxembourg de- the freezing and then conservation been to reduce the levels of twin fined the ‘human embryo’ as eve- of embryos. However, following pregnancies after FIVET, main- ry ‘human ovule from the stage of a change made by a sentence of taining a good level of births af- fertilisation’ given that ‘fertilisa- the Constitutional Court to sec- ter FIVET. To this end, increasing tion is such as to set in motion the tion 3 of the same article, it was importance has been given to the process of development of a hu- indicated that the transfer of em- selection of embryos, that is to say man being’. For this reason, in the bryos must be carried out ‘with- to that stage which seeks to iden- same sentence the directive was out prejudice to the health of the tify the embryos of higher quali- issued to the effect that one can- woman’, a phrase which raises by ty with the aim of assuring higher not patent a procedure which, in means few problems at the level levels of success. The technique resorting to the removal of stem of interpretation and keeping open of selection that is widely used is cells taken from a human embryo the possibility that at the discre- based upon the microscopic ob- at the blastocyst stage, involves tion of the agent the freezing and servation of the morphological the destruction of the embryo it- conservation of embryos can take characteristics of the embryo and self. place as a foreseeable and planned its level of cleavage. This tech- act and not only as a consequence nique has been shown to be suf- of a grave and documented cause ficiently effective for the identi- The Advent of Artificial involving greater force, as was in- fication of embryos with a good Fertilisation Techniques dicated in the original version of implantation potential but it is not the law. always able to identify genetical- Over the last thirty years we The regulations of Law 40, how- ly abnormal embryos. It is known have witnessed a decisive acqui- ever, could not avoid sterile cou- that a relatively high proportion sition of power by man over life ples from deciding to go to other of embryos produced follow- and over man himself as regards nations where such practices are ing the use of IVF are genetical- his wide ‘genetic-germinal’ iden- used without any obstacles, giv- ly abnormal (Kirkegaard, 2012). tity. This is a power that is as ex- ing rise thereby to the practice of However, they can appear to have alting as it is worrying and it is so-called ‘reproductive tourism’ normal morphological charac- without precedent in human histo- (De Geyter 2012). In the most fa- teristics when examined through ry: scientific research, and genetic mous social networks, indeed, it the microscope. Pre-implantation research in particular, has no long- is not rare to see advertisements genetic screening subsequently er confined itself to knowledge that propose the donation of gam- represented a more sophisticated about, control of, and responsible etes or state-of-the-art techniques technique directed towards iden- transformation of, nature, as it had of artificial procreation. The com- tifying aneuploid embryos before always traditionally done. It has plexity of the problems, the deli- their transfer. New methods are gone ‘beyond’ this. cacy of the applications and the now being studied, although they In Italy, Law 40 of February rapidity with which it is necessary are not yet available for clinical 2004 tried to establish limits in to formulate questions and pro- use, to achieve an increasingly order to introduce order into the vide recommendations for ethi- effective selection of embryos in so-called ‘procreative far west’ cal reference points, are thus clear order to improve the implantation

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rates. One of these techniques, were obtained, of which 10,744 Health Organisation entitled ‘Cur- namely ‘Time-Lapse Monitor- were monitored, with 8,161 births rent Practices and Controversies ing’, involves the constant ob- (1,772 multiple births) and 10,036 in Assisted Reproduction, “Infer- servation of an embryo through children born alive. tility and Social Suffering” 384- a video camera applied to the in- In the Italian data as well one 385’ (Daar and Merali, 2001) it cubator in order to register on finds an enormous discrepancy, is emphasised that ‘the media are film the dynamics of its develop- which is described in the litera- often responsible for the creation ment and thereby register signs of ture, between costs in terms of of a very promising image of IVF weakness or asynchronism in the embryos, that is to say in terms of and of what it can offer to an in- sub-division (Kirkegaard, 2012). human lives, and assured results. fertile couple. However, it is well The improvement in levels of effi- The relationship between trans- known that in many countries the cacy in techniques of in vitro fer- ferred embryos and births is 10/1. general public lacks basic knowl- tilisation has witnessed a parallel Such is the high price paid to as- edge about infertility, its causes increasingly fierce ‘hunt’ for em- sure the hoped-for result. and its prevention, as well as cor- bryos that are defective because rect information about the realis- of the procedure of manipulation tic possibilities for the treatment itself. This is to say that more are of infertility’. produced to select more and to When New Life Does In the report of the Bertarelli improve the standards of produc- not Begin: Ethical Foundation’s Second Global Con- tion. Solutions in the Field ference, which was held in Prague The latest data of the European of Sterility on 16-17 November 2002, Lunen- Register of the ESHRE (the Eu- feld (2004), a pioneer in the field ropean Society of Human Repro- The balance of thirty years in the of infertility, expressed himself duction and Embryology) on the use of IVF techniques with about in the following way: ‘over re- use of reproductive techniques in four million children born in the cent years the advances in medi- thirty-six European countries in world following IVF from 1978 cal technology have offered hope the year 2008 in 1,051 clinics re- until today (Finn H., ‘The Baby to many sterile couples, above all port a pregnancy rate through as- Chase’, July 23, 2011, Wall Street in the developed world. Howev- piration of the oocyte of 28.5% in Journal Online URL), of whom er, the advances that have been the case of FIVET and of 28.7% in 60% were born in Europe (Nygren made have raised new medical, the case of ICSI. In the case of the & Lazdane, WHO, 2006), and the ethical and social questions which re-implantation of frozen embryos questions of the scientific commu- require attention not only from ((97,120 out of a total of 532,260), nity and of society, have increas- health-care professionals but al- the pregnancy rate with de-freez- ingly brought out the need for so- so from the whole of society… ing was 19.3%. The cumulative lutions that are more congruous the use of these technologies of percentage of births with FIVET to, and safer for, the increasingly assisted reproduction should not and ICSI was 21.7%, almost the emergent problem of infertility. take the place of a proven medical same as that reported over the last Infertility is a condition that af- approach through individual ex- three years. fects one in every seven couples aminations and diagnoses’. The Italian data, published (Templeton A., ‘Infertility-Epide- It is this context that we should in the report of the Ministry of miology, Aetiology, and Effective locate the function and originality Health of 28 June 2012, and re- Management’, Health Bull., Edin- of the Paul VI International Scien- lating to the activities of 357 cen- burgh, 1995,53(5):294-298; Tro- tific Institute – ISI – for Research tres for artificial reproduction in lyce, 2011). into Human Fertility and Infertil- the year 2010, report, as regards In the World Report on Disa- ity for Responsible Procreation. direct techniques, that is to say bility of 9 June 2011 (WHO and This is an institute that exists to where resort has not been made The World Bank), infertility is de- defend life at its origins. to the de-freezing of embryos fined as a ‘disability from various Eighty years after the founda- or gametes, that out of a total of points of view: the physical, the tion of the Catholic University, 44,350 patients and 52,676 cycles cognitive, the mental, the sensori- and at the time of the Great Ju- begun, the cumulative pregnan- al, the emotional and the develop- bilee of the year 2000, on 9 No- cy rate for FIVET and ICSI was mental, in conjunction with each vember 2000 the rector of the equal to 23.1% for cycles with other as well’. university, Sergio Zaninelli, gave oocyte removals. The use of IC- In developing countries second- His Holiness John Paul II, who SI was predominant and involves ary infertility is seen as one of the was present at the inauguration 84% of cycles with the removal six conditions of maternal mor- of the academic year, the news of of oocytes. The cumulative per- bidity which remain ignored in the the creation by the university of a centage (FIVET and ICSI) for live defence of maternal health (Hard- foundation dedicated specifically births from cycles with the remov- ee, Gay and Blanc, 2012, ‘Mater- to the delicate and decisive sector al of oocytes was 17.8%. nal Morbidity: Neglected Dimen- of human procreation. This initia- The same report of the Ital- sion of Safe Motherhood in the tive was presented as the answer ian Ministry of Health informs Developing World’, Global Pub- to the calls made by the Holy Fa- us that from 103,587 transferred lic Health (2012), 1-15). ther in his message for the Day for embryos, 11,964 pregnancies In the report of the World Catholic Universities of 5 May

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2000 and for the Jubilee of Uni- stages that lead to its expression, the value of every unborn life that versities of 9 September 2000, intervening professionally upon is entrusted to our care. when he expressed himself as fol- what can alter the normal devel- lows: ‘aim for a culture that as- opment of this process. sures the centrality of the person, Clinical management involves: The Sector of Research into his inalienable rights, the sacred- The treatment of infertility in Fertility and Infertility ness of life’; ‘reaffirm the need for couples through an evidence- a culture that is truly humanist… based diagnostic-therapeutic pro- The role of the ISI in this field is become involved in the construc- tocol which is innovative because fundamental in the advancement tion of a culture for the human of the fact that it involves in par- of knowledge about the physiol- person, do not give way to rela- allel both members of the couple, ogy of production, the study of tivism, to pragmatism, to learning implementing a multi-specialist causes that are still unknown of for its own sake’. approach that envisages the con- infertility in men and in women, The Paul VI ISI Foundation for tribution of a team of specialists and progress in the diagnostic research into human fertility and (a gynaecologist, an andrologist, a process and therapeutic solutions infertility was created on 22 June gynaecologist who is an expert in within the framework of natural 2001. In March 2003 clinical ac- reproduction surgery, an endocri- procreation. On this sector de- tivity was begun with the opening nologist, etc.). pends the future developments of of the ISI clinic for the treatment In our experience we have seen what the ISI wants to do for the of sterility in couples, which was that in many cases it is possible scientific community. then flanked by research activity. to remove the causes of infertili- The clinical activity of the ISI, The defence of life in the experi- ty and in particular to obtain suc- ever since it was begun, has wit- ence of the ISI coincides with the cesses even when there is a diag- nessed an increasing presence of defence of life at its origins. This nosis of infertility rooted in the couples and a constant increase in is a priority and delicate task be- female tubes or a semen dysfunc- the services that are available and cause it is applied at the very mo- tion (cases where the general ten- in correlated research activity. ment that life comes forth. dency prevails of proposing only With respect to the strong the artificial solution). points of our protocol (reconstruc- Sectors in which the ISI is The recovery of the normal re- tive surgery and andrological re- Involved productive function places the search), it is useful to examine the couple in a condition of engaging salient aspects of the pathologies The operational sector con- in an experience that is complete- that are taken in hand, the forms nected with the Study Centre for ly different from that of artificial of treatment that are undertaken, the Natural Regulation of Fertil- procreation: the couple can fol- and the results that are obtained. ity concerns the stage when the low the coming forth of life as a couple decides with a responsible natural event which involves them choice to open itself or otherwise profoundly in the perception of a Sexually Transmitted Diseases to welcoming a new life by tak- mystery. as a Fallopian Tube-Peritoneal ing advantage of the most modern The treatment of cases involv- Factor in Sterility: Prompt instruments for knowledge about ing multiple miscarriage. Given Diagnosis and Pharmacological the rhythms of fertility (the most that the causes of multiple mis- Treatment recent methods for the natural reg- carriage can be many in number ulation of fertility). Knowledge and often interacting, a protocol The normal process of recep- about fertility opens up a pathway is applied which envisages team tion and fertilisation of the oocyte of self-awareness and the taking work, with the involvement of a released by the ovarian follicle at of responsibility of the couple gynaecologist, an endocrinolo- the moment of ovulation requires which is a distant preparation for gist, a haematologist, a geneticist a whole series of pre-requisites: welcoming life. This takes place and other specialist figures. an ovarian surface free from ad- both through the professional con- The experience of repeated mis- herences, the fimbric-ampoule tribution of workers in the sector carriages profoundly marks the portion of the tube being free to in the field of consultation for the lives of the woman and of the cou- receive the ovary and, in addition couple, through information and ple. In these cases one observes to the tube being pervious, a nor- teaching, and through scientific the complexity of the events with mal activity of the ciliary and se- studies in the field of the natural which a new life comes into ex- creting cells within the tube and a regulation of fertility. istence and the multiplicity of fac- normal peristalsis of the muscles The clinical sector connected tors that can interfere with its nor- of the tube. with the ISI clinic. Specialist skills mal evolution. This condition of highly spe- and knowledge are concentrated Every life that is lost is a defeat cialised normality (the presence on the process which is at the ori- for a medical doctor who is called of chemical tactical factors which, gins of life in order to obtain a nat- to utilise his or her knowledge to freed from the mature follicle, ural conception and foster the nor- defend every life from the mo- make the terminal part of the tube mal evolution of a pregnancy. Our ment it comes into existence. draw with its fimbrias near to the work is directed towards defend- The efforts that are made are ovarian follicle in order to facili- ing life by following directly the proportionate to the perception of tate the reception of the mature

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oocyte freed at the moment of tified, in the presence of one or allowed a better selection of pa- ovulation, has been demonstrat- more of the following minimal tients as candidates for recon- ed), can be compromised as a re- criteria: pain on lateral movement structive tubal surgery through the sult of infections that rise up from of the uterine cervix with biman- identification of those who have a the lower genital tract. ual exploration, uterine pain, ad- good reproductive prognosis. nexal pain. Lastly, as regards the results of Pelvic Inflammatory Disease These guidelines suggest appro- surgical therapy, to summarise we priate protocols of treatment with can state that the proximal occlu- Over the last two decades the antibiotics by intravenous infu- sion of the tube, a frequent cause growing spread of sexually trans- sion, taken orally, and criteria for of directing patients to FIVET, is mitted diseases has put at risk for the hospitalisation of patients with a false positive in probably near to many women the possibility of PID in order to prevent the nega- 96% of cases (Al Jaroudi, 2005). achieving pregnancy by natural tive consequences of PID for fe- In the case of peri-tubal adher- pathways by altering the above- male fertility. ences the mucus inside the tube mentioned normal relations be- is conserved in 80% of patients tween the tube and the ovary. and these last can expect a like- Pelvic inflammatory disease The Tubal-Peritoneal Factor lihood of a completed pregnan- (PID), the most important of the in Sterility: the Surgical cy of roundabout 70% . Patients sexually transmitted diseases Treatment of Female Sterility with distal tubal occlusion have (STD), is due to the ascent of path- a normal mucus in about 40% of ogenic microorganisms from the Sterility of tubal origins is re- cases and these cases have a 40% vagina and the cervix to the upper sponsible for about 25-3% of chance of a completed pregnancy. genital pathways (endometrium, cases of female sterility. The tubes and contiguous structures) principal cause of the tubal-peri- (Centre of Disease Control, 1982). toneal factor in sterility is damage Sterility Associated Recent epidemiological data caused in previous episodes of with Endometriosis (Haggerty, 2010) indicate that pel- pelvic inflammatory disease, re- vic inflammatory disease afflicts sulting from the rising up of sexu- Endometriosis, defined as the 1.7% of women between the ages ally transmitted infectious agents presence of tissue of the endome- of 16 and 46 in the United King- into the reproductive tract. These trium, of glands and of stroma in dom every year, 8% of women infectious episodes can give rise sites outside the uterine cavity, of reproductive age in the United to a declared clinical picture or a is present in about 7-10% of the States of America, 15% of Swed- sub-clinical form. The last three female population of the repro- ish women during their lives, with decades have witnesses a notable ductive age. In sterile women the more than a million women treat- increase in this component of fe- presence of endometriosis rises to ed for this condition every year in male sterility. Previous surgery 25-30% whereas about 30-50% of the United States of America. and endometriosis are another two women with endometriosis have The rate of sterility of tubal or- causes of pelvic adherences. sterility (ASRM, 2006). igins is 12% after an episode of In assessing the results of re- Conservative laparoscopic sur- PID, 23% after two episodes, and constructive surgery we must bear gery is seen as a front line treat- 53% after three episodes. in mind that whereas it is possible ment by recent guidelines and al- The prevention or reduction of to re-establish normal anatomical low the obtaining of pregnancy in important negative consequences relationships that have been dis- 50% to 60% of cases. of acute PID for the female geni- torted by the production of adher- In the experience of the Paul tal apparatus requires prompt di- ences because of the process of VI International Scientific Insti- agnosis and the implementation infection by surgical means, it is tute, 143 patients with suspected of a swift and appropriate anti-mi- not possible to repair functional or ascertained sterility of tubal- crobe therapy. damage that is caused by the pro- peritoneal origins had a diagnos- Because of this, it is of funda- cess of infection (for example the tic or operative laparoscopy, with mental importance that a medi- working of the endo-tubal epithe- peritoneal or endometrium salpin- cal doctor who works within a lium, the capacity to contract of gochromoscopy, salpingoscopy hospital institution knows about the tubal musculature). The suc- (when indicated), associated with the most recent change in the cess rates of surgical treatment are diagnostic or operative hysteros- guidelines of the Center of Dis- thus closely correlated with the copy. Nine of them had minilapa- ease Control of Atlanta () kind of pre-existent damage and rotomy for intramural/sub-mucus on PID which were published in its location. Recent advances in myomas or voluminous/multiple 2010. laparoscopic equipment and the intramural myomas subsequent to According to the recent guide- increased skills of surgeons in sur- hysteroscopy and salpingochro- lines, all women who are sexual- gical laparoscopy now allow lapa- moscopy. ly active and have pain at a pelvic rotomy to be avoided in the ma- The patients were subsequently level or in the lower abdominal jority of cases. contacted by telephone in order quadrants should be treated for The introduction of salpingo- to obtain information on possible PID, if another cause for the mor- scopy which allows a direct as- pregnancies and their outcome. bose condition cannot be iden- sessment of the tubal mucus, has The average follow-up was 49

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months (the range was from 11 to the analysis carried out by Milardi An assessment of the possible re- 118 months). et al. demonstrated that only 35% productive risk also takes advan- Of the 152 patients, 61 wom- of conceptions achieved from 2003 tage of specific data banks that are en achieved pregnancy (40%). to 2011 came about in the presence available at an international lev- Of these, 27 patients achieved of normal semen parameters and el. The Red Telephone is indeed more than one pregnancy. In to- that in the majority of pregnancies integrated into a network of ho- tal, 94 pregnancies were obtained. (65%) the husband had alterations mologous services (the Teratogen 23 pregnancies were ended by a in at least one semen parameter. Of Information Service) at a Europe- miscarriage (24%), 2 were extra- these, 9% had a reduction in com- an (ENTIS) and extra-European uterine pregnancies and one pa- bination that ranged from moder- (OTIS) level, with which there is tient decided for VIP after a diag- ate to severe of the three principal a relationship involving a constant nosis of Down syndrome. In total, semen parameters (oligoastenoter- exchange of information connect- 32% of patients received a ‘babe atospermia). This fact highlighted ed above all else with the rarest or in arms’. that a reduction in the semen pa- newest questions and issues. rameters does not exclude the pos- sibility of a spontaneous concep- Treatment of the Male Factor tion. Every patient should thus be Repeated Miscarriage in Sterility able to have access to an in-depth diagnostic and therapeutic assess- Reference is made to repeated Aetiological therapies for male ment, even when the prospects of miscarriage when in the obstetric infertility, that is to say therapies obtaining ‘normal’ semen param- history of a woman two consecu- designed to eliminate the cause of eters appear low. tive episodes of miscarriage take infertility and in this way obtain a place during the first twenty weeks conception, pre-suppose and fol- of pregnancy. This condition is to low an attentive diagnostic pro- be found in about 1% of couples cess that seeks to find the patho- When Life has Begun of the fertile age. Recurrent mis- genesis of the infertility. carriage, is, instead defined as the Amongst the aetiological situa- Correct Consultations as presence of three or more consec- tions that are most frequently en- Regards Fears about or the utive episodes of miscarriage. At countered in male infertility are Risks of Pregnancy: the Red the present time, reference is made endocrinal pathologies such as Telephone generically to multiple miscar- male hypogonadism; hypoprolac- riage and screening is done for this tinaemia; tyroid pathology; infec- This is a telephone line for fu- starting from the second consecu- tious diseases affecting the genital ture or recent mothers. It is called tive episode of miscarriage. In the apparatus; and varicocele, that is the ‘Red Telephone’ and it is a majority of cases of multiple mis- to say a dilation of the vessels of special free service of the Study carriage it is not possible to find the testicular vein plexus Centre for the Defence of the a certain cause at the base of this A correct diagnostic-therapeu- Health of Mothers and the Un- problem. However, amongst the tic approach thus allows a search born Child at the Catholic Univer- principal causes known as factors for such situations which give sity of Rome. It offers informa- that involve a predisposition to re- rise to infertility as well as inter- tion and clarifications ‘at home’ current miscarriage one may iden- vention through medical or surgi- for the prevention of congenital tify chromosome anomalies (5%), cal therapy designed to overcome defects of neonates and an assess- uterine malformations (15-27%), such situations. ment of teratogenic risks (factors and pathologies in the mother (20- In the presence of alterations that can cause malformations in 50%), such as infections of the in the semen parameters, of a se- the embryo), for example involv- genital tract, exposure to medical vere character as well, a complete ing the taking of pharmaceuticals products and toxins, endocrinal al- diagnostic-therapeutic process during pregnancy. The Red Tel- terations, and congenital and ac- has to be followed which seeks ephone provides medical consul- quired thrombophilias. to identify and where possible re- tancy during the pre-conception The ISI has the basic task of in- solve the causes of such altera- stage, during pregnancy, or during vestigating the principal causes of tions. This approach in many cas- breastfeeding to those who ask repeated miscarriage through clin- es allows an improvement in the for it: for example couples, and ical and basic research and of sug- quality and the parameters of the in particular women who wish to gesting new therapeutic approach- semen, although not reaching lev- have a child or who are during the es in order to reduce the incidence els that are considered to be ‘nor- first stages of pregnancy, but also of repeated miscarriage and to mal’ (normospermia), such as to general medical practitioners and protect the initial development of allow a spontaneous conception. other socio/health-care workers. the foetus. This is confirmed by the experi- The consultation is given by med- ence of the Paul VI International ical doctors who are specialists in Scientific Institute which was de- obstetrics and gynaecology with a Pregnancy scribed in a recent scientific work particular competence in the field published in the International of prenatal medicine, pregnan- Pregnancy is a physiological Journal of Endocrinology. Indeed, cies at risk and clinical teratology. condition accompanied inescap-

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ably by a series of modifications (as in the choice of anti-hyper- monitoring, as simple as this may relating to the whole of the fe- tension drugs and antibiotics) and appear in the absence of additional male organism. As a consequence the most effective therapies rec- risk factors, and all of this to pro- of these changes, during the preg- ognised by international guide- tect the foetus and the mother and nancy (and for a certain period af- lines. Taking all of this into con- thus to allow them to experience ter birth as well) some chronic pa- sideration, it becomes evident that the pregnancy as a physiological, thologies can temporarily change prevention and the education of special and happy event in the life their development (both for the patients is the first line of defence of a woman. worse and for the better) whereas that should be used. Prevention other specific pathologies of preg- means above all else ‘pre-concep- nancy can arise. Albeit always tion consultation’, both in generic Malformations of the Foetus: within the inescapable unity of terms as regards pregnancy (and the EXIT Procedure the foetus and the mother, some suggestions such as the simple of these directly concern the foe- but very effective folic acid sup- The acronym EXIT refers to tus and what is connected to it, plements) and in specific terms the so-termed ‘Ex Utero Intrapar- whereas in other cases the symp- for each patient. Those who re- thum Therapy’ procedure that lit- toms that arise are prevalently ceive chronic treatment need to erally refers to a treatment of the ones of the mother. We can thus reach pregnancy in optimal and foetus outside the maternal uter- encounter neuro-vegetative phe- stable physical conditions and us during the period of birth. This nomena such as vomit and nau- with a suitable choice of medical procedure is based upon the as- sea, which are typical of the first products, in particular with the sumption that in a particular group three months, with an incidence of elimination of teratogens. Having of pathologies involving malfor- 60-80%. Amongst the common- to change chronic therapies dur- mation to the foetus (voluminous est illnesses we find gestational ing pregnancy without being able neoplastic masses on the neck or diabetes (with an incidence of be- to foresee the effects in a precise the lung, anomalies of the larynx tween 1% and 3%), for which a way is not to be welcomed. and the trachea, diaphragm her- screening is required of all preg- At a secondary level in preg- nias and congenital heart disease) nant women between the twenty- nancy the woman should be ed- there exists a high likelihood of fourth and twenty-eighth week of ucated in paying attention to her obstruction of the upper breath- pregnancy through an analysis of symptoms and to her behaviour, ing pathways such as to involve at the curve of the glycemic load. A for example being attentive to di- the moment of birth the neonate second pathology that can be en- et, control of body weight, and the being unable to breathe sponta- countered quite frequently is hy- keeping of a blood pressure diary. neously with the risk of a severe pertension induced by pregnan- All of this helps to decrease the reduction of cerebral oxygenation cy which affects about 5-10% of risk factors for some of the most and as a consequence permanent pregnant women. One should al- frequent pathologies mentioned damage if not also possible death. so add that that this condition can above in order to avoid the devel- Pathologies that cause malfor- complicate further and develop opment and the complications of mations in the foetus and which into preeclampsia/eclampsia (up the gravest. Amongst these, which may require an EXIT procedure at to 3-7% of pregnant women, in- may concern both the foetus and the moment of birth are, as has al- cluding light forms) or the more the mother, we may cite, for ex- ready been observed in this paper, fearful HELLP syndrome (4-12% ample, the hyper-development of voluminous neoplastic masses on of patients with preeclampsia), the foetus, late miscarriage, neo- the neck or the lung (such as lym- which is characterised by a multi- natal prematurity, the inappro- phangiomas or teratomas of the organic involvement with a pos- priate detachment of the placen- neck, cystic adenomatoid malfor- sible rapid compromising of the ta, renal insufficiency, CID, and mations of the lung), anomalies of pregnancy. An alteration of the in general post-partum mortality the larynx (atresia of the larynx) hepatic parameters can, in addi- connected with the hypertension/ and of the trachea, diaphragmatic tion, be present within the frame- preeclampsia/eclampsia complex. hernias and congenital heart dis- work of the so-termed ‘intra-he- In the case of diabetes there is a ease. These are pathologies with a patic cholestasis of pregnancy’ risk of an increase in maternal in- very low incidence, in some cases where there is an increase in the fections, a pre-term birth, a wors- as low as 1:100,000-200,000 live biliary acid levels and transami- ening of the involvement of the births, and which are thus diag- nase. Itching, however, remains a micro-circle, malformations of the nosed before birth in a relative- characteristic of this condition. foetus (in particular of the heart, ly ‘sporadic’ way in our country. On the therapeutic front, in of the nervous system, of the gas- However, the increasingly com- many cases the symptom is treat- tro-urinary system and of the gas- mon use of policies of ‘mass’ ed, and behaviour at the level of tro-intestinal system), death of the screening in the obstetric-peri- hygiene and diet are suggested foetus and even dysmetabolisms natological field, which has been which will help the patient to face and their consequences during made possible over the last twen- up to the pathology. Whatever the childhood. ty years by the ‘systematic’ use of case, reliance must be placed on It is evident, therefore, that the screening methods during the first the pharmacological sets of treat- approach to pregnancy requires an weeks of pregnancy, has meant ment allowed during pregnancy attentive, targeted and continuous that such diagnosis, and thus re-

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quests for help in these highly formations to the foetus referred as a consequence less traumatism complex cases, are constantly on to above, and in particular for the at the level of the pelvic floor. the increase. use in selected cases of the EXIT The EXIT method seeks to procedure. transform a ‘critical’ event in- The Role of the Obstetrics volving high risk into a controlled Team in the Delivery Room: the and systematic procedure in order Preparation for Birth Obstetrician, the Gynaecologist to reduce in a significant way the and Neonatologist. Urgent likelihood of grave neonatal com- Pregnancy and birth involve Needs and Emergencies in the plications. It can be summarised the woman, the couple and the Delivery Room in the following phrases: 1. the environment that surround them planning of birth with a caesarean in an experience that is not only The team, made up of an ob- operation; 2. general anaesthetic physical and biological but which stetrician and a medical doctor, for the mother in order to assure also relates to the mental, affec- of the delivery room has the task a relaxing of the maternal tissues; tive and intellective field. Today, of receiving the pregnant woman and 3. the partial extraction of the obstetrics seeks not only to en- in labour with empathy and of ac- neonate from the uterus (in gener- sure women the medical care and companying her throughout all al only the head and shoulders) in treatment that are needed during the stages of childbirth, as well as order to allow the maintenance of pregnancy but also to provide hy- assessing the state of wellbeing a certain volume within the uter- giene and health-care elements, of the foetus during the stages of us itself (thanks as well to an in- and ethical-social elements, that childbirth that involve dilation and fusion of a warm saline solution prepare them for pregnancy and expulsion. Although childbirth is into the amniotic cavity) and to monitor its harmonious develop- a physiological event, there is no impede the separation of the pla- ment until the final moment of la- other setting in which emergency centa. bour and birth. Pregnant women is experienced so often as in a de- A caesarean operation using the often say that have been given livery room EXIT procedure differs substan- dramatic information about the Real obstetric emergencies are tially from a traditional caesarean pains of childbirth. It is the task those which take place in an un- because of the fact that in a birth of courses preparing women for expected and sudden way, that is using EXIT the absolute priority childbirth to render ‘non-dramat- to say they emerge from the ‘nor- is to impede the separation of the ic’ the problems connected with mal’. In a few minutes the sce- placenta (which must continue to labour and childbirth and to re- nario can become complex and provide oxygenated blood to the duce them to their proper level, at times dramatic. It can be diffi- neonate during the manoeuvres describing them as a natural func- cult to maintain the lucidity that is indicated above). The second fun- tion of the maternal organism and needed in order to remember eve- damental need is to obtain a suf- creating conditions of serenity rything that should be done or to ficient level of anaesthesia in the and self-control. make it happen; the team must be neonate who can also be subject- The course to prepare women trained to deal with the prolapse ed to surgical manoeuvres in the and the couple for childbirth en- of the funicle, an obstetric surgi- case of an especially difficult in- visages seven meetings held on a cal birth, the dystocia of a shoul- tubation. weekly basis. During the course der, an emergency podalic birth, From these needs in July 2012 a the meetings take place in the de- the separation of the placenta, an joint initiative (in their respective livery room in order to foster en- embolism in the amniotic liquid fields of interest) was born of two counter with all the professional and post-partum haemorrhage. In internationally important medical figures who will accompany the order to deal with an emergency institutions: the Catholic Univer- couple within the framework of everything should be organised sity of the Sacred Heart – A. Ge- the experience of childbirth: ob- beforehand, everything should be melli Polyclinic and the Baby Je- stetricians, anaesthetists, gynae- planned beforehand, and commu- sus Children’s Hospital of Rome, cologists and neonatologists. The nications should also be thought two institutions that are strongly benefits of the course to prepare about and organised through the united by a shared Catholic ap- women and the couple for child- creation of local protocols that are proach and by a constant search birth are also opportunities to pass practical and agreed upon. for excellence both in the clinical/ time with other couples and for a care field and in the field of sci- greater involvement of the father entific research. This initiative in- in the pregnancy. The course also Conclusions volved the establishment of a ref- provides a weekly opportunity to erence centre at a national level ask questions between one obstet- The journey towards the birth and the creation of a ‘mixed’ mul- ric examination and another and of a new human life is a conquest tidisciplinary team, one, that is to to develop confidence in a capac- achieved by stages that are not al- say, made up of specialists from ity to address labour and child- ways easy and which require from both these institutions, to ‘take re- birth. All of this preparation leads those involved in service to un- sponsibility for’, and the prena- to a reduction in the times of la- born life competence, commit- tal and postnatal management of, bour, a reduction in psycho-mo- ment, a spirit of cooperation and pathologies involving those mal- toric agitation during labour and great passion for life.

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But when one speaks about the as well, it is difficult to assess the care field. In addition, some results origins of life, one requires, per- quality of service to life in eco- of a health-care action can be iden- haps, greater sensitivity and care nomic terms or in terms of results tified often only after a period of for a new life which, even before that can be quantified. time following that service (WHO being visible only through a di- The document of the WHO that 2008, Wareham, 2001, Brook, agnostic examination, should be has already been mentioned in this McGlynn and Melzer, 2001). thought about and prepared for by paper (World Health Organization This is very true as regards all fostering the natural process by 2008, on behalf of the European the services that a hospital like which it can come forth in a way Observatory on Health Systems ours can activate in defence of that is consonant with its dignity. and Policies, ‘Assuring the Qual- frailest life: unborn life, beginning We believe that service to life ity of Health Care in the European with its origins. at its origins, to which the ISI is Union’), like other publications on A preferential commitment to called, is very important and of health-care policies, warns about economic support for these servic- contemporary relevance not only the widespread error of basing es is today absolutely necessary for our university but also for the judgement on the quality of ser- and will in the future be a demon- Church and civil society. vices solely on results obtained stration of the quality of a commit- At a historical time when the in quantitative terms, inasmuch ment that will never be running at logic of the global economy pre- as they do not constitute the best a loss because life can never be a dominates, in the health-care field measure of quality in the health- question of ‘the market’.

