Dolentium Hominum N

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DOLENTIUM HOMINUM N. 45 – Year XV – No. 3, 2000 JOURNAL OF THE PONTIFICAL COUNCIL FOR HEALTH PASTORAL CARE

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

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Contents

4 Message of the Holy Father 78 Leprosy: Past, Present and Future for the IX World Day of the Sick Prof. Cairn Smith Sydney, February 11, 2001 82 The Creation of the ILEP JUBILEE DAY OF THE SICK AND HEALTH CARE WORKERS André Recipon VIII WORLD DAY OF THE SICK ROME, 9-11 FEBRUARY 2000 84 Raoul Follereau: an Extraordinary Witness of the Twentieth Century, a Look of Love Towards Others 10 That Suffered and Joyful Prayer of so many People Jos Hilger Confined to Wheelchairs Rev. Gianfranco Grieco 88 The Figure of Padre Damien André de Schutter 12 Address of Homage H.E. Mons. Javier Lozano Barragán 90 The Lok Seva Sangam Rev. Carlo Torriani 13 For the Suffering, Christ is the Door to Life John Paul II 91 Leprosy in Mozambique Dr. Leonida Compostella 15 With Thousands of Sick People through the Porta Santa of St. Paul’s 94 Rehabilitation Needs in Leprosy Dr. Alessandro Iapino Dr. Enrico Pupulin Dr. Sunil Deepak 17 The Homily in the Basilica of St. Paul’s Outside the Walls 97 The Newsman and those Suffering from Leprosy 2 H.E. Mons. Javier Lozano Barragán Prof. Igor Man ‘HEALTH CARE WORKERS AND 101 Leprosy: A Word Synonymous THE CHALLENGES OF THE THIRD MILLENNIUM’, with Marginalisation 9 FEBRUARY 2000 Dr. Claudio Ragaini

20 Speech of Greeting to the Joint STUDY-SEMINAR Conference of Professionals of Health ‘THE SACRAMENTS IN PASTORAL CARE IN HEALTH’ H.E. Mons. Javier Lozano Barragán 2-3 JUNE 2000 21 National, Episcopal, Diocesan and Parish 104 Introduction to the Deliberations Co-ordinating Bodies for Pastoral Care in Health H.E. Mons. Javier Lozano Barragán H.E. Mons. Javier Lozano Barragán 105 The Sacraments in Pastoral Care in Health 24 The Pontifical Council for Health Pastoral Care Prof. Sergio Belardinelli 1985-2000 H.E. Mons. José Luis Redrado 108 The Sacraments: Anthropological Approaches Prof. Denis Biju-Duval 26 Catholic Doctors’ Challenges and the New Millennium 112 A Sacrament for Suffering. Prof. Gian Luigi Gigli Faith in God and Hope of Life Prof. Sergio Ubbiali 31 The Identity of the Catholic Medical Doctor H.E. Mons. Javier Lozano Barragán 116 Signs of Salvation: The Sacraments in the Health Care Ministry 38 The Identity of the Catholic Nurse Prof. Mons. Sergio Lanza Rev. Joseph Joblin 129 Conclusions 44 Challenges for the Third Millennium An Verlinde ‘MEDICINE AND HUMAN RIGHTS’ ROME, 3-7 JULY 2000 52 The Identity of the Catholic Pharmacist on the Threshold of the Third Millenium 132 Prayer Written by the Holy Father Rev. Felice Ruffini for the Congress of Catholic Medical Doctors John Paul II 59 The Challenges for Pharmacists during the Third Millenium 133 The Medical Doctor should Respond Prof. Alain Lejeune as a Conscientious Objector to Legislation in Favour of the Crimes of Abortion and Euhanasia 63 The Celebration of the Eighth World Day John Paul II of the Sick in the World Dr. Alessandra Ciattini 135 Greeting to the Congress on ‘Medical Rights’ H.E. Mons. Javier Lozano Barragán SEMINAR DAY ON LEPROSY ‘REALITY AND LEPROSY’ 136 Greeting of the President of IFCMA 15 JANUARY 2000 Prof. Gian Luigi Gigli 70 Opening Speech by the President of the AIFO 137 The Greeting of the AMCI Dr. Enzo Zecchini Prof. Domenico Di Virgilio 71 Speech of Greeting 138 The Year 2000 - The Activity of the Pontifical H.E. Mons. Javier Lozano Barragán Council for Health Pastoral Care Rev. Don Krzysztof Nykiel 72 Speech of Greeting by Minister Rosy Bindi Rosy Bindi 74 The Raoul Follereau Association of Benin (ARFB) The illustrations in this edition are taken from the book: Prof. Henry Valere T. Kiniffo “La Biblioteca Privata di Pio IX al Laterano” 76 Poverty and Health Colapinto, Grimaldi, Bettini Dr. Maria Neira (P.U.L., Mursia, 1997). “I entrust you to Mary, Mother of the Church...” DH n.45 ing 1-68 2.8.2001 15:41 Pagina 4

Message of the Holy Father for the IX World Day of the Sick Sydney, February 11, 2001

1. Enriched by the grace of the Great Jubilee and by contemplation of the mystery of the incarnate Word, in which human pain finds “its supreme and surest point of reference” (Salvifici Doloris, n. 31), the Christian community is preparing to celebrate the Ninth World Day of the Sick on 11 February 2001. The place designated for the celebration of this significant event is the cathedral of Sydney, Australia. The 4 choice of the Australian continent with its cultural and ethnic wealth highlights the close bond of ecclesial communion: this bond transcends distances and fosters the encounter of different cultural identities made fruitful by the one liberating message of salvation. The cathedral of Sydney is dedicated to the Blessed Virgin Mary, Mother of the Church. This fact emphasizes the Marian dimension of the World Day of the Sick, which has now been observed for nine years on the memorial of Our Lady of Lour- des. As a loving Mother, Mary will once again enable not only the sick on the Aus- tralian continent to feel her protection, but also all who dedicate their professional skills and often their whole lives to serving them. As in the past, the Day will be an occasion of prayer and support for the countless institutions devoted to the care of the suffering. It will encourage the many priests, religious and lay believers who seek to respond in the Church’s name to the expectations of sick people, while paying special attention to the weakest and those strug- gling the most, in order to assure the victory of the culture of life over the culture of death everywhere (cf. Evangelium Vitae, n. 100). Since I too have shared the experience of illness several times in recent years, I have come to understand more and more clearly its value for my Petrine ministry and for the Church’s life itself. In expressing my affectionate solidarity to those who are suffering, I invite them to contemplate with faith the mystery of Christ crucified and risen, in order to discover God’s loving plan in their own experience of pain. Only by looking at Jesus, “a man of sorrows, and acquainted with grief” (Is 53:3), is it possible to find serenity and trust. DH n.45 ing 1-68 2.8.2001 15:41 Pagina 5

2. On this World Day of the Sick, whose theme is The New Evangelization and the Dignity of the Suffering Person, the Church intends to stress the need to evangelize in a new way this area of human experience, in order to encourage its orientation to the overall well-being of the person and the progress of all people in every part of the world. The effective treatment of various pathologies, commitment to further research and the investment of adequate resources are praiseworthy objectives which have been successfully pursued in vast areas of the globe. However, while applauding the efforts made, one cannot overlook the fact that not everyone enjoys the same opportunities. I therefore make a pressing appeal that everything be done to encourage the necessary development of health services in the still numerous countries which are unable to offer their inhabitants proper living conditions and appropriate health care. 5 I also hope that the vast potential of modern medicine will be put at the effective service of human beings and applied with full respect for their dignity. In her 2,000-year history, the Church has always tried to support therapeutic progress for the sake of ever improved assistance to the sick. She has intervened in various situations with every means at her disposal to see that the rights of the person are respected and his authentic well-being always pursued (cf. Populorurn Progres- sio, n. 34). Today too, faithful to the principles of the Gospel, the Magisterium never ceases to offer moral criteria to guide medical personnel in studying those aspects of research which have not yet been sufficiently clarified, without violating the requirements of an authentic humanism.

3. Every day I go on a spiritual pilgrimage to hospitals and treatment centres, where people of every age and social background live. I would particularly like to pause beside the patients, their recitatives and the health-care personnel. These places are like shrines where people participate in Christ’s paschal mystery. Even the most heedless person is prompted there to wonder about his own life and its meaning, about the reason for evil, suffering and death (cf. Gaudium et Spes, n. 10). This is why it is important that the skilled and significant presence of believers should never be wanting in these structures. Therefore how could I not make a pressing appeal to medical and nursing professionals to learn from Christ, the physician of souls and bodies, to be authentic “Good Samaritans” towards their brothers and sisters? In particular, how could I not hope DH n.45 ing 1-68 2.8.2001 15:41 Pagina 6

that everyone dedicated to research will work tirelessly to identify suitable ways to promote the integral health of the human being and fight the consequences of diseases? How could I not, in addition, encourage those who are directly involved in the care of the sick to be always attentive to the needs of the suffering, combining skill and humanity in their professional life? Hospitals, centres for the sick or the elderly and every institution which cares for the suffering are privileged areas for the new evangelization, which must be committed to making the Gospel message of hope heard precisely in these places. Only Je- sus the divine Samaritan is the fully satisfying answer to the deepest expectations of every human being in search of peace and salvation. Christ is the Saviour of every person and of the whole person. For this reason the Church never tires of proclaim- 6 ing him, so that the world of illness and the search for health may be enlivened by his light. It is important, then, that at the beginning of the third Christian millennium a new impetus be given to the evangelization of the world of health as a place particularly suited to becoming a valuable laboratory for the civilization of love.

4. In recent years, there has been a growing interest in scientific research in the medical field and in the modernization of health-care structures. We can only look favourably at this trend, but at the same time it must be stressed that there is a constant need for it to be guided by the concern to offer the sick an effective service, supporting them efficaciously in the fight against disease. In this perspective, there is increasing discussion of “holistic” care, that is, care that pays attention to the biological, psychological, social and spiritual needs of the sick and of those around them. It is particularly necessary, with regard to medicines, treatments and surgical operations, for clinical experimentation to be conducted with absolute respect for the individual and with a clear awareness of the risks and, consequently, of the limits involved. In this area Christian professionals are called to bear witness to their ethical convictions and to be constantly enlightened by faith. The Church appreciates the efforts of those who, by engaging in research or treatment with dedication and professionalism, help to improve the quality of the service offered to the sick.

5. The equitable distribution of goods, desired by the Creator, is also an urgent im- DH n.45 ing 1-68 2.8.2001 15:41 Pagina 7

perative in the area of health: the persistent injustice that deprives a large part of the population of the treatment indispensable to health, especially in poor countries, must cease once and for all. This is a grave scandal which can only prompt national leaders to make every effort to ensure that those who lack material means are provided with access to at least basic health care. Promoting “health for all” is a primary duty for every member of the international community; for Christians it is a commitment closely connected with their witness of faith. They know that they must proclaim the Gospel of life in a practical way by promoting respect for it and rejecting every kind of attack on it, from abortion to euthanasia. Reflection on the use of available resources also belongs in this context: their limitedness calls for the establishment of clear moral criteria to guide the decisions of patients or their guardians regarding extraordinary procedures which are expensive or risky. In any case, re- 7 course to forms of aggressive medical treatment should be avoided (cf. Evangelium Vitae, n. 65). Here I would like to praise the individuals and structures, and especially religious institutions, which perform a generous service in this sector by courageously responding to the urgent needs of persons and peoples in regions or countries of great poverty. The Church expresses to them a renewed appreciation of the contribution they continually make in this vast and sensitive apostolate. I would like, in particular, to urge the members of religious families involved in the health-care ministry to respond boldly to the challenges of the third millennium, following in the footsteps of their founders. In view of the new tragedies and diseases which have replaced the plagues of the past, there is a pressing need for the work of “Good Samaritans” who can offer the sick the treatment they need, but at the same time provide them with spiritual support to endure their difficult situation with faith.

6. I extend a particularly affectionate thought to the many men and women religious who, with an ever increasing number of lay people, are writing wonderful pages of Gospel charity in hospitals and health-care centres. They often work in frightening war zones and daily risk their lives to save those of their brethren. Unfor- tunately, many have died for their service to the Gospel of Life. I would also like to mention the many non-governmental organizations which have recently arisen to help those disadvantaged in the area of health. They can rely on the contribution of “on-site” volunteers, as well as on the generosity of a large DH n.45 ing 1-68 2.8.2001 15:41 Pagina 8

number of people who financially support their activity. I encourage them all to continue this praiseworthy work, which in many nations is sensitizing consciences in a significant way. Lastly I address you, dear sick people and generous health-care professionals. This World Day of the Sick is taking place shortly after the conclusion of the Jubilee Year. It is therefore a renewed invitation to contemplate the face of Christ, who became Man 2,000 years ago to redeem man. Dear brothers and sisters, proclaim and bear witness to the Gospel of life and hope with generous dedication. Proclaim that Christ is the comfort of all who are in distress or difficulty; he is the strength of those expe- riencing moments of fatigue and vulnerability; he is the support of those who work zealously to assure better living and health conditions for everyone. 8 I entrust you to Mary, Mother of the Church, to whom, as I recalled at the beginning, the cathedral of Sydney, the spiritual centre of the Ninth World Day of the Sick, is dedicated. May Our Lady of Consolation make her motherly protection felt by all her suffering children; may she help you bear witness before the world to the tenderness of God and make you living icons of her Son! With these wishes I impart a special Apostolic Blessing to you and to all your loved ones.