Ethical Committees in Hospitals Today

Prof. John M. Haas, Ph.D. keep this Oath unviolated, may it ally out of a sense of compassion President of the National be granted to me to enjoy life and and love for humanity, particular- Catholic Bioethics Center, the practice of the art, respected ly this patient suffering here be- Philadelphia ,USA. by all men, in all times.” The gods fore me now. But as the physician Consultor of the Pontifical and the family and the communi- might be tempted to do something Council for Health Care ty are called to bear witness to the wrong for a good reason, the com- Workers taking of this sacred oath. munity is there to strengthen him, The communal dimension of to reorient him, to hold him to his health care can be seen in this pa- Oath. “I will give no one a deadly eorges Clemenceau, the gan oath as true to human nature. medicine even if asked, nor coun- GPrime Minister of France be- We are communal creatures. The sel any such thing,” as stated in fore and after the First World War, communal character of the pro- the Hippocratic Oath. This helps declared: “War is too important to vision of health ought to be even keep the physician true to his call- be left to the generals”. There is a more clearly seen when it is pro- ing even when a false sense of way in which the same thing can vided by the Church, by the Mys- compassion might tempt him to be said about health care. “Health tical Body of Christ. We are saved do otherwise. And an ethics com- care is too important to be left to in community, in and through mittee might be called upon to the physicians.” The existence and the Body of Christ. The moral help the physician decide whether the function of ethics committees strength of any one member of or not the removal of the feeding is one expression of this fact. The the Church strengthens the entire tube from this comatose patient in provision of health care is truly a Body; the moral turpitude of any this particular circumstance might communal affair. member of the Church weakens constitute euthanasia. It is striking that the Hippocrat- the entire Body. Ethics commit- There is a way in which ethics ic Oath, the enduring physician’s tees help to keep the healing min- committees in hospitals bear wit- pledge to practice moral medicine, istry of the Church true to itself, ness to the communal character of takes place in a communal setting, true to Christ. One reason physi- health care and to the uncompro- both celestial and earthly. The phy- cians take an oath is so that they mising commitment of health care sician swears by Apollo and As- will be provided divine and hu- to the good of the patient. Ethics clepius, and all the gods and god- man support when they might be committees help health care pro- desses in front of the community. tempted to do something wrong fessionals and institutions guard Only in the keeping of his sacred for good reasons. One is tempt- against ever violating the dignity oath can he hope to enjoy respect ed to euthanasia, for example, not of the human person. Ethics com- from others. “While I continue to out of hatred of humanity, but usu- mittees can help the health care

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provider by developing institu- al and an advisory capacity. These the American bishops state: “First, tional policies or protocols which educational and advisory tasks the Catholic health care ministry clarify the demands of the moral take on their own unique character is rooted in a commitment to pro- law when they might not appear in Catholic institutions since they mote and defend human dignity; so obvious, for example, in an are aided by a highly sophisticat- this is the foundation of its con- emergency situation. ed and developed moral tradition cern to respect the sacredness of In the United States the larg- which the Church has refined over every human life from the mo- est provider of health care after centuries. Even as the Catholic ment of conception until death.”8 the government is the Catholic Church provides health care to ail- This should be the ultimate con- Church. And the Church, more ing bodies and minds, she ought cern of any ethics committee, sec- than any other institution today, is never forget that her ultimate task ular or Catholic, i.e., respecting committed to the principles of the is assisting all people attain their the dignity of the human person. pre-Christian Hippocratic Oath ultimate goal, which is eternal life It is just that the Catholic institu- and the spirit of the Divine Phy- with God in the next. tions understand the eternal sig- sician, Jesus Christ. The Hippo- In the United States, the bishops nificance of this and have received cratic Oath was always embraced exercise their pastoral oversight invaluable assistance in the task by Christians as articulating in of the vast health care ministry of from divine revelation and the health care the demands of the the Church in part through a docu- trustworthy moral guidance of the natural moral law. In The Gospel ment known as the Ethical and Re- magisterium in its interpretation of Life, Pope John Paul II referred ligious Directives for Health Care of the natural law. to “...the still relevant Hippocrat- Services5 which they issue them- ic Oath which requires every doc- selves. In that document the bish- tor to commit himself to absolute ops speak of the source of their The Task of Ethics Committees respect for human life and its sa- ethical guidance for health care be- credness”.1 ing the natural moral law clarified Except in the most rare cases, The Catholic Church is invaria- through divine revelation. “The ethics committees do not assume bly forward looking as it address- moral teachings that we profess responsibility for actions taken in es the ethical issues of any given here flow principally from the nat- a health care setting; such respon- age. This is particularly true with ural law, understood in the light of sibility rests with the health care respect to the provision of health the revelation Christ has entrusted professionals in their practice of care, and in this case even with the to his Church.”6 The bishops go on their healing art or with the ad- use of ethics committees. Since to point out that these moral teach- ministrators who manage health 1973 the bishops of the Church ing are ultimately ordered beyond care institutions. However, eth- in the United States have insisted this life. “The dignity of human ics committees can help establish that Catholic hospitals have ethics life flows from creation in the im- protocols, institutional policies, committees to assist in the provi- age of God, from redemption by and guidelines to assist those pro- sion of health care. On the other Jesus Christ, and from our com- fessionals. Physicians, nurses and hand, ten years later, in 1983, the mon destiny to share a life with other health care professionals United States President’s Com- God beyond all corruption. Catho- often have to act quickly in diffi- mission for the Study of Ethical lic health care has the responsibil- cult and complex circumstances. Problems in Medicine found that ity to treat those in need in a way Protocols usually reflect the care- only about 1 percent of all hospi- that respects the human dignity ful and reasoned deliberations of tals even had ethics committees.2 and eternal destiny of all.”7 a health care institution, usual- The Catholic Health Associa- The only thing that can place ly with the assistance of the eth- tion, on the other hand, did a sur- in jeopardy that common destiny ics committee, to assist their pro- vey of its member hospitals and of all, i.e., a life with God beyond fessionals carry out their tasks in found that 92% had formal ethics all corruption, is sin, is acting a way that is consistent with the committees.3 It is only now that against the dignity of the human mission of the hospital in its ser- the accrediting agency for hospi- person, either one’s own digni- vice to those who are weak and tals in the United States requires ty or that of one’s neighbor. The vulnerable. that hospitals give evidence of a moral tradition of the Church is functioning ethics committee be- an essential guide to assist every- fore giving them accreditation.4 one in the journey of life toward The Composition of Ethics Here we can see that the Catholic that ultimate goal. Ethics com- Committees Church led the way in making use mittees within hospitals ought to of ethics committees in its hos- serve this role as well. They are Perhaps it would be good to pitals, a practice that has finally not concerned about some ab- mention briefly the ideal compo- become virtually universal in the stract set of moral principles or in sition of ethics committees be- United States. a code of ethics issued by some fore addressing their fundamental Ethics committees can serve a large bureaucracy. Rather ethics tasks. It is obvious that there ought very useful role within a hospital committees are concerned about to be representatives of the medi- helping it to provide the most hu- safeguarding the dignity of the cal and nursing staffs on the com- mane health care possible. They human person who has been en- mittee. Since the administration do this primarily in an education- trusted to Catholic health care. As of the hospital usually appoints

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the members of the committee The educational task of an eth- in the United States. The National and since the ethics committee an- ics committee can be undertaken Catholic Bioethics Center has de- swers to the administration of the in a number of ways. It is usual- veloped a year-long certification hospital, there should be a repre- ly sufficient that these committees program which is principally of- sentative of the administration on meet once a month, but someone fered on the internet and which the committee serving at least as a on the committee should assume can be utilized by anyone virtu- liaison if not an active participant. responsibility for the education of ally anywhere in the world. It is However, the composition of eth- the committee members and the targeted specifically at members ics committees should also reflect broader hospital community and of ethics committees. But whatev- the communal character of the de- establish an educational program er materials are utilized, a system- livery of health care. covering a year or two. There have atic educational program should There are many more individ- been many authoritative docu- be developed for the sake of the uals than medical professionals ments issued by the Church that committee itself as well as those who are needed to provide holistic can of great assistance in this task. health care professionals serving health care to patients, and the eth- For example, an ethics commit- within the hospital. ics committee should reflect this. tee could undertake a systematic There should be representation study of the Charter for Health from the chaplaincy program, for Care Workers issued by the Pon- The consultative role example, and social work. There tifical Council for Health Care should be someone trained in eth- Workers in 1995. There are very When one hears of ethics com- ics. In areas where there is a di- helpful magisterial documents. mittees one often thinks first of verse ethnic population, it could There are the teachings of the its consultative role to physicians be important to see that there is Popes themselves. Pius XII, Paul faced with difficult moral deci- representation from these groups VI, John Paul II, and now Bene- sions. Even though this is not the since cultural differences are of- dict XVI have provided encycli- most common task of the ethics ten very significant in the provi- cals and allocutions addressing a committee, it can be of great as- sion of health care. Some popula- wide range of medical moral is- sistance to individual health care tions tend to be more passive in a sues. One the is the great encycli- providers and well as the larger hospital setting, perhaps unwilling cal The Gospel of Life, or the al- community of the hospital. The to engage those providing medi- locution by Pope John Paul II to consultation can be anticipatory, cal services and reluctant to share the Transplant Society in August immediate or retrospective. The information that might be vital 2000 or his allocution on the pro- anticipatory consultation is per- for their care. Ethics committees vision of hydration and nutrition haps the most helpful since the would be aware of and sensitive to to patients in a persistent vegeta- committee is able to study and re- such matters. tive state which he delivered in flect on ethical issues that might Sometimes there is even the at- April 2004. There are also for- arise and to assist in the formula- tempt to expand membership on mal documents issued by the Con- tion of protocols and guidelines to an ethics committee to those out- gregation for the Doctrine of the be adopted by the hospital. side the hospital setting itself but Faith such as its Declaration on Unfortunately the consulta- who are often essential in saving Euthanasia in 1980, or Donum Vi- tive role of the ethics committee lives and providing care, such as tae on the means of overcoming is sometimes falsely perceived paramedics, or even police or fire infertility issued in 1987 or Dig- as a disciplinary one. Physicians fighters who often have to respond nitas Personae in 2008. The Pon- will sometimes not want their in emergency situations. Such tifical Academy for Life has also best medical judgment called into breadth in representation will as- released a number of studies and question by others who were not sist the committee in carrying out analyses which can be of tremen- party to his or her care of a partic- its work. dous help in the educational task ular patient in a difficult situation. undertaken by ethics committees. However, ethics committees have And of course there are the pub- no policing powers and ought not The educational task lications of approved authors, to be seen as if they did. They are such as Cardinal Elio Sgreccia there to assist their peers and col- Perhaps the most fundament and his monumental work, Man- leagues in the humane delivery task of ethics committees is edu- uale di Bioetica9 which has now of health care. Some professional cational. The committee cannot been translated into English by societies or governmental bodies, provide advice if the members The National Catholic Bioethics such as legislatures, have ethics themselves are not well ground- Center under the title Personal- committees which do act in a dis- ed in the art of medicine and in ist Bioethics. There are certainly ciplinary manner which is prob- the moral tradition. And the com- ample authoritative ecclesiastical ably one reason why it is some- munity of health care providers publications which can be of tre- times falsely understood to be the in the hospital likewise cannot mendous help in the education- task of hospital ethics commit- hear or receive the advice of an al tasks of an ethics committee. tees. ethics committee if its members There are also educational pro- As an ethics committee pro- themselves are not educated and grams developed by various insti- vides counsel, it must be remem- formed as well. tutions such as Ascension Health bered that at the heart of the heal-

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ing process of the care provided are a number of tasks of the ethics Committees”. These committees to the sick is the intimate and con- committee in carrying out its con- are designated to approve and fidential relationship established sultative function. The committee monitor bio-medical and behav- between the physician and the pa- can clarify institutional policy for ioral research on human subjects. tient. The ethics committee may the physician and patient, it can They might also be involved in be drawn into this relationship in raise questions and issues which the ethical oversight of drug tri- order to facilitate it or enhance it may not have been considered als. Most hospitals would have but it ought to be invited into it. In by those seeking its advice, it can clinical ethics committees; Insti- the directives of the United States explain what legal or regulatory tutional Review Boards would bishops, one reads of this sacred constraints might be involved in be important for teaching hospi- bond between physician and pa- the particular case under consid- tals which certainly can include tient. “The person in need of eration, it can clarify the proper Catholic institutions. Again, their health care depends on the skill of role of a surrogate decision mak- fundamental concern would be the health care provider to assist er for an incompetent patient, and in protecting and safeguarding of in preserving life and promoting it can apply the ethical norms of human dignity in research and so health of body, mind, and spirit. the Church which are in place for would have the same motivation The patient, in turn, has a respon- the sake of both the patient and the as the clinical ethics committees. sibility to use these physical and physician.12 As human beings, we are born mental resources in the service of It must be made abundantly and nurtured in community. As moral and spiritual goals to the clear that the ethics committee has Catholics we are born again best of his or her ability.”10 The no authority to make medical de- through baptism and nurtured ethics committee merely assists cisions. Its role is to educate and in community. The provision of in this intimate and sacred bond provide counsel to the decision health care, whether Catholic or between physician and patient in makers. It ought not to be stepping secular, is inescapably a commu- the healing process; it ought never in to assume the decision making nal task. Ethics committees pro- undermine it. responsibilities of the health care vide an invaluable service to this The Declaration on Euthana- professionals or of the patients communal task by assisting health sia also speaks to mutual deci- or their surrogates. One author care professionals and institutions sion-making roles of the patient writes: “…regularly assigning to remain true to their sacred calling and the physician which must be ethics committee the task of mak- through education and counsel. respected. The physician brings ing decisions on life-sustaining expertise and competence in the treatment could undermine rec- medical arts and the patient deter- ognizing the obligations of those Notes mines what kind of intervention who should be principally respon- 13 1 Evangelium vitae, March 25, 1995, 89. he or she is willing to accept. It sible.” And those who should 2 Deciding to Forego Life-sustaining is necessary to look to the com- be primarily responsible are the Treatment: Ethical, Medical, and Legal Is- petencies of the physician in as- health care professionals and the sues in Treatment Decisions, President’s Commission, 1983, 443-449. sessing appropriate therapies. As patients. They cannot shift re- 3 “Today’s Ethics Committees Face Var- the Declaration points out: “It sponsibility to an ethics commit- ied Issues”, Lappetito, J. and Thompson, P., will be possible to make a cor- tee. There are some jurisdictions Health Progress, 1993 November; 74 (9): 34 – 9, 52. rect judgment as to the means in the United States which will 4 Joint Commission for Accreditation of [of treatment] by studying the designate an ethics committee as Healthcare Organizations (JCAHO). Com- type of treatment to be used, its the final arbiter on disputed ques- prehensive Accreditation Manual for Hospi- tals. Oakbrook Terrace, IL: JCAHO, 1996. degree of complexity or risk, its tions which might arise in a hospi- 5 Ethical and Religious Directives for cost and the possibilities of using tal. By and large, however, mem- Catholic Health Care Services, Washington, it, and comparing these elements bers of ethics committees assume D.C.: United States Conference of Catholic Bishops, Fifth Edition, 2009. with the result that can be expect- no legal responsibility and are not 6 Ibid., Preamble. ed, taking into account the state at risk of legal liability for the ad- 7 Ibid., Introduction to Part Two. of the sick person and his or her vice they offer.14 8 Ibid., Introduction to Part One. 11 9 Elio Sgreccia, Manuale di Bioetica Vol. physical and moral resources.” There are those emergency situ- 1: Fondamenti ed etica biomedica. 2007. These complex questions clearly ations, however, that can arise any 10 Op. cit., Introduction, Part Three. fall within the purview of those time of the day or night and the 11 Congregation for the Doctrine of the who have the professional com- chair person of the ethics commit- Faith, Bona et Jura, May 1980, Part IV. 12 See Daniel O’Brien, “HealthCare Eth- petence to address them. How- tee might be called in the middle ics Committees: Purpose, Functions, and ever, the Declaration also speaks of the night and forced to convene Structure”, Catholic Health Care Ethics: A of the “reasonable wishes of the a meeting of key members of the Manual for Practitioners (Second Edition), Philadelphia: The National Catholic Bioeth- patient” assisted by “the advice of committee by phone or in person. ics Center. doctors who are specially compe- Membership on an ethics com- 13 Paul W. Armstrong, “Legal and Judi- tent in the matter.” mittee is a task of service to oth- cial Issues of Ethics Committees.” In Eth- ics Committees: A Challenge for Catholic The ethics committee, then, has ers and should be acknowledged Health Care, 44 – 54. St. Louis: The Pope a very circumscribed role assisting as such. John Center and Catholic Health Associa- the physician and the patient and A brief word should be said tion, 1984. 14 Legal Aspects of Clinical Ethics Com- perhaps family members in mak- about “Institutional Review mittees, J. Hendrick, Journal of Medical ing health care decisions. There Boards” or “Independent Ethics Ethics, 2001 April; 27 (Suppl 1): 50 – 53.

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Round Table Catholic Hospitals in a Changing World

1. Catholic Hospitals in Africa in a World Undergoing Transformation: ‘Wells’ of Encounter with Christ

approach of Jesus at the well of hospitals in general, and Catho- H.E. Msgr. Joachim Sicar in order to make our places lic hospitals in particular, is far Ntahondereye of ministry or of apostolate – in- from being sufficient when we Bishop of Muyinga, cluding hospitals – settings where take into consideration the rapid Director of Pastoral Care we sit ‘at the side of the men and growth in the population and the in Health, women of this time to make the multiplicity of illnesses that have Burundi. Lord present in their lives so that to be addressed. Benedict XVI Consultor of the Pontifical they can encounter him, because in his Africae Munus recognises Council for Health Care only his Spirit is the water that this fact when he addresses the Workers gives true and eternal life’.1 health-care personnel of the con- 2. This is why I believe that it tinent of Africa: ‘Difficulties of is important to reflect on the way every kind rise up along the way: in which our Catholic hospitals in the growing numbers of the sick, Africa try to respond to this rec- inadequate material and financial Introduction ommendation. And, taking into ac- resources, the withdrawal of sup- count the request to link my paper port by organizations which had 1. I was happy to answer the to the mutations that are underway helped you for years and are now request made to me to make my in our world, it is advisable to try, abandoning you; at times all this contribution to this round table subsequently, to engage in an iden- can give you the impression that and I will try to engage in a mod- tification of the challenges that are your work produces no tangible est analysis of the questions and connected with the impact of these results’.2 issues relating to the need to adapt mutations, in relation to the voca- 4. It is in these very conditions our Catholic hospitals in Africa to tion of these hospitals. In addition, that the pastoral action carried their vocation as settings for evan- it will be necessary to see wheth- out in Catholic hospitals seeks gelisation in this world which is er there are not other challenges to help those hospitals to answer undergoing transformation. I will to be faced up to that are inherent their evangelising vocation by do this in the awareness that the in the situations that are typical of expressing witness to charity, by subject of this conference was our continent because of its cul- listening and sharing, by the ex- chosen specifically to have us tural traditions and its recent past. plicit proclaiming of the Gospel share in the concern of the Church And we cannot but ask ourselves, and by the celebration of the sac- to engage in a new evangelisa- lastly, what we should do to meet raments.3 There undoubtedly ex- tion, we who are engaged at vary- these challenges and to place, in ist differences from one country ing levels of proximity in pastoral an effective way, our pastoral min- to another or even from one area care in health. The Instrumentum istry under the banner of the new to another, both from the point Laboris of the XIII Ordinary As- evangelisation that has been urged of view of quantity and from the sembly of the Synod of Bishops by the Church. point of view of quality. Not be- invites us to see in ‘every activity ing able to examine them all in of the Church an essential evan- order to identify their characteris- gelising note’ and to never sepa- Our Catholic Hospitals and tics, I will confine myself to com- rate it ‘from the commitment to their Vocation Today menting on testimony received help everyone to encounter Christ from the chaplain of the Hospital in faith’ (IL, n. 34). The final mes- 3. We may observe first of all of Bukavu which is in the Demo- sage of that assembly calls upon what we all know or can easily cratic Republic of Congo. us to draw inspiration from the imagine: in Africa the number of 5. In reading his testimony, I

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note with joy that, although he cannot but emphasise because of sation, they emerge easily from concentrates principally on the ac- the potential they have to bear up- those that we find in the second tivities of ordinary pastoral care, on the lives and the management chapter of the Instrumentum La- that is to say the expounding of of our hospitals. One is dealing boris of the recent Synod of Bish- the catechesis, the celebration of above all else with the survival of ops or in the fourth chapter of the the sacraments, the animation of a mythical conception of reality, encyclical Redemptoris Missio of various devotions and the exer- together with a mentality of resig- the Blessed John Paul II. Taking cise of charity, the efforts involv- nation.9 I mean by this a concep- into account the question of hos- ing evangelisation engaged in at tion which holds that behind what pitals which is here the subject of his hospital include the forma- happens as perceived through our attention, I believe that I should tion of managers and the medical/ senses there are invisible myste- first and foremost cite secularism health-care personnel and the use rious forces that have to be con- with its dual corollary made up of of the means of social communi- ciliated, according to the indica- hedonism and relativism. Then cation. These are two encouraging tions of people who are held to be there is the danger of falling in- advances when we consider the experts in such matters, whether to the trap of what the Instrumen- needs of evangelisation in an Af- one wants to or not. This can also tum Laboris of the recent Assem- rica that is not in the least immune be described as a conception that bly of the Synod of Bishops calls to the effects of globalisation and involved magic and witchcraft. ‘the culture of the ephemeral, of the Western secularist revolution. This mentality of resignation, in the immediate and of appearance’ What have these consequences its turn, is characterised by a con- which is channelled by the infor- been? science that adapts itself to sub- mation and communications tech- mission and to a concern to save nologies.10 The third challenge both the fox and the chickens. connected with the phenomenon The Challenges that Still have 9. The second challenge of the of globalisation, and which is of to be Addressed series is that this conception and importance for pastoral care in this mentality, which are deplor- a hospital context, has advanced 6. While there has still not been able, unfortunately coexist in by with the proliferation of sects and a recovery from the anthropologi- now means few Africans, with a consists of the risk of a utilitar- cal crisis4 caused by the cultural consciousness that is dominated ian conception of religion which shock of the ‘irruption of the col- by an ‘assistance complex’. Rath- measures its authenticity accord- onising West into its historical er than relying upon their own ing to immediate success or pros- trajectory’,5 Africa today has to personal efforts and upon pride in perity. Given that these are the deal with the assault of the ‘trans- flying with their own wings, they challenges posed to evangelisa- national agents of transformation’ base themselves on cliental sys- tion in our hospitals, what should who are trying to ‘change men- tems, where a favour from an in- we do to address them and there- talities’ in order to make it capa- termediary prevails over capacity by win the wager of conforming ble of being permeated by secu- and professionalism. As a conse- our hospitals to their vocation? larism.6 This led Benedict XVI quence, this unhappy attitude be- to say that ‘Like the rest of the stows upon our countries a bur- world, Africa is experiencing a den of clientalism and corruption, Future Prospects culture shock which strikes at the to the detriment of the common age-old foundations of social life, good and the development of the 12. Without having to dwell and sometimes makes it hard to community. upon each of the challenges that come to terms with modernity’.7 10. Lastly, the third basic chal- have just been pointed out, I will 7. Amongst the challenges lenge that I cannot ignore is that immediately give you some sug- linked to the historical element of the very deep psychological gestions for action which came that has already been cited, the wounds and violated memories to my mind, by intuition, while most important are in practice which demand, respectively, to be I was reflecting about the con- those that the first Special As- treated and also healed. I believe tents of this paper of mine. They sembly for Africa of the Synod of that for all of this there is no need are principally of a strategic and Bishops deplored in its final mes- in the least for explanations. The methodological character. The sage. It regretted, in particular, ‘a wars and other forms of violence first is connected with the need frightening poverty, bad admin- that our continent has experienced to conjoin our efforts in order to istration of scarce available re- provide sufficient testimony of engage in discernment and act in sources, political instability and this. These are challenges which synergy. The second, on the oth- social disorientation’.8 One thus in my opinion underlie the others. er hand, concerns the need for understands how the difficult con- They, too, are linked both to the formation and the spiritual and ditions indicated at the beginning cultural past of our countries and moral accompanying of medical/ of this paper as the context for the to the social (that is to say also health-care personnel. work of our Catholic hospitals did ethical) disorientation mentioned 13. At the beginning of my pa- not begin yesterday. above which was generated by the per I referred to the difficult con- 8. But at the basis of these chal- shock of colonisation. ditions in which our hospitals lenges which stare us in the face 11. Dealing now with the chal- work. In directing my attention there are another three which I lenges connected with globali- to the common denominators of

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our African countries, I did not ig- portunity for a fruitful exchange deed, greatly need. In the face of nore the great diversity of situa- of experiences on what we al- the transformations that are un- tions and I am well aware of the ready manage to do in the field of derway in our world, our hospitals complexity of the challenges to the hoped-for ongoing formation. cannot allow themselves to func- be found that are contained with- It would at the same time offer us tion as if Africa were immune to in them. I thus believe that in or- a possibility to help each other to these transformations. Our conti- der to address these challenges discern what still remains to be nent is called to take advantage, with a greater chance of success, done. I have no doubt that such an to the extent that this is possible, our bishops’ conferences and our event would also have the effect of the scientific advances of our pastoral workers should organise of engendering emulation and al- world, albeit conserving jealously their work in synergy and in soli- so encouragement for the diocesan the values which made Benedict darity. As Benedict XVI reminds and national systems of coordina- XVI see Africa as ‘the spiritual us in Africae Munus, confirming tion of our health-care services. lung of humanity’. The Church, what was stated by the Fathers of 16. A need for the ongoing for- through her pastoral action, the Second Special Assembly for mation of our managers and the should help Africa to place these Africa of the Synod of Bishops, personnel of our hospitals does values at the service of mankind, ‘the Church is a communion that not relate solely to the doctrinal, as a sign of gratitude for the goods gives rise to an organic pastoral spiritual and moral aspects – it al- that it receives. If God wanted Af- solidarity’.11 In the field of pas- so refers to the managerial dimen- rica to be the ‘cradle of humanity’ toral care in health, it is required sion. It is certainly the case, as the as we have known it to be hith- that ‘this communion appears in bishops of the recent Special As- erto, this is because Africa helps particular in the effective and af- sembly for Africa of their synod humanity to conserve the meaning fective collegiality of bishops in emphasised, that ‘we should con- of all these values today, values their ecclesiastical provinces and tinue to work hard in forming which are being undermined by at a national, regional, continental consciences and changing hearts, the secularist culture transmitted and international level’.12 through an effective catechesis by globalisation. The Church has 14. On this point I congratulate at all levels’.13 But our dioceses the task of applying this idea and and thank the Pontifical Council and their works, as well, ‘must be of drawing from it all its pastoral for Health Care Workers because models of good governance, of consequences. And it seems to me, every year, through this interna- transparency and of good finan- on this point, that Catholic hospi- tional conference, it deepens in cial management’. tals constitute a pastoral channel those bishops who are responsible 17. Belonging to the same cat- that should be privileged. for pastoral care in health a sense egory of ideas, we cannot forget of the importance of this solidarity that our countries and our local and calls on us to implement it in Churches still suffer an evident Notes our respective countries. In doing need for medical and managerial this, I take the liberty of asking the skills and expertise. We should, 1 XIII Ordinary Assembly of the Synod of Bishops, Message to the People of God, Pontifical Council to do something therefore, invest a great deal in n. 1. more: to think about organising initial academic formation in or- 2 Benedict XVI, post-synodal exhorta- for the continent of Africa and the der to achieve a better future for tion Africae Munus, n. 140. 3 Cf. Ordinary Assembly of the Synod of islands off it, in cooperation with the performance of our hospitals. Bishops, Instrumentum Laboris, n. 92. the SCEAM, an integrated meeting I was happy to learn that our Pon- 4 Cf. F. Eboussi Boulaga, La crise du on the model of the meeting that tifical Council has invited rep- Muntu : Athenticité africaine et philoso- phie, Présence africaine (Paris, 1977 and was organised by the Pontifical resentatives of our Faculties of 1997). Council for the Pastoral Care of Medicine to this international 5 The phrase is taken from Kä Mana, Migrants and Itinerant People in conference and to a meeting at Théologie Africaine pour temps de crise (1993). the month of September last in Dar which their colleagues will partic- 6 Cf. the paper already cited of M. Peeters es Salaam. A meeting of this kind ipate for an exchange on the situ- given at the colloquium of Abdjan. would enable us not only to be- ation of their institutions and their 7 Benedict XVI, post-synodal exhorta- tion Africae Munus, n. 11. come aware of the importance of future prospects as well. 8 John Paul II, post-synodal exhortation the synergy and solidarity that are Ecclesia in Africa, n. 40 called for – it would also help us to 9 Cf. Michel Kayoya, ‘Développement et mentalité rundi’, paper given in March 1971 bring things to completion through Conclusion in Bujumbura. an analysis of the shared challeng- 10 Cf. XIII Ordinary Assembly of the es which have to be addressed and 18. I will end my paper by ex- Synod of Bishops, Instrumentum Laboris, n.62 pressing the wish and the hope 11 of how to discern more effectively Benedict XVI, post-synodal exhorta- the ways and means by which to that this initiative will help to pro- tion Africae Munus n. 105. do this. mote a strengthening of the aca- 12 Second Special Assembly for Africa of the Synod of Bishops, final list of proposi- 15. In relation to the second sug- demic formation in question and tions, n. 3. gestion as well, I think that this the scientific research which our 13 Second Special Assembly for Africa of meeting would be for us an op- Catholic hospitals in Africa, in- the Synod of Bishops, Final Message, n. 19.

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2. Asia: Catholic Hospitals in a Challenging World

H.E. Msgr. Bernard will analyse the challenges faced economic situation (CBCI Health Blasius Moras by Catholic health-care facilities Policy, 2005, p. 3). According to Archbishop of , India, in India. government statistics, in 1951 the Member of the Pontifical number of hospitals in the coun- Council for Health Care try was 2,685 but by 1997 it had Workers 2. An Update on the Health grown to 13,692. During the same Scenario in India period, 23,015 new dispensaries came into being. In India, there has been a re- The new economic liberalisa- markable improvement in the tion policy of the government 1. Introduction health situation of people. There of India has involved a notable has been a gradual and steady change in all sectors of Indian ‘To be healthy’ and ‘to be fully growth in personnel, health-care life, especially in industrial devel- alive’ is everybody’s dream. It is facilities and the availability of opment, export growth, food and a basic human drive. Jesus’ mis- some of the best treatment and agriculture production, the utilisa- sion was to respond to this fun- care. This has contributed posi- tion of natural resources, etc. Glo- damental human yearning. As he tively to the health situation of the balisation has created many new said, ‘I have come to give life, life people in our country. highly specialised hospitals in our in its fullness’ (Jn 10:10). Christ country. These ‘state-of-the-art’ gave the same mandate to his dis- 2.1 New trends, new facilities have brought new trends ciples, saying: ‘Go and heal!’ (cf. achievements in health care, including ‘medical Mt 10:1; Lk 9:1). This is a mis- tourism’. sion entrusted by the Master. This Through the initiatives of suc- major mission of the Church is so cessive governments, and their 2.2. A reality that is shocking challenging and at the same time attempts down the years to im- its exigencies are so demanding. plement various national health The aforementioned achieve- The Holy Father, Pope Benedict programmes, the country has ment is only one side of the coin! XVI, when addressing the inter- achieved great progress as regards For the vast majority of people, national conference organized by the health situation of its popula- especially the poor in the under- the Pontifical Council for Health tion. There are some indicators served areas, basic survival itself Care Workers, on 15 November which helps us to understand this is still a daily struggle. Today, in 2010 said: ‘It is necessary to work advance. our globalised and highly com- with greater commitment at all The crude birth rate (CBR) de- mercial world, despite the many levels so that the right to health is clined from 29.5 in 1991 to 26.1 advances in preventive medicine rendered effective, favouring ac- in 1999, while the crude death and therapeutic skills, for a vast cess to primary health care’. The rate (CDR) declined from 9.8 section of the people health is a Holy Father further also said: to 8.7 per 1,000 people over the distant dream, both as individuals ‘Justice requires guaranteed uni- same period. The annual popu- and as communities. Many peo- versal access to health care, the lation growth rate declined from ple do not have access to afford- provision of minimal levels of 1.97 in 1991 to 1.74 in 1999. The able medical care. Basic necessi- medical attention to all is com- increase in life expectancy at birth ties such as safe drinking water, monly accepted as a fundamental rose from 58.7 in 1990 to over sanitation etc. are still not avail- human right’. 62 in 2001. Infant mortality de- able. In this paper, I will first try to creased significantly from 146 in While preventable diseases are have a general understanding of 1951 to 64 per 1,000 people in still major concerns in many parts the health scenario of India to- 2001 (R. Misra, 2003, p. 12). of the country, chronic illnesses day, particularly the emerging This substantial improvement often related to lifestyle, behav- challenges. The second part will in key health indicators is the re- iour etc. are on the rise, causing be an attempt to understand bet- sult of many factors, including much suffering in most parts of ter the healing mission of Jesus. improved public health services, the country. In the third section, I will seek to the prevention and control of in- India has more tuberculosis outline a better understanding of fectious diseases, access to mod- patients than any other country the mission of the Church in In- ern medical practices in diagno- in the world. ‘About 14 million dia in the field of health in today’s sis and treatment, as well as an people are estimated to be suf- context, and in the last section I overall improvement in the socio- fering from active TB, of whom

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3 to 3.5 million are highly infec- versed, it will probably also wipe kept the poor far away from ac- tious. India accounts for nearly out decades of development in cessing any medical care, but one third of the global T.B. bur- our country (CBCI HIV/AIDS worse still, the tough competition den and every year has more than Policy, 2005, p. 3). has led to the closure of many of 2 million new cases of tubercu- India has 61% of the world’s the ordinary hospitals, including losis. Approximately 2.9 million recorded leprosy patients. About some of the mission hospitals. people die from tuberculosis each 14-20 percent of the patients are year worldwide; about one fifth children. India also has 60 million 2.3.3 Widespread poverty and of them in India alone. Nearly diabetics, 40 million arthritis and uncontrollable migration 500,000 die from the disease – 40 million hepatitis B patients. The large uncontrolled influx more than 1,000 per day: nearly (Hameed, 2002, p. 10). of rural migrants to urban areas in one every minute. The spread of The costs of medical care have search of better earnings and job HIV/AIDS would increase the risen to prohibitive levels, making opportunities leaves them very number of TB cases, as well as facilities unavailable to many and vulnerable and this is particularly deaths’ (Ministry of Health, Re- leading to medical systems be- true of the children of the migrant port, 2000-01, p. 53). coming unsustainable. High tech- families. Our metropolitan are- Malaria has taken many lives nology has an inhuman face and as and cities are becoming over- over the past two or three years, this leads people to feel isolated crowded whereas villages are be- especially in the northern States. and fragmented. Death in modern coming less populated. According to the official statis- medicine is seen as failure and tics, malaria deaths were below is aggressively fought, indeed to 2.3.4 Lack of monitoring 500 annually until 1993, but they such an extent that people are not and assessment more than doubled by the year able to die with dignity. There is a substantial difference 1995, and are now on the increase. between States as regards their In India it is estimated that 2.3. An analysis of reality health indices. The inefficiency of there are 2 to 2.5 million can- systems, the lack of true commit- cer patients at any given point in When we attempt a closer anal- ment on the part of the implement- time, with about 0.7 million new ysis of this appalling scenario, we ers, and above all widespread cor- cases every year and nearly half realise that there are some strong ruption have led to the deplorable die every year (J. Kishore, 2001, undercurrents prevalent in Indian situation in which millions of the p. 98). society. poor are deprived of basic health Since the identification of HIV needs. There is a huge shortage in in 1986 in India, the rate of in- 2.3.1 Inequality in access to human resources in institutions, fection has been increasing at health care especially in the remote rural and an alarming rate and reached Research reveals that the rich- tribal areas where health-care 5.1 million people by May 2004 est 20 percent enjoy three times needs are the greatest. with an adult prevalence rate of the share of public subsidies for 0.9 percent. Although India is health compared with the poorest still considered a low prevalence quintile. The poorest 20 percent 3. Jesus and his Healing country, the absolute number of of the population has more than Ministry its current HIV cases makes India double the mortality rates, fertil- the second highest country next to ity rates and levels of under-nu- Given the background de- South Africa. In addition, with the trition compared with the richest scribed above, the health mission size of India’s population, even a 20 percent. On average, the poor of the Catholic Church has to play one decimal point of increase in spend 12 percent of their income a vital role in attending to the sick the nation’s HIV prevalence rate on health care, as opposed to the and alleviating their suffering, es- would result in an addition of only 2 percent spent by the rich pecially those who are poor and about half a million new individ- (R. Misra, p. 12). In short, there cannot afford adequate treatment. uals to the total of HIV cases. exists extensive inequality in ac- Let us first try to understand the Every region in India is expe- cess to health-care facilities and healing mission of Jesus to obtain riencing a snowballing increase the availability of care, support a vision with a view to a better re- in the spread of HIV. The infec- and opportunities. sponse. tion has spread from people who practise high risk behaviour (sex 2.3.2 Progress that ignores 3.1. The entire Biblical tradi- workers, drug-users through in- the poor tion, as it describes the salvific jection, and people having same- Globalisation has certainly intervention of God in human sex relationships) to the general brought about encouraging eco- history, systematically gears it- population (housewives and chil- nomic growth. As a result, many self to the redemptive mission dren) and from urban to rural ar- new hospitals have been created, of Christ. The Prophet Isaiah, for eas. If the spread continues at its mainly in major metropolitan ar- example, foretold: ‘He endured present pace, it is going to have eas, with very modern equipment, our suffering. He bore our pain. devastating effects on the entire advanced technology and sophis- We are healed by the punishment fabric of our society. If the spread ticated treatment facilities. This he suffered’ (Is. 53:3-6). In the is not checked and the trend re- welcome progress has not only New Testament each Evangelist

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testifies to the healing ministry of lost dignity of the individual and fering is not just a social profes- Jesus. thus the liberation of the total per- sion, but is also a ‘mission’. It is As regards the four gospels, we son. a mission for evangelization. One find most healing episodes in the is called to discern the very image gospel of Luke, the author who 3.5. Healing activity led to a of Christ in the image of the sick, is traditionally called a medi- liberating experience of God always recalling what the Lord cal doctor. Jesus in the gospel of said, ‘I was sick, and you visited Luke is portrayed as a healer par Christ’s healing activity helped me’ (Mt 25:36). The twofold di- excellence (4:40; 7:11-17; 5:15; people to a unique experience of mension of this mission, the care 6:18-19; 9:11; 13:10-13; 14:1-6; God, in particular intense divine of the sick and the announce- 17:11-19; 22:50-51). Whoever intervention during a time of pain ment of the Good News, contin- approached the Lord with firm and suffering. The cured paralytic ues through the work of all Chris- faith and trust received a new life and the crowd give witness to this: tians. To care for the sick is not of peace and serenity. ‘He went to his home, glorifying just a health or economic issue. It The Acts of the Apostles sum- God and were filled with awe, is above all a sign of God’s love, marises the entire life and minis- saying, ‘We have seen strange which Christ wants to manifest try of Christ by saying ‘He went things today’’ (Lk. 5:25-26). to each one through the Church’ about doing good’. (Gauer, 1994, p. 38). 3.6 The redemptive meaning Christ, the ‘first evangelizer’, 3.2. Personal contact of human suffering above all proclaimed the Gospel to the sick and the poor in spirit ‘It has been observed, person- ‘From a simply human point of and in body. ‘Evangelizing cul- al contact is the element which is view, pain and illness might ap- ture to a great extent means hav- most prominent in the healings. pear as an absurd reality. How- ing to deal with experiences of Christ places himself in physical ever, when we allow ourselves to suffering, illness and death’ (An- contact with the sick. He touches be enlightened by the light of the gelini, 1994, p. 9). the eyes of the blind, he touches Gospel, we succeed in appreciat- Following in the footsteps of the the ears of the deaf, he touches ing its profound salvific meaning’ Divine Healer, Jesus, the Catho- the hands of the infirm, and so (Pope John Paul II, 2004, p. 10). lic Church has provided yeoman forth. We can see in this activity The cross and resurrection of service in the field of health from a kind of compassion on the part Christ affirms that God’s heal- time immemorial. Health care is of Christ himself, and compassion ing power is not staying apart one of the most crucial and essen- in the strictest sense of the term. It and above the reality of pain, bro- tial services required by every cit- is a compassion which is effective kenness and dying but is reach- izen regardless of caste, creed or that cures the illness’ (Barragán, ing down to the very depths of status. Appropriate and high qual- 2002, p. 47) human and creational suffering, ity care can save and change innu- bringing light and hope in the ut- merable lives. 3.3. The request for faith termost depths of darkness and Catholic health-care institu- despair. The image of the resur- tions are based upon the message Another element which is of- rected Christ may be encountered and example of the merciful Jesus ten evident in the healing inter- among people who suffer (Mt Christ and adhere to his mission- ventions of Jesus is the request 25:31-46) as well as among vul- ary mandate: to go all over the for true faith in God of those who nerable and wounded healers (Mt world and preach the Good News approach Jesus for healing. Christ 28: 20 and 10:16; 2 Cor. 12: 9; Jn of salvation. His disciples set out, praises the faith of those who go 15:20). preached the Good News, cast out to be healed and also at times of demons and anointed the sick and those who are near to the sick. healed them. Therefore, faith is often required 4. The Health Care Mission as a prerequisite for his healing of the Church 4.2 The holistic approach activity. ‘All the miracles have in health care only one aim: to proclaim the 4.1. The health mission kingdom of God has arrived; and The definition of health given this kingdom has its centre in the ‘The mystery of Christ casts by the WHO envisages three spe- resurrection of Christ (Barragán, light on every facet of Catho- cific dimensions: the physical, the 2002, p. 49). lic healthcare: to see Christian mental and the social. The servant love as the animating principle of God, Pope John Paul II, took 3.4 The restoration of healthcare; to see healing and our understanding even deeper of human dignity compassion as a continuation of by explaining health as ‘far from Christ’s mission; to see suffer- being identified with the mere The respect, protection and care ing as a participation in the re- absence of illness, [it] strives to proper to human life derives from demptive power of Christ’s pas- achieve a fuller harmony and its singular dignity. Most of the sion, death, and resurrection. For healthy balance on the physical, narratives on healing by Jesus are a Christian, the involvement in psychological, spiritual and social examples of the restoration of the healthcare and to serve those suf- level’. In the age of hyper-spe-

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cialisation the care of the whole this vast network of ours, in spite people to draw on the resources of person is often forgotten about of the fact that Catholics consti- faith to see them through. Through whereas in the true Christian un- tute around 2% of the population pastoral care, faith communities derstanding a holistic approach, of India, our Catholic health fa- can endeavour to meet the spirit- which includes emotional and cilities account for around 20% of ual and emotional needs of people spiritual care, is followed. the health care provided in India. affected’ (HIV/AIDS Policy, 2005, Therefore, a true Christian ap- Looking at this from a global p. 44). ‘When life is challenged by proach would be to see integrally perspective, India has around 4% conditions of sickness and inexpli- the needs of the whole person and of Catholic health-care facilities cable pain, it is the constant and to get him or her involved in his or available in the world. intimate communion with the Ab- her restoration to health. ‘Health While Catholic health facilities solute that springs forth in a per- is the core of all human develop- globally continue to perform the son an incessant hope and seren- ment. It is to be understood in a mandate of Christ, the changes in ity’ (Barragán, 2005, p. ix). broader sense to include all as- the world around us call for some pects of human life: physical, so- serious introspection. There are 4.5. The option for the poor cial, mental, and spiritual. There- various challenges that face Cath- fore, health would mean adequate olic hospitals anywhere. Some ba- ‘Jesus Christ decidedly sid- food, housing, clean water, clean sic questions remain: what should ed with the poor. Health institu- air, good social milieu, and good be the identity of a Catholic hos- tions administered by personnel social and interpersonal relation- pital? What should be the level who are his disciples must do ships. In short it means the satis- of Christian witness in a Catholic the same. Today equipment costs faction of ones basic needs: har- health-care structure? How can much, some specialized medi- monious relationships with one we make it a privileged place for cines are expensive, doctors’ fees another, nature and God. Togeth- evangelization? How can we con- are high and the poor are some- er with the physical and psycho- tinue to remain more relevant in times unable to afford the care logical aspects, the spiritual and a world where the commercializa- that they need. It is here that the pastoral areas are to be properly tion of health care has become so Catholic hospital’s role is seen, attended to’ (CBCI Health Policy, rampant? where through a system of sound 2005, p. 3). There are numerous challeng- management, the rich subsidize es faced by Catholic health-care the medical care of the poor. No 4.3. Catholic health facilities facilities across the globe. Man- poor person should turn away agement of health care has be- from a Catholic hospital because The Catholic Health Associa- come more and more complex. of lack of money, as no one turned tion of India (CHAI) is one of the The administration of hospitals away from the Lord because he or world’s largest non-governmental and health-care institutions has she was poor’ (, organizations. It has an expan- become a highly technical and 2003, p. 88). sive base of 3,300 member insti- specialized function. Religious In order to make the health care tutions, including large, medium communities are not able to pro- more affordable, available and and small hospitals, health cen- vide all these highly trained pro- sustainable, the Church needs to tres, and diocesan social service fessionals as well as keep pace think seriously about introduc- societies. Its network compris- with the technological advances ing some sort of health insurance es 11 regional units, 600 sister- and requirements they impose in scheme that caters especially to doctors, 25,000 sister-nurses and terms of manpower and finance. the lower income groups of soci- 10,000-plus religious paraprofes- Medical litigation is also on the ety. The existing experiences in sionals. Every year approximate- rise which makes it difficult to health insurance schemes could ly 21 million people access CHAI provide low-priced care based on be studied and an adaptable pro- health-care facilities. trust and there are fewer diagnos- gramme could be prepared which The Catholic Church has 746 tic tests. could be implemented either at a hospitals, 2,574 health centres, 70 diocesan or a regional level. rehabilitation centres, 107 centres 4.4. Pastoral care for the sick for mental health care, 61 centres 4.6 Creating a culture for alternative systems of medi- An essential element of a Catho- of humanizing care cine, 162 non-formal health fa- lic hospital is the pastoral care giv- cilities, and 115 nursing training en to patients. Even though a vast The words of Pope John Paul centres which include 6 medical majority of the beneficiaries in our II, in his message for the World colleges. health-care facilities are people of Day of the Sick of 2003, are very Along with these there are 165 various other faiths, they all treas- significant in this context: ‘Catho- leprosy centres, 416 health care ure the spiritual solace offered to lic hospitals should be centres of centres for the aged, 62 centres them, of course respecting their in- life and of hope, where, togeth- for tuberculosis or the terminally dividual religious affiliations and er with the chaplaincies, ethical ill, 67 community care centres for sentiments. ‘Pastoral care is com- committees, the training of lay people living with HIV/AIDS and passionate, spiritual care given to healthcare staff, the humanisation 60 counselling centres. It is inter- people who are going through dif- of care and treatment for the sick, esting to note that as a result of ficult times. Pastoral care helps care for their families and a spe-

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cial sensitivity towards the poor and longer lives. The challenge 5.6. Genetics and the marginalised should al- faced is the uneven distribution so grow. Their professional work of the fruits of these technologi- Similarly to the previous rev- should be expressed in a concrete cal advances because of global in- olutions in health-care deliv- way in an authentic witness of equalities. ery brought about by the discov- charity, bearing in mind that life ery of anaesthesia and penicillin if a gift of God, of which man is 5.3. Health care as a commercial as well as the current revolution only the administrator and guar- commodity in practice patterns associated antor’ (John Paul II, 2003, p. 4). with the remarkable achieve- The culture of care implies re- Health care being seen as an ments in pharmacology (i.e. de- spect for, and the value of, the economic commodity is a real signer drugs), we are at the cusp life of every human being. The challenge. This stands in stark of a new revolution brought about Health Policy explains in clear contrast to the teaching of the by the mapping of the human ge- terms that ‘from the moment of Blessed John XXIII who in Pacem nome. Genetics and cell research conception, the life of every hu- in Terris wrote: ‘Man has the right are finding an entirely new way of man being is to be respected in to live. He has the right to bodily practising medicine and deliver- an absolute way...Human life is integrity and to the means neces- ing health care. sacred because from its begin- sary for the proper development The result of these challenges ning it involves the creative ac- of life, particularly food, clothing, and those of technology is that tion of God and it remains for- shelter, medical care, rest and fi- the very face of Catholic health ever in a special relationship with nally, the social services…’. care has changed. The tradition- the Creator, who is its sole end... Both the government and the al hospital which in recent times Therefore, respect for the sacred- private sectors have increasing- has been the centre of health-care ness of life marks an important ly come to view health care as a delivery today is often described element of a Catholic healthcare commodity to be managed like as a dinosaur, a relic of the past institution. Every medical pro- any other product intended to that stands in the way of a vi- cedure, care and treatment has to generate profits on a sustained ba- brant future. Patient health care be oriented to the betterment of sis. increasingly is provided along a the quality of life of the patient’ ‘continuum of care’ that includes (Health Policy, 2005, p. 7). 5.4. Funding ambulatory care centres, free- standing diagnostic services, re- The continuing attempt at the habilitation centres, out-patient 5. Challenges Faced by Catholic state and federal levels to con- surgery programmes, home-care Health-Care Facilities tain government expenditure services, assisted-living, long- on health care as well as the fis- term care and hospices. Social 5.1 A culture of death cal constraints emerging from services often are needed to help the realignment of private insur- – especially in a hospital setting – The sanctity of human life is ance through managed care have the patient and the family plan for under attack in the world today. challenged the financial stability and access the services they will This is manifested in various of the ministry. This has become need once the patient has been forms. Whether it be threats to the even more acute due to the finan- discharged from hospital. life of the unborn by abortions, cial recession sweeping different taking decisions on whether a per- parts of the world today result- son should live or die through the ing in governments further de- 6. Conclusion: Witness in the movement to legalize euthanasia, creasing resources allocated for World of the Sick is True or the modern tendency to reduce health care. Similarly, many do- Evangelization human worth to its so-called pro- nor agencies involved in funding ductive or relational capacity, the health-related initiatives in de- ‘Charity is the heart of the sacred dignity of human life made veloping world settings have also Church; without charity the in the image and likeness of its significantly decreased their fund- Church is not the Church of Je- Creator is threatened by a culture ing which in turn is impacting the sus Christ’, said Pope John Paul of death. provision of health care. II. We also recall the famous dic- tum of St. Augustine who said: ‘If 5.2 The technological/ scientific 5.5. Labour you see charity, you see the Trin- imperative ity’. Charity is the privileged way The combination of signifi- to make the Gospel credible. The The discovery of penicillin and cant pressure from labour unions mandate given by the Lord, ‘Go antibiotics, the introduction of and other forces to significantly then, preach the Gospel and heal vaccinations, advances in radiolo- increase salaries as well as the the sick’ (Lk 10:9), compels us, as gy and imaging, the development emergence of a critically short true followers, to be credible wit- of non-invasive surgery and phar- supply of trained nurses and other nesses in the world of the sick and macological treatment – these health-care professionals have put the suffering. This witness is true have transformed health care by an incredible strain on the health- evangelization. enabling people to live healthier care delivery system. The healing ministry has a

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greater role to play in the existing ble power of the cross! O ineffa- ‘Foreword’, Sharing the Fullness of Life, Health Policy of the Catholic Church in In- health-care situation of the coun- ble glory of the passion! Through dia (CBCI Health Commission, 2005), p. ix. try which is marked by challenges you believers find strength in CBCI Commission for Health, Commit- posed by communicable and non- weakness, glory in opprobrium, ment to Compassion and Care, HIV/AIDS Policy of the Catholic Church in India communicable diseases, women life in death itself’. (2005). and children’s problems, as well CBCI Commission for Health, Sharing as environmental issues. Lethar- the Fullness of Life, Health Policy of the Catholic Church in India (2005). gic government and profit-minded References Gauer, Philippe, ‘Christ the Physi- private health care cannot alone cian and the Vocation of the Christian Doc- succeed in providing accessible, Pope Benedict XVI, ‘Address to the Par- tor’, Dolentium Hominum 27 (1994) pp. 37- ticipants at the International Conference Or- 40. available and affordable care to ganized by the Pontifical Council for Health Gracias, Archbishop Oswald, ‘Identity people. It is in this context that Care Workers’, 15 November 2010 in Faith in Catholic Hospitals’ Dolentium it becomes even more important Pope John Paul II, apostolic letter Salvi- Hominum, 52 (2003), pp. 86-92. fici Doloris, in Insegnamenti XII/1, pp. 605- Gupta, Ashum and Nidhi Singhal, ‘Psy- that the sustainability of Catholic 608. chological Support for Families of Children health-care facilities is ensured. Pope John Paul II, ‘Address of the Pope with Autism’, Asia Pacific Disability Reha- The Church in India is a tiny on the World Day of the Sick’, 11 February bilitation Journal, vol. 16, no. 2, 2005, pp. 2004, in Health in Abundance, January- 62-83. minority community: just 2.3% March, 2004, vol. 2, n. 1, pp. 10-12. of the total population in this vast Pope John Paul II, ‘Message for the sub-continent. The mandate to World Day of the Sick, 2000’, Contemplate the Face of Christ in the Sick, August 6, (Ordained a priest in 1967, the author witness the mission, death and 1999, p. 13. has held various clerical positions. Besides in the world Angelini, Cardinal Fiorenzo, ‘Christ, being Bishop and Archbishop, he has held of the sick can have a transform- the First Evangeliser, Proclaimed the Gos- the office of the Chairperson of the Pasto- pel to the Sick’, Dolentium Hominum, 27 ral Commission for Health of the Catholic ing impact in the lives of the sick (1994), pp. 8-12. Bishops’ Conference of India (CBCI) as themselves, their families and in Barragán, Cardinal Javier Lozano, ‘In well as Ecclesiastical Adviser to the Catho- society as a whole since the mo- the Footsteps of Jesus, the Divine Heal- lic Health Association of India ( CHAI). er: Healings in the Gospels’ in Alex Vada- Acknowledges references to various is- ments of the cross and suffering kumthala (ed.), Care and Compassion (CB- sues of Dolentium Hominum, Health Action are the closest to the Absolute. St. CI Commission for Health, 2002), pp. 25-49. and www.cbcisite.in, www.catholicnewsa- Leo the Great wrote; ‘O admira- Barragán, Cardinal Javier Lozano, gency.com.

3. North America

H.E. Msgr. Robert J. gy, particularly the technology of tions in their distinctively Catho- McManus, D.D., S.T.D. modern communication. One far- lic mission. This mission finds in Bishop of Worcester, reaching result of this explosion foundation in the healing ministry Chairman Subcommittee on of highly innovative and sophis- of Jesus which he exercised dur- Health Care ticated communications media is ing his public ministry two thou- the phenomenon of globalization. sand years ago. 1.2. The arrival of modern tech- nology has also had a dramatic ef- fect on Catholic hospitals. In the 2. The Mission of Jesus and 1. Introduction last century, there has been a radi- the Mission of the Catholic cal transformation in how Catho- Hospital 1.1. The topic of our discus- lic hospitals operate and organ- sion is “The Catholic Hospital in ize themselves, in large measure 2.1. All four canonical Gos- a Changing World”. It is an indis- because of significant advances pels attest to the fact that heal- putable fact that rapid and often in medical technology. But what ing the sick was an integral and dramatic change is characteristic has not changed in the culture awe-inspiring part of the public of our contemporary society and and daily operations of Catholic of Nazareth. culture. One of the driving forces hospitals and what is responsible He cleansed the ten lepers (Lk. behind such change in the world for the continuity of health care 17:11-19); he restored sight to the is the advent of modern technolo- in these Catholic medical institu- blind (Mt. 20:29-34; Mk. 10:46-

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52); he made the lame walk (Mt. intellect and free will do indeed the human person could flourish 15: 29-31) and he even raised the make the human person “God- was soon called into question. son of the window of Naim from like,” but they do not make the Moreover, with the demise of a the dead (Lk. 7:11-17). Indeed, human person divine. The human traditional metaphysics, the no- the words of the prophet Isaiah person’s share in divinity is a re- tions of a common human nature “Yet it was our pain that he bore, sult of grace. and of the natural moral law that our sufferings he endured... by his 3.2. In anthropological termi- is derived from the fundamental wounds we were healed” (Is. 53: nology, the creaturely status of inclinations of such a nature were 4-5) were fulfilled in the healing the human person may be de- called into question. The very ministry of Christ. scribed as a person’s enjoying a meaning of human existence was 2.2. The healing ministry of “theonomous autonomy”. To be subject to various speculations, Jesus was also confided to the who he or she is called to be, to and the ability to know objective Twelve: “He summoned the achieve that fullness of humanity truth and morality was widely Twelve and gave them power that is God’s will for all his hu- doubted or even rejected. and authority and to cure diseas- man creature is to live one’s life in A disturbing example of the es and he sent them to proclaim relation to the God who is the Au- rejection of the objective mean- the Kingdom of God and heal the thor of all life itself. This depend- ing of human existence that de- sick” (Lk. 9:1-2). The Acts of the ent, metaphysical relationship be- rives from both faith and reason Apostles which narrates the life tween Creator and creature does can be found in a decision of the of the early Christian community not detract from the fundamental United States Supreme Court of speaks of the healing ministry of dignity of the human person but is 1992. In that decision, a Supreme the apostles. St. Luke even notes in fact the very condition of pos- Court justice wrote, “At the heart that people would place the sick sibility for the existence of such a of liberty is the right to define in the streets on their mats so that lofty human dignity. one’s own concept of existence, ‘when Peter came by, at least his 3.3. The recognition of the Cre- of meaning, of the universe and shadow might fall on them” (Acts ator/creature relationship was an of the mystery of human life...”1 5:15) and they might be healed. integral part of the theological 2.3. Over the centuries the char- and philosophical patrimony of ismatic healing performed by in- Western culture until the mod- 4. The Dictatorship dividual Christians was formally ern period when there appeared of Relativism institutionalized in Catholic hos- the philosophy of Immanuel Kant pitals, often sponsored by reli- which introduced the notion of 4.1. The anthropological shift gious communities, which under- “the turn to the subject”. In some that happened during the Enlight- stood themselves as perpetuating ways, the Kantian turn to the sub- enment and post- Enlightenment the healing mission of the Lord ject precipitated an anthropologi- periods laid the philosophical ba- Jesus. Since the Church is the cal shift in the understanding of sis for what Pope Benedict XVI body of Christ in the world, to the human person. The depend- has repeatedly referred to dur- which Christ’s saving mission has ent relationship between God and ing his pontificate as “the dicta- been confided, it was only appro- the human person was no longer torship of relativism”. This intel- priate that such a central activ- viewed as a reason for the dignity lectual and moral phenomenon ity in Jesus’ proclamation of the of the human person but rather as has influenced every dimension dawning Kingdom of God should establishing a type of rivalry be- of life our contemporary West- remain throughout history in the tween the divine and human. If ern culture, including the field life of the Church’s pastoral min- the human person were dependent of medicine and in particular, the istry. on God, that is, if the human per- doctor-patient relationship. With- son were not autonomous, then in the last forty years, the princi- men and women could not be tru- ple of patient autonomy2 in the 3. Modern and Post-Modern ly free and fully human. moral decision-making process Anthropologies 3.4. The anthropological shift concerning the use or non-use of from theonomous autonomy to medical technology has become 3.1. The psalmist writes: “What the absolute autonomy of the hu- predominant. In a perhaps over- is man that you are mindful of man person became a unques- ly simplified way of speaking, him and a son of man that you tioned presupposition in the phi- the presumption that “the doc- care for him? Yet you have made losophy and politics of the Age tor knows best” has given way to him little less than a god, crowned of Enlightenment. Reason, un- the presumption that “the patient him with glory and honor” (Ps. 8: encumbered by the shackles of knows best”. 5-6). Biblical revelation teach- an outdated faith, would be free 4.2. The principle of patient au- es that God is the creator of all to create a world where men and tonomy is intellectually and mor- that is, and that the pinnacle of women were capable of constitut- ally defensible if its exercise in- his creative activity is the human ing themselves. In the post-mod- volves a well-formed conscience person. White the human person ern period, with the rise of such in making decisions relative to is made in the image and likeness philosophies as deconstructional- one’s health care. In a culture of God, he or she still remains a ism, the very ability of human rea- and society influenced deeply by creature. The human faculties of son to construct a society where moral relativism where there are

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no moral absolutes because, in authentically Catholic hospital: op exercises responsibilities that great measure, there is no com- 1) the social responsibility of are rooted in his office as pastor, monly accepted understanding of Catholic health care services; 2) teacher and priest. As the center the nature of the human person, the pastoral and spiritual dimen- of unity in the diocese..., the dioc- or an acceptance of the natural sions of Catholic health care; 3) esan bishop fosters the mission of moral law, the presumption that the doctor-patient relationship; 4) Catholic health care in a way that patients have well-formed con- medical-ethical issues concerning promotes collaboration among sciences can readily be called in- the beginning and end of life; and health care providers, medical to question. In secular hospitals, 5) Catholic hospital partnering or professionals, theologians and it can be reasonably argued that merging with secular medical fa- other specialists. As pastor, the the physicians in such hospitals cilities. diocesan bishop... encourages share the prevailing cultural bi- 5.3. The moral principles that the faithful to greater responsibil- as in favor of moral relativism. are presented in the ERDs as part ity in the healing mission of the Moreover, even if such secu- of the patrimony of the centuries- Church. As teacher, the diocesan lar hospitals have in place ethic old Catholic moral tradition seek bishop ensures the moral and re- committees that can be appealed to provide an objective moral ligious identity of the health care to in helping to resolve morally framework within which health ministry... As priest, the diocesan contentious medical decisions, it care providers and patients can bishop oversees the sacramental might certainly be the case that at make moral judgments and deci- care of the sick...”5 least a majority of the members sions. The document states, “The 6.2. The role of the diocesan of a hospital’s ethics committee moral teachings that are presented bishop is not to be the Chief Ex- work out of a framework of mor- here [the ERDs] flow principally ecutive Officer (CEO) of a Catho- al decision-making that is relativ- from the natural law, understood lic hospital. His responsibility is istic. This is not the case with a in the light of the revelation Christ to assure that the Catholic hos- Catholic hospital that is true to its has entrusted to his Church. From pital is authentically Catholic in mission to provide compassion- his source the Church has derived all dimensions of its operation by ate care that respects and pro- its understanding of the nature of adhering to the fundamental and motes the inviolable dignity of the human person, of human acts, objective moral principles of the the human person. and of the goals that shape human Catholic moral tradition. The di- activity.”4 ocesan bishop in a very practi- 5.4. The ERDs are an invalua- cal manner exercises his teaching 5. The Catholic Hospital in the ble instrument in assuring that the and governing roles in relation to United States of America moral decisions concerning the Catholic hospitals within his lo- practice of medicine in a Catholic cal church by being the authorita- 5.1. Catholic hospitals in the hospital are not subject to a cal- tive and ultimate interpreter of the United States of America are culus of decision-making that is Ethical and Moral Directives and governed by a document that morally relativistic. This moral their proper implementation in his the United States Conference of assurance is not readily available diocese. Catholic Bishops (USCCB) has in secular hospitals in the United 6.3. A related matter to the ex- crafted and that is now in its fifth States of America in our rapidly ercise of the diocesan bishop’s edition. This document is entitled changing world. teaching and governing roles Ethical and Religious Directives is the matter of Catholic hospi- for Catholic Health Care Services tals’ merging and affiliating with (ERD). It has been adopted as par- 6. The Role of the Diocesan secular hospitals. These mergers ticular law in many of the archdi- Bishop in a U.S. Catholic and affiliations can present seri- oceses and dioceses in the United Hospital ous challenges to the preservation States and reflects a body of mor- of the Catholic hospital’s identi- al principles that has developed 6.1. A final point that is perti- ty and medical service. Yet such throughout the centuries. In the nent to our discussion of “The challenges do not automatically Preamble of the ERDs, the pur- Catholic Hospital in a Changing preclude on moral grounds the pose of these directives is articu- World” is the role of the local di- possibility of these types of merg- lated as follows: “The purpose of ocesan bishop in safeguarding the ers and affiliations. The ERDs of- the Ethical and Religious Direc- Catholic identity and mission of a fer several directives pertinent to tives is two-fold: first, to reaffirm Catholic hospital under his juris- assuring that proposed mergers the ethical standards of behavior diction. and affiliations of Catholic and in health care that flow from the The pastoral responsibilities secular hospitals are done in a Church’s teaching about the dig- of a diocesan bishop flow from morally justifiable manner. nity of the human person; second, the episcopal “triplex munus” of Directive 67 states: “Decisions to provide authoritative guidance teaching, governing and sancti- that may lead to serious conse- on certain moral issued that face fying. The ERDs concisely ex- quences for the identity or repu- Catholic health care today.”3 press how these episcopal respon- tation of Catholic health care ser- 5.2. The ERDs touch upon a sibilities are exercised in relation vices, or entail the high risk of number of current realities that to a Catholic hospital in his lo- scandal, should be made in consul- are integral to the mission of an cal Church. “The diocesan bish- tation with the diocesan bishop...”6

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7. Conclusion ized.”7 A Catholic hospital that “the governing of one” self according to one’s own system of morals and beliefs” strives to promote the mission ar- (Veatch, Robert M. Medical Ethics. Wash- 7.1. In 2003, Blessed John Paul ticulated by the late and beloved ington, D.C.: Jones and Bartlett Publishers, II wrote in his message on the oc- Blessed John Paul II is desper- Inc. 1989). 3 United States Conference of Catholic casion of the World Day of the ately needed in a changing world Bishops, Ethical and Religious Directives Sick in Washington, D.C.: “Cath- that is becoming increasingly sec- for Health Care Services, Fifth Edition. olic hospitals should be centers of ular and indifferent to the Gospel Washington, D.C.: USCCB, 2009, p. 102. 4 Ibid., p. 2. life and hope which promote – to- of Life. 5 Ibid., pp. 4-5. gether with chaplaincies – ethic 6 Ibid., p. 31. Also see Directives 68-71, committees, training programs pp. 31-32. 7 Dolentium Hominum. Proceedings of for lay health care workers, per- Notes the XXVI International Conference. “Pasto- sonal and compassionate care of ral Care in Health at the Service of Life in the sick, attention to the needs of 1 Planned Parenthood of Southeastern the Light of the Magisterium of the Blessed Pennsylvania, et al. vs. Casey, Governor of John Paul II. (Editrice Velar, Gorle (BG), p. their families and a particular sen- Pennsylvania, et al., June 29, 1992. 75. sitivity to the poor and marginal- 2 Patient Autonomy can be defined as

4. Central and South America

H.E. Msgr. Sebastián there is a preference for works of is done with basic social organisa- Ramis Torrens T.O.R. a small size and involving accom- tions, community leaders, families Bishop of Huamachuco, panying, and for primary health and associations of sick people. Bishop Responsible for Pastoral services for the poor sectors of the A hospital is a school of forma- Care in Health, population. In addition, an increas- tion for future health-care pro- ing difficulty is encountered in the fessionals. It is also important provision of services according to that people are made responsi- the current neo-liberal model, and ble when the formation of pasto- this has placed many of the Cath- ral workers, families, patients and olic clinics and polyclinics of the healthy people takes place. A ‘for- A Look at Reality region in a state of crisis, forcing mation of the heart’ is required them to try to finance themselves (Deus caritas est 31a) as well as The State recognises that there or to close, if they are not success- preventive health. the structures and human re- ful in this. In the state hospitals sources of hospitals are twenty- there is also a shortage of chap- five years out of date. We suffer lains and Catholic volunteers.1 A Privileged Place a shortage of basic medical prod- for Evangelisation ucts and antiretrovirals, princi- pally in the provinces, as well as Illuminating Reality In the Gospel of Luke (10:31), of medical products to combat Jesus describes two figures: a tuberculosis, especially for mul- In the Gospel of Matthew (4:23) priest and a Levite who ‘pass by’ ti-resistant or extremely resistant we read that ‘Jesus went about all in the face of situations of pain cases. Specialist care is concen- Galilee, teaching in their syna- and the loss of health without giv- trated in the regional capital cities. gogues and preaching the gospel ing priority to a person in need. The State has steadily withdrawn of the kingdom and healing every Catholic hospitals and clinics from the responsibility of assuring disease and every infirmity among must bear in mind that they are health for the whole of the popu- the people’. We thus see that Je- privileged settings for evangelisa- lation and prefers, instead, to en- sus is concerned not only about the tion where the health-care person- courage private mechanisms. health of individuals but also about nel should be marked by a solid As regards Catholic hospitals, in the health of the whole population. human, Christian and social for- South America these are responsi- He promotes public health. mation. ble for 15-20% of health care and for even a higher percentage in the case of psychiatric hospitals, cen- Formation of the Heart Challenges tres for elderly people, orphan- ages, centres for teenage mothers A hospital is a space of action One should not pass by in the and centres for the chronically or and promotion for pastoral care in face of situations where there are terminally ill. At the present time health2 and it is important that this sick people and their families.

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One should, instead, promote hu- One needs a health-care system sure that health-care policies have manisation and integral service. with a human face that promotes as their goal the good of the hu- In the management of hospitals this new culture which takes into man person. the human and spiritual aspects account the sick person and the must be of priority importance healthy person in order to prevent compared to the economic and illnesses. The New Evangelisation administrative dimensions. One should organise and be a When cooperation exists with part of hospital ethical commit- This requires the participation government health-care institu- tees. One should promote knowl- of all baptised people in vari- tions, one should ‘assure that con- edge about bioethics starting with ous pastoral contexts, includ- scientious objection is integrated the criteria of the Magisterium of ing fraternal relations with other into legislation and verify that it the Church. Churches, bodies and movements is respected by the public admin- that work in the vast world of istrations’ (Documento di Apare- health and health care in order cida, 469 i). Humanisation to make the message of Christ, ‘I The organisation of hospital came that they may have life, and pastoral care should be a part of Individual humanisation: through have it in abundance’, a reality. the overall pastoral care of dio- openness to everything that helps ceses and the pastoral care in us to understand a person, his or health of bishops’ conferences. her interiority, his or her world, Notes One should not lose from sight and his or her culture. 1 H.E. Msgr. Carlos Aguilar Retes, Bish- the profound corporeal, affective, Social humanisation: through op of Texcoco, Mexico; President of the Lat- intellectual, spiritual, social and the direct use of all health-care in American Bishops’ Council, CELAM. environmental unity of human be- workers and pastoral workers in 2 Discípulos Misioneros en el Mundo de 3 la Salud, Guía para la Pastoral de la Salud ings. order to: promote, each one in en América Latina y el Caribe (Consejo One needs a medicine that sees their own context, conditions suit- Episcopal Latinoamericano, 2010), pp. 96- and serves the whole person; a able for health; improve institu- 97. 3 Dolentum Hominum n. 76, 2011: ‘Car- medicine that has the person at its tions; foster the right distribution itas In veritatis. Towards an Equitable and centre. of health-care resources; and en- Human Health Care’.

5. Europe

H.E. Msgr. Firstly, a brief look at European and euthanasia, which are meeting Edoardo Menichelli countries. As we know, legislation with increasing assent within soci- Metropolitan Archbishop appears to be increasingly less re- ety, above all in so-called ‘extreme of Ancona-Osimo, spectful of human life, above all cases’, such as, for example, the National Ecclesiastical Assistant during its initial and final stages. conception of a child with incur- to the A.M.C.I. (Association This raises a serious problem of able pathologies or a long terminal of Italian Catholic Medical a moral nature which goes beyond stage to a person’s life. This does Doctors), individual laws and once again in- not exempt us from two responsi- Italy volves the conflict between legal bilities. norms and ethical norms. First of all, that of an educating Law, which should be a guar- nearness which, as believers, we y paper is organised around antee of morality for the common are always called to exercise even, Mthree points. First of all, in good, encounters difficulty in still and above all, in relation to those my capacity as national ecclesias- being such, given that it seems to who engaged in error. It would be tical assistant to the AMCI, I will be placed at the service not of the a grave mistake to transform the dwell upon the figure of the medi- common good but of an individu- Church into a tribunal which af- cal doctor and the Catholic medi- al good. This conflict, whereas in flicts humanity by declaring its cal doctor as well, in a Europe and past times it involved events and guilt. an Italy that appear to be increas- laws that later received the unan- The Gospel is the proclaiming ingly secularised. imous rejection of the commu- of truth and of grace, and thus of 1. What Role Can and Should nity (I am alluding obviously to mercy. Those who err must always a Catholic Medical Doctor have the race laws), today involves ex- find in us the merciful face of the within Health-Care Institutions? istential choices, such as abortion Father and not the severe face of

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a judge. And since such events ucating. A privileged setting for wounded and tempted by hopeless. take place in various forms in the such a dialogue is specifically a This is certain way not only for the health-care world it should be spe- hospital or a ‘health-care territory’ witness, but also for the holiness, cifically health-care workers who given that, as appears evident, to- of the medical doctor. bear witness to the truth and the day not everyone goes to church mercy of God. but everyone passes by way of this 3. I will now allow myself a Secondly, the – albeit incum- temple of pain. third perspective which I like to bent – emphasis on the problems b. The professionalism of think is a new great task in rela- of the beginning and the end of life health-care workers is by now tion to which everyone, and in should not make us neglect what heavily bound up with technology particular men and women who is between this beginning and this and increasingly distant from that base themselves on the Gospel and end, that is to say life in its whole- humanitas that is an integral part build their life choices on it, should ness. of the ‘ars curandi’. It is of urgent pay attention. Unfortunately, at times our voic- importance to unite knowledge a. Our Western society, as is well es are raised only in relation to and knowing how to do things known, is secularised and places an problems which, we could say, re- with the third component part exaggerated emphasis on econom- volve around the fifth command- of professionalism, that is to say ic realities and efficiency. In my ment, neglecting the grave moral ‘knowing how to be’. It is true that way of seeing things, the organi- transgressions of the other nine: people speak much about the ‘hu- sation of health-care, which can- we may think of honesty in work, manisation of care’ and of ‘narra- not be subjected to the criteria of of corruption, of the very many tive medicine’, of ‘high-tech’ and mere productive efficiency, cannot and new forms of theft, of neo-Na- ‘high touch’, as the English say, be allowed to fall into this circle. zism disguised as ethnocentrism, that is to say of high technology The more a sick person is cared for of policies that do not take the united with high humanity. How- and retrieved for society, the more family sufficiently into account, of ever, it has to be observed that this that society grows. From this point the unresolved problems of young does not seem to be achieved in a of view, expenditure on health care people, of the very many and di- capillary way. is never ‘useful’ expenditure. It versified forms of illegality… c. Working witness requires seems absurd that in some quar- What have medical doctors to do competence, seriousness, correct- ters there is a wish to communicate with all of this we could ask our- ness, presence, dialogue and self- to the patient who has been dis- selves? giving. This testimony is not con- charged not only the treatment that They are relevant to the extent fined to a place (I am thinking here has solved his or her problem but that they defend and experience, as of ecclesiastical health-care insti- also the cost of that treatment. The citizens and as professionals, the tutions) but, rather, to the person, Association of Medical Doctors uni-totality of the mystery of life. to his or her lay vocational riches, should be a voice of dissent as re- For that matter in one of the ver- and this is specific to a medical gards everything that would like to sions of the oath of Hippocrates doctor and every member of the make the recovery of health simple the physician promises: ‘I will de- lay faithful. This is what the Sec- a matter of economics. fend the patient against everything ond Vatican Council proclaimed b. This subject also bears upon that is unjust’. when it entrusted to the laity the health-care institutions which are ‘Christian animation of the tem- under the authority of the Church 2. And now our Italy poral order’ (cf. Apostolicam Ac- or which are managed by religious In this approach I would like to tuositatem n. 7). The words of families. highlight three points which in my the physician and saint, Giuseppe I will not specifically enter the view appear to be of a certain ur- Moscati, which he addressed to the subject but I believe that it would gency: ward sister who constantly asked be an example of absolute hu- a. The Christian identity, which him to go to church for a religious man and Christian witness if one runs the risk of no longer being celebration are instructive This ho- retrieved the message of chapter motivating and illuminating. This ly medical doctor, in the face of her 25 of the Gospel According to St. happens not because of increased insistence, answered: ‘Sister, one Matthew (the famous Works of and different cultural presences but serves God by working’. Mercy) and also the charitable ge- because believers no longer ‘real- In addition, this witness must be nius of certain saints who founded ise the hope that is in them’, as is illuminated by hope. As the Holy religious Orders or Congregations observed in the first letter of Peter Father Benedict XVI reminds us in and who saw in a sick person the (cf. 1Pt 3:14-17). his encyclical letter Spe Salvi, the figure of the suffering Christ. The Christian identity does not Christian is always and whatev- I understand that the subject is in any way fear cultural and reli- er the case a man of hope (cf. Spe a delicate one and would need to gious dialogue, nor even less does Salvi, n. 31). This hope, which is be explored outside this meeting. it fear falling into homogenisa- tangibly nourished by very many However, I cannot but remind my- tion. The Christian identity has the daily and often unknown examples self and all of you that ‘gratuitous- strength to engage in dialogue with of humanity and holiness, is espe- ness’ and ‘co-participation’ would other religions and with a dialogue cially requested of those who are give a new image to the ‘holiness’ that is respectful, fruitful and ed- near to sick people who are often of our days.