From Castel Gandolfo, 22 August 2000. DH n.45 ing 1-68 2.8.2001 15:41 Pagina 9

Jubilee Day of the Sick and Health Care Workers

VIII World Day of the Sick, Rome, 9-11 February 2000 DH n.45 ing 1-68 2.8.2001 15:41 Pagina 10

That Suffered and Joyful Prayer of so many People Confined to Wheelchairs *

11 February 2000 in St. Peter’s Square Ð a episcopal conferences. Thirty-nine priests in- cosmic embrace of the world of suffering on volved throughout the world in the health care the day of the jubilee of the suffering and ministry also took part in the celebration. health care workers. A liturgical celebration There were also the singers of the Sistine with the Virgin Mary of Lourdes. In the Grotta Chapel, directed by Maestro Giuseppe Liber- di Massabiele with our Lady dressed in white, to, and they sang the invocations, after a brief with wheelchairs, cots, and stretchers, and so pause of silence: “Lord, shining light in the many sick people, as well, on their beds of darkness who illuminates every man, have pain, who today more than ever before renew mercy on us”. “Kyrie, elieson”, replied the as- an encounter of communion. Souls and hearts, sembly with the Gregorian chant. “Christ, close by and far away, linked to that thread of first-born Son of the Father, born of a woman, love and hope which is faith in the Cross of born under the law to redeem man from every 10 Christ which redeemed the world. slavery”. “Christe eleison”, answered the as- St. Peter’s Square was like a great and im- sembly once again. “Lord, light of the divine mense open-air aisle. 2,400 sick people in glory, who purifies man of sin, have mercy on wheelchairs and 1,700 people standing at the us”. “Kyrie, eleison”, concluded the assembly. feet of the statues of St. Peter and St. Paul. John Paul II then intoned the “Gloria” and Family relatives, medical doctors, para- immediately afterwards the collect oration: medics, nurses, people who accompany them, “Grant to your faithful, our Lord God, to al- and voluntary workers. Wounded bodies, bod- ways enjoy the health of the body and of the ies full of pain. But on their faces there was so spirit and by the glorious intercession of the much joy and so much Christian hope. Most Holy Mary, always virgin, save us from From the altar the Pope greeted the assem- the evils which now sadden us, and lead us to bly with the following words: “The Lord Je- joy without end”. sus revealed the presence of the Kingdom of In Spanish Renzo Paccini read out a pas- God amongst men with marvellous signs sage from the Prophet Isaiah: “I will make which accompanied his words. Mary, his prosperity flow towards you like a river”. Af- Mother, still sings with us the wonders of the ter the responsorial psalm sung by Michel Father because he saw the humility of his Galcotti, An Verlinde in English read a pas- handmaiden. The whole Church exults”, con- sage from the Letter of St. James the Apostle: tinued the Pope, “at the gift of the spirit ef- “who amongst you is in pain, pray; who is in fused over each of her children through the joy sing psalms. Who is sick, call to him the sacraments. We, too, gathered together to ren- presbyters of the Church and let them pray up- der thanks to the Lord together with our sick on him, after anointing him with oil in the brothers and sisters experience the beauty of name of the Lord. And the prayer said in faith the grace which radiates in our weakness. To will save the sick man”. Before everybody’s celebrate this solemn action of graces in a eyes the precept was carried out and the won- worthy way, we ask for forgiveness for our der was performed. sins”. The deacon Dino Mulassano sung the Mari- an gospel of Luke: the visit of Mary to St. Elizabeth and the ‘Magnificat’ of the Virgin of The Statue of the White Lady of Lourdes Nazareth: “Great things the Almighty has Next to the altar the white statue of the done in me and holy is his name”. Madonna of Lourdes. And fifty concelebrants The liturgy of anointing then followed with with white chasubles, amongst whom Cardi- the litany prayer and the laying on of hands. nal Etchegary, President of the Committee of “Brothers”, said the Pope, “we turn to the the Great Jubilee of the Year 2000, with its Lord the prayer of faith for our infirm brothers Secretary, Archbishop Sepe; the President of and for all those who treat them and take care the Pontifical Council for Health Pastoral of them”. The ministering deacon Don Ste- Care, Archbishop Lozano Barragán, and fano Maffei invited the assembly to invoke forty-seven archbishops and bishops made re- the Almighty: “Hear us O Lord!”. The deacon sponsible for pastoral care in health by their then raised to heaven the intentions: “May the DH n.45 ing 1-68 2.8.2001 15:41 Pagina 11

bishop of Pisa, President of Unitalsi; Mons, José Luis Redrado Marchite, O.H., Secretary of the Pontifical Council for Health Pastoral Care; Rev. Pascual Piles Ferrando, Superior General of the Hospiteller Order of St. John of God (Fate Bene Fratelli); Rev. Angelo Brusco, Superior General of the Regular Priests Min- isters to the Sick (Camillians); and Rev. Felice Ruffini, M.I., Under-Secretary of the Pontifi- cal Council for Health Pastoral Care.

The Prayer to the Father and the Intercession of Mary In the prayer to the faithful, in Portuguese, Sister Laurinda Faria, Councillor General of the Hospital Sisters of the Sacred Heart, spoke the following words: “O Father, whose only Son took upon himself the poverty and the weakness of all men, ensure that your Church knows how to bend in front of every man bent 11 in his body and in his spirit and pour on him the oil of consolation and the wine of hope”. In Arabic Dr. Maya El-Hachen, head of the paediatric dermetological section of the ‘Baby Jesus’ hospital prayed as follows: “You who in every time raise men and women who by vocation and profession dedicate their lives to service to the sick, ensure that in their daily endeavour they are inspired by the example of Lord bless the infirm; give them strength and Christ, Teacher and Lord”. health; lighten their suffering!” The intentions In Polish Prof. Henryk Chmielewski, direc- were then widened: “May all sick people feel tor of the neurological clinic at the military the comfort of his grace; may his blessing ac- academy of medicine of Lodz, raised this in- company those who take care of the sick; may vocation: “You who in the passion of your these sick people through the holy anointing Son revealed to us the Christian value of suf- with the laying on of hands obtain life and sal- fering, ensure that to each sick person there vation”. does not lack the comfort of the Word and the sacraments of the faith”. Muhindo Mughanda in Swahili prayed with The Liturgy of the Laying on of Hands the following intention: “You who know the The Holy Father laid his hands on the heads times and the moments of our lives, ensure of ten sick people while another eight concel- that when we are visited by trials and pain we ebrants did the same to one hundred and nine- can experience the solidarity of those who, by ty sick people placed at the sides of the parvis. your grace, enjoy good health”. There then followed the prayer of the “be- In French Prof. Alain Lejeune, President of stowing of graces through oil” and of the the International Federation of Catholic Phar- “holy anointing” on the foreheads and the macists, then prayed as follows: “You who in hands of the sick people. “By this holy anoint- this Jubilee Year invite us to rediscover our ing and by his most holy mercy may the Lord countenance as brothers and sisters around the help you with the grace of the Holy Spirit. sole table of the Body and Blood of your Son, And, freeing you from sins, save you and in hurry the day in which every tear will be dried his goodness raise you”. During the ‘Liturgy and when we will finally be able to sit with of the Anointing’ the Holy Father was helped, you in refound peace”. among others, by Archbishop Mons. Javier The Holy Father concluded as followed: Lozano Barragán, President of the Pontifical “God our Father, who, at the school of Christ Council for Health Pastoral Care; Mons. your Son, revealed to us the hope which buds Crescenzio Sepe, Archbishop, Secretary Gen- from the Cross, hear our supplications and eral of the Committee of the Great Jubilee of provide us with the gift of receiving with joy the Year 2000; Mons. Allesandro Plotti, Arch- the word and of putting it into practice with DH n.45 ing 1-68 2.8.2001 15:41 Pagina 12

commitment following the example of Mary, of Nola; the Maronite Bishop El-Hachem; and the Mother of your Son”. the members, the officials and the consultors Sixteen people, who were infirm or health of the Pontifical Council for Health Pastoral care workers, presented themselves in front of Care. the Pope for the offering of gifts. Amongst The reserved posts were for the Minister of others, there were presented three projects for Health of the Italian Government, Rosy Bindi, health care structures for certain countries of and other authorities. On the parvis amongst the third world, a large candle, and a basket of the sick brothers and sisters there was also flowers. present Kirk Kigour, a former volleyball champion, on a wheelchair for twenty years. There served at the altar the Regular Priests of From Czestochowa to Fatima the Ministers to the Sick (Camillians), of the Lourdes, Czestochowa, Yamoussoukro, Hospiteller Order of St. John of God Guadalupe, Fatima, and Harissa in the (FateBene Fratelli), and of the Urban Pontifi- Lebanon Ð such were the Marian sanctuaries cal Council. The choir of San Vito di San Vi- where over recent years the World Day of the to dei Normanni (Brindisi) accompanied the Sick was celebrated. But St. Peter’s Square, liturgical singing. today, in the year of the Great Jubilee is the One thousand five hundred faithful who site for this celebration. The history of suffer- had arrived on a Jubilee pilgrimage from ing continues. The heroism of the sons and the Massa Carara were on the Loggia del Mag- 12 daughters of the Church who immolate them- giordomato. selves on the altar of suffering with heroism When the celebration had finished the Holy and with a dedication which is without limits Father entered the jeep and descended into the also continues. square to greet, comfort and bless the sick Around the altar were present the Cardinals people who were present. Schwery, Bishop emeritus of Sion, Vincenzo On their faces full of light there shone joy Fagiolo, and Dino Monduzzi; Archbishop and the sun of spring. Rizzato, Almoner of His Holiness; Bishops James Michael Harvey, Prefect of the Pontifi- Rev. GIANFRANCO GRIECO cal Household, and Stanislaw Dziwisz, Sub- stitute Prefect; Archbishop Remegio Ragone- si; Mons. Umberto Tramma, Bishop emeritus * From L’ Osservatore Romano, 12 February, 2000

Address of Homage

Most Blessed Father, tion of the resurrection. They want, in addi- today in St. Peter’s Square are to be found tion, through indulgence, to increase their sick people and health care workers from the communion and to be witnesses of Christ, the five continents who are here to celebrate with only way of Truth and Life, as an answer to Your Holiness the Jubilee Day of the Sick the very many questions raised by the state of and Health Care Workers. infirmity and illness, both to these people and They have prepared for this by engaging in to the whole world. long pilgrimages: they left their places of ori- The presence of Your Holiness is the high- gin, with all the forms of suffering which de- est strengthening of this communion, through rive from having to face up to major journey- our union with the successor of Peter, source ings. Yesterday they celebrated the Eucharist of unity and of solidity throughout the in ‘St. Pauls Outside the Walls’ and today Church. We strongly wish that Your Holiness these sick people and health care workers will lead us, with all the force of the Jubilee find themselves in this square so that Your Year, in this Eucharist, to the only answer Holiness may lead them towards full indul- that the world can find, faced with the prob- gence, allowing them to find Christ, the cen- lems of the culture of death, in full openness tre of history, in suffering and in pain, but al- to the culture of life. so in the health of the resurrection. H.E. Mons. JAVIER LOZANO BARRAGÁN, The presence of these sick people and of Archbishop-Bishop Emeritus of Zacatecas, President of the Pontifical Council these professionals of health wants to be a for Health Pastoral Care, canticle of solidarity and of hope in the salva- the Holy See DH n.45 ing 1-68 2.8.2001 15:41 Pagina 13

For the Suffering, Christ is the Door to Life THE HOMILY OF THE HOLY FATHER DURING THE CELEBRATION OF THE EUCHARIST IN ST. PETER’S SQUARE, 11 FEBRUARY 2000

1. “The day shall dawn upon us from on dear sick and suffering people gathered in St. high” (Lk 1:78). With these words Zechariah Peter’s Square from Rome, from Italy and foretold the Messiah’s imminent coming into from the whole world. The invitation is ex- the world. tended to you who are connected by a special In the Gospel passage just proclaimed, we television link-up and are united with us in relived the episode of the Visitation: Mary’s prayer from the shrine of Czestochowa in visit to her cousin Elizabeth, Jesus’s visit to Poland: I offer you my cordial greeting and John, God’s visit to man. gladly extend it to everyone who is following Dear brothers and sisters who are sick and our celebration on radio and television in have gathered in this square today to cele- Italy and abroad. brate your Jubilee, the event we are observ- Dear brothers and sisters, some of you 13 ing is also the expression of a special visit have been confined to a bed of pain for years. from God. With this in mind, I welcome you I pray God that today’s meeting will bring and greet your warmly. You are in the heart you extraordinary physical and spiritual re- of Peter’s successor, who shares your every lief! I would like this moving celebration to concern and anxiety: welcome! Today I offer everyone, the healthly and the sick, an deeply share this celebration of the Great Ju- opportunity to meditate on the saving value bilee of the year 2000 with you and with the of suffering. health-care workers, family members and volunteers who are at your side with loving 3. Pain and sickness are part of the human devotion. mystery on earth. It is, of course, right to fight I greet Archbishop Javier Lozano Bar- illness, because health is a gift of God. But it ragán, President of the Pontifical Council for also important to be able to discern God’s plan Pastoral Assistance to Health-Care Workers, when suffering knocks at our door. The “key” with his staff, who have organized this Ju- to this discernment is found in the Cross of bilee meeting. I greet the Cardinals and Bish- ops present, as well as the prelates and priests who have accompanied groups of the sick to today’s celebration. I greet the Health Minis- ter of the Italian Government and the other authorities here. Lastly, a grateful greeting goes to the many professionals and volunteers who have made themselves available to serve the sick during these days.

The cross of Christ is the key to understanding suffering

2. “The day shall dawn upon us from on high”. Yes! Today God had visited us. In every situation He is with us. But the Jubilee is the experience of a very special visit from Him. In becoming man, the Son of God came to visit every person, and for each one he has become “the door”: the door of life, the door of salvation. Man must pass through this door if he wants to find salvation. Each person is invited to cross this threshold. Today you especially are invited to cross it, DH n.45 ing 1-68 2.8.2001 15:41 Pagina 14

Church, and let them pray over him, anointing him with oil in the name of the Lord; and the prayer of faith will save the sick man, and the Lord will raise him up; and if he has committed sins, he will be forgiven” (Jas 5:14- 15). We will relive the Apostle’s exhortation in a particular way when, in a little while, some of you dear sick people will receive the sacrament of the Anointing of the Sick. By restoring spiritual and physical vigour, this sacrament shows clearly that for the suffering Christ is the door that leads to life. Dear sick people, this is the crowning moment of your Jubilee! In crossing the threshold of the Holy Door, you are joining all those in every part of the world who have already crossed it and those who will be crossing it during the Jubilee Year. May passing through the Holy Door be a sign of your spiritual entry into the mystery of Christ, the cru- 14 cified and risen Redeemer, who for love bore “our griefs and carried our sorrows” (Is 53:4).

5. The Church enters the new millennium, clasping to her heart the Gospel of suffering, Christ. The incarnate word embraced our which is a message of redemption and salva- weakness, taking it upon himself in the mys- tion. Dear sick brothers and sisters, you are tery of the cross. Since then all suffering has a exceptional witnesses to this Gospel. The possibility of meaning, which makes it re- third millennium awaits this witness from markably valuable. For 2,000 years, since the suffering Christians. It also awaits it from day of the Passion, the cross shines as the you who work in the health-care apostolate supreme manifestation of God’s love for us. and in various ways carry out a mission to Those who are able to accept it in their lives the sick that is highly significant and most experience how pain illuminated by faith be- appreciated. comes a source of hope and salvation. May the Immaculate Virgin, who came to Dear sick people, called at this moment to visit us at Lourdes, as we recall with joy and carry an even heavier cross, may Christ be gratitude today, bend down to each of you. In the door for you. May Christ also be the door the cave of Massabielle, she entrusted to St. for you, dear friends who accompany them Bernadette a message which brings us to the and care for them. Like the Good Samaritan, heart of the Gospel: to conversion and every believer must offer love to those who penance, to prayer and trustful abandonment live in suffering. It is not right to “pass by” into God’s hands. those who are tried by sickness. Instead, it is With Mary, the Virgin or the Visitation, let necessary to stop, to bend down to their illus too praise the Lord with the Magnificat, ness and to share it generously, thus alleviat- the hymn of hope for all the poor, the sick ing their burdens and difficulties. and the suffering of this world, who exult with joy because they know that God is beside them as their Saviour. The Redeemer bore our griefs So, together with the Blessed Virgin, let us and carried our sorrows proclaim: “My soul magnifies the Lord” and turn our steps towards the true Jubilee Door: 4. St. James writes: “Is any among you Jesus Christ, who is the same yesterday, to- sick? Let him call for the elders of the day and for ever! DH n.45 ing 1-68 2.8.2001 15:41 Pagina 15

With Thousands of Sick People through the ‘Porta Santa’ of St. Paul’s* 10 FEBRUARY 2000: THE HOLY MASS PRESIDED OVER BY ARCHBISHOP LOZANO BARRAGAN