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6. Oceanie

H.E. Msgr. While our hospital wards were, of care and are often people’s first Donald Sproxton just a few short decades ago, full port of call when seeking medical Auxiliary Bishop of Perth, of religious sisters who had cho- attention. Bishop Responsible for Pastoral sen that as their path to glorify Across Australia, 5 per cent Care in Health, God, today it is a committed group of all beds are in Australia of lay people that is carrying on Catholic-run facilities. In the Aus- that legacy in a manner that makes tralian Capital Territory, Catho- those sisters extremely proud and lic hospitals provide 40 per cent our Excellencies, Reverend grateful. of the public beds serving a pop- YFathers, Brothers and Sisters St John of God, which has been ulation of around 350,000. Else- in Christ, it is a great joy to be with providing health care in Western where, Catholic hospitals provide you today – in this Year of Faith Australia – my home state – for al- major proportions of services – for the Universal Church, and a most 120 years, is a great exam- maternity in our Mater Hospitals Year of Grace for the Church in ple of how the Sisters of St John of in Brisbane, for example. And, Australia, the Great South Land of God created and operated health when we combine our renowned the Holy Spirit – to talk of the role services for people in need after ar- private hospitals to the equation, of Catholic hospitals in a chang- riving in a new outpost thousands Catholic providers account for one ing world. I also wish to recognise of miles from the established cen- in 10 of all hospital beds in Aus- the presence today of Rowena Mc- tres of Sydney and Melbourne. tralia. Nally, the chair of the Stewardship Today, the lay leaders of St John In addition to the quality of care, Board of Catholic Health Austral- of God Health Care are continu- our health care organisations are ia, who has joined us for these im- ing the mission of the Sisters and also seen as valuable partners be- portant deliberations, and thank Brothers of St John of God and cause they have been proven to de- her for her attendance. we are just weeks removed from liver services in a more cost-effec- In many ways, Catholic hospi- the commencement of work on a tive manner than government-run tals – along with Catholic schools, 307-bed public hospital in a less hospitals. In the case of St John aged care and social services affluent part of Perth, to be oper- of God’s Midland Campus, it is agencies – are becoming the place ated alongside a new 60-bed pri- predicted the Western Australian where the rubber meets the road in vate hospital. Government will save $1.3 billion the Church in many Western coun- During a competitive tender over the life of the contract – a tries. As societies change, and re- process set up by the Western Aus- 20 per cent saving on the forecast ligious adherence along with that, tralian Government, a number of Government expenditure. our hospital, schools and care hospital providers made their case This model of publicly funded agencies become some of the most for why they would be the best hospitals being operated by Cath- visible signs of Christ’s love in the choice as the Government’s part- olic providers may therefore be- community. ner. St John of God, with its histo- come more and more common- For the Church in Australia, the ry of providing care to the needy, place. Indeed, the Government in provision of health care – with a was indeed a fine choice for an Australia’s most populous state, preferential option for the poor, area like Midland, where – in a New South Wales, has held dis- the weak, the vulnerable and the booming economy such as Perth’s cussions with Catholic health care marginalised – dates back more – some of the most disadvan- networks to see if very tight state than 180 years. And, unlike in taged people live, and entered in- budgets might go farther with the some other parts of the world, the to a 23-year contract with the state engagement of Catholic services. Catholic health system is grow- to care for that community. One The Church in Australia is well ing. Around the turn of the cen- thousand new jobs will be creat- equipped to co-operate with such tury, there were 55 Catholic hos- ed as part of the hospitals’ posi- a model. pitals in Australia. There are now tive impact on the people of Perth Of course, not all people liv- 75. Our 550 aged care services are when the hospitals open in 2015. ing in a changing world – with also growing rapidly as we, like In many ways, what St John of the rising influence of secular- most of the world, deal with an God is being able to achieve in ism and atheism – are receptive ageing population. Our services Western Australia is something to such a system. As St John of employ somewhere in the vicinity that other Catholic health provid- God observed, some in society of 40,000 employees, almost all of ers in Australia’s eastern states are uncomfortable with the idea whom are lay. have been doing for decades. In of a faith-based health provider. That is one aspect of how a the three main centres on Austral- Outspoken politicians and atheist changing world, in which fewer ia’s eastern seaboard – Melbourne, groups were among those who felt women, in particular, are entering Sydney and Brisbane – Catholic the Church’s unwavering respect religious life, is also changing the hospitals have established them- for life was somehow incompat- provision of Catholic health care. selves as outstanding providers ible with the provision of public

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health care. They made that case ing of nurses in particular. Some the care – medical and personal – that only an organisation that pro- Catholic hospitals are already as- they know they will receive. That vides a full suite of services should sisting in the medical internships means Catholic hospitals are often be able to operate a public hospi- of new doctors, but in the past few seeking partnerships with chap- tal, seemingly oblivious to the fact months, some have offered to help laincy services from other church- that virtually no hospital in Aus- address the lack of available train- es and other faiths to ensure any tralia – private or public – actually ing places for medical graduates. patient or resident has their spirit- provides every possible service. Given the demands on hospital ual needs addressed in a culturally It is likely that other Catholic staff, there has to be some creative appropriate fashion. providers invited to operate pub- thinking done about how best to In many ways, that is a liv- lic hospitals elsewhere in Aus- offer that training, but those plans ing out of many of the principles tralia will face similar opposition, are already being formulated. the Council Fathers were espous- but we remain confident that such Catholic health care is obvious- ing 50 years ago in this place dur- voices are seen as representing a ly about more than just caring for ing the Second Vatican Council. small sector of the community. a person’s body, though. It is also Those visionary men saw how The success stories of Catholic about caring for a person’s soul, the world was changing and saw public hospitals around Australia and the changing world is present- how the Church could shape and provide proof that the partnership ing its own challenges in that area. brighten that world by greater en- model works. As with the declining number of gagement with society and, in this Another way in which the world religious, Australia is experienc- context, with people of other be- is changing and affecting the role ing a drop in the number of priests liefs. Some might have seen it as of Catholic hospitals is the im- in our country. From a pastoral unthinkable, just 50 years ago, for pending drastic change in the perspective in a medical context, a Catholic hospital to have a Bud- country’s demographics. With Ba- that obviously has some implica- dhist or a Hindu chaplain walking by Boomers soon to enter their re- tions, most significantly in the area its halls, but that is today’s reality. tirement years and birth rates hov- of chaplaincy and the administer- Christ himself showed us the ering around replacement level, ing of sacraments. way in his parable of the Good Sa- the proportion of older Austral- While the Church has been for- maritan – the parable that inspires ians is set to rise dramatically and tunate to find a number of com- the Shared Purpose Statement that create a strain on the country’s re- mitted people – some of whom are was recently adopted by Catho- sources. theologically trained – who are lic Health Australia. The role of a I am proud of the leadership willing to carry out many of the Catholic hospital or aged care ser- Catholic Health Australia, on be- pastoral care tasks that ordained vice is to see the woman in need, half of the 550 Catholic aged care ministers have previously car- to see the man calling out for help, services around the country, pro- ried out, there are clear delinea- and to be the person that lifts them vided in response to the care im- tions between what a priest can do up and places them on the meta- plications that flow from that de- and what a lay person can do. On- phorical donkey and seeks to pro- mographic shift. In fact, Catholic ly priests can administer the last vide physical and spiritual well- Health Australia was a leading rites or Extreme Unction – what ness. voice on behalf of all providers the Church now more commonly That is a vision that is shared in seeking aged care reform that refers to as the Anointing of the by Catholic health care provid- would allow older Australians to Sick. And while extraordinary ers around the world, and we are enjoy the level of care, compas- ministers can offer Communion to therefore supportive of the idea sion and dignity that they deserve, those who are infirm and unable to the Pontifical Council is set to con- all in a financially sustainable attend Mass, only a priest can cel- sider about the re-establishment system. ebrate the Eucharist for those who of an international federation of As in other aspects of care for are able to attend Mass in the hos- Catholic health associations. The the human person, Catholic pro- pital or aged care facility’s chapel. Catholic Health Australia model viders were working hard to en- This is an issue that is exercising in Australia has proven incredibly sure that any proposals being the mind of Bishops in Australia, successful, and we believe an in- considered by the Federal Gov- and no doubt in other countries ternational group will be a valua- ernment were scrutinised based on also. ble network. their possible impact on the poor, The changing world also leads So we find ourselves, in this the weak, the vulnerable and the to a much more diverse mix of third millennium, responding to marginalised within Australia’s patients and residents in Catho- the challenges of the time with an older demographic. lic hospitals and aged care facili- authentically Catholic response. An associated consideration ties. The days of the vast major- Our Catholic hospitals and aged Australia faces with the ageing ity of patients being Catholic or care facilities are a source of great population is who will care for a Christian of another denomina- pride for the Bishops of Australia, those people in their later years. tion are increasingly a thing of the caring for those whom we serve in Catholic hospitals already play past. The stellar reputation of our a world that is changing, but is still a major role in the education of facilities means that people from moved by those carrying out the the doctors and nurses of tomor- all faiths or no faith often seek compassionate and loving work of row, and in the practical train- out a Catholic hospital because of Jesus.

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III. The Spirituality and Deaconate of Charity

The Hospital Chapel: a Beating Heart of the Mission of the Church for the Sick

Fra René Stockman, F.C. gins. It is even becoming very dif- existence and in their struggle Superior General of the ficult in certain countries to main- with the ultimate existential ques- Brothers of Charity, tain an ethical profile according tions1. Belgium to the guidelines of Catholic mo- This description already pre- rality, and one must dare to go sents two angles or perspectives against the current and, at times, starting from which pastoral care get into a tussle with the legisla- can be approached: the general tive government, who is also the human desire for meaningfulness Introduction care financier. There are often no in life and the Jewish-Christian means available for pastoral care inspiration that attempts to pro- When we talk about a Catholic in a health care system that is in- vide an answer. hospital, one of the quintessential creasingly and purely determined On the one hand, pastoral care features is the pastoral care that is by finances. In countries that still can be approached from that gen- provided there. A Catholic hospi- lack a primary provision of care eral human desire for meaningful- tal that dedicated itself to provide and where the Church still has a ness and the existential struggle good medical care, and that suc- pioneering role when it comes to with the ultimate life questions. ceeded in doing so, but that did health care, the same maxim ap- People always try to make their not pay any attention to a pastoral plies: here, the field of health care existence and their co-existence framework, would fulfil only part is a pre-eminent place for the into something meaningful, and of its mission and should in fact Church to be with an adapted pas- in certain moments in life, people be given an unsatisfactory mark toral supply, while not being lim- start explicitly asking questions across the board. This applies ited to the pure development of about the meaningfulness of life. to countries where health care care in itself. In sickness and suffering, these is generally well-developed and The title that I got from the or- questions arise with great inten- where Catholic hospitals main- ganisers, “La Cappella dell’o­ sity, and it is important that a per- tain their reason for existence to- spedale, cuore pulsante della son can find another person who day, in addition to providing qual- mis­sione della Chiesa per gli in- is willing to listen so as to vent ity therapy and care that puts the fermi”, even though it sounded a these questions. This is clearly patient first, exactly by paying ex- bit strange to me at first, even a about the existential-spiritual di- tra attention to two areas, namely bit scary, entails a huge challenge mension in life, which demands a pastoral care and a medical-eth- around which we wish to devel- direct and distinct approach, just ical policy, which is oriented in op this contribution: how can we, like the somatic, the mental, and Catholic morality. Particularly in as a Catholic hospital, continue the social should be approached Western countries, it is a real pit- to create the necessary space for through individual ways and an- fall to solely focus on high qual- pastoral care to be present like a gles. We know the health care ity therapy and care as a Catholic beating heart? pitfall of listening to existential hospital and even withstand the questions but wanting to answer competition with other hospitals, them through psychotherapy. Ex- to possibly still have extra atten- 1. How can we describe istential questions are being psy- tion for the availability of care pastoral care today? chologised at that point. for the poor, which certainly re- On the other hand, pastoral care mains a hot topic in the US, and Pastoral care can generally be can be approached starting from with which a Catholic hospital described as the Jewish-Christian- the faith in the meaningfulness of can still create a distinct profile, inspired, existential, and spiritual life in spite of everything, and the but to act neutrally ethically and care for people in their pursuit of ways that are offered to us by the relegate pastoral care to the mar- meaningfulness in their everyday faith to find and continue to find

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meaning in all circumstances of sick person is referred to anoth- have 9 minutes to attend to each life. The answers that are offered er caregiver when he or she asks resident. You try and do that! I al- to this general human desire by a deeper question. After all, it is so notice how difficult it is to have our Jewish-Christian tradition, known that certain carers have a quiet conversation nowadays and particularly the theology of difficulty dealing with existential and not be constantly interrupted salvation that Christian religion questions as these questions al- by mobile phones. When I was offers us, gives a person perspec- ways touch on the carer’s own ex- on the bus here in Rome the other tives that no other life ideology istence. Others believe that, as a day, I noticed that almost every- can provide. People can gener- caregiver, one must stick to one’s one was talking, but no one was ously draw from this for their per- own discipline and never enter talking to each other, they were sonal dealing with their existential into questions of faith because of all on the phone, and I was able questions, and in the liberating re- the so-called therapeutic neutral- to hear everything that was being lationship with God, which is the ity and the therapeutic distance said, I even overheard a family ar- essence, they can find strength that the person requiring care and gument. There has probably never and inspiration. the caregiver should keep. Still been a time of so much communi- Pastoral care in a hospital will others feel embarrassed and sim- cation yet so few still really listen always involve these two dimen- ply cannot find the words to pur- to each other. Certain hospitals sions: creating a climate and an sue such questions because every- have become medical companies, effective space for expressing and thing that involves existence and medical centres where technically listening to the questions for the faith is no longer part of their life good care is provided but where meaning of life in life-threaten- territory due to their heavily sec- everything is reduced to the most ing situations, which sickness and ularised background. Therefore, efficient treatment of the illness suffering do bring on, and, on the that which we cite as functions of possible and the sick person as a other hand, offering answers in pastoral care applies to both the human being is barely considered. an appropriate way in the form of specialised pastoral worker and It will be very hard to apply the words, symbols, and rituals, with- the caregiver as such if caregiv- presence theory, and practise pas- out wanting to impose these an- ers wish to continue to honour the toral care in such surroundings. swers yet also without wanting ideal that they are there for man Pastoral care workers will have to withhold them. It will always in his entirety, not just for his sick to experience so-called moments be about being close, in a hum- body! of slowing down, of relaxation, ble way, without being deterred In pastoral care, everything just visiting the sick person with- by this humility or without being starts in the loving and respectful out doing anything. The presence restricted in the offering, uttering presence with the sick person. One theory continues by saying that and particularly in the sharing of listens to the patient’s daily living one should not act as a special- our faith. situation and one shows the will- ist but simply as a fellow man, a ingness to dwell on it. We might neighbour. This is also quite dif- call this pastoral care of the incar- ficult in a hospital environment 2. How can we experience and nation, pastoral care of everyday where one enjoys walking around live pastoral care today? life. Recently, a new theory was wearing white or a different col- developed on this matter that, in our and a badge and clearly show- Pastoral care always starts from my opinion, fits in very well with ing patients and colleagues that what we call a pastoral basic at- our reflection on pastoral care: the one has got something to say on titude: humbly listening to the presence theory2. This theory that a professional level. At this stage, questions that arise in people and mainly focuses on people with the pastoral guide should not be a then with profound respect refer- mental problems is about being pastoral guide in the strict sense ring to the framework in which there for a person, being present of the word but someone who is we want to place these questions in his everyday life in a very ac- unconditionally there for the oth- in the hope that answers might tive way, by actively listening and er, specialised in the use of eve- grow from there that can give sol- by taking seriously everything ryday events, stories of the mo- ace to people and that might sup- that this person puts forward. One ment, in order to pave the way for port their own answers. will always be there as a caregiver further pastoral guidance. Finally, Pastoral care is made up of dif- with one’s own backgrounds and the presence theory says that one ferent moments, call it functions one’s own discipline, however should have an open agenda, not that have their own value and this is set aside at first. One does directly focused on solving the that are part of what we call pas- not use one’s knowledge, one’s problem but just to be there for toral care. We should mention in theoretical and theological frame the other. advance that pastoral care is of of thought but one simply listens And so, the way for the actual course a separate discipline with- and makes time for the sick per- pastoral work is paved. Now is in the hospital setting and there- son. Again, we have arrived at a the time to go deeper: enter deep- fore requires an individual frame- very intricate point in our current er into a certain problem, a cer- work with specialised people yet health care system; many caregiv- tain question that needs clarify- on the other hand, all health work- ers no longer make time to listen ing. This is also the moment when ers are expected to have pastoral to the sick person. I know a rest the pastoral guide can bring for- attention, and it cannot be that a home for the elderly where carers ward something of his own re-

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ligious background, yet always Sometimes healing is not possi- people in order to come to terms careful not to formulate answers ble, only assistance, consolation. with oneself, with the other, with for the other too quickly. At this At that point, the pastoral coun- God. This is the work of recon- stage, it is very important to re- sellor can do little else but stay ciliation: being able to be recon- peat the things that the sick per- with the other person, watch over ciled once again with a sick body, son puts forward in order to make the other like a shepherd, a pastor, being reconciled with long gone it clear to him or her that you are to be close to him and offer sol- failed relationships, being able to on the same wavelength. The field ace. It is the image of the friends discover God again as a merciful of psychotherapy provides us with of Job who went to him to offer Father who is there with this for- the term ‘counselling’, which is him consolation, even though giveness, etc. described as follows by the well- they were more ‘lamenting’ con- Healing, assistance, guidance, known psychotherapist Rogers: solers at times. Saint Paul urg- and reconciliation; we could refer “The counselling relationship is es us, through perseverance and to it as pastoral care’s four-leaf one in which warmth of accept- comfort, to have hope (Rm 15:4). clover, and pastoral care will al- ance and absence of any coercion Comfort and hope do belong to- ways need to have these elements. or personal pressure on the part of gether: it is maintaining the per- Other divisions of pastoral care the counsellor permits the maxi- spective of hope in difficult situ- are of course possible, however I mum expression of feelings, at- ations. believe that, owing to our limited titudes and the problems by the Pastoral care also means to time and taking into account the counsellee. In this unique experi- guide, and we are talking about topic as such, we cannot exam- ence of complete emotional free- the spiritual guidance that is of- ine the matter further. What we dom within a well-defined frame- fered to people starting from a can do, is refer to the abundantly work, the client is free to recognise certain framework, from a phi- available literature on this topic. and understand his impulses and losophy of life in the hope to find And so, we arrive at our final patterns, positive and negative, as answers to existential questions. question: in no other relationship.” Spiritual guidance is always a It is therefore good that pasto- delicate matter: on the one hand, ral care workers in their training something should be offered, yet 3. What space can and should and formation learn about this on the other it should not be im- we give to the religious aspect presence theory and counselling posed. One should be more than as such in our pastoral care? as basic attitudes in pastoral work a reflective mirror, and always be as such. cautious that one does not start Pastoral care means more than We do not enter into liturgical to think for the other and in fact and is different from social work and catechetical pastoral care in delude the other person. Perhaps or psychotherapy, even though order to keep the classic arrange- we can use the image of the re- social work and psychotherapy ment. This will certainly get a lationship between the Father and will always be involved. As we place within the hospital frame- the Son from the New Testament: have said in our definition, pas- work. I think that it would be how Jesus always refers to the Fa- toral care will involve existen- more interesting to dilate upon ther to know the Will of the Fa- tial questions but these existential the different functions of pasto- ther, yet he reaches decisions by questions will have to find a re- ral care: healing, assistance, guid- himself and carries them out. This ligious framework in which they ance, and reconciliation3. is the ideal of guidance: offering, will find an answer. And this re- The healing function of pasto- listening, growing, deciding. The ligious framework should be of- ral care actually dates back to Je- pastoral counsellor should be the fered through pastoral care. sus himself, who, by profession sick person’s ‘brother’ or ‘sister’, In this, I would like to formu- and practice, acted as a healer. not the man or the woman who late two remarks. People are broken by their suf- knows everything, but the one First of all, about the person of fering, by their illness, by their who inspires trust, who can lis- the pastoral carer. Working in pas- mortal fear, and want to be able to ten and give space, who is relia- toral care demands an individual vent it and find comfort in a word ble and who stands for what he or spirituality. Those who truly wish or a gesture from another person she says, a kind of person of refer- to be a pastor for a dying patient who tries to understand them. In ence, better yet, a person to iden- for instance will never be able to healing it is very important for tify with. be one if he is not capable of facing people to express their fears and Finally, pastoral care means to his own death and of dealing with hurts and to be guided into the reconcile. People become stran- this inevitable reality in a Chris- depths of the wound. The pastoral gers to themselves, to others, to tian way. Pastoral care demands a counsellor can in this case, as part God. It is the brokenness that is constant renewal and a deep spir- of his training and formation, find present in every human being be- itual life, a prayer life to be able to support within the fields of psy- cause sin controls us. In situa- indeed be that healer, guide, and chotherapy and logotherapy with- tions of sickness and severe suf- reconciler. The main question is: out needing to be a psychothera- fering, one can feel as though one as a pastoral carer, how do I get pist or a logotherapist. It is about is falling to pieces. Every sense the strength to be someone like obtaining the skills necessary to of wholeness and unity is lost. At Saint Paul, who, through all tri- act as a healer. that point, it is a matter of helping als and tribulations, remains an

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integrated man because of his un- ity has offered wonderful models ty contains within itself a promise shakeable faith in Christ? Pastoral of people who, exactly starting of salvation; evil is present in the care and spirituality can therefore from their faith, were able to give world partly so as to awaken our never be detached from one an- their illness, suffering, and death love, our self-gift in generous and other, and in addition to the differ- a profound meaning. I am always disinterested service to those vis- ent skills that one needs to have, struck by how young people like ited by suffering.”6 In reference to which can be obtained in training Chiara Badano, experience spir- this text, Pope Benedict made the and formation, the greatest need itual growth in their suffering in following observation during his in pastoral care remains the devel- which they see their suffering as Christmas message to the Curia in opment of one’s own spirituality. a pure act of love in the end, and 2005: “We must also do the utmost On this topic, Nouwen said: “Pas- truly consider themselves as fel- to ensure that people can discover toral care is not a nine-to-five job; low saviours on the cross of the the meaning of suffering and are it is essentially a way of life. In Lord. The Blessed Pope John Paul thus able to accept their own suf- our time, there is a great hunger II was a powerful example of this fering and to unite it with the suf- for a new spirituality that exists for many people. During his life fering of Christ.”7 The mysticism in a new experience of God in our and particularly during his pontifi- of the cross is not a cheap mys- own life. Praying becomes living; cate, he knew a great deal of suf- ticism but exactly requires a fath- prayer and pastoral care converge fering, and he wrote about it in oming of the essence of our faith: and can never be separated”4. That his encyclical ‘Salvifici Doloris’, that Jesus became man to deliver which is particularly true for the in which he tries to describe the us through his suffering and that pastoral counsellor should in fact Christian meaning of suffering in this work of salvation continues also be true for every caregiver in a magnificent way. This encycli- today, which makes it possible a Catholic hospital: the attention cal should be a required read for for us to place our own suffering that he or she should have for his everyone who works in a Catho- on the cross with Jesus. Pastoral or her own spiritual life in order to lic hospital, and perhaps it is the care can then be the place where be able to deal with suffering on task of the pastoral care workers this great perspective, call it joy, a daily basis without falling apart to guide their co-workers in this. may be shared. Let the chapel or lapsing into cold indifference. However, it is mainly in his times of the hospital continue to be an Nursing the sick remains a voca- of illness, and in his long period open space where, the sick, their tion above all else, and just like of suffering that he wrote an en- families, and their caregivers can any other vocation, it can only cyclical without words, as it is so go to be with the Lord in prayer grow if it is nurtured by a spiritual beautifully phrased in the book and receive the only true consola- life. ‘Let Me Go to the Father’s House’ tion. Yes, the chapel as the beating Secondly, a word about offer- with a powerful testimony by Car- heart of the mission of the Church ing faith within the pastoral rela- dinal Dziwisz5. Looking back on to the sick. tionship. Faith can never be im- the attempt on his life on 13 May posed, we all agree on that, but 1981, Pope John Paul wrote the have we not become too bashful following in his final book ‘Mem- Notes these days when faith is barely be- ory and Identity’: “The suffering ing discussed, even in a pastoral of the Crucified God is not just 1 Heitink, G., Pastorale zorg: theologie, differentiatie, praktijk. Kampen, Kok, 1998, relationship? It is as though one one form of suffering alongside p. 41. is stuck in the preliminary work, others… In sacrificing himself 2 Baart, Andries, Een beknopte schets never reaching the actual task. In for us all, Christ gave new mean- van de presentietheorie. Onuitgegeven tekst 2010, pp. 4. other words, should we keep the ing to suffering, opening up a new 3 Heitink, Gerben, Pastoraat als hulpver- wealth of our faith and the ex- dimension, a new order: the or- lening. Kampen, Kok, 1979, pp. 412. traordinary power that faith ema- der of love. The passion of Christ 4 Nouwen, Henri, Pastoraat en spiritual- iteit. Tielt, Lannoo, 2010, pp. 349. nates in moments of sickness and on the cross gave a radically new 5 Dziwisz, Stanislaw, a.o., Let me go to suffering from people, should that meaning to suffering, transform- the Father’s house. Boston, Pauline, 2006, not be the most beautiful flower, ing it from within. It is this suf- p. 33. 6 John Paul II, Memory and Identity. the most characteristic therapy fering which burns and consumes Weidenfeld and Nicolson, 2005, p. 189. that can bloom and be offered in evil with the flame of love. All hu- 7 L’Osservatore Romano, December 23, a Catholic hospital? Christian- man suffering, all pain, all infirmi- 2005, p. 4.

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Vocation to Consecrated Life and Charismatic Witness in Places of Care

Mother Laura Biondo, cally human dimension of the pa- fessing the evangelical counsels they F.S.C. tient. The critical point of Western responded to a divine call so that by Superior General, medicine today lies in its low lev- being not only dead to sin (cf. Rom. the Institute of the Daughters el of ‘humanisation’. Health-care 6:11) but also renouncing the world of St. Camillus, workers, today more than ever be- they may live for God alone’ (n. 5a). Italy fore, ‘do not have time’ to listen a sick person very much…A great deal is said and written about this Dialogue and Humanisation his paper of mine seeks to be phenomenon, but the remedies Ta contribution to a reflection are still weak. Today the sciences of language on ways of bearing witness to the In this paper, starting with the have demonstrated how much the Camillian charism in places of experience of the Institute of the ‘humanisation’ of a person de- care today. This involves refer- Daughters of St. Camillus, I will pends on interpersonal commu- ring to the meaning of the ‘char- confine myself to proposing some nication. The self becomes aware ism’ of Camillian consecrated life points for thought about the spe- of its own identity in front of a and thus of saying how women cific contribution that consecrat- ‘You’. It is the other who awak- Camillian religious are called to ed life, called to take care of sick ens the self-consciousness of the express it today in places of care people, offers in the process of the self. This takes place in encoun- in a secularised society. The two ‘humanisation’ of the art of medi- ter through listening and speech. points to remember are the Camil- cine and nursing nowadays. By this way one discovers that the lian ‘charism’ and the world of If all health-care workers, be- anthropological structure of a hu- health and health care today. lievers and non-believers, are man individual is ‘dialogical’. A All the charisms of the Church called upon to increase the at- child grows and matures in his or arise from the heart of God who tention that is paid to this factor, her identity through his or her re- ‘calls’ some of His sons and what kind of ‘humanisation’ is of- lationship with his or her mother, daughters to express something of fered by a man or a woman who with his or her father, and with oth- His ‘care’ for humanity. The mis- is ‘consecrated’ through a profes- er members of his or her family. sion, therefore, that springs from sion of religious life to this ser- But this applies in a different a charism has its origins in God vice? What is the proprium of way also to an adult. It is only and a person is called to receive humanisation that comes from a ‘company’, being with others, and and assimilate the feelings of God ‘consecrated’ person? participation in social and commu- and ‘bear witness to them’, that is When speaking about religious nity life that allows a man to ma- to say to express them and to im- profession the Second Vatican ture in his self-perception and that plement them in relation to the re- Council explicitly stated that the also allows him to know and de- cipients of that mission. faithful by a vow ‘bind them- velop his potentialities. Closing in Scientific and technological selves to the three aforesaid coun- on oneself is the most deleterious progress as applied to medicine sels…By such a bond, a person thing there is for the development has over recent decades engaged is totally dedicated to God, loved and conservation of an adult and in giant strides forward. Scien- beyond all things. In this way, that mature personality that is capa- tific medicine has broadened the person is ordained to the honour ble of integration in a constructive concept of ‘health/illness’ and and service of God under a new way into the fabric of human life. has witnessed its structuring into and special title… he is more inti- a plurality of dimensions: the or- mately consecrated to divine ser- ganic, the mental, the social and vice’ (LG, n. 44a). Religious life, Dialogue with Sick People the spiritual. And so reference is therefore, in its essence is to give made to holistic or psychosomatic oneself totally to God and to dedi- There are, however, circum- medicine which thus includes the cate oneself fully to His service. stances in life that can impede or totality of the human person. It is In Perfectae caritatis the same con- anyway obstruct this dynamism the human individual in his or her cept is emphasised: ‘The purpose of communication. Situations in entirety that is in a state of ‘ma- of the religious life is to help the which an individual runs the risk laise’ and not only one of his or members follow Christ and be of going back to self-closure. The her dimensions. united to God through the profes- reasons for this can be of the most However, such progress has sion of the evangelical counsels’ varied nature – loneliness, im- not been matched by suitable at- (n. 2e). ‘Members of each institute posed isolation, marginalisation, tention being paid to the specifi- should recall first of all that by pro- failures, mental or neurological

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problems, misfortunes, mourning, tation – in such a case the other, ficiency at the level of organisa- etc. Physical illness also causes a as I was saying, constitutes a sort tion, some limitation due to the self-centred inward folding be- of ‘sounding box’ which contains insufficiency or rigidity of insti- cause of the simple fact, some the madness of emotions, of feel- tutions, or perhaps some special scholars of the phenomenolo- ings and of fears that have in- obedience (for example a daugh- gy would say, that it ‘commands vaded the spirit of the suffering ter of St. Camillus who rather than attention’, that is to say that it person. And this last, gradually, having a hospital ward as a place leads to ‘self-attention’, so as to becomes calm: that being listened of ‘work’ has instead the room of be treated. Every pathology of a to has allowed an organisation in the financial administrator of the certain gravity tends to deterio- a new form of his or her emotions, Order; or a ‘missionary’ sent to rate the interior space of an indi- his or her interior world, opening a house of formation; or a ‘her- vidual profoundly. Everything be- him or her up to a future of mean- mit’ appointed a procurator!), one comes problematic and confused. ing and of hope. Let us try to ap- would enter a state of crisis and The future appears to be closed ply this highly humanising mech- call one’s vocation into question. off and it is not possible to plan anism to Christian faith. ‘We would like you’, said Paul VI something. Everything is a tur- to a group of sisters, ‘to bring to bine of thoughts, of concerns, and the four corners of the world the of fears that rain down on the in- Dialogue in Christian Faith belief that one religious profes- dividual. ‘Whys’ follow each oth- sion commits a person at a level of er, anxiety invades the soul, and In what way can this process be such profundity that changes at an insecurity projects life towards an read in Christian faith? How is it institutional level or in activities emptiness of meaning… expressed in the believer and in have only a relative importance, How should the person who is those who live Christian faith as even when suffering takes place called to ‘take care’ of this per- a ‘consecrated person’? In what because of this. The essential is to son react and respond? Here one way does it correspond to his or conserve a very alive awareness clearly sees that the medical or her ‘vocation’ to ‘bear witness to of the call of Christ who himself nursing act cannot be reduced to his or her charismatic identity? chooses his own friends’. a health-care service. Because, as Obviously, the first answer is A religious vocation arises I have already pointed out, illness that God Himself educates the from an encounter that is so in- alters the human person in his or disciple in dialogue: God speaks timate and personal with God her entirety: body and spirit, or- and man listens, and vice versa. and with His Christ that the soul ganic dimension and mental di- This is the central imperative of is stolen. The pattern that takes mension, and relational and spir- the Bible: ‘Listen, Israel!’. In the place in falling love is repeated: itual dimension. New Testament a disciple of Jesus the faithful feels that he or she is Perhaps a reference to the behav- is described as a ‘listener to the taken so profoundly that he or she iour of a mother towards her child word’ (Rom 1:5; 15:18; 16:26). can do nothing else but adhere to can help us to understand this. A ‘All scripture is inspired by God Him alone and forgo, therefore, newly-born child, experts say, has and profitable for teaching, for re- everything else (VC, n. 19). Just as an apparatus designed for the vi- proof, for correction, and for train- the person who is in love says to his sion and understanding of external ing in righteousness’ (2Tm 3:16). or her beloved “you are my life”, so reality but on his or her own he or Charisms, which are a constituent the person who is called feels that he she cannot actuate it. The empa- part of the various religious insti- or she can repeat in the fullest way the thetic mediation of the mother is tutes, are ‘experiences of the Spir- words of Paul: ‘For to me to live is needed. She knows how to deal it’ (Mutuae relationes n. 11) which Christ’ (Phil 1:21). In strict terms, with the needs of the child and to make people encounter Christ ‘in one does not forgo such valuable and respond to them in a suitable way. contemplation on the mountain, in necessary goods in order to be more Does not something similar His proclamation of the kingdom ready to engage in a specific activ- also happen to an adult when he of God to the multitudes, in His ity, however noble it may be, but it or she is agitated and worried, healing of the sick…’ (Lumen gen- is because one has forgone that one when a grave fear or serious ill- tium, n. 46). In finding in the tests is more ready to act, and one has for- ness threatens him or her and he of revelation that specific face of gone because one has been called and or she strongly feels the need to Christ that expressed the charac- taken by Christ. The forgoing of eve- confide in someone and does not teristic of his or her own institute, rything else is only a consequence of always manage to express him- a consecrated person assimilates a direct experience of God, of total self or herself correctly? In such those feelings of the Lord that he conversion to Him. This is lived in a case the other, if the other real- or she then expresses in the exer- faith, in hope, in love, as a supreme ly listens to him or her – that is cise of his or her mission. possession, as a supreme destiny. to say receives that state of mind, Bearing this truth in mind is of A Camillian sister well knows those apprehensions, and does fundamental importance. For a that the central core of her charis- not hurry in wanting at all costs choice of this kind there is no oth- matic identity lies in ‘bearing wit- to understand and to understand er justification than God and His ness to the living mercy of Christ’1 everything or block that person Christ. Were the opposite the case, towards those whom she is ‘called with a judgement, with a sentence whenever one was faced with to care for’. One should note the that seeks to be an exact interpre- some important change, some de- statement ‘bearing witness to the

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loving mercy of Christ’: she must heals’,2 who ‘takes care of’:3 heal- much as a sister truly assimilates bear witness to, and actualise, the ing and care come from God, who this approach of Christ which love of Another, of Jesus Christ. uses men and women mediators, leads her to see ‘Christ as present A ‘charism’, indeed, is a ‘gift’ that both men and women ‘of God’ in a sick person’ – ‘you did it to comes from Another. Those who (prophets) and ‘physicians’, as we me’ (Mt 25:36-40) – and ‘Christ receive it are called upon to wel- find in the books of history and of as present’ in the person who en- come and assimilate the feelings of wisdom.4 gages in service in his name (Lk Another, that is to say Jesus Christ. In the New Testament Jesus is 10:29-37).8 The ‘proprium’, therefore, of also presented as a healer. If the Just as a Christian vocation the help that a sister should offer healings are seen, in the gospels, does not exist in the abstract but to a sick person lies in expressing, as ‘miracles’, ‘powerful works’, only when concretely embodied in bearing witness to the involve- the truth of his message and his in a specific personal vocation, ment of God, of Jesus Christ, in divinity is thereby demonstrat- so there is no religious vocation this provision of care. It is no ac- ed. Indeed, they are also signs of that is not embodied in a Congre- cident that the apostle Paul, when his mercy and compassion, signs gational charism which in its turn speaking about the ‘comfort’ that of his concern and tenderness to- each member can love personally. a disciple of Jesus should offer, wards suffering humanity. This But the Congregational char- declares that this is a matter of be- means, observes an eminent ex- ism will also have as its own and ing able ‘to comfort those who are egete, that his deeds of healing central contents not a particular in any affliction, with the comfort ‘have a more intimate relationship style of life based upon specific which we ourselves are comfort- with the Kingdom of God’, that is virtues or a special service to be ed by God’ (2Cor 1:3-4). It is, to say with the presence, within performed, but, rather, the per- therefore, that kind of ‘comfort’ him, of the salvific and merciful son of Christ. If this were not the that the consecrated person ex- acting of God.5 The more frequent case, it would not be a Christian periences in his or her encounter use in the gospels of the term ter- vocation, which is always a call to with God that he or she must now apeuein (to treat) than iasthai (to live in Christ so as to become, like provide to those whom he or she heal) in the judgement of many him, sons, and thus to share in the is called to take care of. exegetes means that Jesus, in ad- Triune life. But here one must be clear: this dition to, and even more than, The Second Vatican Council reference to the action of God does healing, ‘took care of, treated, helps us to understand the spe- not mean a denial of what the hu- served and honoured’ sick people. cific charism of an institute when, man sciences have told us. Rather, The emphasis of the gospels in taking up a thought previously it pre-supposes it: the dialogical on the ministry of care and heal- expressed by Pius XII in his en- dynamism illustrated by the hu- ing of Jesus enables us to under- cyclical Mystici Corporis, it ob- man sciences should be integrated stand the importance of his dedi- served: ‘Religious should careful- into theological dynamism. And cation in affirming the presence of ly keep before their minds the fact it is specifically this human dy- the Kingdom of God in the world. that the Church presents Christ to namism that God ‘needs’ for His And thus the exegete that I have believers and non-believers alike help to be able reach sick people. already quoted is able to add: ‘all in a striking manner daily through God acts through the mediation of consecrated people who work in them. The Church thus portrays those who care for others. A be- the world of health and health Christ in contemplation on the liever ‘knows’ this truth different- care can find here inspiration and mountain, in His proclamation of ly, perhaps, from those who do not encouragement’.6 the kingdom of God to the multi- believe or do not think about it… The ‘com-passion’ that Jesus tudes, in His healing of the sick This is something known about by during his life demonstrated to- and maimed, in His work of con- a consecrated person: he or she is wards the sick and the suffering verting sinners to a better life, in aware of the ‘treasure’ of the ac- reached its apex when Jesus him- His solicitude for youth and His tion of God that he or she bears self was ‘suffering’, that is to say goodness to all men, always obe- within him or her, in his or her his passion. The ‘priestly prayer’ dient to the will of the Father who ‘earthen vessel’ (2Cor 4:7), that that we read in the gospel of John sent Him’ (LG, n. 46 a). is to say in his or her frailty and (17:1-26) reveals that Jesus saw From these words one can eas- weakness, in the poverty of human his passion as a , ‘for ily deduce that the charism of an language. Faith attests to him or them I consecrate myself’ (17:19), institute does not consist simply her, and assures him or her, of this that is to say ‘having loved his of engaging in certain works but, mysterious action of God with- own who were in the world, he rather, in representing Christ who in him or her. And the consecrat- loved them to the end’ (Jn 13:1), engages in them. One is dealing, ed person experiences this during which means: to the point of giv- therefore, with a particular con- times of prayer and of contempla- ing his life for them (Jn 15:13). formation to Christ who lives tion in order to then transmit it in And this is the reason which jus- some aspect of its mission. One is the exercise of his or her mission. tifies, for we women Camillian dealing, in other words, with con- If, indeed, in the Bible there is religious, the profession of the forming oneself to Christ who in a statement on ‘care’ for illness, it ‘fourth vow’: to serve the sick chastity, poverty and obedience is the declaration of the Old Tes- ‘even at the risk to our life’.7 preaches the Gospel, converts sin- tament that God is the ‘Lord who This is possible only and inas- ners, welcomes children, heals the

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sick, etc. St. Camillus did not em- It is this way of loving Jesus (com- mation to the merciful Christ and brace poverty, he embraced Christ passion!) that a Daughter of St. the passion to make him, today, in sick people; St. Francis did not Camillus must share in and then visibly present in history. embrace poverty, he embraced transmit to the sick. It remains At this point one would have to the poor Christ; and St. Dominic true that she must be able to see open a new sub-section in order to did not embrace preaching but the Jesus in the other, but it is above answer the question: how should a preaching Christ. All the so-termed all true that she must go with the ‘place of care’ be made a space of saints of Charity were conquered love of Jesus towards the other. ‘bearing witness to the charism of by Christ who showed himself to She must feel that she is a bearer the institute’ when, together with them in that specific approach of of this love. But she can do this the women religious, lay people, service; they fell in love with him, only if she receives it from Christ both believers and otherwise, al- they conformed themselves to him through a deep personal commun- so work in it?...In such a context, and they continued to show that he ion. Understanding this is of fun- indeed, it becomes more difficult was present in history, or, to put it damental importance. Before serv- to express the specific ‘logic’ of better, to show that Christ through ing the sick Jesus in the other, one the witness of consecrated life, them continued to make himself should bring the merciful Jesus to which is gratuitousness. Today, visibly present. the other. This, in essential terms, the health-care world is becoming It follows from this that it is not is the specific content of this mis- increasingly complex and requires enough to have a particular in- sion: to bring Jesus and to make specific skills and a high number of clination to engage in a specific him known about as merciful love. health-care workers which women humanitarian service, for exam- And to do this one should be con- religious on their own cannot al- ple caring for the sick, to speak formed to him, almost identified ways sustain…But that, indeed, is about a Camillian vocation. There with him. If this does not take another chapter which cannot be should be a special attraction by place, at least at the level of being addressed in this paper. Christ and towards Christ, first a profound wish of the heart, one and foremost. could, perhaps, be a good woman But it is not even sufficient for nurse but one would not be a true Notes there to be present a call to live Daughter of St. Camillus. in charity, poverty and obedience It is important not to confuse no- 1 Costituzione delle Suore Figlie di San Camillo, art. 1. like Jesus to be able to speak about ble and important activity, such as 2 Ex 16:21; Ps 103:3; 107:20; Tb 5:4. a Camillian vocation. It is also caring for the sick, with the char- 3 Ps 8:5; 144,3; James 7:17-18; Heb 2:6-9. necessary to encounter and share ism of the institute. A person may 4 2 Kings 1:1-17; 20:1-7; 5:1-19; Sir 1-15. 5 A.Vanhoye, Vita consacrata sanitaria, in Jesus in an approach of com- have talents that make him or her in: AA.VV., Dizionario di Teologia Pas- passion and devotion to the sick. particularly suited to practising torale Sanitaria (Ed. Camilliane, Turin, Those who do not share in this the profession of a nurse but this 1997), p. 1391. 6 Ibid., p. 1392. perhaps may have a vocation for does not mean that he or she has a 7 Costituzione delle Suore Figlie di san another institute but not a vocation Camillian vocation. At the base of Camillo, art. 12. for the Daughters of St. Camillus. everything there must be confor- 8 Ibid., art. 13.

Home Care for the Sick

Dr. Konstanty Radziwill, senting the Standing Committee ever, the CPME during the fifty MD, PhD of European Doctors (CPME), years of its existence has placed President of the Standing the European association of the the good of patients, their safe- Committee of European most representative national med- ty when they are treated and the Doctors (CPME), ical organizations, I know that in quality of health care, very high Poland our present economy- saturated in its activity. Also, medical eth- times it is harder and harder for ics as an integral dimension of the us to see the ethical dimension, or practice of medicine has been al- irst of all, I would like to ex- simply the human dimension, of ways one of our priorities. Fpress my gratitude for having health care. Also medical organ- I very much appreciate that been invited to this conference. It izations, sometimes rightly, are the organizers of this conference is a great honour and privilege for being accused of only a one-sid- asked me to speak about home me and for my organisation. It is ed representation of the particular care for the sick. The fact is that also a major challenge, as repre- interests of the profession. How- the vast majority of research and

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reports in health care and medi- – the terminally-ill (among ephone). A physician should be cine is being done in the field of them patients of all ages – includ- ready for this. The moment when medical intensive hospital care. ing seriously ill and dying babies a doctor begins to realize that a pa- What happens to the patient af- and children); and tient needs to have more care and ter discharge to his or her home – residents in nursing homes. symptomatic treatment (such as is a field that is much less known reduction of pain, depression, nau- about or described. A family doctor visits patients sea and vomiting, dizziness, itch- On the other hand, it is known who are generally healthy but due ing, constipation, etc.), rather than that the vast majority of people’s to an acute illness ask for medi- intensive diagnosis and treatment, lives, and not only in health but cal care in their homes. In addition is extremely challenging. Tactful- also when they are sick, are not to giving advice, a doctor in such ly informing about the patient’s spent in hospitals but in their situations has an excellent oppor- health condition, coming to a de- home environments. As a family tunity to understand better the pa- cision to go to palliative care, is doctor who has practised for thir- tient and his or her environment. a must, but it is not an easy task. ty years I know how much many This can prove to be valuable in- This is also a place where one must of the chance elements and chal- formation and experience for fu- decide about preparations for dy- lenges are associated with this ture reference, useful, for instance, ing at home. Trust at that point has fact. A family doctor takes care of in diagnosing psychosomatic and to be ‘earned’ earlier by a doctor his or her patients in their home family-created problems and seek- through caring and competent care environment, families, schools ing that support of family mem- in the past. From that moment on- and neighbourhoods for many bers that is needed for care. Obser- wards, the increasing importance years. This means that in addition vation of the patient in his or her of a close relationship with the pa- to a medical aspect of his or her own home, surrounded by mem- tient emerges, and not only having practice he or she must also take bers of his or her family, makes a enough knowledge and medical into account other dimensions of doctor see a lot of things that now skills. The doctor’s ability to en- care: good contact with the fami- and in the future can determine the gage in an empathic attitude and lies of his or her patients and of- patient’s health problems. to accompany the patient and read ten supporting those families, Under the care of a family doc- his or her real needs counts more. knowledge about the patient’s en- tor there is always a group of peo- There is also a place for a tactful vironment (home, school, work- ple with physical disabilities who response, conducted with great place, etc.) and so on. He or she need medical attention from time sensitivity, to the sometimes hid- may also, in the essential meaning to time. When visiting these peo- den emotional and religious needs of this word, become their friend. ple in their homes, a doctor can of the patient. A doctor should not There are several models of care better identify their real needs for take the attitude of imposing his or for patients who due to different essential social services and or- her views, but there is no reason reasons remain in their homes. ganize neighbours and the sup- to hide them. A relationship based There are European countries in portive environment that is neces- on openness and truth is definitely which it is the family physician sary for medical care in the future. best for the patient. It is obvious who is the person responsible for It is important that their disability that this is also a time to testify to such care, as the coordinator of the does not become a cause of poor- the importance of the patient and team of other health and social pro- er health. to the sanctity of life regardless its fessionals as well. There are other An increasing number of pa- quality. solutions where care for patients at tients require home visits from Visiting patients living in insti- home is entrusted more to profes- their doctors because of physical tutional care homes is a difficult sionals and institutions outside the disability caused by chronic ill- task for a family doctor. These pa- health-care system. Without pre- nesses and ageing. Due to their tients often suffer from numerous judging which solution is better, disability which increases over illnesses, they recover slowly and I would like to focus on my per- time, they require not only medi- with difficulties. Well-seen prob- sonal experience as a family doc- cal and nursing care but also sup- lems in their cases are loneliness tor in this field. In Poland, it is still port from other professionals. The and longing for a real home and the family doctor who is the person best way to provide them with their loved ones. The task of a who visits the sick in their homes. permanent loving care is to assist doctor and other caregivers can- Those who require care at family members who try to help not be just medical care – these home can be divided into several them through their own efforts. patients need a second person, his groups: If a patient lives alone, the fam- or her closeness and friendship. – patients bedridden by acute ily doctor becomes his or her best These patients, perhaps more than illness (among them patients after friend and sometimes the only others, also need spiritual sup- acute hospital treatment); partner for serious dialogue about port, to talk about the most seri- – persons with mobility disabil- life, family, the future and so on. ous issues, and deep contact with ity who have a health problem; The big challenge for a fam- another human being. – patients with chronic illnesses ily physician is care for the ter- As has been seen from the above who, because of their conditions minally sick and dying. They or examples, a family doctor, in addi- of health, are not able to visit a their carers often need assistance tion to an obvious obligation to the doctor; outside hours of work (e.g. by tel- best fulfilment of his or her pro-

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fessional tasks through his or her she has to collaborate with other And to end, three quotations knowledge and skills, must be able health professionals, social work- from John Paul II, which, as al- to deal with his or her suffering pa- ers and spiritual care-givers (par- ways, in the best way possible, tient as a friendly guest and sup- ish priests and lay helpers). He or show the right direction to be tak- porter in another person’s home. she should seek to maximize the en, especially when dealing with Long-lasting relationships of mu- involvement of the relatives of the terminally ill: tual acquaintance make it easier to the patient and encourage them to ‘How should one face the in- understand the needs of a concrete care for their sick relative while evitable decline of life in old age? patient, but at the same time they supporting them in their difficult How should one act when facing increase the emotional involve- situation. Often, despite the will- death? The believer knows that ment of the doctor and this often ingness to help, they feel helpless his life is in God’s hands, and he becomes truly exhausting. A fam- in the face of the suffering and dis- accepts from God the need to die. ily doctor should not flee from en- ability of their loved one. The phy- Man is not a master of death, just as tering into a closer relationship sician and other professional car- he is not a master of life’ (Evange- than just professional contacts with egivers should help them perform lium Vitae, 46). his or her patients, especially when this difficult role. Preparing the ‘Death is something entirely dif- visiting seriously ill people in their family of the patient for a time of ferent from the experience of hope- homes. In order to increase his or dying, and the death itself of their lessness: a door which opens wide her chances for reaching friend- loved one, should not be omitted. on eternity and experience of par- ship with them he or she must be a To summarise: a suffering pa- ticipation in the mystery of Christ’s good man. Then he or she can also tient requiring home health care death and resurrection’ (Evangeli- bear witness to his or her faith. of course first of all deserves ful- um Vitae, 97). A family doctor does not oper- ly professional medical care. But If care-givers reach this level, it ate in a vacuum. Not forgetting due to his or her unique situation will be possible that even in the that each patient has a right for au- often he or she desperately needs most difficult situations: ‘death tonomous decision-making about simply another human being. can also be a source of life and his or her health and care, a physi- Medical professionals, especially love’ (Fides et Ratio, 23). cian should assume the role of the family physicians, should be pre- Are we preapared to bear wit- friendly coordinator of care. He or pared to undertake this task. ness to this to our patients?

The Hospital Chaplaincy

Fra’ Benigno Ramos I have been a brother of St. also work with this team and are Rodríguez, O.H. John of God for some years and engaged in various initiatives that Superior of the Community of my formation and my spirituality are organised by the team. the Tiberine Island of Rome have been much marked by pro- I have to say that to be a chap- of the Religious of the Hospital viding assistance to the sick and lain in a hospital is not in the least Order of St. John of God, the needy. At the present time I easy since following sick people Italy work in the service of religious pastorally in a hospital context care at the San Giovanni Calibita has begun to be a very complex Hospital, which is better known activity for various reasons. It is as the Fatebenefratelli Hospital of complex because of medical ad- the Tiberine Island here in Rome. vances and the applications of Introduction My service as a chaplain forms a state of the art technology which part of the spiritual and religious are making therapeutic process- I extend my greetings to all team on which the hospital relies. es ever more effective. But also those taking part in this interna- This team is made up of two chap- of relevance in this complexity is tional conference of the Pontifical lains who work full time and one that fact that today people work Council for Health Care Workers, chaplain who works part time, a with new models of care that see whose President, Msgr. Zygmunt sister and a woman volunteer. the person in the plurality of his Zimowski I sincerely thank for Fourteen extraordinary ministers or her dimensions. This whole the opportunity he offered me to of the Eucharist and the members reality means that the service of be able to share with you my ex- of the three religious communi- care for spiritual and religious perience as a hospital chaplain. ties connected with the hospital needs must profoundly reflect and

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at times supersede models that are give answers but always with suf- the Father, in whose goodness and already obsolete in order to find ficient humility to recognise that mercy it is always possible to find space in which to implement the the answers are not so clear and welcome. He freed them from sin mandate of the Lord Jesus who that some times we are accompa- with the possibility of reconcil- sent out his disciples to cure the nied by silence, ‘to let love alone ing themselves with God, offer- sick in an integral approach of all speak’.2 ing them forgiveness (cf. Mk 2:5). the aspects that bear upon a sick The service of pastoral care at- Jesus’ contribution to health person – the somatic, the psycho- tempts to make itself present in takes place at a deep level, free- logical, the social and the spiritual the same way that Christ did, em- ing the person from everything – as the medicine of the twenty- bodying salvation in signs that that threatens his or her true hu- first century requests. bring health, being a universal manity. And this action that frees sacrament of salvation, which is the sick constitutes, we could say, effective and credible, bringing to the essential core of the kingdom 1. Evangelising in the World of concrete reality the signs and the of God. These liberating deeds of Health and Illness deeds of health, embodying them Jesus reveal that this sick world and involving them in the events contradicts the designs of God Pastoral care in hospitals has that we live through every day. and proclaims total and full salva- advanced with the passing of time For a hospital chaplain it is im- tion for all men. since we cannot engage in pas- portant to reflect upon and to lis- toral care in health that is solely ten faithfully to the words that centred around the administra- Jesus addressed to his disciples: 2. The Church and the Sick tion of the sacraments. We are ‘When you go into a city…heal walking towards team pastoral the sick that you find there and With her mandate from Je- care that accompanies the pro- say to them, “the kingdom of sus, the Church has continued to cesses involved in personal situa- God is near’ (Lk 10:8-9). This is evangelise the world of pain and tions of especial vulnerability. For the charge that we receive: to en- illness with the liberating and this reason, when we speak about ter the city, to enter a hospital – saving force of the experience a ‘chaplaincy’ we must mean a to which most people go because of salvation that the whole of the pastoral team that works inside a they are undergoing grave patho- person who evangelises lives.3 health-care institution.1 For this logical processes – to heal and to In a hospital a good evangelisa- reason, at times it would be bet- free today’s sick people. tion will not exist if there are no ter to speak about a pastoral team In the light of the behaviour of believers involved in this living constituted by the shared respon- Jesus towards the sick we seek experience of the salvation that sibilities of those who are sent by to enter into harmony with this God gives through Jesus Christ. the Church and attend to pastoral hospital world. Nobody doubts Our service has its foundation care for sick people. that the Lord Jesus demonstrated in Jesus, in being servants of the A hospital is not just a build- nearness to the world of sick and gospel in the world. And we can- ing, an organisation or advanced defenceless people. Jesus drew not impoverish or reduce all of technology. It is a much more near to these people, to those our activit to a health-care service complex reality since this term who did not count in this world, or professional work alone. refers to people and pathologies, to those who were beyond the All of those of us who work in experiences, and the patients and boundaries of normality, and to pastoral care in health proclaim the professionals who treat them. those who felt enmeshed in pain what we have seen, heard or ex- And all of this during an existen- and sent to the margins of society. perienced, and our witness must tial stretch of time that is especial- He drew near to these people, he refer back directly to our Saviour ly critical for sick people and their welcomed them, he touched them and Lord, he who it is said ‘went environment. and he healed them. And he did about doing good and healing’ As chaplains and as a team we this with total gratuitousness (cf. (Acts 10:38). often pose to ourselves questions Mt 10:7-8). Jesus was not moved But our most radical question as to which it is not easy to give an- by a professional duty or by in- servants of the Gospel, as preach- swers: how can one evangelise terests involving proselytism: he ers of the Gospel, is this: can we in a secular environment or in a acted moved by love, a profound offer today what Christ offered? highly qualified and technologi- love for the defenceless. And he I will now stress three funda- cal professional context? How did this by drawing near and seek- mental approaches of the Church can one ensure that sick people ing encounter with the person. We of today. Each person who is sent experience Christian salvation as could say that from the outside he out to evangelise must reflect up- an offering of integral health and was able to enter the deepest in- on his or pastoral action in the full life? How can one embody teriority of the sick person, offer- world of health and health care, in this world of health the values ing integral care for both the body following the example of Christ. of the Gospel, always respecting and the spirit. the autonomy of earthly realities Jesus welcomed, listened and Evangelising with Love and legitimate personal options? understood the sick and the mar- The service of spiritual and reli- ginalised. But above all else he Jesus acted when he saw sick gious care of the hospital wants to transmitted to them his faith in people because he was ‘deeply

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moved’. All of the action of Je- ers now must be accompanied by Lord Jesus who strengthens and sus comes from love and is done gratuitous love, by total respect gives peace. through love. He was concerned for the person, by patience and a Sick people themselves through about the sick person and want- great deal of affection. Those who their personal experience, through ed to him or her good. If will not seek to speak in the name of God their sufferings and through their be easy to care for someone if we must be aware of the deep mys- struggles with serene acceptance do not put into this all of our con- tery of each human being. We of their limitations, through faith science and affectivity because, should seek to gather together and and love, can help other people for Jesus, healing someone was a to transmit through our lives this to place their trust in the Lord of way of loving. unfathomable love of God to all Life, opening a horizon of hope people, and especially to the sick. for those who at times live in anx- Evangelising in gratuitousness Our work should always be done iety and in pain. Chaplains who with humility, with patience, and are near to those who suffer are Jesus did not act out of eco- also with faith and hope in God, also through their very presence nomic self-interest or a sense of who can give us salvation in all a sacrament of Christ. In celebrat- professional duty but, rather, be- fullness. ing the sacraments, in offering the cause of the love that he showed Word of Life, and in facilitating for all sick people and defenceless spaces of prayer and of deep di- people. Our action in the world of 3. Those who Provide alogue. chaplains bring the name pain should be like that. We can- Religious/Spiritual Assistance of the Lord, health and life, peace not proclaim that God is near if in Hospitals and health care to sick people. we do not do so with a gratuitous service because this is one of the The charge of Jesus to assist most important signs by which and cure the sick is addressed to 4. A Spirituality with its Gaze to make God, who loves us gra- the whole of the Church because Turned Towards the Lord tuitously, present. Our readiness we make up the Christian com- Who Heals and Does Good to help and our nearness will be munity. All of us participate in evangelising deeds that say much a jointly responsible way in this When we reflect upon the spir- more than fine words. Love and mission according to the various ituality upon which the agents of service, tenderness and affection, charisms, ministries and services pastoral care in health must base words that animate and reassure, that the Holy Spirit brings forth in themselves, our gaze turns to- offered gratuitously, are signs of the Church. wards the Gospel in order to dis- the always gratuitous love of God. The bishops are the first to be cover in it the approach that Jesus responsible for promoting and or- had towards all the people who Evangelising by assisting the ganising pastoral care in health in encountered him and especially person in his or her totality their dioceses. towards the sick. This approach is Christian professionals, who in transformed for us into an imper- Jesus does not only offer biolog- virtue of their baptism share in the ative expressed with vigour and ical health, he also offers integral mission of the Church, have an ir- need at the end of the parable of healing aimed at the totality of the replaceable role. The exercise of the Good Samaritan: ‘Go and do human being. We should not help their professions is transformed likewise’ (Lk 10:37). a sick person seeing only the so- through their nearness to the sick Drawing near to the gospels matic processes of the pathologi- and witness, and this is an authen- demonstrates in all clarity that Je- cal process but, rather, by seeking tic service to evangelisation. They sus consecrated a large part of his the healing of the whole person, have the task of providing an at- time to people afflicted by vari- in all his or her dimensions. We tentive professional service, of ous kinds of illness, and when he are called as pastoral workers to assisting the sick with humanity, sent out his disciples on a mission help to heal everything that pro- and of ensuring that health-care he charged them with comfort- duces pain in the life of a sick per- organisations always have at their ing and healing the sick. It is well son, what dehumanises him or her centre service to the sick. known that in that context sick and wounds him or her in any di- Volunteers with their support- people were also frequently mar- mension of his or her being as a ive spirit and their witness to grat- ginalised because of social and re- person, fostering healthy relation- itude, provide valuable help to the ligious prejudices. The solicitude ships with other people and with sick and can also be inestimable of Jesus towards the sick, his ac- God. If we draw near to a patient agents of evangelisation, visiting, tions of healing and his words of with an approach of service and listening to and accompanying comfort were a manifestation of total readiness to help, he or she the sick and their family relatives. God. Through his deeds of com- will make us discover what his or Through their presence and passion and mercy Jesus revealed her needs are and what the ‘Good their service, the extraordinary to us that God is a compassionate News’ of which we are the bear- ministers of the Eucharist com- Father who is full of tenderness ers on behalf of the Lord Jesus plete the work of chaplains, bring- and knows the sufferings of His can achieve for him or her. ing to the sick the Bread of the people. He wants to save His Peo- Our mission as continuators of Word and the Bread of the Eucha- ple. Today, as well, the mission of the mission of Jesus as evangelis- rist, manifesting the nearness of the Church, through her agents of

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pastoral care, is a revelation of the for this reason a pastoral agent al- ally if one does not take into ac- love of God that heals and reha- lows himself or herself to be guid- count the families of sick people, bilitates, prolonging in time the ed by the sick and to be evange- bearing in mind their needs and mission of Jesus and his special lised by them as well. offering them that pastoral care devotion to those who, for any – He or she lives and cultivates that they need at every moment. reason, suffer. a community sense of his or her One should provide very special Thus an agent of pastoral care mission, he or she feels sent out care at the most critical moments must be an evangeliser capable by the Church to assist the sick of the process of illness, including of responding to the troubles of and the needy and does not work help in accepting the loss of loved the men and women of today, il- in isolation but in union and coor- ones and working through mourn- luminating life with the light of dination with the rest of the com- ing in a suitable way. the Gospel and being responsible munity. Our service must also provide through a commitment of faith – He or she looks for spaces for care to all of the personnel, at- for making Jesus Christ present in celebration and for prayer, for re- tending to the human and spiritual the world. The role of the agent flection and study at both a per- dimensions in professional prac- of pastoral care has three impor- sonal and a group level. His or tice as an important contribution tant aspects:4 1) his or her identity her pastoral service is a source to personal growth and to achiev- is understood through his or her of happiness and of joy and is an ing higher quality in the service adherence to Christ; 2) he or she opportunity for personal growth. that is provided to sick people. lives supported by the experience Basing himself or herself on the Our gaze must also reach the of faith; and 3) he or she is in- way that Jesus acted and embody- hospital institution, contributing volved in service to other people. ing all the traits that I have point- to sensitising the whole of the or- An agent of pastoral care lives ed out as specific to his or her spe- ganisation to providing integral and manifests a special spiritual- cific spirituality, a pastoral worker assistance to the sick, their fami- ity so as to follow Jesus and live is able to express in his or her life lies and the staff, working to en- according to the Spirit, which we and the pastoral activity that has sure that the patients always oc- can summarise as having the fol- been entrusted to him or her those cupy the central position that they lowing features: approaches that we see as being should have and working together – He or she has as Christ as a fundamental in the carrying out of to humanise assistance. reference point, accentuating the his or her mission in the Church, dimension of healing and libera- which are: generous service, gra- tion of the gospel message, ex- tuitousness, solidarity, hope, tak- 6. Concrete Pastoral Activity pressed in the words and deeds of ing up the cross, and mercy. the Lord Jesus, and he or she feels Our pastoral care in based up- anointed and sent out with a con- on the style in which Jesus treated crete mission. 5. The Recipients of Pastoral the sick. I would like to emphasise – He or she is centred around the Activity in the Hospital above all the nearness, the ten- paschal mystery. The cross which Context derness, and the offer of integral illuminates suffering and the res- healing that characterised the be- urrection which motivates and in- The religious service in a hos- haviour of the Lord Jesus towards spires efforts for health and life. pital accompanies the members of sick people. We know that the pro- – He is or she is forged though the Christian community, but it al- cess of an illness marks a critical his or her own experience of suf- so enters into contact with people point and a very important expe- fering, with its wounds, which who belong to other religious con- rience in the lives of individuals. makes the agent of pastoral care fessions and even with people who On many occasions it is a key able to draw near to and to help do not believe. For all of these moment by which to make con- those who suffer, in the dynamic people, with words and deeds, a tact with the religious experience of the incarnation (cf. Heb 4:15). pastoral worker must be a witness so as to reawaken, accompany – He or she is enriched in con- to the Gospel of Jesus Christ. and help the process of drawing crete service to the sick and their The principal recipients are the near to faith. In this experience needs. sick to whom the pastoral worker one can engage in the following – He or she measures himself or draws near with respect, with an activities of pastoral service.5 herself by the values of the King- approach of listening, attentive to dom which are not efficacy or their spiritual needs, ready to help The pastoral visit success but recognition of what is them to live their illnesses with apparently insignificant, the den- meaning, also offering advice in Emphasis should be placed on sity of daily life, the person and ethical decisions which may be the great importance of the meet- his or her concrete realities, and problematic. ing with the patient and for this the option for the needy. Experience of illness is not reason our visits must be made – He or she recognises the sick lived in solitude. In addition to with suitable preparation and with and those who draw near to them the patient, those who feel most a certain method that helps us and in the name of Christ as represent- afflicted by the illness are his or makes them gratifying both for atives and recipients of pastoral her family relatives. One cannot the patient and for the pastoral care. Both give and receive and understand what is good spiritu- worker. In the visit it is advisable

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to distinguish the various needs been received. And hope, when of faith of each patient and his that exist for each patient and to the patient is preparing to take the or her sacramental life. A patient make to each patient the most ap- decisive step towards the house of must be the protagonist and it is propriate visit possible, which is the Father. he or she that must ask for, and what we may call a ‘friendly vis- As it is one of the most impor- accept, the sacraments. We know it’ or one directed towards pasto- tant moments, prayer with the that this is not always the case and ral help. A sudden visit should not patient highlights certain points in some cases it is the family that be made but one that belongs to which I believe we should not asks for the celebration of a sacra- the pastoral plan, one of the fun- avoid: ment. One must carefully discern damental policies of which is to – It must arise from the needs the various situations that exist facilitate meetings with pastoral and the wishes of the patient. with the greatest respect for the workers. – One must know how to lis- sick person, offering, as well, an In the visit of great importance ten to the patient in relation to his opportune catechesis so that the is utmost respect for the religios- or her experience, his or state of sacraments are understood and ity of each patient – a statement mind, and help him or her to ex- experienced in a suitable way. that I see confirmed by my own press in prayer everything that he This is a task that has to be per- daily experience as a chaplain or she is living in his or her inte- formed over a longer time period – with respect for his or her per- rior world. and which influences all of the sonal rhythms and with no impos- – We must bear in mind the ex- process of formation in faith. ing of our styles. Such a meeting perience of faith of the patient and is very often an opportunity to his or her way of expressing it in Pastoral care for the families go on a journey together, which prayer without forcing him or her of patients is not the journey of the pastoral at the level of methods or style. worker but the journey that God – The emphases of prayer must This is an essential aspect since wants in order to bring the patient be in harmony with the existen- families are very much influenced to a meeting with Him. A constant tial situation of the patient who by the illness of a loved one. Near- exercise must be engaged in of prays, expressing lament, grati- ness, listening and attention to his drawing near to the varying situa- tude, trusting devotion, supplica- or her spiritual needs are also the tions of faith (even the absence of tion and intercession, the action task of the pastoral worker who faith), placing oneself with humil- of the graces and praise. must know how to value families ity and simplicity near to the sick – Our model for prayer is al- as a very important pastoral aid in person, principally to listen to him ways that of Jesus. We must base order to serve the sick person in or her. During this visit evangeli- ourselves on him, and it is he who a suitable way. One should work sation must truly take place be- accompanies us in helping the pa- with families in an intense way so cause a personalised meeting, of- tient. that they can face up to the most ten with a trusting dialogue which We must also attend to prayers painful situations, in many cases is respectful and free, allows one for the patient, a dimension that helping them to prepare for the to arrive at the innermost parts of the Church has always cultivated moment of separation from the the person and open him or her to with especial attention. Pastoral patient with hope and peace. Our the experience of faith. workers pray with the patient, but service takes practical form in of- they also know to pray for the pa- fering them a respectful nearness, Prayer with and for the patient tient. listening and guidance, making available to them the aids of faith. It has always been said that ill- The Celebration The situations and the experienc- ness is a propitious moment for of the sacraments es that they go though are very prayer. The need to pray arises diverse and for this reason care spontaneously in a sick person The sacraments that accom- must be personalised and suited and also in his or her family. This pany a Christian in the experi- to each case. prayer takes many forms, with ence of illness are reconciliation, emphases that have a great deal to the Eucharist-communion and Pastoral care for the health-care do with the personal pathway of anointing of the sick. We must personnel faith and the situation of the mo- value these sacraments in all of ment, but it acquires in the patient their meaning, going beyond re- Providing care to people who great profundity and sincerity. ductionist ways of understanding are dedicated to caring for oth- For all of these reasons, prayer is them. They are signs that demon- ers is an important duty in rela- one of the most important instru- strate the love of God for the pa- tion to the health-care personnel ments that exists for the pastoral tient and also the nearness to him as well. This is an indirect way worker because through prayer or her of the Christian communi- of contributing to a better service we can create a climate of trust ty, a dimension that must be taken for sick people. Our pastoral care and peace, finding in prayer the into account when they are cele- takes practical form in a readiness strength to bear the pain and trib- brated in the context of a hospital. to work together in a team and in ulation that accompany illness. The offer of the celebration of the respectful and simple way in Prayer that also opens to joyous these sacraments must be done which we offer our Christian vi- recognition of the gifts that have paying attention to the situation sion of life. A pastoral agent can

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contribute to giving meaning to should not have this centrality, panying with the help that is nec- the work engaged in by profes- which falls to the patient alone. essary so that everyone can live sionals by enabling them to dis- The team for pastoral care can in a more worthy, responsible and cover the ethical and spiritual cooperate in performing this task hopeful way, whatever their exis- values that must direct their ac- through its witness to humanity tential situation may be. The ulti- tivity and by sharing with them and professionalism, but also by mate meaning of, and reason for, spaces of reflection on questions supporting all those activities that our service in a hospital is to offer of an ethical-spiritual character come from other areas and should the saving grace of Christ to men that may emerge. The pastoral be directed towards humanisation. who suffer. team must contribute to creating a model of a humanised hospital which far from suffocating the 7. Towards Integral Care Conclusion person in its structures values the efforts of professionals and is al- We pastoral workers must co- I have attempted to describe the ways directed towards better care operate in the search for the to- work of our team for pastoral care for patients. And all of this, fun- tal and integral health for all peo- in hospitals which is at the same damentally, is accomplished by ple. For integral care to exist one time an evangelising task and an close and assiduous contact, also needs on the part of everyone in- attempt at humanisation in the knowing how to appreciate the terdisciplinary cooperation where world of health and health care. meetings that are planned and the patient is assisted in his or The centre of attention of this at- even offering spaces for prayer her totality. We cannot ignore the tempt should always be the sick and celebration for those within spectacular advances that have person because, as Fra Pierluigi the hospital institution who share been achieved by medical science Marchesi, Father General of the the Christian faith. and which bring so many ben- Brothers of St. John of God ar- Our contribution as pastoral efits. But one should also foster gued, ‘If the sick person is not the workers to subjects of an ethical dialogue with other disciplines centre of a hospital, the centre of character is to illuminate these such as anthropology, psycholo- the concerns of all those who act situations with a Christian philo- gy, ethics, theology etc in an an- for him, others take his place’. sophical perspective, following thropological understanding that The breadth of the subject and the approaches of the Magisteri- recognises that what is human the diversity of approaches that um of the Church and cooperat- has a plurality of dimensions. To- can be encountered led me to ing in the ethical formation of the day, interdisciplinary cooperation present my experience within a professionals. We must also be in needs an appreciation of the mul- hospital chaplaincy with certain a condition to offer ethical con- tidimensional character of care strong approaches and models of sultation to the patients, to their for the sick, with each sector ac- work that are broadly shared. families, to the personnel and to cepting its specific responsibili- A pastoral worker who works the institution itself, when this is ties as regards integral care for with a team in a hospital must be asked of us. Certainly, this is one the person. suitably trained at a theological- of the most delicate and difficult We know, for that matter, that spiritual level but he or she must missions within the context of a every sick person whatever may be also be able to establish deep dia- hospital which requires suitable his or her vision of life, his or her logue with the culture of the world formation at both a theological- faith or his or her religious confes- of health and health care. Pastoral moral and a scientific level. sion, has the right to be respected activity in a hospital must not be and helped in his or her requests of improvised. It must be planned Cooperation in the humanisation a spiritual character. It often hap- using the instruments that are of the hospital institution pens that sick people go through available to us and going forward strong experiences that mark the in the belief that the good perfor- One of the greatest challenges person in his or her innermost self. mance of the whole of the mecha- today for any hospital institution A sick person feels the need to ad- nism depends in large measure on is that it should really be a set- dress some of these needs which the ability to work in a team both ting for hospitality and welcome we say are of a spiritual charac- with other pastoral workers and where a sick person does not feel ter and certainly it is during these with the other professionals of the an outsider. The team for pastoral delicate moments that one must hospital, taking part in a multidis- care of a hospital should be sen- heal this dimension which we say ciplinary team which attends to sitive to this task and cooperate is spiritual, as an extra service in all the dimensions of the person. in contributing all the newness of health care that is directed towards The integral care which today the Gospel to the way in which a the totality of the person. is one of the fundamental instru- patient is treated and assisted. To We have the obligation as pas- ments of the world of health and achieve a good humanisation one toral workers to facilitate for eve- health care reminds us that our needs the dream to come true of ry sick person the spiritual assis- model of assistance is interdisci- the patient really being at the cen- tance to which he or she has the plinary. And this requires suitable tre of the whole of the organisa- right. We affirm the value of the organisation, work methods that tion. Political and ideological in- person in any circumstance and make this model possible, and a terests, and even technology itself we do this with a spiritual accom- very fine sensitivity towards care

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and assistance for people seen in today as well draws near through 3 See for this sub-section, José Antonio 6 Pagola, Evangelizar el mundo de la salud y an integral way. the ministry of the Church ‘to the la enfermedad (Madrid, 2004), pp. 149-168. Spiritual assistance, pastoral man who suffers in body and spir- 4 Cf. AA.VV., ‘Pastoral de la salud. care, is a right which the sick per- it, and cares for his wounds with Acompañamiento humano y sacramental’, Dossiers CPL, 60 (1993), p. 181. son cannot be deprived of in the the oil of advice and the wine of 5 Cfr. COMISION EPISCOPAL DE PAS- context of a hospital institution. hope’.7 TORAL DE ESPAÑA. La asistencia religi- And the Church, faithful to the osa en el hospital: orientaciones pastorales (Madrid, 1987). Some of the points listed mandate of the Lord, must de- here are based on this document. vote all of her commitment and Notes 6 Cf. La Orden Hospitalaria, comunidad her efforts to being near to peo- evangelizadora, desde los excluidos (Fra- ple who suffer because of illness, 1 Edoardo Gavotti, “La cappellania telli di San Giovanni di Dio, Provincia San come modello di azione pastorale” (Conveg- Rafael, Barcelona 2003). thereby continuing the mission of no Internazionale Camilliano, Rome, 2005). 7 Misal Romano, ‘Prefazio Común VIII’, Christ the Good Samaritan, who 2 Benedict XVI, Deus Caritas est, n. 31. Spanish edition, 1988.