A long, deep and unending river of pil- which we walk towards this centrality of the grims flowed on Thursday afternoon into Lord Jesus.” the basilica of ‘St. Paul’s Outside the Walls’. The faith of the sick and of their family The people who went through the ‘Porta relatives. The charity of those who accom- Santa’, however, were not ‘ordinary’ pil- pany them. “To accompany them is like grims but the ‘privileged people’ of this helping one of the family. It is a simple and Holy Year Ð the suffering, the sick, and dutiful answer to someone who calls you, those who accompanied them, that is to say who asks you to lend a hand”, we are told by family relatives or voluntary workers. Giusi, aged twenty-five, who has come from Behold the privileged pilgrims! This was Salerno with Unitalsi. how they were called in recent past days by 15 Archbishop Crescenzio Sepe, Secretary General of the Committee of the Great Ju- Simple People, Serene People bilee of the Year 2000 during the press conference to present the Jubilee of the Sick and In the same train there also came Eleonora Health Care Workers, the celebrations for and Antonio, husband and wife, with their which were inaugurated on Thursday after- son Antonio, struck by encephalitis when he noon by that river of people who took part in was only fifteen months old. the solemn mass in the basilica. He is now thirty-two. He is sitting between them on a bench at the back of the basilica. That River of Suffering and Love These are simple people, tested by life yet at the same time serene. “It is faith which Even when the celebration had begun, the has brought us here”, Eleonora tells us, with flow of pilgrims Ð on foot, in wheelchairs or in cots Ð gave no idea that it would halt, flowing into the inside, in the naves, almost an ocean of suffering and of pain but also and above all else of love and of faith. In his homily Archbishop Javier Lozano Barragán, President of the Pontifical Coun- cil for Health Care Workers (of Health Pas- toral Care), who presided over this Eucharist concelebration, spoke of this love and this faith. With him the Secretary of the same Pontifical Council, Bishop José Luis Redra- do Marchite, and another twenty-three archbishops and bishops, in addition to more than a hundred priests from various parts of Italy and the world, joined in this concelebration. “Christ is the centre of the convergence of everyone and to him, together, we must all come”, said Archbishop Lozano Barragán. “He is the centre which gives us unity and communion: the centre of the history of the whole of humanity and the history of each one of us. To reach Christ we need, however, two actions Ð the action of faith and the action of love, which are like the feet with DH n.45 ing 1-68 2.8.2001 15:41 Pagina 16

The Story of Francesca

We met Francesca, who was standing beside a young man in a wheelchair Ð the gestures with which she looked after him were so affectionate that we thought that they were mother and child! Francesca is a ‘dame of charity’, sixteen years old, and has accompanied Antonio to Rome. He is eighteen years old and has been afflicted by spastic tetraparesis ever since his birth. They come from Sibari in Calabria. “We have been travelling with Unitalsi for two years”, Francesca tells us, “for him it is important because before that he never went out of his home. Now he is becoming more confident”. “I came for reasons of faith but also out of curiosity”, observes Antonio, who goes to a 16 classical high school. “It is important to meet others who have the same problems as you, both from a human point of view and from a religious angle. I am happy: I went through the ‘Porta Santa’ and I even met a candid and sincere expression which is some friends of mine”. worth rivers of words. We ask him if he feels that he is a ‘privi- The faith and the devotion of this crowd leged’ pilgrim. “No”, he answers, almost de- which has come from all over the world is riding the idea. “I feel like everybody else. borne witness to, in addition to their de- Of course suffering increases your sensitivi- meanour, by their expressions, above all by ty. Above all else it is good to see so many their wish to be reconciled with the Lord. people working for the good of others”. For the whole of the Holy Mass, along the lateral naves of the basilica, next to the confessional boxes but also in the corners of the An Important Lesson church, sizeable groups of people could be seen waiting to engage in confession. But those who really do something for Forgiveness and indulgence, and nothing other people, we would like to tell Antonio, else, these pilgrims have come to ask for, as are people like him, who suffer but do not Archbishop Javier Lozano Barragán empha- disdain to distribute smiles. sised in his homily. He, instead, asked them This is an important lesson which Silvia to join their suffering to that of Christ, and to and Francesco have also absorbed. They are offer with him, in communion with Mary, respectively seventeen and eighteen years with the saints and the Pope, their pain and old, and we meet them in the basilica. They their prayer for the salvation of humanity seem to have carefree expressions on their “so that Christ shines with new light in this faces. They have also come to accompany new millennium”, and “so that atheism dis- sick people, and they have come from An- appears Ð a practice which is invading our cona. countries with secularisation”. “We have learnt many things”, they tell us “May passing through the ‘Porta Santa’ be with a sudden seriousness, “above all to re- for you a move from darkness into light, spect other people, and that we, given our from hatred to love, from injustice to justice, good health, are really very fortunate in- and from sadness to happiness”, also de- deed. Their suffering teaches us the real val- clared the Archbishop. ues of life; that is to say, they teach us to However, there was no sadness in the live”. faces of those thousands of people. Suffer- ing, certainly, but not sadness, Rather so ALESSANDRO IAPINO much light, so much hope, so much love, and so much sweetness. * From L’ Osservatore Romano, 12 February, 2000 DH n.45 ing 1-68 2.8.2001 15:41 Pagina 17

The Homily of H.E. Mons. Lozano Barragán in the Basilica of St. Paul’s Outside the Walls

I extend my greetings to all of you, bish- apostolic nature, we come to the Seat of Pe- ops, priests, professionals of health care, and ter so that the Pope himself can enable us to sick people, who have come from so many obtain the grace of mercy and complete for- countries of the world to meet Christ, source giveness. of health, during this Jubilee Year. This is the meaning of our pilgrimage. We There are many elements which accompa- have come resting ourselves on our two spe- ny us and help us to meet Christ during the cial feet, those of faith and love, of charity, Jubilee Year. The most important is that and after much effort and trial, given our Christ is the point of convergence of all men special condition, we have reached the Porta and that we must all go to him together. As a Santa. We have passed through it to show centre, he is the source of unity and commu- that we have passed from the darkness into nion. The date that we are celebrating today, the light, from hatred to love, from injustice 17 the two thousand years since the birth of to justice, and from sadness to joy, and we Christ, reminds us that Christ is the Lord of have reached the tomb of the apostles in this the history of the whole of humanity and of basilica of St. Paul’s Outside the Walls to ob- each and every one of us. The whole of the tain, by their intercession, full and complete life which we have passed finds its own hori- indulgence. We will repeat this action tomor- zon, its own centre, its own reason for being row in the basilica of St. Peter’s in the pres- in him. ence of the Holy Father John Paul II. To reach Christ two elements are neces- We have passed from sadness to joy. We sary: faith and love, which can be seen as the realise that this suffering of ours, our pains, two feet with which we walk towards this united to those of Christ in his passion and centrality of the Lord Jesus. In this way, re- glorious cross, are not elements which are pentant about everything that has distanced negative. Rather, Christ himself has taken us from him, we ask his forgiveness and in- them upon himself and transformed them indulgence. We also need humility to recog- to something positive, a source of joy, of re- nise our mistakes and our sins and to ask the demption, and of resurrection. Our trials have Lord that they may be forgiven. We also been transformed in this pilgrimage of the practice the virtue of hope as something Jubilee Year into a source of life. The aim of which is specifically Christian Ð we take this pilgrimage of ours has involved passing refuge in the mercy of God trusting in the merits of Christ, through whom the merits of the Most Holy Virgin and the Saints acquire value. We ask God to apply these merits to us in order to obtain our full love for his forgiveness. We have very great faith in the mediation of the Church so that our poor persons, need- ful of forgiveness and indulgence, can be participants in the merits of Christ, of the Most Holy Virgin, and of the Saints. We know that the Lord Jesus entrusted his apostles, led by Peter, with the power to forgive sins in his name, and that this power has been exercised in an alive way during the course of the whole of history, and that this will be the case until the end of the world through the bishops, guided by the Pope, as the successors of the apostolic college. We believe in the Church which is one, holy, Catholic and apostolic, and trusting in this DH n.45 ing 1-68 2.8.2001 15:41 Pagina 18

graces to all of you and to the whole of the Church. These gifts are forgiveness for the pains suffered for our sins, and they allow us to draw near lovingly even more to Christ in order to receive, thereby, full and complete indulgence. We have said that the fundamental steps to take to ensure that our pilgrimage bears fruit are faith and love, charity. Indeed, through them we can affirm that Christ is the source of our union, our communion, horizon, and centre. For this reason the Pope invites us to offer our suffering and our Jubilee prayers for two well-defined ends Ð so that Christ can be preached where he is not yet known and so that there is freedom to practice the Christian religion throughout the world. At this moment we offer all our trials, our suffering, and our pains so that Christ may shine with new light in this millennium 18 which is beginning, so that everywhere a new evangelisation may take place; so that through the Porta Santa, and this has meant practical atheism, which is invading so many to move from death to life. Such, then, is the of our countries with secularisation, can be full and complete indulgence to which we as- ended; so that the whole world may recog- pire Ð to always live in fullness of health, nise that there is no other saviour than Jesus; even when we are in pain and suffering. and so that all man may exercise their funda- Within the Church there exists what we mental right to believe in him and behave ac- call the Communion of Saints. That which cordingly in all the contexts of their lives. everyone does in life which is good, in virtue We need to bring Christ into such different of the merits of Christ, becomes a source of areas as the economy, politics, culture, and salvation for others. This takes places thanks the whole of society. Our prayer during this to the merits of the Most Holy Virgin Mary, Jubilee Year is that our illnesses, our suffer- of all the saints, and also of all of us, and es- ing and our pain, may become springs from pecially the sick. We live in close commu- which there comes real life for the whole of nion and unity with the Church. This is the mankind. one and holy Church, in her universality and May the Most Holy Virgin, the great Porta Catholic nature, which, thanks to the apos- Santa of the history of salvation, help us to tolic force, is transformed for everybody into pass through this door to encounter her Son a source of salvation, naturally enough be- Jesus Christ, medicine of all our illnesses ginning with Christ, the one and only Sav- and treatment for all our pains! In this Ju- iour. bilee Year we will thus find Christ the Divine Today, in this vigil of prayer, I exhort all of Physician who gives us happiness. you, and in particular those who are sick, to offer your sufferings and your pain to Christ H.E. Mons. JAVIER LOZANO BARRAGÁN so that he may take them upon himself. In- Archbishop-Bishop Emeritus of Zacatecas, President of the Pontifical Council deed, he has already taken them upon him- for Health Pastoral Care. self, and beginning with them, he extends his The Holy See DH n.45 ing 1-68 2.8.2001 15:41 Pagina 19

Jubilee Day of the Sick and Health Care Workers

‘Health Care Workers and the Challenges of the Third Millennium’

The Congress of the Bishops Responsible for Health Pastoral Care, and Catholic Associations Engaged in Health Pastoral Care

9 February 2000 The New Synod Hall The Vatican DH n.45 ing 1-68 2.8.2001 15:41 Pagina 20

Speech of Greeting to the Joint Conference of Professionals of Health

Within the context of the cel- As you yourselves are prob- ebrations of the Great Jubilee ably aware, the presence of of the year 2000, I have great people at this conference is pleasure in celebrating this based on selection. All of you conference which is of great come in your own names, it is importance for all profession- true, but at the same time you als of the world of health. I also represent the other profes- would like to express my cor- sionals of the health care sec- dial welcome to all of you: tor of which you are a part. bishops, medical doctors, male And it is through you and your and female nurses, pharmacists various different organisations and voluntary workers. I wish that the results of this confer- and hope that our meeting will ence must reach all the other bring to all of you one of the members of your various pro- 20 most important fruits for the fessions. You thus bear the re- health care ministry, as a be- sponsibility for many other ginning to this third millenni- people who have not been able um. to be present at this confer- In this conference we will can study, in particular, its own ence, even though they wanted work in the same spirit as the questions and issues and offer to attend, because for reasons Jubilee, whose aim is to place those solutions which it thinks of space it was not possible to Christ at the centre of history, are most suitable; during the extend the invitation to a of times, and of the cosmos. second we will meet for an ex- greater number of people. The form that we will follow change of the various solutions Your presence is thus a very for a real and authentic health which have been proposed and qualified one, and this places care ministry will be that of to achieve an overall vision. you in a position of great re- placing Christ at the centre of Bishops, priests, medical sponsibility with regard to the medicine in all its expressions. doctors, male and female nurs- evangelisation of medicine in Faced with the questions and es, and pharmacists Ð each of the specific place in which you difficulties which now affect these categories will have a work and practice your profes- the various categories of health separate place to study the sub- sion. care professionals and which ject matter with which it is May the Most Holy Virgin, are often the consequences of concerned. The method which the great ‘Porta Santa’ through the globalisation of the econo- we will follow will be very which Christ came into the my, we propose a new model simple Ð meetings which will world and through whom we of medicine whose goal, end outline the question and indi- pass in order to reach him dur- and horizon are Christ alone. cate relevant solutions, and ing this Jubilee Year, accompa- It is within this trajectory discussions within the same ny us during this first act of our that we have located the sub- group in a sort of forum. In Jubilee Day of the Sick so that ject of this conference: the each group there will be a sec- we may place Christ at the cen- identity and the challenges retary who will write down tre of all our lives, both at a which are faced during the new what has emerged during the personal level and in the pro- millennium by those responsi- discussion and then present it fession to which we belong, in ble for the health care ministry, during the second part of our order to offer to today’s society medical doctors, and pharma- meeting. In this way the whole a light on how to reach full cists, all those, that is to say, of the assembly will be able to health in a world in which har- who in one way or another, are know the results of the studies mony is often destroyed and concerned with this sector of each sector of the various solidarity profoundly wound- which is so important in the professions of the field of ed, having the effect, in partic- life of today’s world. health and the intended overall ular, of marginalising those Given the complexity of the vision will thereby be who are most poor and the subject, the deliberations of the achieved. We wish and hope to sick! conference will, with the help be able subsequently to proof God, be organised in two duce a publication of this first H.E. Mons. JAVIER LOZANO parts Ð one which is analytical general study of the health care BARRAGÁN, and one which is summarising. ministry to be engaged in dur- Archbishop-Bishop ing this millennium, and the re- Emeritus of Zacatecas, During the first we will divide President of the Pontifical Council ourselves into groups so that sults will then be available for for Health Pastoral Care. each sector of professionals use within the Church. the Holy See DH n.45 ing 1-68 2.8.2001 15:41 Pagina 21

National Episcopal, Diocesan and Parish Co-ordinating Bodies for Pastoral Care in Health*