The Human and Spiritual Formation of Hospital Voluntary Workers

Dr. Salvatore Pagliuca haps recognising the hands of God is commonly practised, starting National President of UNITALSI in the presence and deeds of a pro- with the experience of the asso- (the Italian National Union for fessional or pastoral worker, God ciation whose president I have the the Transportation of can be recognised and loved’.1 honour to be, namely UNITAL- Sick People to Lourdes and If presence and deeds can make SI,2 which during the 110 years International Sanctuaries, Italy). people recognise and love God, of its existence has undergone a Consultor of the Pontifical those who work, whether they development in its way of under- Council for Health Care have been professionally trained standing and providing service to Workers or are simple volunteers, have a sick people, the disabled, the el- great responsibility to be, in hu- derly, the poor, and the alone. man and spiritual terms, predis- This is kind of voluntary work our Excellency, Ladies and posed to relate to sick people as which more than other can be de- YGentlemen, Participants in the bearers of hope. fined as being ‘Christian’. this Conference, ‘Voluntary work’, understood What does a person who works as the free provision of a service in the world of illness need in ad- Hospital Voluntary Work as to those people who are in some dition to professional formation? Commonly Practised state of need, in order to have the We can understand how neces- connotation ‘Christian’ must have sary human and spiritual forma- I wanted to centre my paper as its foundation and model Jesus tion is from a fine insight of Ms- around the hospital voluntary Christ, who, ‘always had the na- gr. Zimowski, the President of world not in the classic sense, ture of God, but he did not think the Pontifical Council for Health that is to say volunteers who work that by force he should try to re- Care Workers: ‘To entrust oneself inside hospitals, but in a broad- main equal with God. Instead of to divine Providence thus means er sense, taking into account the this by his own free will he gave to continue to a give a meaning development of the figure of the up all he had, and took the nature and a purpose to our lives, not- hospital volunteer who attends of a servant. He became like a hu- withstanding the pain. However, to long-term admissions or disa- man being and appeared in human many times hopelessness seems bled patients in institutions such likeness’.3 to grip a sick person, a hopeless- as hospitals or institutes, but al- He gave us an example of ser- ness where it is not easy to bring so in local areas, with a nearness vice by washing the feet of the words of help. Words seem to be that does not take into account the apostles4 and he gave us the ‘new empty and do not manage to cre- place but, rather, the person and commandment’ that ‘you should ate a relationship: only a presence the endemic evil of this era of love one another as I have loved and deeds can express something. ours which is loneliness. you’.5 But specifically starting from this I will, therefore, speak about This specific observation ‘as situation of absolute poverty, per- hospital voluntary work as is it I have loved you’ constitutes

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the originality of Christian love as empathetic listening directed actions, it was clear that many of which must be a freely-given towards the recognition of the these people are excluded, in the love, a love of donation and a person and an understanding of contexts they live in, from social love of transforming and univer- his or her malaise, ending his or life and that they only occasional- sal sharing. her interior dialogue so that he or ly take an active part in social life. This is an action inspired by she can draw near to the person in They often can only count upon a charity and we can say together front of him or her, without judge- small network of friends and their with Msgr. Pompili: ‘The action ments and without requests, rec- families are not always involved of the Church inspired by chari- ognising and referring to the other in recreational activities but con- ty is confirmed as the hardcore of responsibility for his or her needs. centrate, instead, on the meeting resistance to the spreading phe- – ‘The relationship’: this is in- of their primary needs, as a result nomenon of secularisation, but it stalled through contact directed of which the need is seen to de- is even more. It is the founding towards the satisfaction of the velop strategies to work against principle of Christianity. And the needs that have been expressed exclusion through actions that en- pre-condition for humanity sur- by the person concerned. visage ongoing social activity, ex- viving itself’.6 – ‘Mediation’ in the relation- change, and the activation of good Ever since its beginnings, UNI- ships between the beneficiaries of practices. TALSI has based the service of its the service, those who implement stretcher-bearers, sisters of assis- it, and voluntary workers in gen- tance, medical doctors, men nurs- eral. Actions of the System that have es and chaplains on the style of – ‘Working in a network’ direct- been Implemented those who work in hospitals. Thus ed towards the mapping and acti- a train, with stretcher carriage, be- vation of local communities and UNITALSI has worked to cre- came a ; the places realities that can promote actions ate the basis of the system of ser- receiving sick people in Lourdes to provide support and inclusion vices by achieving the following (Accueil and St. Frai) were au- to people in a state of difficulty. objectives: thentic hospital wards; and the – The creation of a shared path- timetables and turns were run ac- This evolution in the way of way for voluntary workers which cording to a hospital institution. seeing things has been strength- has allowed all participants to im- Over the years this way of see- ened through daily work because plement their knowledge as re- ing things evolved. It was under- it emerged clearly through con- gards the phenomenon of social stood that a volunteer engages in tact with the people who were exclusion and to acquire skills re- a service of nearness which goes encountered that they rarely ex- lating to the problems often borne beyond a hospital institution and pressed a single request or were by people who are in a state of thus the methodology that was the bearers of a single need. difficulty. employed by activities within the It is often the case that the lim- – The setting in motion or the framework of UNITALSI was its of our actions are to be found implementation, starting with a defined above all else as greater in meeting the requests of people photograph of existing realities, ‘nearness’ and the possibility of in accordance with sectors, there- of good practices that are useful entering into a relationship in or- by privileging only the ‘problem’ in providing indications as re- der to know about the needs that a that is directly related to us, where gards the promotion of processes person in a state of difficulty sees it is obviously not possible to take of autonomy, the taking advan- as being of priority importance, responsibility for a problem in to- tage of important opportunities and this so as to construct a rela- to. The challenge for many vol- for recreation by disabled people, tionship that can be a stimulus for untary workers is to activate both through experiences of temporary a subsequent project for the im- the resources and the skills of the community accommodation as provement of a person’s life con- person who is involved as well well, activating as much as possi- ditions. the entire network in order to try ble their residual capacities. This is because Lourdes is in to solve the problem to hand. – The creation of services of re- every home, in every family, and lief for the family relatives of dis- in every place of care, whether a abled people. hospital or a nursing home or a The Process that Led hospice or a protected residential to the Construction of complex, where frail people are a ‘System of Services’ Some Services that have been cared for and taken responsibil- Established ity for (they are not only treated). At a national level, from an anal- And they are loved and respected ysis of the data worked through In particular in Rome, UNI- for what they are. following a survey that was car- TALSI works with the Baby Jesus The operative instruments have ried out by means of a question- Hospital and the Gemelli Poly- been: naire which was directed towards clinic, and in particular with the ‘Welcome’: this is uncondition- bringing out the use of free time by paediatric wards of these hospital al and without any kind of con- sick people, disabled people and/ institutions. tract. or elderly people, as well as the During these recent years of – ‘Listening’: this is understood frequency/quality of social inter- strong cooperation we have fos-

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tered interaction between the callers must be able to perceive sick people and their parents, who health-care personnel, family rela- from their first contact a reality of perhaps more than any others tru- tives and those voluntary workers service that is understood as total ly needed it, the opportunity to engaged in providing assistance. and free self-giving in a Christian engage in a ‘wonderful experi- At the centre of the synergic work logic. ence of faith and sharing’. there is the primary and exclusive What we do is not mere wel- It is certainly the case that interests of the children and their fare or a simple kind of voluntary the most suitable place for us to families. work. It is an experience of ser- launch this proposal was the Mey- Those voluntary workers who vice following Christ, imitating er Children’s Hospital of Florence come into contact with the real- the charitable spirit that animat- which every day sees pass through ity of the illness of a child are first ed Jesus and the apostles and ani- its wards a very large number of trained from a number of points mates all those who in his name people afflicted by suffering but of view. We are concerned to pro- carry on the work of building up who at the same time are always vide them with instruments which the Kingdom of Heaven. searching for hope. can be useful in their relationships This is our horizon; this is our But the matter was not a sim- with the family relatives and with charism. We work for the needy ple one. We encountered great the children themselves. so as to be that portion of the difficulties in managing to launch For this reason, in recent years Church that walks at the side of ‘our proposal’. We tried to get in- we have taken part in various our friends, both young and old, to contact with other associations courses, all of which have been who are in a state of difficulty. which were already present with- directed towards formation and The courses of formation, in the institution but we did not in-depth analysis. In particular, which are useful and at times in- manage to find people who really we have paid especial and incum- dispensable, are an instrument to spoke our language. There were bent attention to the psychologi- be taken advantage of so as to those who did not want only to cal and emotional repercussions serve. But the engine of our ser- engage in service inside the hos- that this kind of service can pro- vice is faith, it is following Christ, pital but, in contrary fashion, as voke, especially in the youngest the servant out of love. was the case with us, they want- of the voluntary workers. For this reason, of great impor- ed to bring some words of hope, The best way by which to sup- tance is the spiritual formation of to be near others without asking port, in the best way possible, sit- our voluntary workers so that they for anything or seeking anything. uations of extreme difficulty and can receive nourishment from the And to speak about God, per- pain is certainly that of conserv- Word of God and from the Eucha- haps with discretion, but to speak ing, where this is possible and as rist, so that their work can always about God. far as this is possible, the psycho- be directed towards the principles And as often happens in life, logical and emotional equilibrium of the Magisterium of the Church. the occasions, the opportunities, of those who have chosen to serve Respect for the person, for the present themselves only when the their neighbours in this particular dignity of every individual, re- times are ripe and perhaps when field. spect for one’s own body as a the Lord decides that the most All the courses and the meet- temple of the Spirit: these are on- suitable moment has arrived. ings that we organise are oppor- ly some of the points that have And all of this often happens in tunities where voluntary workers been addressed and on which the simplest, most spontaneous can acquire basic information that each participant has been able to way, not because ‘those at the top’ is useful for their service in addi- reflect and reason and bring his or decide it but because people en- tion to skills as regards relation- her own experiences. counter each other, meet each oth- ships. It is never easy to enter in- Formation, therefore, is not the er, appreciate each other and de- to a relationship with people who prerogative of voluntary workers: cide together to begin a pathway. are living situations of great and it is for everyone, for those who This is what happened with Gi- grave difficulty. receive our service as well, spe- ulio and Federica, the parents of For those who engage in service cifically because through a daily the little Andrea who had a genetic in homes of the children’s project sharing of experiences and prob- illness, and Father Guglielmo, the we conceived of a specific forma- lems it is possible to construct a chaplain of the Meyer Hospital. tion. Indeed, the presence of vol- climate that is truly familial in Federica, who is today the untary workers must sustain and character, and it is this that is the president of the Pistoia branch of support, but it must do this with objective of our association. UNITALSI, had the idea of re- due discretion, which is indispen- The activities engaged in by membering what she and her hus- sable in allowing the families to the volunteers of the Tuscan UNI- band had experienced some years have autonomy and intimacy. TALSI at the Meyer Children’s previously when, after the birth of It is also necessary to be trained Hospital, which today is com- her child, she was told that the ill- to answer at the call centre with monly called the ‘Meyer Children ness that had struck her child was its the green number, not only and Families Project’, are the re- ‘incompatible with life’. to be able to provide correct in- sult of a long journey that began Federica remembered her wish formation but also, and this is an more than ten years ago. of that time which was to take her important point, to establish im- The problem was posed of how prayer to the Grotto of Lourdes, mediately a familial contact. The to manage to offer these people, a prayer which, because she was

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unable to leave, she entrusted to write or to draw what he or she mon such as grave situations of her friends of UNITALSI. believes is appropriate. The result poverty, social isolation, the frac- Hence the idea, which was im- is a splendid collection of prais- ture of social and family ties and mediately embraced by the Tus- es to God and to Our Lady which physical deterioration, often run can UNITALSI and the chap- is of a beauty that cannot be de- the risk of producing grave situa- laincy of the Meyer Hospital, to scribed. tions of marginalisation. promote in the wards of the hospi- You find yourself in front of The approach to these situa- tal the initiative which was called what you would never have ex- tions is always complex and for ‘Little Witnesses to Faith’. pected: a very great deal of suffer- this reason it requires specific in- This was a simple idea but at ing but also a great deal of hope terventions of a social character the same time a brilliant idea and desire to live. according to a logic of welcom- thanks to the contribution of the In this way UNITALSI is a ing, of service and of the protec- voluntary workers of certain guarantor of giving to Mary these tion of people in difficulty. branches to assuring at the hospi- books that are full of suffering The services that have been ac- tal a continuous presence during but also of hope as well, books tivated, specifically because of which there could be proposed to that are fill of dismay but also of their capacity to enter in relation- children and their family relatives prayer, during Holy Mass in the ships with people who live in con- the possibility of leaving behind Grotto of Pilgrimage in Lourdes ditions of malaise, have been con- them a thought, a prayer, or even in the month of June, which is firmed to be especially suitable simply a drawing or a photograph characterised by the presence of in reaching the most unreachable in a ‘White Book’. children and their families, there- people who are without protec- White in the true sense of the by extending the spirit and the tion, offering them an opportu- word because the volume, or bet- intrinsic vocation of the associa- nity of being able to move out of ter the volumes given that in the tion, which is to take sick people their situations. For this reason, end only one volume was not suf- to Lourdes the many disabled and/or elderly ficient, were progressively writ- Our constant presence inside people who have used this ser- ten by children and their parents the hospital is a factor behind the vice have been able to regain their with their prayers for help and inspiration that lies behind very social spaces as well as impor- prayers that gave thanks to Mary. many new ideas. tant cultural, sports, recreational This initiative was looked up- One of the most recent and fin- and spiritual opportunities, which on with great favour by the chap- est ideas has been to make the have certainly generated signifi- lain, Father Guglielmo, and by children who have been admit- cant pathways of inclusion. his helpers of the chaplaincy we ted to the hospital to make draw- felt welcomed with open arms ings on the mysteries of the rosary and thus we began to flank them which can then become illustra- Relations with the City in their service. Since then this tions for a short book which is be- Network service has not been interrupted. ing produced as a result of an initi- Today various branches of our as- ative by the national vice-assistant It should be emphasised, there- sociation, even though they are of UNITALSI, Don Danilo Priori. fore, that the idea of creating or distant in a physical sense, alter- This short book is a very impor- strengthening a network of flex- nate in various ways in being pre- tant support for the saying of the ible and sustainable services, or- sent at the Meyer Hospital. rosary during the pilgrimages to ganised around the idea of solidar- Authentic service requires a Lourdes carried out by UNITAL- ity and managed with voluntary marked human and Christian sen- SI whose pastoral theme was that personnel, has shown itself to be a sitivity: it is a matter of knocking proposed by the sanctuary itself: winning policy, not least because at a door behind which one does ‘Praying the Rosary with Berna- in many contexts it has worked to not know what kind of suffering dette’. place within a network the skills could be encountered. But we In this case, as well, the imagi- and resources of UNITALSI, oth- will certainly find suffering, that nation of the children in interpret- er associations and public institu- suffering which is the most diffi- ing the various mysteries of the tions. This has allowed engage- cult to accept and to understand, rosary has led to the collection ment in synergic actions of social I mean the suffering of children. of authentic ‘small masterpieces’ inclusion directed towards people This is not a matter simply of which are not only artistic in char- who often are in contact with all entertaining children with games. acter but also works of true faith. these various bodies. It is also a matter of entering on In some contexts external rela- tiptoes often to listen to what the tions have been strengthened with children and their parents have to Actions in the Local Area institutions and with the network say and perhaps to say a prayer of city organisations which deal together. Then there is the pro- The spread of conditions of with social malaise, and in par- posing of the white book which is physical and material malaise has ticular that of disabled or elderly rarely rejected even by those peo- accompanied the development of people, also trying to define forms ple who do not have a conscious cities and metropolises, and many of cooperation and forms of rec- faith or perhaps do not speak your people with specific needs, but ognition, and defining fields of language. Each person is free to with a series of factors in com- competence and promoting com-

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mon operations, in a way that re- tion of a complex of actions to also stimulate and involve, which spects individual roles and forms protect and foster the inclusion must also judge, and which also of autonomy. within society of disabled or el- involves costs in the choice of During the course of these ac- derly people, has shown that it is people responsible for formation. tivities, both during the organi- also able to restore to them human ‘If you believe that formation is sational and assessment stages dignity and to assure the imple- expensive, try ignorance’.7 and during the more operational mentation of their rights of citi- A formation that is certainly stage, the goals and the objectives zenship. ecclesial and not neutral, which to be achieved at that particular The commitment of UNITALSI operates on all fronts, and cer- moment, in that specific context, is first and foremost to continue to tainly not a formation whose ob- have always been borne in mind. construct pathways of encoun- jective is to convince members of The construction of relation- ter and recognition – recogni- the validity of the decisions taken ships with the target people and tion of the person who is always by the leaders of associations; a the voluntary workers who en- and whatever the case a person in formation that has space for criti- gage in this activity has been a whatever condition he or she finds cism, as a constructive contribu- fundamental element which has himself or herself because a per- tion to the achievement of an ec- allowed: the guiding, sending and son is never everything and only clesial association that works for accompanying of many people what he or she does or the con- the poor and suffering, where our towards certain services of the lo- dition in which he or she lives: ‘governing class’ overcomes the cal area; reaching and containing he or she is first of all a person, approach of ‘direction by author- certain situations at risk; provid- with problems and potentialities, ity’ and moves towards ‘direction ing information and instruments resources, a will and capacities, by agreement’. for the protection of the person; which at that moment, in that spe- It is certainly the case that one strengthening the network of ser- cific context, are activated in var- is dealing with a profound cultur- vices; and building a working ying ways. al mutation which requires first bridge that is useful in managing The need for recognition is the and foremost the credibility of the in a more effective way requests first need of children, as it is for leaders of associations and a con- and needs involving people who adults: an individual who is not dition of serenity. live in conditions of difficulty be- recognised as a man/a woman But it is specifically the mo- cause of their physical conditions becomes invisible, marginal, and ments of crisis of participation, or because of their age. dies. such as the moment that we are It also emerged that the newness For UNITALSI, this is very now going through, that offer the of the work at the outset provoked important: recognising people in greatest opportunities to under- a certain concern about the ap- their totality and complexity, not take or accelerate this process of proach of the administrative work thinking of them in terms of the cultural and organisational muta- that was requested and a notable problems they bear but only and tion. initial ‘hurry’ as regards the man- solely as persons to be encoun- One should always bear in mind agement of the accounts relating tered, known and recognised. that formation must produce a to the activity engaged in at a lo- In order to construct these path- spiritual and cultural elevation in cal level, which had always been ways of encounter and recognition the broad sense inasmuch as the carried out in an informal way. one should of necessity attend to pursuit of quality is an approach It is certainly the case that the human and spiritual formation to our duty in all the actions of this work has also been useful in of voluntary workers because for- our lives. Indeed, if one aspect of knowing about, experimenting mation can well be seen as one of quality is a higher civic level, it is with, and developing a system of the leading columns of a culture inconceivable to think that a per- communication and collection as of high quality. son can behave in an ethical way, regards data which are more pre- We often perceive a authentic as is requested by quality, only cise and careful. cultural backwardness, often con- within an association. This led for the first time to ac- fusing formation with training and It is certainly the case that for- quiring ‘true’ knowledge about aiming at providing a series of no- mation goes well beyond group the multiple activities engaged in tions without being concerned to meetings or the reading of sup- within the national territory and involve the voluntary worker who port material. It requires a con- allowed all the subjects involved must be able not only to acquire tinuous wish and a constant will to understand the real amount of the data that are necessary for his to be nourished at the spring of work engaged in for sick, disa- or her action and knowledge of faith and it calls believers to a bled or elderly people who are as- Church documents but also to be convinced participation in the sisted every day by the volunteers placed in a condition where he or lives of parish and diocesan com- of the association. she can pour into his or her ser- munities, becoming agents that vice all his or her own spiritual- advance pastoral care as well as ity, intelligence and capacity for active members of the entities to Formation cooperation. which they belong. An interactive formation, there- ‘The local Church is the place This pathway, in addition to fore, which is not only a matter of where the economy of salvation having as its purpose the activa- a teaching chair but which must enters more concretely into the

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fabric of human life…The cat- This action is thus a pre-condition of the qualification of being an echesis is the central moment of for a society that is more human; auxiliary member and draws near every pastoral activity, of every it makes up, so to speak, its most to the desired qualification of be- solidarity and ecclesial institu- evident soul. ing an actual member, which, to- tion, of every institution that can Indeed, there is a great, minor day, substantially means being an contribute to the building up of and unknown, world of works of elector and a person who can be the Mystical Body of Christ’.8 good that contributes in an equal- elected. The catechesis is not everything ly relevant way to the quality of To be electable one has to pay but everything within the Church social life. One may think here of attention to a person’s situation needs the catechesis: the liturgy, those who direct their activities in terms of the civil register and the sacraments, witness, service of work to the public good and to the state of one’s family; to be and charity. to public service, or specifically an actual member one must have of widespread voluntary work in paid one’s dues and travelled on hospitals, where workers dedicate trains (or aeroplanes!). The rest An Indispensable Premiss: their lives to assisting people in is a discretional space which at Commitment and Membership need, working silently to listen to times is used and abused! Being people’s sufferings, to attenuate a prophet, priest and king, seems ‘A voluntary worker is a citizen contrasts, and heal wounds. to me to have little to do with the who freely, not carrying out spe- ‘When man develops the earth pre-conditions that are requested! cific moral obligations or juridical by the work of his hands or with I believe, instead, as also hap- duties, basis his life – in the pub- the aid of technology, in order that pens in other associations, that lic and private worlds – on goals it might bear fruit and become a a pathway of growth and ‘draw- of solidarity. Thus, after perform- dwelling worthy of the whole ing near’ should be defined which ing his civic and state duties, he human family and when he con- leads from a promise to actual makes himself disinterestedly sciously takes part in the life of commitment. available to the community, pro- social groups, he carries out the The organisation of the stages moting a creative response to the design of God manifested at the involved already exists, just as al- emerging needs of the local area beginning of time, that he should ready envisaged is the move from with priority attention being paid subdue the earth, perfect creation a state of waiting and of forma- to the poor, to the marginalised, and develop himself. At the same tion to a state of consolidated be- and to the powerless. He commits time he obeys the commandment longing. The problem lies in fill- energies, capacities, time and any of Christ that he place himself at ing in the contents of this existing means he may have to initiatives the service of his brethren’.11 structure, defined with courage of sharing, engaged in preferably Every journey of Hope12 starts as a journey that one has to have through group action. These initi- with the revelation of a Beauty completed, as values that have atives are open to a loyal cooper- that steals the soul: dazzled, there been projected, as experiences ation with public institutions and is the risk that we will remain ad- that have been lived through, and social forces; they are carried out olescent vagabonds of faith with- as tests that have been passed, in with a suitable specific ground- out ever becoming adult pilgrims order to be able to be and ‘feel’ ing; they are actuated with a con- aware of our goal and our com- actual members and thus living tinuity of interventions, intended mitment… our ‘rite of passage’, members of our associative body. both for immediate services and as wanderers and pilgrims, must The actual member says a the indispensable removal of the lead us from the emotion of an ex- spousal ‘Yes’ to a reality that causes of injustice and every kind traordinary event to the enthusi- changes his or her life; he or she of oppression of the person’.9 asm of daily festivity, establishing says an aware ‘Yes’ after know- In the various analyses that are as an indispensable pre-condition ing to the utmost the reality of the engaged in emphasis is not placed a precise choice of belonging… association and after understand- on gratuitousness and it is argued belonging to the Church and to ing the scale of his or her com- that the specificity of an organisa- the association! mitment; and he or she says an tion engaged in voluntary work Our membership of the Church informed and ‘enlightened’ ‘Yes’ lies in the construction of rela- originates from baptismal prom- to the universal Church and to the tionships: this is what differenti- ises which render each one of us local Church! ates the authentically voluntary a ‘prophet, priest and king’:13 a ‘Voluntary work appears inti- action from charitable work or prophet of proclaiming, a priest mately marked by the dimension philanthropy. ‘The strength of a in living offered up to God, and a of the Advent… But for Christian free gift does not lie in the thing king in serving. Our membership voluntary work to employ all of that is given or in the quantum of the association originates in the its potentialities and to produce that is given…but in the special same promises and generates the all the fruits that it bears within human quality that the gift repre- same commitment: to be a proph- itself it has to retrieve its consti- sents because of the fact of being et, a priest and a king! tutive dimensions’, so as to avoid a relationship’.10 This means that The pathway of membership of being reduced to an ‘organisation a voluntary action constructs new our association is bureaucratically of services’ that entirely absorb relationships marked by reciproc- defined: it begins from the chance the ‘value of human promotion’. ity, gratuitousness and solidarity. of an encounter, it passes by way The association has the re-

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sponsibility of making available ed of the members should be ac- – In 2000 the – the instruments of formation and quired and shared facts for those Tertio millennio adveniente and of assessment so as to be able to who are called to services of re- . complete correctly the pathway sponsibility in the association. – The first decade of the twen- of going from being an auxiliary Indeed, the capillarisation of the ty-first century: the pastoral plan member to being an actual mem- project (relating to formation as entitled ‘Communicating the Gos- ber: culturally sensible and theo- well) is entrusted to local people pel in a Changing World’ and the logically founded formative pro- of reference who must be witness- conference of Verona (2006) ‘Wit- posals, opportunities for service es and teachers for the members nesses to the Risen Jesus, Hope of and knowledge about projects, oc- and for the community. the World’; the encyclical Deus casions for communal prayer and An ‘updating course’ for lead- caritas est. reflection, and half-way and final ers is required in a logic of ongo- – The second decade of the assessments. A novitiate, that is to ing formation that should be easi- twenty-first century: pastoral ori- say, which can be transformed into ly accepted and should not offend entations ‘Educating in the Good membership with a solemn prom- the susceptibility of anybody! Life of the Gospel’, Caritas in ise, which is the same for every- veritate. one, formally defined as well. To follow this pathway (which The Formation Pathway for should be assured by the local Leaders The Official Sources leaders of the association) but al- so go achieve many other things, UNITALSI is in the Church and The nature, contents and meth- it would be advisable, in my opin- is of the Church but it is defined od of a pathway of formation are ion, to rely upon the supervision by its vocation and ministry. Our defined by the Italian Catechistic of a group of people who think formation project must, therefore, Project which starts from the four with the same heart, who adhere start from our baptism, yet it must theological Constitutions of the to the full to the same project, also take into account our origins Second Vatican Council: Dei Ver- and who act as a link between the as an association; it must start bum, Lumen Gentium, Sacrosan- leaders and the grassroots: peo- from knowledge about the ‘uni- tum Concilium and Gaudium et ple who provide formation, peo- versal sources’ but without ignor- Spes. ple who provide information, ing knowledge about ‘our sourc- This pathway is summarised witnesses, communicators, mes- es’. in the basic document entitled ‘Il sengers…and, as far as this pos- The orientations of the Church Rinnovamento della Catechesi’ sible, prophets, priests and kings! after the Second Vatican Council, (‘The Renewal of the Cateche- Many problems arise from an addressed to the Eucharistic com- sis’) which was published by the objective difficulty in communi- munity and the community of the Italian bishops in 1970, and in the cation which leads, as in the game baptised, are set forth in ten-year subsequent ‘Lettera di riconseg- of played by people of telephones pastoral plans which are assessed na’ of 1988 and in the eight vol- without lines, to a distortion of during the course of the great na- umes of the ‘Catechismo per la the original message. tional ecclesial conferences held vita cristiana’ (‘Catechism for the The overall project, instead, in the middle of each decade. Christian life’) in its various edi- should reach everyone in its au- They mark in an unequivocal tions until the edition of the year thenticity, avoiding filters and way, for all the faithful and for 1997. censures, because the ‘Yes’ re- every association, the road to be The most recent publication for quested of voluntary workers followed to be ‘in’ the Church and a more immediate understanding must be preceded by correct in- ‘of’ the Church. is the ‘Compendio del Catechis- formation because a homogeneity – In the 1970s: the pastoral mo’ (‘Compendium of the Cate- of opportunities and of conditions plan entitled ‘Evangelisation and chism’). should be assured, because no po- Sacraments’ – the conference in Evangelii nuntiandi, Apostoli- tentiality should be wasted.14 Rome (1976) on ‘Evangelisation cam actuositatem, Catechesi tra- Although one has to submit to and Human Promotion’. dendae, and Christefideles laici in the logical of local areas which – In the 1980s: the pastoral plan an unequivocal way lay down the want the leadership of an associ- entitled ‘The Italian Church and guidelines for every project for ation to look more at geography the Prospects for the Country’ – the lay apostolate. Comunicare il than at people, one can, none- the conference of Loreto (1985) Vangelo in un mondo che cambia’ theless, imagine a technical-op- on ‘Christian Reconciliation and (‘Communicating the Gospel in erative (but thinking!) structure the Community of Men’; the en- a Changing World’) indicates the which is intermediate and direct- cyclicals Sollecitudo rei socialis pastoral directions of the Italian ly connected with the presidency, and Salvifici doloris. Bishops’ Conference for the first which moves in the local area and – In the 1990s: the pastoral plan decade of the twenty-first century which assures a dual transmission entitled ‘Evangelisation and Wit- within which should be outlined from the top to the grassroots and ness to Charity’ – the conference each individual and associative vice versa. of Palermo (1995) on ‘The Gos- pathway of the believer. As regards the ‘middle ranks’, pel of Charity for a New Society The ‘Pastoral Note’ of Pente- obviously the conditions request- in Italy’. cost 2005 of the Italian bishops

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on the ‘Primo Annuncio del Van- or her model is the face of Christ care should be retrieved which is gelo’ (‘The First Proclaiming of who suffers in the Passion and increasingly based upon personal the Gospel’) reconfirmed the call rises in the Resurrection, giving relationships, upon experiences to evangelise, which is the task of Hope to everyone.18 The path- of relationships, and increasingly every Christian. way of the catechesis, therefore, less upon institutions. Il Direttorio Generale (‘The should be strongly rooted in the General Directory’) for the cate- concreteness of works, based on chism asserts without any possi- the theology of hope and of char- Which Providers ble doubt: ‘The catechesis always ity and open to an active and crea- of Formation? draws its contents from the living tive message. source of the Word of God, trans- A search for God as a transcend- There should be an attempt to mitted in Tradition and in Scrip- ent being outside time tears man ‘make of a lay character’ pro- ture, since Holy Tradition and away from the concreteness of claiming, making the cateche- Holy Scripture constitute the only his affairs. God, instead, reveals sis move out of an intra-ecclesial inviolable deposit of the Word of Himself though a history woven syndrome and entrusting to adult God, entrusted to the Church’.15 with events and words and sends lay people the role of narrating Il Documento di Base (‘Basic back man to his weekdays and the Gospel of salvation of Jesus Document’) points out the fol- daily life. The Christian faith, in Christ, outside a metaphysical lowing journey: ‘At the founda- its first and in its final Testament, language but anchoring it in the tions is the law of faithfulness proclaims the face of a God that experiences of life and of service. to the word of God and faithful- is read to man by placing in front ‘But the laity likewise share in ness to the concrete needs of the of everyone His Son and calling the priestly, prophetic, and roy- faithful. Faithfulness to God and man not to a ‘mystical shipwreck’ al office of Christ and therefore faithfulness to man: these are not but to a free and responsible rela- have their own share in the mis- two different concerns but, rath- tionship. sion of the whole people of God er, a single spiritual approach that The commitment for us, there- in the Church and in the world. leads the Church to choose the fore, is to narrate a God who in They exercise the apostolate in most suitable ways by which to communicating Himself without fact by their activity directed to exercise her mediation between reserve and remaining Himself the evangelization and sanctifica- God and men’.16 provokes a historical, responsible tion of men and to the penetrating ‘Modern catechistic experi- and fraternal relationship. and perfecting of the temporal or- ence confirms once again that first Our spirituality radiates out der through the spirit of the Gos- come the catechists and then come beginning with the face of Jesus pel. In this way, their temporal the catechisms; indeed, even be- who was profoundly man but to- activity openly bears witness to fore them comes the Church com- tally God. Our history is woven Christ and promotes the salvation munities. Indeed, just as a Chris- with actions that are at times dra- of men. Since the laity, in accord- tian community without a good matically concrete but which are ance with their state of life, live catechesis is not conceivable, so guided by the irrational certainty in the midst of the world and its a good catechesis without the par- of the possibility of a miracle. Our concerns, they are called by God ticipation of the whole communi- act of faith accepts the scandal of to exercise their apostolate in the ty is not thinkable’.17 pain and the certainty of Hope. world like leaven, with the ardor A hospital voluntary worker (as of the spirit of Christ’.19 I have defined him or her, that is The providers of formation Which Pedagogy? to say as he or she commonly is) should be figures who are no has chosen to narrate God-Man- longer conceived in terms of a Faith is a relational fact and Jesus with his or her own hands delegation. They should, instead, is born and develops in free- as well and by remaining within be understood as an expression of dom with the gratuitous initia- history. Thus it is only by respect- accompanying that is offered to tive of God and man’s readiness ing this dynamism that a proposal the community and they should be to receive. Outside this dynamism for formation can have an answer. capable of sustaining ‘extrovert’ there is no faith, even though It is certainly the case that pastoral action which, although there can be religious instruction. there is no proclaiming that does organised in different places, situ- Thus a proposal of catechesis to not spring from the Word. The ations and circumstances, always adult individuals, already rooted Church is born from the listened assures the homogeneity of pro- in roles involving responsibility, to, celebrated and lived Word. But claiming. requires a pedagogic strategy ‘of proclaiming should be liberated accompanying’ towards this dif- from an excessive ritualisation. It ferent mentality that opens up to should retrieve, instead, the rela- Which Objectives? encountering a God with a histori- tional dimension of faith. cal, relational and communitarian Indeed, the Word is always the The leaders are asked to give face. revelation of an appeal to human a full and convinced ‘Yes’ as re- A voluntary worker narrates freedom as a response to God gards membership of their asso- through works his or her vocation who communicates Himself in ciation, which can prescind from and his or her choice for God; his the Son. Thus a form of pastoral an unconditional agreement as to

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programmes but which must orig- for a policy of homogenous jour- 5 Jn 15:12. 6 Msgr. Domenico Pompili, Under-Sec- inate in a full adherence to the neying that leads from promises retary and Director of the Office for Social project of God for us: God want- to commitment (a sense of be- Communications, launch in Rome on 14 ed us to be brethren in the same longing). June 2012 of the volume Opere per il bene commune. community. 2) The drawing up of ‘itinerary 7 Derek Bok, the former President of Har- They should have an in-depth maps of a lay character’ for the vard University. knowledge of the overall project fields of experience and of service 8 RdC, n. 143. 9 L. Tavazza, the entry ‘Volontariato’, in and of the individual projects of and for spiritual and doctrinal re- Nuovo Dizionario di sociologia, edited by the association, and agree with flections, to be set in motion peri- Demarchi F., Ellena A., and Cattarinussi B. the ways in which they are im- odically and which start from the (Paoline, Milan, 1987). 10 S. Zamagni, Volontariato ed economia plemented, their goals and their subjects addressed in the national sociale: quale rapporto (Studi Zancan, 1, meaning. meetings. They should be ‘popu- 2002). They should be open to the pol- lar’ proposals in order to conjoin 11 The Second Vatican Council, Gaudium et spes, n. 57. icy as regards formation of the as- the quality of formation with a 12 Cf. Benedict XVI, Spe salvi (LEV, sociation and be ready to engage simple communicative form suit- 2007) n. 2: ‘’Hope’, in fact, is a key word in a personal journey of growth in Biblical faith – so much so that in several able for everyone and which the passages the words ‘faith’ and ‘hope’ seem so as to be able to be a reference local leaders could employ as an interchangeable’. point and guide for the members. outline for work with voluntary 13 LG, n. 10. They should live in an active 14 Pastoral directions for the first decade workers. of the third millennium: communicate the way in the parish and diocesan The formation that we intend Gospel in a world that is changing, already communities, bearing witness to to pursue wants to gather together emphasised as… faith is born from listen- the charism and ministry of the ing to the words of God contained in Holy all the colours of charity, colours Scripture and Tradition, transmitted above association. that spring from very many per- all else in the liturgy of the Church through They should live the life of the sonal and associative activities, preaching, at work in the sacramental signs as a principle of new life and thus…it ap- association, its local and national starting with the white of our bap- pears to us to be an absolutely primary task approaches, to the full. tism and going on to the blue of for the Church in a world that is changing Mary, the green of Hope, the red and that is looking for reasons for being joyful and hoping, should be and should of Love, and so on so as to create always remain the communication of faith Conclusion a rainbow of the Gift that leads to in Christ under the guidance of the Spir- a Faith embodied in works. it, of the precious pearl of the Gospel: cf. EPISCOPATO ITALIANO, Comunicare il A human and spiritual forma- Vangelo in un mondo che cambia (Paoline, tion should have stages, or to put 2001), nn. 3 and 4. it better, moments of assessment Notes 15 DGC, nn. 94-96. 16 RdC, n. 160. and advance which I see as two 17 1 Msgr. Zygmunt Zimowski, Sulla via RdC, n. 200. particular moments. dell’uomo che soffre (Libreria Editrice Vati- 18 Benedict XVI, Deus caritas est (LEV, 1) Moments of dialogue of the cana), p. 65 2006), n. 32: ‘As our preceding reflections providers of formation in order to 2 The Unione Nazionale Italiana Tras- have made clear, the true subject of the vari- porto Ammalati a Lourdes e Santuari Inter- ous Catholic organizations that carry out meet the local leaders, and thus nazionali, founded in 1903 by G. B. Tomassi a ministry of charity is the Church herself update the impetus to evangelisa- and recognised by the Italian Bishops’ Con- – at all levels, from the parishes, through tion according to the pathway fol- ference in 1997 as a public ecclesial asso- the particular Churches, to the universal ciation. Church’. lowed and the returns that have 3 Phil 2:6-7. 19 Decree on the apostolate of the laity been made, and a wider assembly 4 Jn 13:15. Apostolicam actuositatem, n. 2.