The Goals and Workings Christian concept of the health care in health changes accord- of Co-ordinating Bodies of the human person in the per- ing to the context of the social for Pastoral Care in Health formance of the mission en- policy of each specific country trusted to that person by God, a which is practiced towards the First of all, there must be a mission which changes accord- sick person. There are countries clear definition of the real na- ing to the individual’s stage of where such action primarily in- ture of a national episcopal life. volves the provision of basic co-ordinating body for pastoral The work of health care health care to sick people in care in health, and this defini- workers, therefore, must be di- their homes or in private or tion must begin with an aware- rected towards ensuring that Catholic hospitals. In other ness of its goals and ends. Such each person has that health countries such action chiefly in- a body must express the care which is necessary to the fulfill- volves the organisation of the and concern of the Church for ment of his or her mission dur- best forms of assistance possi- the infirm because it is con- ing that stage of his or her life ble for sick people in govern- cerned with health care workers which is being being led at that ment-administered health cen- and their pastoral action. It particular time. tres. And in yet others emphasis 21 must know that this action is is placed upon providing help to motivated by compassion and b. The Meaning of Pain sick people in their homes after should want such compassion they have been discharged from to meet the new needs which Pain must be seen and experi- health centres or similar institu- arise in an ever more effective enced from the starting point of tions. fashion. the pain of Christ. Christ re- The co-ordinating body for deems through pain and releases c.2. The Bioethical Aspect pastoral care in health, there- us in definitive fashion from it. With regard to the question of fore, will have health care We know that this is the mean- the origins of life, the basic workers as its targets, and in or- ing of his redemptive death and principle continues to be that der to summarise the action resurrection. human life is a gift of God and which it must engage in, it may The projected co-ordinating should be treated as such. The be said that its goals are as fol- body for pastoral care in health way in which God wants this lows: to express the care of the must illuminate the real concept gift to be transmitted is in the Church for the infirm and help of health in the light of the pain highest form of love, that is to those who serve the sick and the experienced by Christ, and pro- say the conjugal love of two suffering so that the apostolate vide it with that perspective marriage partners within the of compassion which they seek which is not to be found in con- family. Everything that contra- meets new needs in an ever temporary secular approaches dicts this principle is unaccept- more effective way. to the subject. able from a moral point of view. The question arises as to how The same principle applies to this should be put into practice. c. Adjustment to the Times euthanasia. Life is a gift of God To this we can respond with and as a consequence man can- four programmes of action un- The pastoral activity of the not take it from another inno- der the headings of doctrine, health care worker must be ad- cent man. co-operation, promotion, and justed to the times. Nowadays accompanying. there are a vast number of prob- c.3. Health Education lems and difficulties which re- People must be educated to quire suitable solutions. Refer- embrace the cause of humanisa- 1. Doctrine ence can be made here, for ex- tion and of quality of life Ð the ample, to the impact of globali- so-called “QALYS” (quality The co-ordinating body for sation and its consequences for adjusted life years system). We pastoral care in health must pastoral care in health. At this understand the concept of have first and foremost a doctri- point only three contemporary QALYS in the following way: in nal task Ð it must inform people questions will be examined, meeting the need for quality of about the Christian meaning of questions which are of immedi- life one must take into consider- health, illness and human pain, ate importance for those people ation not only the quantity of and it must do this by taking in- who are active in the field of years that a person lives but also to consideration the new times pastoral care in health. These their quality, and this quality is in which we live. three questions are: the sociali- assessed not only in terms of the sation of health, bioethics, and economic resources which are a. Health health education. available but also in relation to those resources of a family, en- Physical, mental, social and c.1. The Socialisation vironmental and spiritual etc. spiritual wellbeing are of funda- of Health character which make life useful mental importance for the The action taken by pastoral for the individual himself or her- DH n.45 ing 1-68 2.8.2001 15:41 Pagina 22

self and for those around him or provides a Christian meaning to tive in the field of pastoral care her Ð a life which successfully health and illness and is con- in health which are to be found performs that mission which has cerned with all the questions, is- in the episcopal conferences. been given to it by God. sues and difficulties which are connected to this meaning. This h. Pharmacists is done at the same level and in The Catholic pharmacist has 2. Co-operation the same area as all the other a very great role to play when it health care workers: medical comes to the provision of suit- The national co-ordinating doctors, nurses, hospital admin- able drugs and medicines. He or body for pastoral care in health istrators, pharmacists and so she also has important responsi- should co-operate with the local forth. bilities with regard to the con- Churches and in the dioceses, trol and supervision of drugs and must provide spiritual assis- d. Female Members and medicines, especially in the tance to health care workers, not of Religious Orders case of chemical precursors and least by supplying them with The responsibilities of male synthetic drugs. the necessary forms of relevant and female religious are becom- support and back-up. ing increasingly difficult in the i. Voluntary Workers hospital world, and in some Today there are many other These are the principal countries the vocations in the kinds of pastoral workers in health care workers: sphere of pastoral care in health health in many parts of the are decreasing. However, today world and they are called Chris- a. The Parishes more than ever before it is nec- tian health care voluntary work- In order to be effective in essary for male and female ers. These are real apostles of practical terms, pastoral care members of religious orders to compassion towards the sick. 22 with reference to health care be present in these places, both workers must be organised because the spiritual approach j. Health Care Authorities within the local parish itself. in the health field is gaining When dealing with the area What has already been said in new ground and because the of health care authorities, refer- this paper about doctrine, secularisation of the world of ence must be made in each co-operation, promotion and ac- medicine is something which is country to that country’s Min- companying in relation to pas- becoming increasingly acute. istry of Health. Where possible toral care in health must be put or where opportune the Church into practice in ways which are e. Medical Doctors must have a representative who suited to the specific character Catholic medical doctors are co-ordinates her pastoral action, of each individual parish. organised at both an internation- or at the very least the relations al and a national level. We must which exist between the nation- b. Catholic Hospitals help them to strengthen their al co-ordinating body for pas- The criteria to be employed union. They are agents who are toral care in health and this to decide whether a hospital can of determining importance for Ministry must be of such a char- really describe itself as being pastoral action in the world of acter as to promote the incultur- Catholic or not are as follows: health and health care. They ation of the message of the whether it continues or does not must recognise and uphold Gospels in the implementation continue the healing ministry of medical ethics to the full and of health care policies. Christ in today’s world; whether their work must go beyond the or not it expresses the Magis- mere exercise of a profession. Subsidiarity terium of the Church in its pro- Their mission is to be heralds of vision of overall pastoral care in the culture of life in the face of The function of the national health; and whether or not it is the devastating currents of the episcopal co-ordinating body accepted as being a Catholic culture of death, and this is es- for pastoral care in health must hospital by the relevant ecclesi- pecially the case with regard to be to serve and help the various atical authority (cf Can. 300). the medical questions and is- dioceses and thus the various The Catholic hospital must ac- sues raised by genetic engineer- bishops as well. Its function, cept the Magisterium of the ing and euthanasia. therefore, should not be to take Church both in relation to the place of pastors in the dis- health and health care questions g. Male and Female Nurses charge of their duties in the dio- in the narrow sense Ð and in Nurses play a very important ceses, but rather to help and particular with regard to the be- part in pastoral care in health, support them. We can thus af- ginning and end of life Ð and in and this is especially true today firm that its work should be of a relation to economic issues as a when we have before us the subsidiary character and that the whole. abandonment by female reli- help which it supplies must in- gious of the world of hospitals. volve the promotion, co-ordina- c. Hospital Chaplains It is therefore nurses who tion and direction of pastoral The figure of the hospital should shoulder the responsibil- care in health in every diocese. chaplain or of the chaplain who ity for pastoral care provided to belongs to any other kind of patients during the daily routine health care centre is becoming of hospital treatment and med- 3. Promotion increasingly important. Where- ical care. The ethical and pro- as previously the chaplain confessional training of Catholic The co-ordinating body for fined himself to pastoral care in nurses is of the very greatest pastoral care in health must help the sacramental sense of sick importance and should be pro- and support national Catholic people, it is now the case that he moted by the various bodies ac- organisations which are in- DH n.45 ing 1-68 2.8.2001 15:41 Pagina 23

volved in pastoral care in health a. Legal Aspects this is possible, can avoid the in both their theoretical and pitfalls of bureaucracy. their practical activities. The action of the national co-ordinating body must also d. Emerging Illnesses a. Foundations address itself to the faculties of and Sanctuaries law of the universities Ð and in In each country there must be particular to those which be- a clear awareness of what these It is very important to encour- long to Catholic universities Ð pressing scourges are. In some age relationships with founda- in order to train and instruct the places one is dealing with tions which can finance, or offer legal conscience of future malaria, in others AIDS, and in patronage to, work which should lawyers who will work in the others drugs, leprosy, tuberculo- be performed, and the same may medical field. sis, cancer, excessive smoking be said of sanctuaries, and espe- and so forth. cially Marian sanctuaries Ð insti- b. Scientific Aspects tutions which have a special relationship with the sick and The centres of bioethics re- Conclusion which can help people in both a quire special attention because spiritual and economic sense. of their research, the results of In this paper an attempt has this research which are offered been made to offer certain ideas b. Faculties of Medicine to the general public, and the about how to define the goals approaches and orientations and workings of a national A national co-ordinating which accompany such results. co-ordinating body for pastoral body for pastoral care in health Here what has been said about care in health acting within an should play an orientating and the legal aspects of parliamen- episcopal conference, and in directive role with regard to the tary bills on the subject, for ex- suitably adjusted fashion to do 23 Catholic faculties of medicine ample on cloning, comes into the same with regard to similar in its own country. The same di- play. The experiments carried bodies acting within dioceses rective function is also needed out in laboratories and the and parishes. Just as the func- with regard to the committees questions and issues raised by tion of this Ministry is to for bioethics Ð organisms which drugs and medicines Ð particu- achieve ecclesial communion in are greatly growing in number larly those created by laborato- the sphere of pastoral care in at the present time. ries Ð are of special impor- health, so the objective of every tance. national episcopal co-ordinating c. Other Organisations body for pastoral care in health c. The Socialisation should be the promotion of this Organisations such as the of Health Care communion in this field by the Red Cross, for example, must local Churches, and these latter learn that they have the support Another question which has should act as a support for the of the national co-ordinating already been referred to in this pastoral care provided by the body for pastoral care in health. paper is that of the socialisation dioceses. The same may be said for the of health services. The envis- As will have been noted, this other organisations which di- aged national co-ordinating paper has sought to establish an rectly promote or direct health body must pay especial atten- analogy between the Pontifical care centres or institutions, such tion to the practical expression Council for Pastoral Assistance as Caritas or certain special of such socialisation in each to Health Care Workers and foundations. country. It must strive to resolve episcopal co-ordinating bodies the bureaucratic problems infor pastoral care in health at na- Support: volved in this process of sociali- tional, diocesan and parish lev- sation and open up the road to a els, and has done this with full Support for these institutions greater efficiency which, where awareness of the need for varia- means promoting and co-ordi- tions in their character accord- nating where possible Ð and di- ing to the level at which they recting according to the eccle- operate. These are suggestions sial Magisterium Ð not only the and guidelines which have been faculties of medicine of univer- made for episcopal conferences. sities but also other institutions. Each conference must find the This direction can take place by most effective way by which to fostering a dialogue between establish its own co-ordinating them and the national co-ordi- body, and every diocese must do nating body. that which it believes to be most opportune for its own situation.

4. Accompanying H.E. Mons. JAVIER LOZANO BARRAGÁN The national co-ordinating President of the Pontifical Council for body for pastoral care in health Health Pastoral Care should follow scientific and legislative innovations in order to illuminate them from the starting * This text is made up of selected parts of the article by H.E. Mons. Lozano Bar- point of the pastoral action of the ragán which was published in Dolentium Church in the health care field. Hominum n.41/II-1999. DH n.45 ing 1-68 2.8.2001 15:41 Pagina 24

The Pontifical Council for Health Pastoral Care 1985-2000

1. What is the of voluntary workers who are the Members, to the Consultors, Pontifical Council? present during office hours. to the Experts, and to the voluntary workers. All of them, with 1. An important date. 11 Feb- prestige, effectiveness, efficien- ruary 1985 is an important date 2. The Activity of the cy and intelligence made possi- for the Church, for the sick, for Pontifical Council ble the immense work of this religious institutions, and for all first stage of the Pontifical health care workers. By the Pa- a. The First Stage, 1985-1996: Council. pal Motu Proprio “Dolentium Twelve Years of Activity Hominum”, His Holiness John b. The Second Stage, Paul II established the Pontifical This is a period which covers January 1997... Commission for Pastoral Assis- the birth of the Pontifical Coun- tance to Health Care Workers. cil, a stage of creativity and the This second stage covers the Three years later, with the re- first initiatives at the level of or- period of the changeover in form of the Roman Curia (C.A. ganisation. presidents: H.E. Mons. Javier 24 Pastor Bonus, 28 June 1988), The creativity was immense Lozano Barragán took the place this Pontifical Commission be- under the presidency of Cardi- of Cardinal Angelini. The new came the Pontifical Council for nal Angelini. The Pontifical president followed the work Pastoral Assistance to Health Council was a new instrument. which was underway with great Care Workers, obtaining thereby With regard to the institution attention. The Plenary Assem- the autonomy that an Apostolic and its functions, it was a matter bly of the Ministry was held on Constitution gives to all the of beginning from scratch. The 9-11 March 1998. All the Mem- Ministries belonging to the Ro- salient features of these early bers and some of the Consultors man Curia. years were: the setting up of the took part in this meeting. The 2. The motivations that lay be- review Dolentium Hominum to fruit of this IV Plenary Assem- hind the Pope’s creation of this be published in four languages; bly was the new work plan of Ministry. The Apostolic Letter a large number of journeys the Pontifical Council for Pas- indicates, amongst other things, abroad to learn about health toral Assistance to Health Care the following motivations: the care and pastoral realities in for- Workers, a valuable instrument care and concern of the Church eign countries; taking part in for the daily work of the Min- for the man who suffers, the various congresses; the interna- istry. This work plan was ap- great advances achieved by tional conference organised by proved by the Holy Father and medicine, and the need to co-or- the Pontifical Council Ð a plat- included forty-seven pro- dinate all the bodies which dedi- form for health care and pas- grammes organised around the cate themselves to the world of toral culture; the World Day of ministries of the Word, of Sanc- health because individual action the Sick; close relations with tification, and of Communion, on its own is not enough. Hence the local Churches, with the fos- and which were entrusted to the the need for joint, intelligent, tering of structures for the eighteen individuals who make planned, constant and generous health care ministry within up the Pontifical Council: Su- work. them; visits ad limina; relations periors, Officials, and collabo- 3. Tasks. The principal tasks with the World Health Organi- rators. In order to ensure that it entrusted to the Pontifical Coun- sation (WHO) and other such was known about, this work cil are the following: to foster, bodies; the publication of books plan was published and distrib- promote, co-ordinate, and co-op- and pamphlets which could act uted to the heads of the Min- erate with the local Churches as instruments of work and istries of the Roman Curia, to and carefully follow health care stimulation; and lastly, the in- the Episcopal Conferences, and programmes and their conse- tense and increasing activity of in particular to bishops respon- quences within the context of the the Secretariat. These were sible for the health care min- pastoral care of the Church. years of fruitful work, years, we istry. 4. Organisation. The Presi- could say, when foundations Through this new planning of dent: H.E. Mons. Javier Lozano were established and roads its work, the Pontifical Council Barragán; the Secretary: H.E. opened up, years in which im- wanted to respond in a more ef- Mons. José L.Redrado O.H.; the portant goals were reached for fective way to the mission en- Under-Secretary: Rev. Felice the health care ministry within trusted to it by the Holy Father Ð Ruffini, M.I. The Council has the universal Church. to be a help to his valuable thirty-four Members who repre- The work was the fruit of in- Petrine ministry in the specific sent the different Ministries of spired leaders who were its en- field of health and of health care. the Roman Curia and religious gine, but also of all those who In the drawing up of the work health care institutions. There worked day by day carrying out plan the point of reference em- are also forty-eight Consultors their mission with effectiveness ployed was the original Motu and a Secretariat made up of a and efficiency. We refer here to Proprio Dolentium Hominum number of Officials and a group all the staff of the Secretariat, to which established the Ministry, DH n.45 ing 1-68 2.8.2001 15:41 Pagina 25

Word, which contains eleven The above mentioned programmes, the Pontifical forty-seven programmes were Council established the follow- implemented with great care by ing objective: “to commemorate all the component parts of the the incarnation of the Word by Ministry. The results were very enlightening health care cultures satisfactory and confirm that the through the signs of the Jubilee: planning of the work matched Pilgrimage, the Holy Door and the objectives fixed for 2000. Indulgence.” To conclude, we would like to In relation to the ministry of mention certain relevant fea- sanctification, which has seven tures of the activity of the Min- programmes, the objective was istry carried out during the the following: “the sanctifica- course of 1999 and the first part tion of the sick person and of the of 2000. world of health in general 1. The celebration of the through the three signs of the World Day of the Sick in the Jubilee: Pilgrimage, the Holy Lebanon on 11 February. Door, and Indulgence.” 2. A large number of In relation to the ministry of inter-Ministerial meetings in and the Apostolic Constitution communion, which has twen- which the Superiors or the Offi- Pastor Bonus. It thus also there- ty-nine programmes to be imple- cials of the Ministry took part. by referred to the Christian mented, the objective was the 3. Participation at various meaning of suffering and life, following: “to obtain the unifica- congresses and meetings: of the the Apostolic Letter Salvificis tion of the health care ministry WHO, Unitalsi, the Academy Doloris, and the Encyclical throughout the world through for Life, on AIDS (Argentina), 25 Evangelium Vitae. the sings of the Jubilee: Pilgrim- in Morocco, Poland, etc. In formulating the practical age, the Holy Door and Indul- 4. Visits by ad limina bishops directions and concerns of the gence.” to the Ministry. general work plan, particular at- In order to achieve the goal 5. Various congresses organ- tention was paid to the sugges- established by the Ministry with ised by the Ministry: tions and the observations made regard to the ministry of the * 1-2 July: on Catholic hospi- by the Apostolic Letter Tertio Word, the following initiatives tals; Millennio Adveniente and by the were taken: an attempt was * 18-20 November: the inter- Charter for Health Care Work- made to promote the meaning of national conference on “the ers. life and suffering, and the mean- economy and health”; Beginning with these doctri- ing of nature and its manipula- * 22-23 November: the sym- nal premises, the Pontifical tion, by explaining them, spread- posium on Catholic chaplains in Council drew up its own work ing and publicising them, and hospitals; plan with reference to four key making them known to every- * 9-11 December: the sympo- elements: its purpose, its poli- body, in particular to bishops sium on AIDS; cies, its forms of action, and its during their ad limina visits or * 15 January 2000, Sympo- programmes. temporary visits to Rome. In this sium of the Leper; area great help was obtained by * 7-12 February 2000, The the celebration of the XIV inter- Great Jubilee of the Sick; The Purpose of the Ministry national conference held by the * 28 March 2000, The Great Pontifical Council, the publica- Jubilee of the Dentists; On the basis of what has been tion of the review Dolentium * 4 April 2000, International described above, the general Hominum, the participation of Congress, Healing the Body and goal of the Pontifical Council the Officials of the Ministry at Saving the Soul; was established with particular various congresses and meet- * 6 April 2000, Second Annu- reference to this time of the ings, ad limina visits etc. al Pan-American Catholic Great Jubilee of the year 2000, With respect to the evangeli- Healthcare Dialogue; and that general goal was as fol- sation of faculties of medicine, * 2-3 June 2000, Symposium, lows: “to commemorate the In- the Pontifical Council always the Sacraments in Pastoral carnation of the Word in line tries to be in contact with the Healthcare. with the Bull “Incarnationis most important Catholic facul- 6. Publishing activity, which Mysterium”, to enlighten health ties of medicine, of pharmacy, centred around the publication of care cultures with the Gospel, to and of law, with a view to pro- the journal of the Pontifical sanctify the sick person and the moting specific courses in the Council, Dolentium Hominum, in health care context in general, future. The other programmes four languages. And for the Ju- and to achieve the unification of promoted with great care in the bilee World Day of the Sick, the health care throughout the world sector of the Word concerned book Curate Infirmos. in the whole Church”. the following areas: publica- Of course behind all this actions, the World Health Organi- tivity there lies the daily, and al- sation, the pastoral handbook ways intense, work of the Secre- The Work of the Ministry for drug-addicts, pastoral guid- tariat. ance in health matters, confer- Regarding the practical level, ences, the international confer- H.E. Mons. JOSÉ L.REDRADO in order to reach this goal, and ence of the Pontifical Council, O.H. taking into account the specific research, teaching centres, and Secretary of the Pontifical Council objectives of the ministry of the special “dossiers”. for Health Pastoral Care DH n.45 ing 1-68 2.8.2001 15:41 Pagina 26

Catholic Doctors’ Challenges and the New Millennium

1. Changes in academic success is often se- wonderful possibilities for bet- medical profession cured by the ability of the doc- ter diagnoses and treatments. tor to further specialise in un- However, apart from the eth- The medical profession has covered fields, trying to be- ical dilemma, posed by tech- changed tremendously during come the number one of a lit- nology, as for example in the the last fifty years of the 20th tle domain. field of artificial reproductive Century. This has been due, in There is a joke, defining the technology, some doctors un- part, to the revolution imposed specialist as the doctor who consciously got the wrong by the expanding knowledge in knows more and more on less message that it was possible to biomedical sciences and, in and less things, to the point of solve most of the problems of part, to the dramatic changes in knowing everything about the patient by simply depend- society, which could not be nothing. Of course, this joke ing on machines. Thus, com- without consequences for med- contains a paradox, but certain- munication with the patient has ical doctors. ly also a fair amount of truth. been considered less and less It is not surprising that med- important, even with regard to 26 a. The increase in scientific ical students are often unable the establishment of personal knowledge in biomedical to consider the patient as a unit histories and physical exami- sciences and the process of body, mind and soul, but nation, thereby losing great op- of hyperspecialization have instead a distorted vision portunities for using communi- of a mere assemblage of or- cation as a therapy in itself. The increase in scientific gans and tissues. A vision that The extreme of this anony- knowledge in biomedical sci- is reinforced by the undoubted mous and impersonal approach ences continues at an expand- successes of transplant medi- of the patient-doctor relation- ing pace. As a result, the num- cine, which urge us to wonder ship is shown by the increasing ber of medical journals has in- where the principle of unity number of web pages where creased to the point that the im- regulating that organ assem- patients can have access to pre- possibility of reading the entire blage is located. sent their complaints and re- scientific production, even in The rate of increase in scien- ceive suggestions for diagnos- very specific areas, is taken for tific knowledge is so fast that tic procedures and pharmaco- granted and there is a prolifera- there is no time to metabolise logical treatment. Internet is a tion of journals offering ab- it and nobody seems to be able wonderful instrument by which stracts or short versions of the to attempt the organisation of to facilitate communication be- full articles, on paper or on the new items of knowledge tween doctors living in differ- line. Certainly, this is not the into a harmonic and coherent ent parts of the world. In addi- single cause of the process of picture. tion, it is a magnificent tool for hyperspecialization that is continuing medical education, modifying the medical profes- b. The technological with possibility of access to sion, but may be one of the invasion of medicine major libraries and journals, most important, together with the only limitation being time the idea that, working as a spe- The second part of the 20th (the joke says that Internet is an cialist, it is possible to make century has also been the era of instrument for insomniacs and more money, compared with the technological invasion of the unemployed). On the other general practitioners. medicine. A realm of measur- side, communication through Hyperspecialization is trans- able events has substituted the computers certainly cannot be forming the medical profes- old medical art, made up of ob- considered as a substitute for sion, substituting the holistic servational abilities, skilful the tête-à-tête encounter be- approach, i.e. the approach hands and wisdom. As a re- tween patient and doctor, de- that takes care of the person sult, the access to technology is spite the real business that is entirely, including his physi- the most important requisite behind this kind of operations. cal, mental and spiritual needs, conditioning success. to a practice based on organ Technology is a crucial ele- c. The expansion of the pathology. This long lasting ment, undermining even the alternative medicines development influences med- budgets of economically de- ical schools also, where inter- veloped societies and discrim- It is not surprising therefore nal medicine has been frag- inating people of different that an increasing number of mented into a series of teach- countries in terms of their right people are turning their backs ings based on organ patholo- to have access to high quality on impersonal medicine and gy. The process seems to have standards of assistance. Of search for relief to their com- no end, since it also affects course, technological develop- plaints in so-called alternative specialist disciplines, in which ment has certainly created new medicines. DH n.45 ing 1-68 2.8.2001 15:41 Pagina 27

In a society that has expelled ly to happen especially in the changes at the level of the pa- traditional faith, the heritage of care of chronic disabling tient-doctor relationship. Our centuries and the fundamentals pathologies, in which current profession, however, is also of modern civilisation, we ob- treatments are not able to stop challenged by external factors, serve an invasion of sects, ma- the progression of the disease the most dramatic one being gicians and vague new age and are the cause of very se- probably the increasing em- spiritualism. The same is hap- vere side effects, as in the case phasis on the limitation of re- pening to medicine. More and of many types of cancer and of sources. more people are turning their multiple sclerosis. backs on cold and impersonal Last year Italy was agitated f.1. The limits of resources medicine, which is unable to by demonstrations of oncologic in affluent societies take care of the patient in all patients and their families, re- Needs and resources are the his dimensions, and prefer questing the possibility of de- heart of the economic relation- kinds of interventions that, deciding a treatment alternative to ship in health policy, but they spite any evidence of real ef- standardised chemotherapy. I are characterised by an internal fectiveness, nevertheless show refer to the case of the so-called tension that can lead to a diffi- an almost sacred charisma. Di Bella Therapy, which was culty of choice, to an impasse. Pranotherapy, Tibetan medi- largely diffused by the media. On the one hand, it is clear that cine, herbs and powders of pre- This alternative therapy was re- health has a cost, but, on the Columbian cultures, healing quested on the basis of anecdo- other hand, health is a priceless powers: very different ap- tal cases and Dr. Di Bella’s possession. For this reason, proaches, unified by the fact charisma, despite the lack of health pressure can be poten- that the specific therapy is less any solid scientific evidence of tially subversive for an eco- important than the contact with efficacy. Under the pressure of nomic system, since it tends to 27 the therapist, who is endowed the demonstrations, the govern- spend the most, to satisfy the with a special healing flow. ment was compelled to autho- maximum of needs. The invasion of alternative rise payment for the unortho- medicines should raise impor- dox therapy by the National tant questions for medical doc- Health Service. The Di Bella tors, who should ask them- case showed, on a national selves why they have lost wide basis, that the asymmetric charisma and how they have relationship of the doctor with lived their relationship with pa- his patient had ended and that tients. Instead, very often there paternalism had been substitut- is only a manifestation of ratio- ed by the patient’s autonomy. nalistic disgust, typical of the man of science closed in his e. The conflict between ivory tower. The same attitude patient and doctor is sometimes manifested towards new professions, like for This brings us to a second example chiropractors, or aspect. If paternalism was cer- acupuncturists, despite the fact tainly wrong, autonomy runs that their modalities of inter- the risk of degenerating into vention are much more under- frequent conflicts. In fact, mu- To bypass the obstacle, standable for those who have tual trust is increasingly substi- health authorities have been received traditional medical tuted by legitimate suspicion, limiting the role of public fi- education. with the patient and the doctor nances in health assistance: the considering each other a poten- welfare state has been criti- d. The patient’s autonomy tial enemy. Medical interven- cised and is under revision all and freedom of choice tion should be effective under over the world. However, once any circumstance. The conse- the budget becomes the most Continuing our reflection on quences are the enormous important concern, new moral the changes in the doctor-pa- business of insurance, the issues come to our attention. tient relationship, two more as- transformation and perversion Affluent societies permit the pects need our attention. First, of the forms for informed con- scandal of having a large part of there is an increased request sent, from instruments for cor- their population without cover- for freedom of choice by our rect information into bureau- age of basic health needs. The patients. This is not only in the cracy for the protection of the value of human life can come to case of immoral procedures, doctor. In my country, a so- depend on age, with the access like abortion, or in the case of called Tribunal for the Rights to expensive procedures denied the refusal of common prac- of the Patient is active in every to elderly people. Free access to tices by certain minorities, hospital. The name “Tribunal” certain expansive diagnostic such as hemotransfusion by Je- is self-explanatory about the procedures can become so re- hovah’s witnesses, but also in underlying mentality. stricted in reality that whenever cases where the patient selects the examination is urgent, the modalities of treatment that are f. The allocation of resources patient is de facto compelled to not sufficiently validated by pay and therefore discriminated scientific research. This is like- These are some of the according to income. DH n.45 ing 1-68 2.8.2001 15:41 Pagina 28

f.2. The lack of resources ter discussion and consensus h. Ageing and denatality in developing countries conferences, lead to the pro- If this is happening to health duction of diagnostic and ther- The explosive combination systems in post-industrial soci- apeutic protocols or guidelines. of ageing and denatality may eties, in the developing coun- These are created by medical provoke the financial collapse tries we continue to witness doctors for other medical doc- of health systems and modify biblical calamities afflicting tors. However, guidelines and the type of patient and the clin- poor societies, devastated by protocols are more and more ical problems that the physi- maternal and infantile mortali- often produced also by health cian will meet in the near fu- ty, malnutrition, old and new authorities, for example to di- ture. Despite the general con- infections, without local re- rect medical profession accord- sensus about the risks, not only sources to be used for health ing to the availability of re- medical, of an old society assistance and with external sources. This leads to an in- without children, the aggres- aid conditioned by the accep- creasing pressure upon med- sion towards life at its begin- tance of programs for birth ical doctors, with possible lim- ning and at its very end contin- control, while pharmaceutical itations on their diagnostic or ues, following the trend inau- companies have no interest in therapeutic freedom. gurated in the second part of producing drugs to cure the the 20th century with mass diseases of the poor. g. The end of the centrality contraception, with legislation of hospitals on legal abortion in many f.3 The medicine of desires countries and with the first On the contrary, in affluent The limitation of resources laws on euthanasia. societies, for those who can af- for health systems in affluent Our societies are not yet ful- 28 ford the costs, there is the ex- societies is pushing in the di- ly aware of the danger of anti- plosion of a kind of medicine rection of a giant trend that will natal mentalities. In the name based on personal desires. change the idea itself of west- of progress and of its superior Aesthetic surgery, sex ern medicine, based on the interests, pressures in favour of changes, cosmetic dermatol- centrality of the hospitals. The a change by an inversion of ogy, strange dietetic regimes hospital is no longer the house current cultural sexual trends, are examples of a medicine of hospitality, it is becoming familial policies, and fiscal based on desires. Doctors agree only a place for the diagnosis laws are considered to be not to be involved with procedures and treatment of acute diseases politically correct and anti-na- that have little to do with the that cannot be dealt with in an tal practices continue. relief of human sufferings. The outpatient clinic. contradiction becomes even Nursing homes, residential i. The manipulations more striking when systems homes, and rehabilitation cen- of human life compelled to limit the health tres are considered to be more services offered to the general convenient than hospitals for Finally, at the turn of the population nevertheless contin- the care of chronic and dis- millennium, we have had the ue to reserve part of their bud- abling diseases, which there- privilege of witnessing a won- gets to the satisfaction of per- fore are pushed out of the hos- derful expansion of knowledge sonal desires. In this very city pital. Emphasis is placed on about human reproduction, of Rome, the quality of onco- the advantages of bringing foreseeing possible future ap- logic assistance outside hospi- medical and nursing assistance plications in the treatment of tals is rather insufficient and directly into the patient’s genetic diseases, which previ- patients are told that resources home, forgetting the difficul- ously had no chance of inter- are insufficient to improve the ties experienced in the assis- vention. As always with sci- service. However, you can tance of chronic patients by to- ence, the applications of mar- change your sex at zero cost in day’s fragile families, exposed vellous scientific discoveries a public hospital in Rome. to rupture, with few or no chil- can be diverted, without strong dren and with no adults at moral issues, into instruments f.4. The Evidence Based home. More and more often in of oppression against human Medicine (EBM) the future we will be confront- beings. Knowledge about hu- The problem of the alloca- ed with a situation of people in man reproduction is now faced tion of resources is not only at need living completely alone, by a parallel expansion of the macroeconomic level, but but our medical schools con- threatening manipulations of it involves the physician in his tinue to pay very little attention human life. personal activity too. To give to educational programs fo- The elimination of embryos just one example, it is more cused on chronic disabling dis- has already taken place, pro- and more common to hear eases with a strong social im- duced in excess in order to in- about so-called Evidence pact. crease the probability of out- Based Medicine. This is in part Particular attention will be come of in vitro fertilisation. the attempt of the scientific requested by the centres for Genetic knowledge is increas- community to found medical palliative cares, where only the ing the number of the condi- profession on solid bases, ex- presence of people who love tions by which it is possible to plicating the criteria of behav- life will be able to offer a achieve a pre-implant diagno- iour. Peer reviewed publica- meaning to the death of people sis, with the consequent genet- tions and experts’ opinions, af- alone with their disease. ic selection and elimination of DH n.45 ing 1-68 2.8.2001 15:41 Pagina 29