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Spirituality as a Resource in Situations of Illness in a Secularized Society

Prof. Dr. arndt Büssing, while 32% state to be R+S- and ment in spiritual/religious prac- M.D. 18% to be R+S+.3 Also among tices, it is evident that religious Professorship Quality of Life, 17/18 year old students from or (spiritual) mind-body practi- Spirituality and Coping, Christian academic high schools, ces are of lowest relevance, whi- Center for Integrative Medicine, 65% would not regard themsel- le humanistic or existential prac- Faculty of Health, Witten/ ves as religious (despite their tices and also gratitude/reverence Herdecke University, Christian denomination, 92%), were of higher importance.12,13 It Germany i.e., 53% are R-S- and 12% R-S+, is obvious that particularly those while only 23% regard themsel- who regard themselves as R-S- ves as R+S- and 11% as R+S+.10 have the lowest scores for gra- n response to chronic illness Thus, we have to state that a lar- titude and reverence – which is Iand life threatening diseases, ge fraction of German individuals simply an issue of the ‘emotional patients are confronted with the would not (cognitively) regard heart’. question of meaning and purpose themselves as religious. Maybe in life, with that what may give we could assume that they have hope and confidence. For sever- turned away from institutional re- What should we know about al of them, spirituality/religios- ligiosity, but might nevertheless these non-religious/non- ity (SpR) is a relevant resource to be interested in individual appro- spiritual patients? cope – even in secular Europe.1-7 aches of private spirituality? However, we have to face the To address who of our patients If we look at patients’ belief fact that an increasing number of are in Search for SpR as a source, in Guardian Angels (Table 1), patients reject institutional reli- and who may have Trust in higher which are quite popular also in giosity, particularly in secular so- support, we have analyzed data of secular societies, it is clear that cieties, while they nevertheless 848 patients with chronic disea- religious individuals are often or may have specific spiritual needs ses. The SpREUK questionnaire, frequently relying on this emo- which are in most cases neither which was used in these studies, tional source of support; but it addressed nor recognized by the avoids specific terms such as is quite surprising that also 38% health care system. God, Jesus church etc., and thus of R-S- patients do believe often In our studies enrolling Ger- can be used also in individuals or frequently in Guardian Angels man patients with chronic dise- who may have problems with in- (Büssing et al., submitted for pu- ases (i.e. chronic pain diseases, stitutional religiosity. blication). Of course there is and cancer, and others) patients in- We have found that only 29% cannot be scientific proof that dicated that they regarded their are in Search for support or ac- Guardian Angels do exist, but SpR as helpful to manage life mo- cess to SpR, while 53% already even the skeptics have this hope re consciously, for a deeper con- do have Trust in higher guidan- to be guided and sheltered by a nection with others and the world ce/source. For 51%, disease may ‘higher being’ who unconditio- around, feelings of inner peace, have a positive connotation, i.e., nally cares for them. This could promotion of inner strength, bet- they are able to regarded illness be interpreted as an implicit ‘pro- ter coping with illness, and to re- as a hint to reflect what is essen- of’ of their ongoing hope that the- store mental and physical health.8 tial in life and which priorities re might be a ‘higher plan’ which Whether these perceptions can might be of relevance.1,11 Althou- would imply meaning in life and be objectified or not, the crucial gh there were significant diffe- illness. point is that patients regard their rences with respect to gender and spirituality as helpful to manage age, most differences can be ex- To clarify the impact of an R-S- life, illness and suffering. plained by patients’ religious de- attitude, we focused on relatively Although research has shown nomination.11 Univariate analyses young patients with multiple that religious engagement can be indicate that denomination rather sclerosis (Wirth et al., in prepa- beneficial,9 we cannot ignore that than (female) gender, age and ration). This disease is characteri- secularization and individualiza- education had the strongest im- zed by the fact that the next acute tion proceeds in Europe. Up to pact on patients’ Search and Re- phase can occur more or less ar- 50% of our patients would not re- flection, while for Trust both de- bitrarily, and that there is no cure gard themselves as religious (de- nomination and (higher) age were for multiple sclerosis. About 70% spite their Christian denomina- of outstanding relevance.11 of the 181 German patients (me- tion, 82%). In fact, 42% regard In line with this observation, an age 42 ± 10 years) investigated themselves as R-S-, 8% as R-S+, when asking for patients’ engage- so far would regard themselves as

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Table 1: Belief in Guardian Angels es not always identify and reach Belief in Gender * SpR self categorization ** All moral suffering, which is the pain of the soul. Guardian Women Men R+S+ R+S R-S+ R-S- (%) Angel (%) (%) (%) (%) (%) (%) never 16 29 7 9 30 32 20 Spiritual Needs in Health Care System rarely 24 23 16 26 16 30 24 often 31 26 31 32 24 28 30 Health care focuses on patients’ physiological needs. Of course, frequently 28 22 45 33 30 10 26 patients’ informational needs are all (n) 401 150 110 174 50 216 551 clearly recognized as an impor- tant issue in health care (i.e., re- N=576 (mean age 51.3 ± 15.4 years; 75% chronic pain conditions, 7% garding treatment options, health cancer, 15% psychiatric disorders, and other). promotions, side-effects, outco- Results differ significantly with ** p<0.0001 and * p = 0.013 (Pearson´s Chi2) mes, perspectives etc. to enable a ‘shared-decision making’). Yet we have to state that patients with R-S-. While life satisfaction and Thus, although several relia- chronic and advanced diseases positive life construction was si- ble resources of our tradition se- often have specific needs. The- milar in the SpR groups, it was em to be forgotten, and althou- re was an important study from striking that those who lack a spi- gh religious rituals and symbols the US that 72% of patients with ritual attitude have significantly may have lost their meaning for advanced cancer reported that lower abilities to see illness as a several Western individuals, and their spiritual needs were suppor- chance to change and personal although praying, attending a ted minimally or not at all by the development when compared to service, reading the scriptures medical system, while 47% felt religious/spiritual patients. Mo- etc. may not be adequate for all minimally or not supported even reover, the ability for gratitude patients, their beneficial value by a religious community which and reverence was significantly could be ‘reanimated’ and lear- could be seen in charge for this is- lower in R-S- patients. ned anew. We only have to foster sue.14 Of importance was the fact To shed some further light on patients’ vital experiences! that spiritual support was signi- these patients we asked for their There was an interesting quo- ficantly associated with patients’ resources of hope, orientation and te which might be important for (psychological) quality of life.14,15 inspiration in life (Wirth et al., in your reflection: Thus, a majority of patients ha- preparation). However, 49% had ve unmet spiritual needs – and no no such resource (or at least they I was never a religious man one seems to care for. did state one), only 22% stated So why should I put my faith This means that physicians children, family or partner, 12% in you? should at least know that some stated faith or God, and 17% sta- You burned your bridges a of their patients may have unmet ted other beneficial sources (i.e., long time ago spiritual needs. Even in secu- love, life itself, hope, happiness, I’m a heathen, searching for lar Germany, the majority of tu- karma, nature, doing good, etc.). his soul mor patients wanted their doctor It was striking that those lacking Alan Averill (Primordial): to be interested in their spiritual such a resource were predomi- “Gallows Hymn” orientation.16 Our studies among nantly R-S-. The self-ascribed patients with chronic pain dise- benefit through the own spiritua- What hinders was the rationa- ases found that 23% would li- lity respectively resources of ho- listic intellect and the impression ke to talk with a chaplain about pe and orientation was highest in that God has ‘burned the bridges’ their spiritual needs, 20% had no those who stated faith as such a which indicates a lack of vital ex- one to talk with, and for 37% it beneficial source. While life sa- perience. Self-evidently, the au- was important to talk with their tisfaction did not differ with re- thor knows that something im- medical doctor about their spiri- spect to the different sources, it portant is lacking, but he can not tual needs.3 Yet medical practitio- became clear that faith was the find a way to get access to his ners may lack the necessary time, resource with the strongest bene- ‘soul’. skills or even interest to uncover ficial impact on the ability to see What could we do to help this and address these needs. illness as a chance for changes, archetypical ‘lost soul’? Who Most of the research on spiri- new priorities in life and also for helps to move the mountains tual needs was done among pa- personal development; moreover when the lost soul is suffering? tients with advanced stages of di- faith as a source had a significant Archbishop Zimowski clearly sease or dying, while only a few impact also on patients’ feelings addressed one of the important studies address spiritual needs of of gratitude and reverence which problems (Stockbridge, Massa- patients dealing with chronic, pri- were highest in those with faith chusetts; May 6, 2011): Thou- marily non-fatal diseases. To deal as a resource of hope and orien- gh medicine manages to identify with these needs we would refer tation in life. and treat physical suffering, it do- to a conceptual framework which

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Table 2: Categories of spiritual needs or Catholic Poland all feel a con- related to Alderfer´s ERG model nectedness with others and a re- Categories of spiritual needs17 Needs according sponsibility to care for them. to Alderfer´s ERG model 18 Religious Needs of Skeptics Peace Existence (Safety) (inner peace, hope, balance, forgiveness, What about the religious needs distress, fear of relapse, etc) of the ‘skeptics’? Among 213 pa- tients from Berlin with chronic Relatedness Connection pain conditions (Büssing et al., (love, belonging, alienation, partner in preparation), 28% stated that communication, etc.) ‘as a rational person’, they do Transcendence not ‘need any belief in a higher (spiritual resources, positive/negative presence’; 55% rejected the sta- relationship with God/Sacred, praying, etc.) tement (‘non-skeptics’) and 18% were undecided (Table 3). Inte- Meaning/Purpose Growth restingly, 13% of these skeptics (meaning in life, self-actualization, role function, stated needs to pray for themsel- etc.) ves and even to attend a religious service – although they identified Table 3: Specific needs of 213 religious ‘skeptics’ and ‘non-skeptics’ themselves as a ‘rational person’ Respective needs among p-value who does not need any belief in a (Chi2) higher presence. Moreover, they skeptics non-skeptics also expressed needs to forgive (%) (%) and to be forgiven. Although one pray with someone 7 33 .035 may suggest that this intention to forgive must no necessarily ha- someone prays for me 10 33 .076 ve a religious connation, it cle- pray by myself 13 42 .003 arly indicates a longing to resolve conflicting situations and burde- attend religious service 13 32 n.s. ning relations; the motifs are si- read spiritual/religious books 3 28 .005 milar. turn to a higher presence 8 40 .001 Perspectives forgive someone 27 36 n.s. to be forgiven 24 33 n.s. The crucial point is how we can offer spiritual/pastoral sup- port when in secular societies can be related to Alderfer’s ERG minantly a-religious patients with up to 50% of patients with chro- model (Table 2). cancer from China, while in Po- nic diseases regard themselves as According to this model we lish patients, who were all Catho- R-S‑.3 Still several of them do ha- have developed an instrument lics, also Religious Needs were of ve spiritual needs. suited for both religious and a- outstanding relevance (Büssing When we in fact face Christ religious patients with chronic di- et al., in preparation). in each and every person, also seases, the Spiritual Needs Que- The aforementioned needs for in those who reject the Church stionnaire (SpNQ).19,20 Using this Giving/Generativity mean that as an institution, then we have to instrument, we found that speci- patients intend to solace someo- reconsider: How could we really fic needs related to states of in- ne, to pass their life experiences meet and help them? Who should ner peace and connectedness to others, and to be assured that care for their spiritual needs? Do were scored the highest among life was meaningful and of value. we have to change as caregivers German patients, while religious It seems that they would like to and chaplains? needs including forgiveness were leave the role model of a ‘passi- When patients have problems scored the lowest. Using catego- ve sufferer’, to become an active, with the institution but still ha- rizing factors, it is obvious that self-actualizing individual able to ve specific spiritual needs, we Religious Needs and Existential give and help others (despite their should respect their situation – Needs were of relevance espe- own illness). This fits Erikson’s and offer our help to enable vital cially for patents with cancer, but psychosocial development stage experiences. The findings of the not for patients with other disea- ‘generativity’ which refers to the aforementioned studies substan- ses; instead, needs for Inner Pe- ability to care for others and gui- tiate up to five main topics we ace and active Giving/Generati- de the next generation.21 Finally, could use as starters to support vi- vity were of relevance.20 Similar this means that patients from se- tal experiences of patients ‘living results were found in the predo- cular Germany, a-religious China in a distance’, i.e.

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Intention Examples of Action Reference the chance to find hope, offer and assist counseling John 14:7: ‘If you really know me, you orientation and inspiration talks/contemplation will know my Father as well. From now on, you do know him and have seen him.’ the ability to be open enable and assist forms of reflexive Luke 22:42: ‘Not my will, but yours be prayer/contemplation done’ the experience to be enable and assist to pray/contemplate Psalm 25:5: ‘Guide me in your truth guided and teach me, for you are God my Savior, and my hope is in you all day long.’ the willingness to forgive, assist guided reflexive John 8:11: ‘Go now and leave your life to be forgiven and to prayers/meditation resulting to states of sin’ change of Inner Peace to encourage caring for assist and guide reflexive Luke 10:33: ‘…and when he saw him, others contemplation/meditation and concrete he had compassion on him’ actions resulting in a vital experience of connectedness

Pope Benedict XVI clearly SpREUK questionnaire. Health Qual Life 13 Büssing A, Reiser F, Michalsen A, Outcomes 2005; 3: 10 (pp. 1-10). Zahn A, Baumann K: Engagement of Pa- advised in his Apostolic Letter 2 Büssing A, Ostermann T, Koenig HG. tients With Chronic Diseases in Spiritual Porta Fidei: “Today too, there Relevance of religion and spirituality in and Secular Forms of Practice: Results with is a need for stronger ecclesial German patients with chronic diseases. Int the Shortened SpREUK-P SF17 Question- J Psychiatry Med. 2007; 37: 39-57. naire. Integrative Medicine: A Clinician´s commitment to new evangeli- 3 Büssing A, Michalsen A, Balzat HJ, Journal 2012b; 11: 28-38. zation in order to rediscover the Grünther RA, Ostermann T, Neugebauer 14 Balboni TA, Vanderwerker LC, joy of believing and the enthusia- EAM, Matthiessen PF: Are spirituality and Block SD, Paulk ME, Lathan CS, Peteet religiosity resources for patients with chron- JR et al. Religiousness and spiritual sup- sm for communicating the faith. ic pain conditions? Pain Medicine 2009; 10: port among advanced cancer patients and (…) Faith grows when it is lived 327-339 associations with end-of-life treatment pref- as an experience of love received 4 Zwingmann C, Wirtz M, Müller C, erences and quality of life. J Clin Oncol Körber J, Murken S. Positive and negative 2007; 25: 555-560. and when it is communicated as religious coping in German breast cancer 15 Winkelman WD, Lauderdale K, Bal- 22 an experience of grace and joy.” patients. J Behav Med. 2006; 29: 533-547. boni MJ, Phelps AC, Peteet JR, Block SD, As medicals doctors, nurses, 5 Zwingmann C, Müller C, Körber J, Kachnic LA, VanderWeele TJ, Balboni Murken S. Religious commitment, religious TA: The relationship of spiritual concerns social workers, chaplains, bi- coping and anxiety: a study in German pa- to the quality of life of advanced cancer pa- shops – as sensitive beings – we tients with breast cancer. Eur J Cancer Care tients: preliminary findings. J Palliat Med. are in charge to help and assist 2008; 17: 361-370. 2011; 14: 1022-2028.. 6 Dezutter J, Luyckx K, Schaap-Jonker 16 Frick E, Riedner C, Fegg MJ, Hauf S, others, we have to address their H, Büssing A, Hutsebaut D: God Image and Borasio GD: A clinical interview assessing spiritual needs and to respond Happiness in Chronic Pain Patients: The cancer patients’ spiritual needs and prefer- adequately. This remains a chal- Mediating Role of Disease Interpretation. ences. Eur J Cancer Care (Engl). 2006; 15: Pain Medicine 2010; 11: 765-773. 238-243. lenging task for a modern health 7 Appel C, Müller C, Murken S: [Strain 17 Büssing A, Koenig HG. Spiritual needs care system – and of our Church! experience and religiosity. A comparison of of patients with chronic diseases. Religions Yet we need the organizational patients with chronic pain and breast can- 2010; 1: 18-27 cer.] Schmerz 2010; 24: 449-457. 18 Alderfer CP: Existence, Relatedness, structures to facilitate this, pro- 8 Büssing A, Koenig HG: The Benefit and Growth; Human Needs in Organiza- fessional competencies, and com- through spirituality/religiosity scale - A tional Settings. Free Press, New York, 1972 passion to act as ‘Samaritans’. 6-item measure for use in health outcome 19 Büssing A, Balzat HJ, Heusser P: studies. Int J Psychiatry Med 2008; 38: 493- Spiritual needs of patients with chronic 506. pain diseases and cancer - validation of the 9 Chida Y, Steptoe A, Powell LH: Relig- spiritual needs questionnaire. Eur J Med Acknowledgement iosity/spirituality and mortality. A system- Res 2010; 15: 266-273. atic quantitative review. Psychother Psycho- 20 Büssing A, Janko A, Kopf A, Lux EA, som. 2009; 78: 81-90. Frick E: Zusammenhänge zwischen psy- I am highly grateful to all collaborators, 10 Büssing A, Kerksieck P, Föller-Man- chosozialen und spirituellen Bedürfnissen i.e., Andreas Kopf Annina Janko and Eber- cini A, Baumann K: Aspects of spirituality und Bewertung von Krankheit bei Patienten hard Lux; Anne-Gritli Wirth, Knut Hum- and ideals to help in adolescents from Chris- mit chronischen Erkrankungen. Spiritual broich, and Kathrin Gerbershagen; Franz tian academic high schools. International Care 2012; 1: 57-73 Reiser, Anne Zahn and Klaus Baumann; Journal of Children´s Spirituality 2012a; 17: 21 Erikson EH: Dimensions of a new Wenbo Peng and Zhai Xiao-feng; Kazimi- 99-116. identity; Norton: New York, NY, USA, erz Franczak and Janusz Surzykiewicz. 11 Büssing A: Spirituality as a Resource 1974. to Rely on in Chronic Illness: The SpREUK 22 Benedict XVI: Apostolic Letter “Mo- Questionnaire. Religions 2010; 1: 9-17. tu Proprio Data” PORTA FIDEI of the Su- 12 Büssing A, Matthiessen P.F., Oster- preme Pontiff Benedict XVI. For the indic- Notes mann T: Engagement of patients in religious tion of the year of faith; Libreria Editrice and spiritual practices: Confirmatory results Vaticana 2011, Chapter 7. (http://www.vat- 1 Büssing A, Ostermann T, Matthiessen with the SpREUK-P 1.1 questionnaire as a ican.va/holy_father/benedict_xvi/motu_ PF: Role of religion and spirituality in med- tool of quality of life research. BMC Health proprio/documents/hf_ben-xvi_motu-pro- ical patients: confirmatory results with the Qual Life Outcomes 2005; 3: 53 (1-11) prio_20111011_porta-fidei_en.html).

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The Mission for the Suffering of the ‘Merciful’

Dr. Manuel de Lemos es of Mercy are and what they ernment has launched a study National President of the Union do. Born within the communities, to evaluate the possibility of the of the Merciful, they are respected, loved and pro- social sector and the Houses of Portugal tected by those communities. Mercy becoming involved in the Following the Carnation Rev- National Primary Healthcare Net- olution of 1974, the Portuguese work. irst of all, on behalf of the Un- government decided to national- This, my friends, is a brief over- Fion of the Merciful of Portu- ise the premises and the manage- view of our presence in the health- gal, and as its national President, I ment of our hospitals and created care sector. As I have already stat- would to like to thank the Pontifi- a public health system, a type of ed, this is a constant presence over cal Council for Health Care Work- NHS. However, in the north of more than 500 years based on a ers and, specifically, its President, the country, 3 of the approximate- set of values that we adopt as our His Excellency Archbishop Zyg- ly 100 hospitals we ran escaped mission. Hence, what may be of mut Zimowsk, for the opportunity nationalisation and they rapidly interest to you is our analysis of to come before you to exchange gained a reputation for credibility the reason for the importance of some thoughts on the work car- based on the quality and humani- this presence, which, once again, ried out by the Union of Merciful sation of their health-care servic- is experiencing rapid growth. of Portugal in the area of health es. So much so that in the 1980s, The first reason is that people care over the last five centuries. the major democratic parties (the and governments are understand- The first thought I would like Christian Democrats, the Social ing more and more that ‘looking to share with you is that our com- Democrats and the Socialists) be- after the infirm’ is something that mitment to health derives from gan to include in their manifestos does not sit well with the nature the work of mercy that instructs the devolution of these hospitals of the private sector, irrespective we Catholics ‘to take care of the to their rightful owners, the Hous- of the adoption of management infirm’. No matter who is suffer- es of Mercy. Thus, slowly – very systems, rules and principles of ing – irrespective of colour, race, slowly – the devolution process great rigour and competence. It creed or income. was initiated. would appear evident to all that Indeed, since 1516, in the reign Each devolved hospital became in the ‘care’ process there is a of King João the Second, to the a success story. Success in terms moment – in my opinion, sev- present day, and without any inter- of quality; success in terms of eral moments – where the nature ruption, the Casas de Misericór- costs (they are least 30% cheap- of the mission and the organisa- dia or the Houses of Mercy have er than comparable public hospi- tion is not compatible with profit. taken care of the sick. In recogni- tals); and success in terms of hu- Perhaps it is for this reason that in tion of this, the Portuguese peo- manisation. Today we operate 19 countries such as the USA, which ple began to refer to these houses hospitals, and in September 2012 has, legitimately, a long-standing as ‘holy’. For this reason, across the government decided to initi- capitalist tradition, the most qual- the parts of the world discovered ate a process, which is currently ified segments of the health sec- by the Portuguese, the Casas de in progress, to devolve a further tor are closely linked to the Third Misericórdia are known as the 15 to 30 hospitals. Sector and to the NGOs – as is the Santas Casas de Misericórdia or Before this, the Portuguese case of the Mayo Clinic, the John Holy Houses of Mercy. In Bra- government had already decid- Hopkins Hospital or the Kruger zil, where there are some 2,200 ed to enter into an agreement Care Hospital Foundation. Houses of Mercy, they are known with the Union of the Merciful For me, the second reason is as Santas Casas or Holy Houses of Portugal whereby the Houses the way we assure humanisation. and are a major player in the area of Mercy would be involved in It is clear that both the public and of acute (hospital) care. setting up a National Long Term the private sectors have made a As I have already said, our Care Network. In six years the huge effort in this direction, and presence in the health-care sector Houses of Mercy have built and today in all health-care units we is the result of an ethical stance, equipped some 120 units with a find professionals who are very the values of which are adopted total of 4,000 beds, the equivalent committed to humanisation. But as our mission. And because that of more than 50% of the national there is a clear difference between presence goes back into the mists network. Some of these units are adopting humanisation as a spe- of the centuries, in Portugal, Bra- already certified by the Interna- cialist or as a value inherent in the zil, Angola or São Tomé there is tional Joint Commission. nature, identity and culture of an no need to explain what the Hous- Finally, the Portuguese gov- organisation.

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Thirdly, the Houses of Mercy, Indeed, the fact that we are or- ly invent/develop a new societal on account of their size and im- ganisations that are rooted in an paradigm based on the society of portance in the specific context ethical approach with regard to togetherness, or, if you prefer, of of the health sector, constitute a voluntarism and have a strong ba- fraternity, which, certainly with- unique case in terms of perma- sis in charity, while asserting the out conceptualising, the Houses nence over time, and for this rea- truth of Jesus Christ in society and of Mercy have always adopted – son, they would make good case having the certainty that develop- naturally and in relation to the ep- studies. For me, it is in the inter- ment, be it social or economic, is och and people. action with the communities they not conceivable without ‘caritas’, Indeed, either we transform serve that we can find the main i.e. without love of one’s neigh- solidarity into much more than reason why the Houses of Mer- bour: all of this places the work of an ethical imperative or a torrent cy have not been assigned to the the Houses of Mercy on a privi- of emotions and give it a status annals of history. Time and time leged level which is deeply rooted based on true rights and obliga- again people come back to the in the Church’s Social Doctrine tions, or our common path will Houses of Mercy movement as an and is reflected inCaritas in Veri- lead to completely unexpected instrument par excellence of the tate. And our health-care units are upheavals, as the present clearly concept of active solidarity. In- a paradigm par excellence of that and unequivocally shows. Cari- deed, it is in coherence with this approach and that privileged posi- tas in Veritate, as we have seen, is thought that we always place our tion! Even for the people who do very clear on this and Portuguese intervention in terms of solidar- not directly turn to them for help, Catholics see themselves reflect- ity and subsidiarity – be it with the simple fact that they exist, that ed in those values, as our centu- the State or with people. At all they are there, is a kind of reas- ries-long attention to those who times bearing in mind that these surance, an instrument of comfort suffer shows. principles take on particular sig- that the private sector clearly can- The history of the Houses of nificance if we understand them not give, and the public sector, in Mercy has been, from its very be- in the way the Holy Father Ben- many countries, is no longer able ginnings, one that expresses its edict XVI teaches us in Caritas in to give. own dimension in the together- Veritate: ‘The principle of subsid- If you will allow me one more ness society, and this is, indeed, iarity must remain closely linked personal comment: the growing reflected in the centuries-old to the principle of solidarity and attention of the media, and even amalgamation of the concepts of vice versa, since the former with- the renewed interest of intellectu- the hospital (of the time) and the out the latter gives way to social als in what the Houses of Mercy institution itself. privatism, while the latter with- are doing and saying, are an ex- My friends: it is time to come out the former gives way to pa- ample of what I have been trying to a close. But before doing so I ternalist social assistance that is to say. The truth is that the com- would like to make three final ob- demeaning to those in need’. mitment to civil dialogue, which servations. The first is that over And finally, another justifica- the European Union asserts, is the last thirty years, science, and tion for the importance of this based on the principle of diversi- medical science in particular, has presence can be found in the con- ty – more so than the essence of pushed the limits of life much fur- cept of selfless voluntarism. The life, as that belongs to biodiversi- ther. Today technology prolongs preamble to the first memorandum ty – which manifests itself in all life; in certain cases it diminishes of the House of Mercy of Lisbon, human acts: from the economy suffering and even increases well- from 1498, made express refer- to law, from religion to fraternity being. State-of-the-art hospitals ence to the founders being people and on to health. are complex institutions full of who had no ‘necessity’; in other And recognition of this fact high-end, extremely expensive words, they were ready to help leads us to the reality that each technology, that require a strong others without expecting anything human being constitutes, togeth- concentration of resources. But in return. Precisely because of this er with all others, a whole, a one- at the same time, that technology the Union of the Merciful memo- ness, a ‘solidum’. And this idea has made proximity treatments randum is known as the ‘Commit- that all of us, in our individuality, accessible, cheap and safe for a ments’, as whoever joins a House have a common nature, origin and plethora of pathologies. of Mercy undertakes to become purpose, is the consubstantiation The second is that over the last involved in its mission which is of the basic idea of solidarity, of thirty years we have witnessed a attuned to the contemporary cir- the relationship of co-responsibil- huge increase in human life ex- cumstances of the period. ity between all members of one pectancy. We have added years At a time when the world is and the same ‘solidum’. to life, now we give more life to experiencing an unprecedented Without wishing to delve into our years. But there has also been crisis at the economic level and the classification of established a shift in terms of expenditure on in terms of values, and when the models of society – the subordi- health-care resources. In Portu- suffering are looked upon as those nation society, the coordination gal thirty years ago only 10% of who have failed, institutions like society and the togetherness soci- health-care expenditure was for the House of Mercy constitute ety – it would seem evident to me the chronically ill; today the fig- and represent an anchor for com- that, given the failure of the first ure is above 70%. munities and individuals. two models, we need to urgent- The third follows from the sec-

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ond, again centring on the effects The National Long Term and Pal- affection to a child or an elderly of increased life expectancy. Yes, liative Care Networks are increas- person, taking the time to listen we live longer, but the number ingly becoming structuring pillars to a related memory, holding the of situations of dependency have of the health system, given the hand of the dying: these are things also increased – be they in the incapacity of families to care for that the Houses of Mercy do natu- physical or the mental sphere. For their infirm, be it because they rally and like no one else. example, the increase in demen- do not have the resources, or the For all these reasons, we are tia has been exponential; in 2009 structure, or the necessary skills. proud of our past, we are atten- there were already 7,300,000 It is in this context of thousands tive to the present and we are cer- people diagnosed with the condi- of people suffering on a daily ba- tain that we are institutions with a tion in Europe, 153,000 of them sis that our mission gains in size great future. In this holy place, I in Portugal. At this point I want and takes it place as something beseech Our Lady of Mercy, Our to inform the conference that the distinctive in the health-care con- Lady of the Great Mantle, to pro- UMP is finishing a Portuguese text. Providing good care, with tect us, as she has always done, building for Alzheimer’s patients quality and competence, giving down the centuries.