embryos with genetic alter- practices against life, and po- the dream of omnipotence and ations. In the case of unwanted litical systems that would like invulnerability. twins, a reduction of the num- him to be neutral towards the These should be elementary ber of embryos is proposed. It inequalities of our time. concepts of our Christian expe- is possible that in the future so- rience, but our way of acting is called twin fission will become usually quite distant from the a routine, with the aim of ob- 2. The responsibility ideal. Even to speak about the taining a twin embryo to be of Catholic Doctors possibility of finding spiritual used for diagnostic investiga- redemption through suffering tion with a bank of homolo- If this is the scenario, what sounds odd to modern ears, in- gous tissues. can we do as catholic doctors cluding those of Catholic doc- of the third millennium to tors or of hospital chaplains. A overcome these challenges, to few weeks ago, after the death be prophets, resisting the temp- in Tunisia of an Italian socialist tations of money and disen- leader who had been sentenced gagement, preventing society for corruption and had lived for and our patients from running years sick and exiled, I had the dangerous risks? grace to listen to his daughter on television, reading a pas- a. The personal level sage of a letter from him to the Pope. In the letter, this man, I think that the first answer is strong, aggressive, arrogant, at the level of personal atti- intelligent, apparently distant tudes. We cannot simply live from a Christian lifestyle, 29 with the culture and the values wrote that he was offering his proposed by the media. We suffering to God for the good must not seek conflict for its of Italy and in response to the own sake, but we have to be intentions of the Holy Father. proud of our diversity, con- We have to be convinced vinced that we are the salt of that genuine religious experi- Summarizing, the doctor, at the earth and that our proposal ence can help the men and the the beginning of the new mil- is more joyful and full of life. women of our era to keep spiri- lennium appears to run the Pressed between a utilitarian tual and physical health togeth- risk of losing a holistic and idea of health, which recognis- er and to solve the apparent personal approach to the pa- es only some health rights con- conflict between the need of tient and having difficulties in sidered socially useful, and personal health and the re- managing the flow of informa- health ideologies which pro- sources of the health systems, tion. He is a doctor whose ac- pose health practices as a form because health (salus) and tivity more and more depends of cult for a sort of new reli- healing are part of the process on technology and he is more gion, for which death seems al- of salvation (salus) and salva- and more conditioned in his most to be avoidable and tion cannot exist if man is not activity by the decisions of health and fitness are modern healed in his entirety. government health and social Gods, we cannot simply with- For this reason, presenting to policies. The relationship with draw to the line of a mercantile our colleagues and students the his patient is made more diffi- ideal of medicine where profit sick person as the true image of cult, not only by problems of (personal and institutional) is Jesus (icona Christi) cannot be communication, but also by a the measure of what is right. regarded just as the devotional latent conflictual confronta- Again, we have to place the attitude of some simple good tion and by a decreased charis- subject at the very centre of our spirits, but as the most impor- ma, while the patient seeks attention and promote a net of tant contribution, authentically more autonomy and the satis- human relationships based on revolutionary, to the process of faction of personal desires not solidarity. improvement of the medical strictly linked to the preserva- We have to manifest the profession and health institution and the recovery of courage of raising again funda- tions. health. A profound revision of mental questions about life, educational programs is re- suffering and death. The pagan b. The responsibility quired to allow him to operate vision that is behind the cult of of Associations more easily in a society with health is afraid of suffering, too many elderly people and ageing, death and even birth. A second level of response is very few children, to prepare To this vision we have to wit- that of our Associations of him to work outside hospitals ness the Christian perspective, Catholic Doctors. and to take care of chronic and looking at birth, disease, suf- disabling diseases. Doctors at fering, care, healing and death b.1 Spiritual growth the beginning of the new mil- as opportunities for growth. Our Associations, at a time lennium appear to be not well The experience of our limits of pluralism and secularisation, equipped to resist the pressure (finitezza in Italian) helps us to cannot continue to be the clubs of alternative medicines, cul- discover the infinite and the re- of some good persons who tural pressure in favour of ality about ourselves, breaking from time to time meet to dis- DH n.45 ing 1-68 2.8.2001 15:41 Pagina 30

cuss some interesting ethical modern societies and it is out Catholic and non-Catholic, problems or join for a beautiful of fashion in the Church itself. serving people in need. celebration. They have to be- The underlying axiom is that come a place of spiritual we must not impose anything c.2. International growth where it is possible to on anybody. However, this Co-operation receive a Christian inspiration kind of approach is mislead- Second, we can promote infor our professional life, from ing. We must not impose, but ternational co-operation, first the living Gospel of Jesus we have the mission to present of all as a contribution to jus- Christ. The Gospel, the Good our faith. It is surprising, for tice and then as an expression News of Jesus Christ, can be example, that in European so- of charity, that is of genuine found alive in the living body cieties, where Islam is the sec- Christian love. It is beautiful of His Church. If our Associa- ond confession, and some- that non-Catholic organisations tions want to continue to be a times the first in terms of prac- are also working in the field of source of Christian inspiration tice, no effort is made to pre- international co-operation, but in a society marked by practical sent the Christian Good News. it makes me sad that Catholic atheism, it is necessary for We seem to be indifferent to doctors are unable to express them to become communities the faith of our brothers. the same level of activity, of prayer. They must become, Again, it is not a problem of while religious congregations more and more, a strong sup- imposition, but of being con- are abandoning the field. Be- port for our faith. The members vinced of the beauty of the yond the good intentions, in of our Associations of Catholic Christian life, to be proposed, fact, some organisations work Doctors must have the possibil- for us in the medical field, for with a reductive vision of ity to feel a spirit animated by others in other temporal reali- health problems. 30 communion and service. ties, with the simple instruments of communion and ser- c.3 Educational campaigns b.2. Communion vice. Third, we can take part in Communion is the funda- promotional health campaigns, mental of our credibility. Jesus c. Social and political witness transforming them into true ed- prayed that we might become a ucational processes. The cam- single thing, so that the world The third level is that of so- paigns for the prevention of could believe. Communion is cial and political witness. drug addiction, of sexually not flatness, it builds up on va- A personal and community transmitted diseases, and of car riety and is in favour of a vari- attitude, like the one that I have accidents, are typical examples ety intended as complementar- tried to describe, can generate a of a philosophy of health ity. A spirit of communion is new culture, which requires en- founded on external protection, necessary inside our national tering into contact with other’s without any request for a associations, between member positions, convinced of our change of lifestyles. For this associations inside FIAMC, own position, in a dialogue that reason they are intrinsically and between our associations has to be competitive, because, amoral. The same campaigns, and local Churches, increasing without attacking others’ cul- to become really educational, the links with the bishops and tures, it wants to promote our need people to have a different the episcopal conferences. way of living. I think especial- conduct and to be able to ask ly of our presence in the uni- for a change. b.3 Service versities and the institutional Service to the sick person presence of Catholic universi- c.4. Promotion of a life and, more generally, to those in ties. We are not requested to centred culture need. Service to the true image manifest our Catholicism serv- Finally, we have an enor- of Jesus, to the icona Christi, as ing at the altar, but animating mous sociopolitical task in pro- a visible demonstration of our the temporal domains of health moting legislation in favour of service to him, manifested by services with Christian values. life. Apart from trying to re- simple but eloquent evangelical There is an enormous activity verse legislation permitting signs, like attention and avail- to accomplish to permeate abortion, embryo wasting and ability to the sick person, diag- health systems with the ideals euthanasia, or apart from fight- nostic and therapeutic attention of solidarity and subsidiarity ing against the introduction of not only for the body, but also promoted by the Church’s so- these kinds of laws in other for the soul, predilection for the cial doctrine. countries, we must feel our- last persons and those in whom Four examples will be suffi- selves engaged in promoting society seems not to have inter- cient in this context. social conditions where life can est, the attribution of only rela- be accepted and fight against tive value to money, and at- c.1. Catholic hospitals those situations where the dig- tempt to live social justice. First, we can work to trans- nity and the sanctity of life are form some Catholic hospitals humiliated. Next Monday, here b.4. The new evangelisation reserved to rich people into in Rome, the fifth anniversary Communion and service are hospitals open to everybody. of the great Encyclical “Evan- requisites for us to become ef- At the same time we have to gelium Vitae” will be solemnly fective agents of the new work for the government celebrated. For Catholic Doc- evangelisation. Evangelisation recognition and support of tors, “Evangelium Vitae” is regarded with suspicion by non-profit institutions, both should be continuously seen as DH n.45 ing 1-68 2.8.2001 15:41 Pagina 31

the greatest document of the discover the origins of our is to accompany today’s men Magisterium in this field, a sort faith, to follow a path of interi- along the most important sta- of “Magna Carta” of our action or purification, to open our- tions of their earthly pilgrim- in favour of human life. Right- selves to greater solidarity and age, so that it will never be- ly, some people think that the fraternity. come a meaningless walk. “Evangelium Vitae” should be Maybe more than medieval We have examined some of catalogued as a social encycli- pilgrims, men and women liv- the challenges that touch the cal of the Church, rather than ing at the turn of the millenni- core of our Christian witness. as a document with moral um need to begin a trip along As lay members of our Church, teachings. the ways going in search of we are called to be present in As a matter of fact, the re- Good and of Truth, trying to the middle of our profession, spect and promotion of life is understand the deepest mean- trying to change structures and the basis of every social aggre- ing of our humanity, something behaviour, so that they can be- gation which deserves to be that only Christ can reveal. come a clearer image of the considered human. From this The pilgrimage to the tombs healing love of Christ. It is ex- point of view, to work in favour of the Apostles then becomes actly the message of the Jubilee of life is, for Catholic Doctors, the image of the other pilgrim- that calls us to a renewal of our the most important contribution age, the one lasting our entire life, operating for the growth of to human civilisation. life. For this reason, the pil- the kingdom of God among grimage of the Jubilee can help temporal realities, i.e. in our us to discover again respect for profession, in study, in scientif- 3. The Jubilee life, the sense of human suffer- ic research, in teaching. ing, the solidarity with those This will be possible if we I would like to end this talk who are closest to Christ on the renew our faith and have a 31 with reference to the Jubilee cross, the meaning of death, stronger participation in the that we are celebrating, the oc- which is not a window opened life of the Church, otherwise casion for our meeting here in onto nothing, but the true end we have nothing special to say Rome. Like many brothers of of human pilgrimage on earth, to our patients and colleagues. previous centuries, we have which will open us to the vi- come to the tombs of the sion of God’s face. Prof. GIAN LUIGI GIGLI, MD, Apostles Peter and Paul to re- The task of Catholic doctors President of FIAMC

The Identity of the Catholic Medical Doctor

Introduction lets, rather than being seen as is absurd and which seems to be people who are in need of med- directed towards people who It often happens in contem- ical help and care. are mad or foolish. porary practice that we en- However, not all medical This is the same for faith in counter motivations behind be- doctors are like that. There are general. St. Paul said that the ing a medical doctor which are medical doctors who greatly account of the Messiah who very different from those that honour the medical profession was crucified and rose again lie behind being a Catholic and who constitute a valuable was offensive to the Jews and medical doctor. Both the eco- example Ð in terms of generosi- seemed madness for non-Jews. nomic factor and prestige count ty and expertise Ð to be fol- However, this is very much a great deal. There are exam- lowed. And more than one of wiser than the whole of human ples of medical doctors who these physicians have asked wisdom, and what can seem a earn a great deal of money and themselves about their own weakness in God is in reality who are surrounded by a halo identities, not only as Catholics stronger than the whole of hu- of fame and prestige; and many but also as Catholic medical man power (I Cor 1:23-25). young people would like to be doctors. The following paper Basing myself on the mean- like them. It is not unusual to seeks to be merely a first ating of the identity of the Christ- encounter medical doctors who tempt to provide answers to this ian as something which follows have come to the end of their question of identity. from his baptism, I would like careers after many sacrifices It must be recognised that to dwell solely upon the identi- and forms of privation and who this paper is written in a lan- ty of the Catholic medical doc- declare that they can now take guage that is incomprehensible tor as a medical doctor. what is theirs. Patients interest to those who do not have faith. I will take as my starting such doctors solely in their ca- For the physician who does not point the “Charter for Health pacity as clients from whom have faith in Christ and his Care Workers” published by the they can gain the greatest possi- Church, everything that is stat- Pontifical Council for Pastoral ble advantage. They are only ed here does not have sense or Assistance to Health Care interesting because of their wal- meaning. It is something which Workers, which in turn refers to DH n.45 ing 1-68 2.8.2001 15:41 Pagina 32

the thought of the Holy Father man is called freely in the Son, have already pointed out, I will John Paul II on the question and by work of the Holy Spirit. seek to reflect upon this identity to the identity of the physician The medical doctor is like the and specify in particular that as outlined by the Pope. With Good Samaritan who goes to this is an identity received from reference to that identity I will the side of the sick man and a vocation and a mission which seek to outline certain ideas makes himself his neighbour is at the roots of a ministry about how it should be inter- through understanding and which is very special: the min- preted and commented upon. sympathy, in a word through istry of life, the ministry of his charity. In this way the med- health. ical doctor takes part in the love The Charter of the of God as an instrument of its Health Care Workers diffusion, and in this way is in- Vocation and the Church fused with the love of God for The Charter for Health Care man. Let us begin by referring to Workers lays down the follow- This is the healing charity of the meaning of vocation within ing in relation to the Catholic Christ, who passed by doing the Church. It is very often the medical doctor. His profession good and healing (Acts 10:38). case that etymologies help us to calls him to be a guardian and And at the same time it is chari- go back to the original meaning servant of human life. This ty towards Christ who is pre- of words that we use frequently must be done through a vigilant sent in every sick person. He is but which seem to be worn out and caring presence at the side the person who is cared for in by use. One of these is the of the sick. Health care activity every man and woman, “I was word “Chiesa” (“Church”). Let is based on an interpersonal re- sick and you visited me”, as the us examine the two etymolo- 32 lationship. It is a meeting be- Lord will say in the Final gies of this word Ð the Greek tween trust and conscience. The Judgement (Mt 25:31-40). and the Latin. The Greek ety- trust of one who is ill and suf- It is thus more than evident mology leads us to the verb fering and who entrusts him- that the identity of the medical “ekkalein” (“chiamare” or “to self to another man who can doctor is the identity received call”). “Chiesa” (“Church”) is help him in his need and who from his therapeutic mission, the plural participle of the verb comes to his assistance to care from his ministry of life. He is a “ekkalein” and means “the for him and cure him. collaborator of God in the recalled”. The sick person is not only a covery of the health of the body Thus, placing ourselves with- clinical case but a sick man to- of the infirm person. The in the Latin etymological per- wards whom the medical doc- Church sees the work of the spective, the Church is the ef- tor must adopt an attitude of medical doctor as a moment of fect of “vocation”. “Vocation”, sincere sympathy, suffering his ministry, and sees service to speaking in etymological terms, with him through a personal the infirm as an integral part of is the Latin substantive of the participation in the concrete sit- her mission. Latin verb “vocare” – to call uations of each individual sick The Church well knows that (the same as “ekkalein”). It person. Infirmity and suffering physical malady imprisons the means, therefore, the same call are phenomena which, analysed spirit, in the same way as mala- that unites the called, that is to in depth, go way beyond medi- dy of the spirit has a negative say which gathers together the cine and touch upon the essence impact on the body. In this way, Church. Vocation, therefore, of the human condition in this the medical doctor, through his makes the Church. world. therapeutic ministry, takes part The only “vocation” or fun- The medical doctor who in the pastoral and evangelising damental call is that which God takes care of these situations action of the Church. The paths makes through the Word, by must be aware that it is precise- he has to tread are those indicat- which He calls to life every- ly here that the whole of his hu- ed by the dignity of the human thing that exists, and this call, manity must be involved, and person, and thus moral law. And this primicerius “vocation” is absolute dedication is required this is especially the case when Christ, who is the Word of God of him. This is the mission he has to carry out his activity through which everything that which characterises him and it in the field of biogenetics and exists and each one of us is is the fruit of a call or vocation biotechnology Ð bioethics fur- called to life (cf. Eph. 1:3-10; that the medical doctor listens nishes approaches and sets out Col. 1:15-20). In particular, it is to, personified in the suffering his principles for action.1 interesting to note that the high- and imploring face of the sick est form of call today made by person who in entrusted to his God in relation to everything care. Here there is the connec- The Identity of the that exists, the highest presence tion with the mission of the Medical Doctor of Christ in the world, achieves medical doctor to give life and realisation in the Eucharist, to give it in abundance (Jn In this position of the Pontifi- which is a memorial, making 10:10). This life transcends cal Council for Pastoral Assis- Christ present in the today of physical life to the point of tance to Health Care Workers, history (cf. Lk 22:19). reaching the heights of the which is, as is clear from the In this call of God we discov- Most Holy Trinity; it is the new references, also the position of er three essential moments and eternal life which consists John Paul II, is to be found a which constitute it and which in communion with the Father, summary of the Christian iden- we can summerise with the four towards whom each and every tity of the medical doctor. As I following words: “to be”, DH n.45 ing 1-68 2.8.2001 15:41 Pagina 33

“with”, and “for”. This is be- with a religious character. A the mentality of Plato and cause we are called to be (to ex- profession is not something of a Socrates, to which Hippocrates ist), with God, for others. This, strictly juridical nature because belonged, is defective because for example, we can observe in what is juridical in a positive it assumes need and is never the call that Christ makes to his sense can be fulfilled or not, or fullness. Indeed, for classical disciples (Mk 3:14-15), and something which can change Greek philosophy God does not above all in the call that he according to the wish of those love. He is infinitely lovable, makes to the Virgin Mary ask- who contract an obligation Ð a but He does not love, because ing her to become the Mother of profession is an obligation and to love means lack and God God the Messiah (Lk 1:26-38). a responsibility which is con- cannot be defective in any way. This, however, is a paradigm tracted with God Himself. It is Love is only specific to man which covers the whole of the a responsibility, and responsi- who is in need and who wants history of Salvation. bility means, in essential terms, to obtain satisfaction; it is not These three words of voca- the ability to respond. The word something which belongs to tion will help us as a model “respond” comes from the God, who is All-perfect. In which we can employ to reflect Greek “spenden”, which origi- Greek mythology, love is born on the doctrine of the Pope in nally meant “a sacrifice of liba- with Poros and Penia, in the relation to the identity of the tion to God”. Professional re- marriage of Aphrodite. Poros Catholic medical doctor, some- sponsibility at a medical level represents the expedient, need, thing which we set out in the means a “compromesso” (“an and Penia represents poverty. “Charter for Health Care Work- agreement”) (from the Greek Uniting need with poverty, love ers”. word “syngrafein” which is born as self-interested desire. This mentality is completely corrected by divine Revelation: 33 1. “To Be” God himself is Love. This is the deepest definition of God. His When we speak about “be- love is not lack of something ing” in vocation we speak about but the highest diffusion of His total existence. God speaks and own goodness, which meant everything begins to exist. As that God the Father so loved Genesis declares: “And God this world Ð which he created said: let there be light. And out of a diffusive love in itself Ð there was light” (Gen 1:3). as to give his Only Begotten When God utters His Word this Son to it to the point of death becomes practice Ð it does what (Jn 3:16). He says and everything For this reason, the Christian achieves its consistency, its be- medical profession centres ginning, an end, its totality. around love. But this is not a When we speak about the au- self-interested and impover- thentic Catholic medical doctor, means “to write together”) ished love, a Hippocratic love. he is such because of an authen- which is written as a dual en- It is rather a love which imitates tic vocation received from God counter between man and God. the perfect love of God and has Himself, from whom he re- From this sacredness of the its paradigm in the Good ceives his whole existence, al- medical profession there sprang Samaritan who in this way suf- though naturally enough with- the Hippocratic oath Ð the oath fers together with the sick per- out excluding the collaboration not to do harm to the patient, to son, feels sorry for him, and with the call which is imple- act always for his best interests, supplies everything that is mented by the medical doctor and to be totally in favour of needed for him to regain his himself. life at all of its various stages. health. In this way the Good What is the medical vocation This is not an oath which is Samaritan is the example to im- to which he is called by God? made to a patient but is some- itate for the Christian medical Let us now outline certain of thing which is addressed direct- doctor. The Good Samaritan is the features of the “to be” of ly to God. The vocation of the the figure of Christ who had this call. medical doctor in this context is compassion for the whole of a vocation that is born from the sick and fallen humanity, and 1.1. Profession love of God, and it is God who raised it up to its deifica- whom the medical doctor fol- tion. He is infinite love and he First of all, let us state that lows in this profession, as the is both in he who loves and in God calls the medical doctor to highest loved Good.2 he who is loved Ð he is in both a profession which is not the kinds of individuals and with same as being called to disen- 1.2. The Love of God fullness. In this way the Good gage from another office. In in the Physician Samaritan is the figure who de- history three professions are termines the identity of the principally recognised: that of However, despite the sub- medical doctor, who has such the priest, that of the physician, lime character of this Hippo- compassion for the patient that and that of the governor or cratic position, it is limited and he does everything he can to judge. It should be said that a defective. I referred to the love heal him, out of love for full- profession is linked to the proof God, but this love, according ness.3 fession of faith; it is something to the classic Greek mentality, When speaking about the DH n.45 ing 1-68 2.8.2001 15:41 Pagina 34

love that the medical doctor of training. Indeed, the curricu- can observe a loss of ethical must have towards God, and lum of the medical career is values in medicine and the thus towards his patients, the based upon two essential parts. anonymity of patients. One can Holy Father Pius XII spoke to The first is basic knowledge also observe that little value is us about the commandments of and the second involves knowl- bestowed on the existential as- the law of God and their bear- edge obtained through the clini- pects of the medical profession, ing upon medicine. He spoke cal sciences which are divided on the figure of the patient, of about the first commandment, up into disciplines, or from the medical doctor, and of the which exhorts us to love God analysis of the various organs nurse. above all things, and of the sec- of the human body. In response to all these ques- ond commandment which tells It is obvious that this teach- tions and issues connected with us to love our neighbour as our- ing must be imparted, but what “being” a medical doctor from selves. The idea is that the iden- is often encountered is a the beginning of the profes- tity of the medical doctor is to biotechnical reduction. In the sional training that he receives, be found in this love when his presentation of various subjects a series of methods have been relations with his patient are the anthropocentric values are formulated which have been permeated by humanity, by lost, as indeed are the ethical, conceived in order to make comprehension, by sensitivity affective and existential values. teaching active, especially and by care and concern. The medical doctor becomes through so-called PBL (Prob- Pope Pius XII completed this defined by the needs of the pa- lem Basic Learning) and the picture of the physician by re- tient and by the requirements of method of teaching directed to- ferring to two other command- an economistic health-care sys- wards the community. This last ments, and above all to the fifth tem which is completely indif- sees the medical person as a 34 commandment: “do not kill”, ferent towards the violation of person who has to be skilled and to the eighth: “do not bear human rights, and especially of and competent at the relational false witness”.4 human life. and scientific levels, is integrat- It often happens that we ened into a communitarian reali- 1.3. Respect for Life counter in the present-day clin- ty, is able to co-operate with and the Defence of Life ical applications the paradigm other health-care figures and of fragmentation and reduction administer the resources which The fifth commandment re- of the patient to organs or bio- are available in a process of minds us that the identity of the logical and technological func- continual training, is always an Christian medical doctor lies in tions and medicines and drugs. advocate of the health of the the fact that because of the love There is an attempt to reach do- patient, and is able to link theo- that he is obliged to have to- minion by fragmented spe- retical knowledge with medical wards God and his patient, the cialised knowledge without a practice, thereby engaging in physician is totally obliged to vision of the overall picture constant training. defend life at every stage but through knowledge and exper- This kind of medical training above all else at its weakest would provide a new under- stages, such as those which are standing of health and illness, to be found at the beginning and would engage in the pre- and the end of life. His person- vention and treatment of illness ality is marked out by a clear within the context of the indi- and absolute “no” to abortion viduality of the patient which is and euthanasia. The fifth com- completed in his family and in mandment covers the whole of the whole of society. It would the meaning of human life thus develop a stage of initial which is seen as a gift given by learning based more upon cu- God in sole stewardship to man riosity and constant investiga- and woman, and which should tion than upon passive acquisi- have its origins only within tion. It would reduce the weight marriage. of information and would favour direct contact with pa- 1.4. Medical Training tients through a personalised analysis of their problems and His Holiness Pius XII ob- the whole of their curriculum. served of the fifth command- One should, therefore, draw ment, “do not bear false wit- up a programme based upon the ness”, that the physician has a tise connected with other hu- following set of principles: 1. clear duty towards truth, both man fields beyond that of med- the existence of a comprehen- the truth of illness and health icine. The idea of health is that sive and final meaning of med- and the truth of medical sci- of passive adaptation to patho- ical knowledge; 2. the defini- ence.5 genic stimuli of a biophysical tion of its epistemological ori- The identity of the medical nature. Clinical adaptation very entation; 3. the definition of the doctor comes from the training often takes place with exclu- values, motivations, psycholog- that he receives, but if we look sive reference to the require- ical maturity, and quality of the at what he receives in many ments (including those of an objective knowledge and rela- faculties of medicine we can economic character) of the national methodological capaci- see that this is a very weak kind tional health-care system. One ties to be applied to the practice DH n.45 ing 1-68 2.8.2001 15:41 Pagina 35

of the profession; 4. the defini- present myself before the ly in death but in a fertile death tion of the values, motivations, Pharoh of Egypt and free the Is- of resurrection as well. capacities and quality of the raelites from Egypt, and God In the same way the physi- training of teachers; 5. the defi- answered: I will be with you” cian must care for and treat in a nition of the general and specif- (Ex. 3:12). way which transmits the death ic objectives of training; 6. the and resurrection of Christ. To definition of the didactic meth- 2.1. The Transmitting obtain this transmittance there ods. These principles accept the of Christ the Physician needs to be an identification of epistemological knowledge of the medical doctor as such, as a present-day medicine which In this contrast we can delin- healer, with the healing Christ. sees health as a psycho-biologi- eate the deepest values which This identification, today, takes cal construction brought about must characterise and shape the place in particular in the Eu- by the accessibility and quality identity of the Catholic medical charist and in the other sacra- of the resources of the person, doctor. The personality of the ments. The sacraments are the and which is directed towards Christian physician is to be historical presence of Christ in providing an overall response identified in this way as the today’s time, in the concrete to the fundamental questions of transmitting of Christ the med- moment which we traverse in human existence.6 ical doctor. Christ invited his life. apostles to take care of every 1.5. Permanent Training form of suffering and illness, 2.3. Health and said to them: “I will be with The identity of the medical you until the end of the world” As a result, the medical doc- doctor is not modelled once and (Mk 16:17; Mt 18:20). The tor must realise that health is an for all by his initial training. It medical doctor thus engages in overall phenomenon and he 35 must be extended through per- the healing ministry at the side must not speak about physical manent training. It requires a of the apostles as a continuation health as being something radi- very careful instruction of med- of the mission of Christ and as cal different from overall health ical students, but at the same his transmittance. We have to Ð something we call eternal time a continuous and progres- understand this transmittance in health, or to put it in more suit- sive training of the teachers all its breadth. The medical able terms, salvation. For this who teach medical teaching doctor must express the whole reason, the ministry of the med- courses, a training which at of the life of Christ because this ical doctor is an ecclesial min- times is lacking. It is above all is the presence of Christ within istry which is directed towards the teachers who are responsi- the medical doctor. This is be- the salvation itself of man from ble for the promotion of new cause Christ cares for every in- his body, but which also in- medical doctors, which is firmity and illness through all cludes other aspects. It is for something which they must of his actions understood in this reason that we have de- never facilitate if they in all overall terms. The miracles of scribed health as a dynamic ten- conscience see that a student healing which he worked, in- sion towards physical, mental, does not have the capacity to cluding the raising of the dead, social and spiritual harmony, carry out such a sensitive mis- were not definitive in his strug- and not only the absence of ill- sion. gle against the evil that is with- ness, which gives man the abili- In virtue of the eighth com- in humanity, against its suffer- ty to fulfil the mission which mendment all medical doctors ing and death, but only a sign of God has entrusted to him, ac- must respect professional secre- the profound reality which is cording to the stage of life in cy, and as has already been ob- contained in his death and his which he finds himself. served in this paper they must resurrection. The mission of the physical have a well-founded medical doctor, therefore, is to work so learning and culture which must 2.2. Pain that this dynamic tendency to- constantly improve through per- wards overall health is manent training.7 Jesus took upon himself all achieved, as indeed is required forms of suffering, all forms of at every stage of the life of this pain, all forms of infirmities concrete man his patient, so 2. “With” without any kind of exception, that he can carry out the mis- and included them in his own sion which God has entrusted We have observed that the death as the death of God made to him. second feature of the Christian man, and this so that nothing Hence it is incongrous to re- vocation is expressed through a connected with pain was ex- duce the medical function readiness to engage “with”: cluded. And from his death he merely to the physical-chemi- with God. This means that the undid death itself, he conquered cal dimension of illness. Its whole of that vocation exists to it with the fullness of his resur- function is of an overall charac- be with God our Lord who is rection. One of the great ques- ter and in addition must not be He who makes man able to car- tions of the medical doctor has static. It must form a part of the ry out his mission, which with- always been the problem of dynamism of the patient which out God’s strength it would be pain, but this question finds its works towards his own harmo- pointless to pursue. We can answer here alone, when pain ny. read in the Book of Exodus does not appear as something In this context, death does what Moses says to God on which is negative but as a posi- not appear as a frustration for Mount Horeb: “who am I to tivity which culminates certain- the physician but as his tri- DH n.45 ing 1-68 2.8.2001 15:41 Pagina 36