The Humanitarian and Missionary Role of the Order of Malta

H.E. Baron Albrecht of knighthood with continuous tion for its charitable humanitar- Freiherr von Boeselager existence, right up to the present ian tasks has never, throughout its Grand Hospitaller of the day. Its first constitution as a lay history, fallen below 60% of its Sovereign Military Order of was approved by total budget at any time. This cer- Malta, Pope Paschal II in the year 1113. tainly is the main reason why the Germany. Its vision was its humanitarian Order of Malta still exists. Its rai- Member of the Pontifical principle: to care for the poor and son d’être did not disappear with Council for Health Care the sick, whatever their religion, the loss of the Holy Land. Workers, their origin or their race – a prin- Today the Order of Malta is ex- the Holy See ciple that today we see as modern, tended across the world as never but for the Order of Malta, is al- before. It has its own structures most a thousand years old. Pope in 55 countries in all continents irstly I wish to thank Msgr. Zi- Paschal granted the Order far and activities in about 120 coun- Fmowski, President of the Pon- reaching independence from oth- tries. The activities rely on 13,500 tifical Council for Health Care er authorities, and when the Order members, 80,000 permanent vol- Workers, for giving me, as the settled on the Island of Rhodes in unteers and some 25,000 employ- representative of H.E. Albrecht 1310, this independence devel- ees. Many more volunteers join Freiherr von Boeselager, Grand oped into sovereignty. After the for special activities from time Hospitaller of the Sovereign Or- loss of Rhodes in 1522, the Or- to time. The Order maintains full der of Malta, the opportunity to der became the sovereign of the diplomatic relations with 104 present the worldwide humanitar- Island of Malta. When Napoleon countries, exchanges ambassa- ian activities of the Sovereign Or- occupied Malta in 1798, the Or- dors with the European Commis- der of Malta. der lost its territory, but its sover- sion, and has Permanent Observer Let me begin with some gen- eignty was confirmed by the trea- missions at the United Nations. eral facts which can clearly il- ty of Amiens in 1802. The description of our activi- lustrate the almost thousand-year The first crusaders arrived in ties poses a challenge. They are commitment of the Sovereign Or- the Holy Land in 1099 and many manifold and diverse. First: the der of Malta. of the knights joined the Order, structure of the Order is decen- It is the oldest chivalric Order. which at that time was called the tralised. The single national enti- It was founded in the middle of Brotherhood of St. John in Jeru- ties – Associations – of the Order the eleventh century with the mis- salem. The military history deriv- hold the operational responsibili- sion to care for sick and wound- ing from this development is well ty for what is done in their respec- ed pilgrims in a hospital in Jeru- known. But I wish to underline tive countries. Second: the Order salem. And it is the only Order the fact that the Order’s alloca- is active in very diverse environ-

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ments, from highly developed and ated a specialised centre for this arrangements with the local au- rich countries to extremely under- purpose. In 2010 Queen Sylvia thorities and the police allow them privileged and deprived regions. opened the first specialised de- access to our clinics without being We have adapted our activities partment in a hospital to care for afraid of arrest. Besides the hu- accordingly, with the traditional patients with different kinds of manitarian aspects of these servic- emphasis on medical and social illnesses, but all suffering from es, they are crucial for safeguard- needs. dementia. It has become a mod- ing public health. The French In Europe the focus is on run- el which is now visited by many Association of the Order, with its ning health-care and social insti- specialists. In March a first day- antennae in the French speaking tutions, for example, hospitals, care centre for dementia sufferers countries of Western Africa, helps clinics, and care-homes for the el- was opened in Germany. It is run people who have been repatriated derly and for the severely handi- by the Order. Geriatric hospital to their country of origin. capped, and on managing volun- departments and palliative care The Order also assists drug-ad- teer organisations with paramedic units complete our field of end- dicted youngsters and lonely old and social missions. For instance, of-life care. people at home. The Roma and in Germany the Order runs 10 Social care for the most de- Sinti in Hungary and the neigh- hospitals, in France it has 15 prived in another focus. I will bouring countries form another homes for severely handicapped give you a few examples from a field of activity. Services to pris- or dependent people, in England wide range of the different servic- oners or their relatives are new 73 care-homes for the elderly, and es the Order provides. activities in a couple of coun- in Italy a hospital and many clin- Help for the homeless is moving tries from Cambodia to the Unit- ics specialised in diabetes care. increasingly into the foreground. ed States. Most of these servic- The Order of Malta has for cen- In most European countries we es are carried out by volunteers. turies been a pioneer in medicine now run projects for the home- The work of volunteers who are especially in the treatment of in- less. The French Association has not members of the Order makes juries and dealing with infectious furnished an old péniche in Par- a very important contribution to diseases. The word ‘quarantine’ is to host homeless people with nearly all the Order’s activities. derives from the time in Malta dogs – it is the only place they Most of the volunteers are or- when the Order isolated patients can take their dogs. In Germany ganised in the Order’s volunteer with infectious diseases on an is- in a number of cities we offer the relief organisations and ambu- land in the harbour of Valletta homeless special days, which we lance corps. They carry out first for forty days. The island is still call ‘Wohlfühlmorgen’ or ‘well- aid missions, and provide disas- called Quarantine. But what the ness mornings’, when they can ter relief and social services. In Order became even more famous shower, get their clothes cleaned, addition, extensive youth work is for is the kind of care it gave to receive medical checks and ba- being carried out in the relief or- the sick. The rules dealing with sic treatment – and there are vets, ganisations of 30 countries. Since care in the Order’s hospital be- too, to look after the dogs! The the foundation of the first ambu- came famous. Centuries before Australian Association supports lance corps in Ireland more than this became standard in Europe, the so-named ‘The Coats for the 70 years ago (1938), the operation the Order insisted that every pa- Homeless Project’, an interna- of relief services has developed tient should have their own bed. tional project involving the distri- into one of the Order’s most im- In modern times the Order of bution of specially designed and portant functions. There are also Malta has played an important role manufactured all-weather coats volunteer groups outside Europe, in fighting leprosy. In many coun- for the homeless. In Belgium, in both North and South America. tries in Europe we concentrate to- in particular in Brussels and in On the African continent the first day on care for the elderly. In Eng- Liege, Malte Assistance runs two groups have now been established land and Germany care for elderly la Fontaine Houses which pro- in Nigeria and South Africa. The people who suffer from dementia vide medical care, showering and foundation and development of has become a field where we again washing facilities, hairdressing, volunteer corps has also been very do pioneering work. The care sewing, cafeteria and company to successful in Central and East- homes in England have developed 18,000 homeless, with the help of ern Europe since the fall of the a special scheme to furnish rooms 130 volunteers. Iron Curtain. For example, there in a old fashioned style, com- Care for asylum seekers and are now nearly 10,000 volunteers mon when the elderly were still people who have immigrated ille- working in the Order’s relief ser- young. They are called ‘reminis- gally is another ever growing field vices in Hungary, the second larg- cence rooms’. This innovation has of action in many countries. In It- est group after Germany which a calming effect and a measurable aly our medical personnel serve can count on 35,000 volunteers reduction of medication. on the boats of the Italian coast- and almost 9,000 young cadets. In Germany the Order coop- guards to provide first aid to the The populations in the former erates with the Swedish founda- boat-people who over the last few Communist countries lived for tion Silviahemmet, created by years have been arriving in their two or more generations under a Queen Sylvia to further care for thousands. In Germany and Italy dictatorial regime in which it was elderly people with cognitive we run small clinics to treat peo- impossible for them to organise impairment. The Order has cre- ple without legal status. Special themselves in private associa-

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tions pursuing social purposes. In ern , through the Centro stan, both co-financed by ECHO. many of these societies the finan- Asistencial Cruz de Malta, car- Unfortunately we had to terminate cial situation of the population is ries out several activities dealing the projects in Afghanistan after such that they often need to work with health, education, nutrition, three of our local staff members at several jobs at any one time to social services for children, teen- were killed by the Taliban. be able to earn enough to support age mothers, young and elderly The Order has various insti- their families. In fact we find sit- people. tutional bodies at its disposal to uations where there are wonder- I will turn now to our activities provide worldwide humanitarian ful examples of private solidarity in the Middle East and then to our and disaster relief, and develop- and neighbourly help, but where international humanitarian activi- ment support to the developing there is no tradition of privately ties. world. They include: the Direc- organised associations. It is a re- One of our lighthouse projects tion Internationale of the Order de ality where volunteer work has is the Holy Family Maternity Hos- Malta France, which runs health little place compared to the need pital in Bethlehem. Two years ago centres and hospitals especially to earn your living. In this envi- we celebrated the 50,000th baby all over French speaking West Af- ronment we aim to work for the born in the hospital since 1990. rica; the CIOMAL foundation of creation and the development of Over 3,000 babies are born there the Swiss Association whose mis- a social volunteer commitment, every year. The European Com- sion is to fight leprosy. Present- specifically in the field of social mission contributed financially to ly it is most active in Cambodia; work. Such social commitment the renovation of the hospital and Malta Belgium International has is also one of the most important occasionally given other finan- distinguished itself in the fund- tools in building free, democrat- cial support. The Belgian govern- ing of hospitals in the Democratic ic societies. Social development ment financed the equipment for Republic of Congo. And there are and its attending benefits in these a modern neonatal department. dozens of bilateral donor projects, countries is therefore particularly Many other institutions and pri- where an Association directly important for the future strategy vate donors support this initia- supports a project somewhere in of our organisations. The impor- tive. Nevertheless the Order has the developing world. tance given to the creation and to contribute around €1.5 million The most important of these support of free civil initiatives in to the running costs of the hospi- organisations is Malteser Inter- the field of health and social care tal every year. national, the Order’s worldwide is one of the essential factors for Most of the Palestinian patients relief service. Its purpose is the a free society; the State has the do not have health insurance and coordination and delivery of dis- great responsibility of supplying are unable to pay even the rela- aster relief and rehabilitation with a supportive legal and financial tively low fees. The Palestin- a view to comprehensive and in- framework. ian authorities frequently fail to tegrated development. It is active Our young volunteers concen- pay the fees for the patients they in the fields of health care, water trate on activities with people who send to us. But the hospital is a and sanitation, disaster prepared- have physical handicaps. For the haven of peace in a turbulent re- ness and prevention projects, live- last thirty years, an international gion. The rate of premature ba- lihood and nutrition programmes, holiday camp for young handi- bies is high due to the permanent and microcredit and micro health- capped people has been organised psychological stress their mothers insurance schemes. each year in a different European are exposed to. The hospital also Malteser International is cur- country. In 2011 it was held in It- provides important jobs in an area rently active in Africa, Asia and aly, this year the youngsters gath- with a high rate of unemployment. Central and South-America and ered in Hungary, and next year the Besides the afore-mentioned has brought vital services to eight camp will be in Ireland. A very project for young people with million people in 20 different special initiative in the Lebanon is handicaps in the Lebanon, the countries. the organisation of holiday camps Order runs 10 clinics around the As the Order itself does, Maltes- for local youngsters with physical country, and in cooperation with er International bases all its oper- and mental handicaps. Participa- other confessions and religions in- ations on strict political neutrally tion in these youth camps may of- cluding the Druse, the Sunni and and its independence from politi- fer them a unique opportunity to Shi’ite communities. In the south cal and economic interests. With share moments of spiritual reflec- we cooperate with a Shi’ite foun- the stated aim of helping people tion and to enjoy leisure and sport dation and you will probably be in need, it is a credible partner for activities together. surprised to hear that the Shi’ite all actors and partners in zones of In South America the Order’s medical personnel wear a service conflict, such as its current work activities, besides those connect- dress with our Cross on it. Once in South-Sudan, Eastern-Congo, ed to disaster relief, are mainly confidence is created a lot can and Pakistan, event in the Swat focussed on humanitarian pro- be done to further peace among Valley. An open and transparent jects for children and mothers liv- different religious communities agenda and a record of reliabili- ing in slums, providing them with through common projects. Other ty allow Malteser International to medical care, social assistance examples of this kind are the Bos- carry out relief operations in areas and education. The Brazilian As- nian women initiative and a sim- like in Southern Congo, where al- sociation of São Paulo and South- ilar scheme applied in Afghani- most no-one else has safe access.

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Maltese International has been mascus, Hamas and Homs will cussing on emergency medical permitted to operate in Myanmar receive start-up and hygiene kits, relief and the distribution of re- since 2001, when it was still ex- including blankets, mattresses, lief items – such as the means for tremely difficult for foreign NGOs kitchen utensils, soap, diapers and water purification and storage, to work in this country. And this baby ointment. In the Lebanon, household items, shelter kits and permission was given in spite of the Order will continue to support basic food rations – are ‘first re- the health-care projects Malteser the Lebanese Association’s socio- sponse instruments’. International provides for the Ka- medical centre in Khaldieh, where After these basic needs have ren, who have left Myanmar for Syrian refugees can receive free been met, the next aim is to fur- political reasons and live in ref- medical treatment. Almost 600 ther reduce vulnerability and to ugee camps along the Thai-Bur- refugees have received treatment provide communities affected by mese border. Thanks to this po- so far. Starting in November, 500 crises and disasters with sustain- sition Malteser International was refugees will be given emergency able reconstruction and rehabili- one of the very few international relief kits and winter clothes. tation programmes, promoting a organisation able to start an im- In South Sudan Malteser In- strong development perspective. mediate relief operation after the ternational has been active since Respective programme compo- cyclone Nargis hit the country. 1997 with its emergency pro- nents include the reconstruction The Order’s international re- grammes in favour of refugees of houses and public buildings as lief agency is also very active in and victims of civil wars. Since well as social rehabilitation meas- favour of the so-called internal- South Sudan became independ- ures such as psychological as- ly displaced persons (e.g. people ent in 2011, Malteser Internation- sistance to the survivors and the forced to abandon their homes al has been working to strengthen reintegration of refugees within and lives because of conflicts, the local health-care structures, in their homeland. wars, natural disasters) by offer- particular in the Lakes and West- The interventions after the ing them a refuge in camps spe- ern Equatorial states, by building earthquakes in in 2010 and cifically built for humanitarian a total of 35 new health-care cen- in Italy in 2009 and 2012, after emergencies, medical and psy- tres equipped with latrines, wells the earthquake and tsunami in Ja- chological assistance, hygiene- and rainwater harvesting tanks in pan in 2011 and after the frequent kits and food. the Maridi and Rumbek regions floods and cyclones in several Just to mention only some of and by offering state health-care Asian countries (such as Cam- the Order’s interventions in fa- employees training in topics such bodia, Myanmar, Sri Lanka) are vour of IDP in 2012 we can re- as drug management and mater- only few examples of the activi- call its interventions in Myanmar nal and child health. ties carried out by the Order in the in Rakhine State in which more As for the past, I wish to recall context or humanitarian emergen- than 90,000 people have been dis- the activity of the Order in the cy linked to natural calamities. placed due to ethnic conflicts; in Democratic Republic of Congo But these success stories should where more than where, during and after years of not hide our general concern re- 65,000 Malian refugees have fled civil war, civilians, often young garding the observation of hu- following a political crisis in their women or even little girls and manitarian principles in the mod- country; and in the Democratic sometimes little boys, were the ern type of armed conflicts. A Republic of Congo where, after a innocent victims of sexual vio- hundred years ago 90% of war series of attacks from armed rebel lence and rape perpetrated by mi- victims were soldiers; today 90% groups in January 2012, thousands litiamen and rebels. Since 2007 of the victims of contemporary of people have fled the Shabunda the Order has been working with armed conflicts are civilians. province in South Kivu. victims in Ituri, Haut Uélé and Time is too short to elaborate on At present Malteser Interna- Bukavu/South Kivu to prevent or this issue here. But the conse- tional is deeply involved in help- treat sexually transmitted diseas- quences of so-called asymmetric ing refugees in Syria and the Leb- es and to provide psychological struggles, the misuse of protected anon. Since the beginning of July, counselling to cope with this ad- civilian or religious facilities, the in collaboration with its partner ditional level of trauma. use of human shields but also the organisation the ‘International The Order is not only involved acceptance of collateral damage Blue Crescent’ it has been sup- in the aftermath of wars, conflicts – the euphemistic wording is per- porting 1,200 families fleeing to or political crises: it also inter- fidious in itself – and the threats Damascus with emergency relief venes with its national and inter- to humanitarian personnel, de- goods. Now, as the winter sea- national corps to help populations mand permanent observance and son is approaching, 500 families affected by natural disasters, like efforts to improve the observation in the Syrian cities of Homs and earthquakes, tsumani, floods... In of these vitality important human- Hama will be provided with warm the early stages of this kind of itarian principles. clothes, blankets and stoves. In emergencies, the focus of any re- The Order is also starting a new addition, more than 15,000 dis- sponse is upon helping people in initiative to improve the funding placed persons in Aleppo, Da- basic survival. Programmes fo- situation for forgotten needs.

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Engaging Catholic Health Providers to Scale up HIV Testing and Treatment

Mr. Gregg H. Alton oped parts of the world. Today, delegation to the 65th World Executive Vice President, 4.3 million people worldwide re- Health Assembly, said he was in- Corporate and Medical Affairs, ceive Gilead HIV therapies, of trigued by the evidence. World Gilead Sciences, which 3.5 million live in low- and Health Organization Director U.S.A. middle-income countries. Margaret Chan and former U.S. Secretary of State Hillary Clinton have made public statements en- Advances in HIV/AIDS dorsing the use of ARVs to reduce Treatment HIV transmission. About Gilead Sciences Over the past decade, the in- Because of social action and ternational community has made science, HIV has been trans- enormous progress in ARV treat- Gilead Sciences, Inc. is a re- formed from a near-certain death ment provision: Between 2002 search-based biopharmaceutical sentence into a chronic, manage- and 2011, the number of peo- company that discovers, devel- able disease. Effective ARV ther- ple in low- and middle-income ops and commercializes innova- apy for individuals provides ben- countries receiving ARV thera- tive medicines in areas of unmet efits that include near-normal life py increased 2,600 percent, from medical need. expectancy and reduced need for 300,000 to more than 8 million. For more than a decade, Gile- hospitalization, and can allow Treatment has averted an estimat- ad Sciences has been a leader in many people with HIV to return to ed 2.5 million AIDS deaths since the development of antiretrovi- work and have an improved qual- 1995. ral (ARV) therapy for HIV/AIDS ity of life. Effective ARV therapy Yet substantial needs remain, with an emphasis on improving also provides significant benefits and continuing to scale up treat- and simplifying HIV treatment for families, keeping them intact, ment is a top health and human- for patients. Gilead researchers allowing parents with HIV infec- itarian priority. The United Na- have developed six commercial- tion to care for children, and re- tions has set a target of reaching at ly available HIV medications, ducing households’ expenditure least 7 million additional people which include the only complete on healthcare. with ARV therapy, to reach a total treatment regimens for HIV in- What is more, effective ARV of 15 million people by 2015. fection available in a once-daily therapy begun early has the po- single pill and the first oral ARV tential to lower the risk of HIV pill available to reduce the risk of transmission. In May 2011, re- HIV Treatment acquiring HIV infection in certain searchers at the U.S. National Needs Persist high risk adults. We are also ad- Institutes of Health (NIH) an- vancing a robust pipeline of next- nounced results from a landmark Thirty years since the first cas- generation therapeutic options. clinical study among heterosexu- es were reported, HIV/AIDS re- The Gilead corporate mission al couples in Africa in which one mains one of the world’s foremost is to transform care for HIV and partner was HIV-positive and one health challenges. Approximately other life-threatening diseases. HIV-negative. The study found 30 million people have died of Gilead also believes that all peo- that for couples where the HIV- AIDS, and more than 34 million ple should have access to the positive partners started treatment people are now living with HIV. medicines they need, regardless right away, the rate of HIV trans- Nine in 10 people with HIV re- of where they live or ability to mission to HIV-negative partners side in developing world coun- pay. To achieve these goals, we was 96 percent lower as com- tries and the vast majority of new believe we must apply innovation pared to couples in which the pos- infections occur in the develop- not just to drug discovery but also itive partners delayed treatment. ing world. HIV is a barrier to so- to finding new ways to get afford- Since that study was published cial development and economic able medicines to people in need in the New England Journal of growth as it reduces life expec- as quickly as possible. Medicine, there has been growing tancy, destabilizes families and In this vein, we have estab- support for the Test and Treat Ap- deepens poverty. In the absence lished innovative programs and proach among political, religious of a vaccine and cure, testing peo- partnerships to expand global ac- and health care leaders. Accord- ple for HIV and providing treat- cess to our medicines, recogniz- ing to Catholic News Service, in ment to those who are infected is ing that the greatest need for HIV 2011, Archbishop Zygmunt Zi- a primary strategy for controlling treatment is in the least-devel- mowski, who led the Holy See the epidemic.

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The Catholic Church’s Global Response to HIV

A vast Catholic health services network spanning more than 100 countries includes approximately 5,000 hospitals, 17,000 dispensa- ries and 15,000 houses for the ill and elderly, many of which treat people living with HIV. In fact, through this network Catholic in- stitutions and charities provide health care to approximately 1 in 4 people worldwide with HIV. The Catholic Church’s engage- ment on HIV treatment has also involved its most senior leaders. Addressing an international con- ference in 1989 (Pontifical Coun- cil for Health Care Workers, IV International Conference), His Holiness Pope John Paul II stat- ed that HIV represents a “double- edged challenge ... prevention of the disease and healthcare offered to those who suffer from it. Truly effective action … results from a constructive vision of the dignity of the human person.” More re- cently, His Holiness Pope Ben- edict XVI in 2011 called for a “medical and a pharmaceutical response” to HIV/AIDS.

Collaboration on Test and Treat Project

Gilead believes in strength through partnership. Collabora- tions of all kinds – with partners in science, academia, business and local and faith communities – are central to our work. Partner- ships enhance our ability to de- velop innovative medicines and deliver them to people in need as efficiently as possible. One ongoing example of this commitment with regards to com- munities of faith is a pilot project being carried out in collaboration with the Vatican and Tanzanian Episcopal Conference, conducted at a rural site in Bugisi, Tanzania. The Tanzania project is intended to demonstrate how, by imple- menting voluntary universal HIV testing in health care facilities and immediately connecting those treated to effective ARV therapy, providers can reduce viral load, improving health for people with

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HIV infection and lowering HIV nities that result when we reduce cluding health workers, and how transmission in communities. viral load. Additionally, the pro- to continue optimizing ARV ther- In Bugisi, the project aims to gram will provide key data for re- apy to reduce costs. increase HIV screening in Catho- searchers to analyze that will help We consider this collabora- lic health care facilities across 35 them design more effective test- tion to be a critical opportunity villages, home to approximately and-treat initiatives in the future. to demonstrate not only the effec- 75,000 individuals, with direct re- Important questions the project tiveness of HIV treatment-as-pre- ferral to therapy for patients diag- will help answer include: how to vention, but also to show how in- nosed with HIV. We expect that effectively scale up testing, un- dustry and faith leaders can make the project will treat 20,000 pa- derstanding the barriers to early tangible progress in addressing an tients, providing the direct bene- initiation of ARV therapy, need epidemic that hits the neediest the fits to patients as well as commu- for adequate infrastructure, in- hardest.

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Conclusions

Msgr. centuries because of the will of ebration in St. Peter’s presided Andrea Pio Cristiani Jesus: ‘Heal the sick’ (Lk 10:9). over by His Eminence Cardi- Founder of the ‘Shalom’ The first thing that we must ask nal and it end- Movement, Italy, ourselves is whether those who ed with the meeting with the Su- Consultor of the Pontifical enter our institutions really en- preme Pontiff who encouraged all Council for Health Care counter Christ in these settings those who had spoken at the inter- Workers, where ‘still today as the Good Sa- national conference with his illu- the Holy See maritan he comes next to every minating words. This was a great man bent in body and spirit and sowing for the whole world which pours upon his wounds the oil of will undoubtedly bear abundant o sum up in a brief way the comfort and the wine of hope’ (cf. fruit. Tconclusions of such an ex- Prefazio comune VIII MR). The settings in which human traordinary meeting, which this Those who work as disciples health is cared for should be au- twenty-seventh international con- of Christ in the world of health thentic ‘sanctuaries’, starting ference of the Pontifical Council and health care do not work to ac- with universities where research for Health Care Workers has un- quire fame, prestige, or even less should be understood as the iden- doubtedly been, is without doubt to become rich. ‘Talents’ have tification of the multiple possibili- a notable undertaking, both be- been given to them. The greatest ties that the Creator has placed in cause of the international impor- proof of the goodness of the cause nature, offering to human intel- tance of the event during which that these serve is the gratuitous- ligence the ability to work heal- all the five continents of the world ness of their work. We are faced ings in a progressive and exalt- were represented and because of with a depressing spectacle when ing growth of successes. Just a the very high quality of the papers we witness speculation in relation short time ago some surgical op- given by the various learned and to health, the cutting of research erations, but therapeutic initia- distinguished speakers. The sub- funds, of funds for health care, tives as well, would have seemed ject suggested by the Holy Father and of funds for welfare in gener- incredible miracles. In harmo- is topical and global: ‘Hospitals al. It is always the least who bear ny with each other, the synoptic as Places of Evangelisation: their the costs of this situation. For the gospels tell us that Jesus entrust- Human and Spiritual Mission’. rich and powerful, in the contem- ed the Apostles with ‘casting out The subjects have been in full porary crisis as well, there will al- unclean spirits’ (which were held harmony with the extraordinary ways be the best medical doctors to be the cause of maladies) and year of the faith, established to re- and the best treatment. to heal every kind of illness and member the golden jubilee of the This twenty-seventh interna- infirmity (Mt 10: 1; Mk 3:1; Lk Second Vatican Council. tional conference has not only 6:13). This mandate addressed to We have at the level of ide- been an exchange of views on the Twelve is also a clear invita- as crossed the thresholds of the various scientific, social, pastoral tion to the whole of the Church to doors that humanity crosses when or spiritual questions and issues. develop that knowledge that re- it falls ill and suffers. It has also been, as is to be ex- lieves human pain and improves We have directed out attention pected of a congress promoted by quality of life, making life free to the very many settings where a pontifical council, an authentic and beautiful. illness is addressed. It is though ‘theophany’. From the papers given to this in- we had come from sixty-five na- We came from all the continents ternational conference it emerged tions of the planet to ask ourselves of the world of enjoy the universal with clarity that to evangelise is whom we encounter beyond those dimension of this Catholic Church a priority commitment of eve- doors and what it is exactly that of ours which was founded by Pe- ry Christian health-care worker. we are looking for there. ter. Leaving aside the papers that To evangelise is above all to de- Each sick person, with a state of followed one another during the nounce the scandalous differenc- mind imbued with fear and with various sessions of the confer- es between the innumerable very hope, hopes for a warm welcome ence and the value of the religious poor people and the opulent few. and effective treatment. Such is and civil figures who honoured That a child should die because of not always the case. It may happen us with their constant presence, it the lack of an antibiotic in coun- that they are not treated as persons was perceived that the only true tries where life expectancy does but as ‘numbers’, in relation to chairman and animator was Jesus. not go beyond forty, whereas else- whom one should act spending as The comforting and illuminating where exaggerated treatment no little time as is possible and with presence of his Spirit imbued all longer helps people but merely the lowest possible costs. those who people took part. extends their sufferings, is a scan- The globe is threaded through The annual ‘Pentecost’ of our dal. The principle of the equality with hospitals, nursing homes and Pontifical Council began in the of the human person and his or her dispensaries which arose over the morning with the inaugural cel- inalienable right to health was as-

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serted forcefully and repeatedly. It with an immortal soul, with intel- but love and serve the sick with is as though the Church, strong in ligence, and with freedom. The devotion, will also be saved, as her social teaching, had outlined whole of his being is expressed in the Gospel of Matthew tells us (cf. a world political project around an immortal soul which is the seal 25:31-46). The finest surprise will which the intentions of national of his uniqueness, unrepeatable be for those who did not know this governments and religious and nature, and eternity. It is his spirit- and did not realise that in the sick civil institutions could converge. ual faculties that suggest to man a there was God. This is that ‘when A condemnation of the vi- destiny beyond this earth. As Pope did we visit you?’ which allows us sion of man upheld by nihilistic Benedict XVI observes in his Je- to hope for eternal salvation for all and materialistic neo-approaches sus of Nazareth, man awaits com- those who give of themselves. sounded out in a strong way in the plete healing: ‘Those who really In the passage from the Gospel synodal hall. These philosophies want to heal man must see him in according to St. Matthew, the re- reduce the human being to a low- his wholeness and must know that warding of the just is announced level biochemical product, an ac- his final healing can only be the in three statements: the bless- cident produced by chance that love of God’. During this interna- ing of the Father, the inheritance took shape through a long evolu- tional conference, evangelisation of the kingdom, and eternal life. tion of cosmic magma, a ‘simple’ appeared as an urgent need to re- Connected with the performance compound of cells that arranged store to man his true dignity. of the ‘vocation’ to health-care themselves of necessity. At the end of our deliberations service there is the real success of In animalism, which has be- it has been necessary to ask our- a life. In the final analysis we will come fashionable today, there is selves about the mission that not have asked of us the science no difference in terms of rights awaits us at home, that is to say that we produced or the healings between animals and people. In the mission of being the champi- that we obtained, and even less the confusion of the contemporary ons not only of an authentic vision the amount of money that we ac- world, animals should die of old of man but also of how God is ‘in- cumulated: having reached the age whereas for humans euthana- carnated’ in sick people. Our task threshold of the doors of Eterni- sia is advocated. On this subject, is to say to the world that to heal ty to welcome us we will find pa- the breath of the Spirit, which blew the sick is to worship God Him- tients who have been treated and in the hall, reconfirmed the Gos- self. Contact with suffering peo- who, having cast off their ‘earthly pel of Man, his being which came ple is like a sacrament, a source masks’, will show us the shining out of the heart of God, made in of grace and salvation. Those who face of the Lord who will say: ‘It His image and likeness, endowed have not received the gift of faith, was me: you did it to me’.

Concluding Reflections and Recommendations

Fr. Jacques Simporé, M.I. of business and, for the sick, spac- a setting for a new evangelisation; Rector of the University es of anonymity, of loneliness, of the role of hospitals in interna- of St. Thomas Aquinas, anxiety and of death without hope. tional health-care policy; the hos- Ouagadougou, Burkina Faso. Some countries have legalised eu- pital as a temple for humanity and Consultor of the Pontifical thanasia and already practise it; crossroads of peoples; the genesis Council for Health Care other societies are presently agitat- of hospitals; biomedical research; Workers ing to validate it in order to reject telemedicine; spirituality and the the void or fill the emptiness of in- deaconate of charity; ethics and duced in the hearts of patients who humanisation…’. These multiple have been admitted to hospital. contributions to reflection demon- However, a hospital, which is strate to us, on the one hand, how Introduction a place where patients interrupt our sick brethren are followed and their stressing daily activities, treated: neonates, young people, Today more than ever before, should be a place of inner peace, adults or the elderly, rich or poor, under the guidance of the science, of reflection about life, about the atheists or believers, and, on the of biomedicine, of modern bio- meaning of life and about the fu- other, how these patients suffer, technology and of systems of nu- ture of man. recover or die in those ‘temples of merical management, our hospi- In recent days, during this inter- life’ which hospitals should be. tals are tending to lose a human national conference, we followed As concluding reflections I will face and steadily to become, for with great interest a large number summarise, starting with the sub- some health-care workers, places of papers such as ‘The hospital as jects of the various papers, the

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challenges for today’s hospitals. moil’. Hospitals and clinics have of their social activities. At times, Subsequently, my recommenda- to face up to enormous challeng- faced with hopelessness, only one tions for hospitals as health-care es which can be met only through solution remains: to ask to die in and life institutions will begin a targeted high-quality manage- dignity. The alarming legalisation from personal reflections based ment. Because of today’s com- of euthanasia invites us to revis- upon the traditional African expe- petitiveness, hospitals and clin- it the deep reasons for this social rience of care for the sick and the ics . which are large, medium and crisis. What suitable Christian an- personalist vision of man. small companies or public or pri- swers should be given to the ex- vate institutions – are forced to clusion and loneliness which in improve their efficacy by mak- numerous patients lead to desper- 1. The Challenges to be Met in ing public the quality of their re- ation and suicide attempts? Today’s Hospitals sults in a transparent way. Hospi- tals thus run the risk of becoming Modern science and medicine ‘business centres’, sector of com- 2. Recommendations have revolutionised human health merce where a sic person can be and have pusher it to engage in at one and at the same time a cus- 2.1. Starting with the vision of significant progress from the point tomer and the object of negotia- illness, sick people and the care of view of the quality of life and tions. Each patient receives care and treatment that should be giv- life expectancy. However, this and treatment according to his en to them of Africans, we could search for therapeutic efficacy, us- or her wallet. From this point of suggest some recommendations ing the modern instruments of re- view, the quality of care and treat- favourable to a better humanisa- search, has destabilised traditional ment becomes proportionate to tion of the hospital world. medical care for patients in hospi- the financial capacities of the pa- In the view of Professor Joseph tals. There are a number of chal- tient! Ki-Zerbo,1 ‘Every culture bears lenges which have to be met. within it the seeds of the great- 1.3. The challenge of est achievements, in faith as well. 1.1. The challenge of drawing up pharmacological-clinical This is especially true of Afri- a policy for hospitals based experimentations can culture which, despite some on local areas defects, has notably positive as- All biotechnological advances pects in the field of dedication to Health policies (or health-care as regards ‘dominion over life’ the sick’. In his view, the physical policies or public health policies) as in the case of medically as- commitment of Africans towards include the set of strategic choices sisted procreation lead us to think their sick derives from a civilisa- of public and private authorities of the famous phrase of Prof. tion that is principally agrarian. to improve the state of health of Jacques Testard: ‘We have left a Thus in this Africa of other times, populations for which they have horse without reins or bit in na- hospitals were everywhere and no- responsibility. One is dealing ture’. Here we are faced with new where. There were no old people’s here with: 1. deciding the areas ethical challenges that were never homes for the elderly nor places and fields of action: 2) specifying suspected which bring into ques- to take in the mentally ill. In this the objectives to be achieved; 3) tion the very foundations of gen- sense, the very idea of the segre- make judicious choices as regards eral ethics, of our universal inher- gation of the sick was unthinka- priorities; and 4) planning the itance of wisdom! ble both because there was as yet means that will be used at this lev- no precise idea of what infectious el of collective responsibility. The 1.4. The challenges of diseases were and because, and challenge to be met at this level is secularisation above all else, because it was a sa- the drawing up of a policy for hos- cred duty to be physically near a pitals based on local areas which Nowadays a ‘secular’ ethics parent or a friend who was sick. has on the one hand equal access has been decoded which does not Thus in traditional Africa, every to care and treatment throughout have any foundation in the Trans- kind of obligation was forgone in the whole national territory in or- cendent and called ‘global ethics’. order to help sick people physi- der to fight against regional dis- It is undermining biomedical eth- cally, even though in normal life parities, and, on the other, internal ics from within and finds in hos- adversaries were involved. This medical organisation and manage- pitals a favourable setting for the was because in their view the ment which place the person of spread of its principles. grave illness of an adversary au- the patient at the centre of the in- tomatically marked a tie for a so- terests of the hospital. 1.5. The challenge of loneliness cial truce. In all cases, thus physi- and desperation cal commitment was to observed 1.2. The challenge of the in body to body contact which an transformation of hospitals In a hospital a sick person al- African accepted with a sick per- into ‘business centres’ ways becomes a number. No- son as though challenging the ill- body calls him or her by his or ness rather than the patient. Do we As the newspaper Le Temps em- her name. In addition, he or she not perhaps see men or women di- phasised on 21 October 2012, ‘the is often abandoned by his or her rectly behind a sick person, put- world of health is in complete tur- parents who are too busy because ting him or her between their legs

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or carrying them on their chests in and ends with his or her death. these components of what man is order to relieve their pain, to feed Starting with the personalist vi- need care and treatment. them better, give them something sion of man, we can formulate a In his Motu Proprio ‘Porta to drink, precisely as was done series of recommendations for Fidei’, Pope Benedict XVI an- with circumcision or childbirth? hospitals: the formation and up- nounced a ‘Year of Faith’. Even There was a pact, a sort of trilo- dating of hospital personnel in though today we see, with regret, gy between the healer, traditional relation to new medical technol- our churches, our sanctuaries, our medicine and the sick person. In- ogies; the formation of hospital cathedrals and our basilicas emp- deed, after receiving for free the personnel in relation to the prin- ty because many people nowa- therapeutic prescriptions from the ciples, foundations and values of days pursue with ardour the world gods, each ‘tradipraticien’ (‘tradi- bioethics; the formation of hospi- of business and have no time for tional physician) asked for sym- tal chaplains in relation to bioeth- God, the Teacher of Life is always bolic fees from his patients: three ics and pastoral care in health; the patient – He awaits them at the kola nuts or salt or three bales of creation of pastoral teams made up threshold, in hospitals, ‘Temples tobacco. It was a contradiction, a of chaplains; the celebration of the of Life’ and crossroads of peoples, confusion of language, to speak sacraments in hospitals; the crea- where one day they will rest, im- about a rich ‘tradipraticien’ inas- tion within hospitals of places for mobilised and with all the time much as his priesthood was only healthy recreation and entertain- they need, therefore, to speak to for suffering humanity. ment for patients; the sensitisation them ‘heart to heart’. Starting with these observations of civil society to support for sick Nowadays, seeing what is ex- about traditional African culture, people in hospitals; the develop- perienced and done in our hospi- what recommendations can we ment of systems for the control of tals, we are tempted to day: ‘ho- make about our societies and our pain so as to block the way to eu- mo sapiens has too much science hospitals? thanasia; the promotion of respect and not enough wisdom’. For this 1. For the health-care person- for life in hospitals: from the con- reason, today the hospital world nel: ‘more heart in the hand’; ception of the human person until suffers because it needs a new ap- placing the person of the patient death; and leading patients to live proach to evangelisation which at the centre of the interests of the their illnesses in a Christian way takes into account the reality of hospital. so that they become, in their turn, our epoch. Thus everyone in hos- 2. For the patient: living in hope evangelisers of their environment. pitals are afraid that they will be because, as a proverb of Burkina alone amidst the void. However, Faso says, ‘if God does not kill a there is no fear without hope just sick person, the ‘tradipraticien’ Conclusion as there is no hope without fear will not kill him at all’ or ‘the (the Blessed John Paul II). physician treats but it is God who During the course of this twenty- Hospitals, ‘temples of life’, heals!’ seventh International conference mirrors of society, guardians of 3. For society: organise things of the Pontifical Council for Health life and settings for the encounter so that the patient is not left alone; Care Workers we have heard on a between heaven and earth, should always support the patient physi- number of occasions that hospitals be places of solicitude and not of cally, morally and financially; say as settings for evangelisation, and loneliness. Beyond any political, to society that: medical doctors thus for life and hope, should be philosophical, ethical and ideo- have not yet discovered the elixir welcoming and healing institutions logical tendency of a government, of immortality; life belongs only that are full of life, of plants and of every nation should always pro- to God; and exaggerated treatment colour. Places where solidarity, so- mote not only the better organisa- reduced the human aspect in man. licitude, professionalism, human- tion and management of hospitals ism, prayer and meditation should but also practical measures so that 2.2. Starting with a personal- be practised. each patient is well cared for and ist view of man, what recommen- At the beginning of the 1990s treated, surrounded by his or her dations can be formulate for hos- the World Health Organisation dear ones, and can live his or her pitals as institutions of health an proclaimed ‘Health for All by the faith. life? Year 2000’ (WHS, Geneva, 1991) According to the personalist ap- and the UN restated that every proach, human life is a fundamen- man has the ‘right to health’ (UN, Acknowledgements tal, sacred and intangible value. 1949; WHO, 2003). We are by Life is a gift of God. And the hu- now in the year 2012! What has I thank Father Padre Joseph Sawadogo, of man person created in the image really been done? To bring all the St. Vincent de Paul, of Burkina Faso, for his and likeness of God is a psycho- peoples of the world, all nations, to contribution in the writing of this paper. somatic being, that is to say body the highest level possible of health and spirit. In this way, for the per- we need to review in an urgent sonalist way of thinking, the hu- way our hospitals, our systems of Note man being is the most important care and treatment for sick people. KI-ZERBO J., ‘Culture africaine et char- value of the create world. His or Man is not only his body inasmuch isme camillien’, Fidélité et Renouveau, n. her life begins with fertilisation as he also has a spirit and both of 122, 1982.

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