umph. This is because he has really received this vocation he him by God bear fruit. He must followed the patient in such a will always maintain it, and he not yield to the pressures to way that his patient has been must practice it for the benefit make him engage in attacks up- able to express his talents at of humanity as a mission re- on life. He must be strong when each stage of his life. When the ceived for the good of every- faced with the temptations of patient arrives at the end of his body, and in relation to which materialism.9 life the medical function of the he must render account to God The good medical doctor physician ceases, not with a cry when God says to him: “I was must in this way possess the di- of impotence but in the satisfac- sick and you visited me”(Mt anoetic and political virtues and tion of the knowledge that a 25:36-43). ensure that they really are mission has been carried to its virtues, that is to say by adopt- fulfilment, both by the patient 3.1. Openness to the Patient ing an approach whereby both and by the medical doctor him- the virtues of the theoretical self. We have observed that the sciences and the virtues of actu- In this way the physician is love of the medical profession al practice can meet in him as really with Christ and his pro- follows the love of God which though they were his second fession is identified with this is in itself diffusive. The med- nature.10 communion with Christ him- ical doctor cannot imprison his self, and thus the medical doc- knowledge in pure theories and 3.2. The Fundamental Qualities tor unites with God the Father laboratories. He must spread it of the Medical Doctor in the same way as a son comes for the benefit of the communi- to his father, and his profession- ty. He has received the gift of Thus we come to categorising al love becomes converted into caring for life and enabling it to and characteristing the funda- 36 the action of the Love of God, grow. His vocation is for life, mental qualities of the medical which is the Holy Spirit. For and never for death. To be for doctor under five headings: this reason, the Christian med- death would be to extinguish awareness of responsibilities; ical doctor is the person who is the mission which God has en- humility; respect; love; and always guided by the Holy trusted to him for each person. truthfulness. Awareness of re- Spirit. From the Holy Spirit and Pope John Paul II declares that sponsibility leads him to work with the Holy Spirit one grasps to the religious ministry is with the sick man and to be all the empathy which must ex- joined today the healing mis- aware that a medical doctor is ist between the medical doctor sion of medical doctors in up- the person who points out the and his patient, all the due hu- holding human life and all paths to be followed. Humility manisation of medicine and all those special contingencies in tells him that the medical doctor the need for realisation and per- which life itself can be compro- protects his patients and not the manent training, because the mised by an intention of human contrary; humility leads him to Love of the Holy Spirit makes will. see himself as the relative of the the medical doctor a person In their deepest identity med- sick person. The medical doctor who is above all open to others. ical doctors carry with them the cannot speak about “his” pa- This is what he has committed fact of being ministers of life tients Ð the patients must speak himself to do before God with and never instruments of death. about “their” doctor. The physi- his profession of Faith which This is the innermost nature of cian must receive his patients in means his medical profession. their noble profession. They are a way which follows what is In this way we come to delin- called to humanise medicine written in the architrave of an eate the third dimension of the and the places in which they old German hospital: “recipere medical identity Ð to be for oth- practice their profession, and to quasi Christum”, that is to say ers. This is the “for” of his vo- ensure that the most advanced as though they were Christ him- cation and his professional forms of technology are used self. Respect and love in rela- identity. for life and not for death; and in tion to the sick person, some- this they should always have as thing which has already been their highest model Christ him- discussed in this paper, are the 3. “For” self, the physician of souls and bases of his humility. He knows bodies.8 that he is the steward of a mis- When God chose Moses it is Pope Pius XII declared that sion for which he does not pos- very clear that he did this in or- the Catholic medical doctor sess the necessary strength but der to ensure that his people es- must place his knowledge, his he also knows that he receives caped from the power of the powers, his heart and his devo- such strength from those who Egyptians. God said: “I have tion at the service of sick peo- direct him towards that mission. come to save you from the pow- ple. He must understand that he Truthfulness contains in itself er of the Egyptians” (Ex. 3:8). and his patients encounter each being aware of the great trust The medical doctor cannot other placed beneath the will of which is given to him by the become shut up within himself. God. Medicine is a reflection of sick person in revealing his in- He cannot merely think that he the goodness of God. The nermost problems and difficul- now has enough money, that he physician must help to ensure ties. Truth is required in both dino longer needs to work, and that the sick person accepts his agnosis and treatment not only that for this reason he can retire illness, and he himself must at a physical level but in an from his profession. A real protect himself against being overall sense, that is to say from physician is a physician for the dazzled by technology and a mental, social, psychic and whole of his life and if he has make sure that the gifts given to spiritual point of view. He must DH n.45 ing 1-68 2.8.2001 15:41 Pagina 37

never carry out experiments on to medical excellence, that is to foremost to other medical doc- the sick person if he sees that say to what Aristotle called tors and have sufficient humili- the danger is not proportionate “teleios iatròs” (the perfect ty to work with other people to the benefits which he is seek- physician) and to what Galenos and in a team, both with regard ing to obtain. Such a policy termed “aristòs iatròs” (the to strictly structural questions must be absolutely necessary best physician). and in those relational areas and the patient must give his that bear upon fields where he consent. The medical doctor 3.4. Morality and Law is not necessarily in charge be- must inform the sick person cause in a certain sense they are about the evolution and devel- In this paper it has been ob- beyond his competence Ð for opment of his illness, tell him served by way of a principle example where sociological, the truth about his condition, that the medical profession is anthropological and political is- and all this at the appropriate something which rises above sues are at stake, or in technical moment and in the ways that are law and is to be found in the di- fields which are outside his pro- the most suitable. He must link mensions of morality. This is fession, i.e. everything connect- his action with the action of the certainly true, but we cannot ed with the field of computers priest because both missions Ð depart from medical law. Med- and informatics. the mission of the priest and the ical law without a suitable Thus within this openness in mission of the physician Ð are morality would be mere arbi- the Spanish medical field there intimately bound up.11 trariness based upon unconfess- emerges what two authors call able interests. Morality without the decalogue of the new med- 3.3. Portrait of the medical law would be some- ical doctor, which they outline Medical Doctor thing confined to general prin- in the following way: ciples and without direct appli- 1. Work in a multidiscipli- 37 The “Portrait of a Physician” cation. The rules and regula- nary team and with a sole ulti- from sixteenth-century Spain is tions of medical law must be mate director. 2. The more sci- certainly of great contemporary sufficienctly clear and brief to entific the professional person, relevance. This portrait em- facilitate the action of the med- the better. 3. The human aspects ployed a flowery language to ical doctor. The guiding princi- of professional practice should ple is always the same: the pur- become more emphasised. 4. pose of the medical doctor is to Action should be adapted to help and to heal, never to do scientifically allowed diagnos- harm, and never to kill. tic and therepeutic protocols. 5. Special reference should also Medical doctors should be be made to the field of ethics, aware of expenditure. In addi- the field of morality, in which tion to the protocols the guide- the medical doctor must be lines of good practice should be competent, even though it very followed. 6. The medical doctor often happens that he is not a should facilitate working to- specialist. For this reason we gether, and solidarity, with need bioethical committees in work colleagues and patients. 7. every health-care centre and The medical doctor should be- their creation in teaching insti- lieve that all action of care can tutions to achieve an open dia- involve preventive action and logue with specialists who be- thus the promotion of health. 8. long to the various relevant dis- The medical doctor should con- ciplines. stantly bear in mind that he describe Enrique Jorge En- In this way the medical doc- must take care of the need to riquez, and the words which tor becomes aware that he can obtain satisfaction for the user were used were the following: bear witness to God in all med- of the service. 9. The special “the physician must have fear ical, trade union, political etc. patient attention units should of God and be very humble, not contexts, and can be a valid in- become stronger, and should proud or vainglorious, he must strument of ecumenical dia- give increased space to the charitable with the poor, meek, logue with other religions, in complaints and suggestions benevolent, friendly and not particular because illness does produced by patients. 10. It is vengeful. He must not reveal not recognise religious bound- of fundamental importance to secrets, he must not talk too aries. In this way the medical apply ethical principles to pro- much, he must not be a gossip, doctor will actively belong to fessional activity14. he must not flatter, and he must the Church both as an individ- not be envious. He must be pru- ual and as the member of a dent, moderate, not overly bold group.13 Conclusion: ...he must be restrained and practice honesty and listen with 3.5. Team Work Being a Catholic medical great attention; he must work doctor is a ministry which for his art and hate sloth. The In order to the carry out this springs from a vocation within physician must be very well very demanding mission, the the Church. It is the mission of read and know how to accept medical doctor must not remain healing. It is strongly linked to that others are right”.12 shut up in his own individuality God our Father and expresses At the present time we refer but must open himself first and Christ the physician, full of DH n.45 ing 1-68 2.8.2001 15:41 Pagina 38

Love, which is the Holy Spirit. Notes sità Ambrosiana di Milano, inaugu- razione della Scola di Medicina). To be a medical doctor is a path 1 The Pontifical Council for Pastoral 7 Cf. PIUS XII, ‘Discorsi ai Medici’, by which to reach and achieve Assistance to Health Care Workers, loc. cit. the fullness of the human being. Charter for Health Care Workers (Vati- 8 Cf. JOHN PAUL to the XV Congress can City, 1995), 1-7. of Catholic Doctors (AMCI), ‘Cinquan- It involves a special nearness 2 Cf. DIEGO GRACIA, ‘Il Giuramento t’Anni di Vita per la Vita’, Orizzonti to, and intimacy with, God; and d’Ippocrate nello Sviluppo della Medici- Medici (1994), pp. 105-114. it also means an openness and a na’, Dolentium Hominum (31), 1996, pp. 9 Cf. PIUS XII, ‘Radio Messaggio al 12-14. VII Congresso Internazionale dei Medici total giving to other people. 3 Cf. V. CAPPELLETTI, ‘Dove c’è Cattolici (11.9.1956)’, ‘Discorsi ai This, then, is the Catholic iden- Amore per l’Arte Medica, c’è Amore per Medici’, p. 503. tity of the medical doctor Ð to l’Uomo’, Dolentium Hominum (31) 10 Cf. D. GRACIA, ‘Il Giuramento d’Ip- 1996, pp. 22-28. pocrate’, pp. 12-14. be the transmittance of the heal- 4 Cf. PIUS XII, ‘Discorsi ai Medici’ in 11 Cf. P.MAZZINI, ‘Arzt un Seelsorge’, ing Christ. Orizzonte Medico (Rome, 1959), pp. in LTK(1). 46-54. 12 Quoted by DIEGO GRACIA, ‘Il Giura- H.E. Mons. JAVIER LOZANO 5 Cf. PIUS XII, ‘Discorsi ai Medici’, mento d’Ippocrate’, p. 26. pp. 46-54. 13 Cf. S.LEONE, Orizzonte Medico (6) BARRAGÁN, 6 G.R.BRERA, ‘La Formazione dei Nov-Dec. 1996, pp. 10-11. Archbishop-Bishop Medici del Terzo Millennio. La Scuola 14 M. ANSENJO and A.ANGEL-TRILLA, Emeritus of Zacatecas, Medica come Scuola di Uomini and ‘Necesidad de Nuevos Profesionales para President of the Pontifical Council Umanità’ (Conferenza Inaugurale del- las Nuevas Situaciones Sanitarias’, Todo for Health Pastoral Care l’Anno Accademico 1998-1999. Univer- Hospital (149) Sept. 1988, pp. 497-499.

38 The Identity of the Catholic Nurse

Catholic nurses love to state and in our professional activi- with which I would like to set that they have their own identity. The fact that this specific out the identity of Catholic ty. For this reason, they often character is denied, forces us to nursing personnel and to insist find themselves in opposition reflect not only on the reasons upon the responsibility of the to their environment, which which lead us to say that we CICIAMS, which can indeed does not appreciate the fact are Catholics but in addition, be representative of the reli- that they want to address them- and above all else, on the con- gious aspirations of humanity. selves to their professional task sequences that the upholding My paper is divided into with specific concerns and pri- of a specific identity can have three parts: 1. the challenge of orities. According to the most for our professional activity. identity; 2. the legitimacy of indulgent, this means adopting Some present-day societies the upholding of a specific a mentality which belongs to no longer make Christianity Catholic character within soci- other times. But often it is the the basis of their public organi- ety; and 3. the consequences very legitimacy of their aspira- sation; others are outside this which flow from this for tions which is called into ques- vision of existence. All dispute Catholic health care profes- tion. Some people dispute the the right of Christians to be- sionals. This last point is the right of these nurses to have an have in a way which is differ- most sensitive because these originality as Catholics be- ent from most of those people professionals must keep intact cause, they say, the require- who make up those societies. the inheritance received from ments and needs of their pro- Whether these are societies the past and at the same time fessional service must deter- born from Western civilisation adapt themselves to the new mine the behaviour of each and or from other civilisations, prospects experienced by con- every person, irrespective of Catholics feel in sociological temporary society. sex, race or faith. Others, for terms that they are in a minori- their part, perceive in the up- ty, and even that they are treat- holding of a specific identity ed as foreigners in their own 1. The Challenge an approach which is contrary country. They, however, realise to the development of the mod- that from the human and reli- The answer of believers to ern world which asks us to end gious point of view they are in the opposition that they come our differences and to unite to a majority. Their difficulty up against within society must construct a new society. The comes from the fact that the re- be adapted to the specific chal- questioning to which Catholic ligiosity of popular movements lenges of their epoch, which nursing personnel are subject- has still not yet found the in- today concerns the crisis of ed must be examined with lu- struments by which to express values within Western society cidity and courage. It is possi- itself at a socio-economic level and the new kinds of relations ble that certain ways of think- because the populations con- which are established between ing and expressing ourselves cerned have still not grasped religions. We will not here must change, but, in basic the strength that they represent analyse these causes at a deep terms, we cannot stop affirm- and have not yet found ways level but only recall the chal- ing that the fact of being by which to achieve forms of lenges which Catholic nursing Catholics affects the behaviour co-operation amongst the reli- personnel must address them- which we adopt within society gions. This is the approach selves to because of the plural- DH n.45 ing 1-68 2.8.2001 15:41 Pagina 39

ism of Western societies, the tionships within hospital ser- Christians too often appear as crisis of values which is pre- vice. Today this is no longer foreigners in their national sent within non-Western soci- the case. New responsibilities communities. A similar situa- eties, and the prospects created have been added to the activity tion exists in Islamic countries by the drawing near of the var- of nursing staff. Societies where the Koran is seen as the ious spiritual and religious which for centuries lived under sole source of inspiration for families. the exclusive, or almost exclu- social behaviour, when, that is, sive, influence of Christianity it is not seen as the fundamen- a. The Calling into Question have had to open themselves tal law of the state.2 which is Caused up to pluralism. This means The predominant values in by the Pluralism that those who govern are Asian societies are those which of Western Civil Society obliged to concede rights place man in a social group which are the same for every- and make him a servant of the There is a tension within so- body whatever their creed may collective entity. Indeed, the cieties which are based upon be. From the moment when notion of the person and that of the Western model between collective feelings were no his supernatural destiny are for Catholics attached to certain longer centred around tran- these societies incomprehensi- values and the holders of a mil- scendent spiritual values ble. Islam certainly has the no- itant/narrow secular approach whose general acceptance en- tion of the person but locates who exercise a determining in- sured the unity of society, this the responsibility of man not in fluence on public opinion unity had to be searched for in the initiatives which write the through the mass media, other paths: that of the ‘politi- design of God into reality but which, indeed, are under their cally correct’, which imposes a in the observance of the rules control. Western societies are way of thinking and margin- contained in the Koran. The 39 no longer based upon the val- alises those who reject it; or fact that Christianity is open to ues of Christianity. Even that of dialogue with a view to pluralism (which also raises though some of them may con- defining the contents of the problems of adaptation in the tinue to refer to Christianity in common good hic et nunc. West) introduces a new ele- their constitutional documents, Catholic nurses support this ment into its civilisations. For they all live under what is last path because it allows the centuries the Christian pres- called the regime of pluralism. construction of the unity of so- ence was seen as a foreign ag- In this system the state is no cieties based upon respect for gression. Today it widens the longer the guarantor of an in- the opinions of everybody. possibilities for a concertation terpretation of life, and even This approach is that which between spiritual forces at a less of a religion, but an arbiter was adopted by Vatican Coun- moment when globalisation is between the different currents cil II and recent Popes. Paul VI imposing a reassessment of the of thought which are ex- and John Paul II spoke and traditions and ways of thinking pressed. As Cardinal Pavan ob- have spoken about the need to which have been received from serves, just as the state is not construct a ‘civilisation of the past. This is not a question competent to define what is love’ which should be counter- of abandoning ancient tradi- beautiful so also it is not composed to that civilisation of a tions as though they were old petent to say which religious practical and inhuman materi- clothes but of enriching them truths should be believed in.1 alism which now seems to pre- by opening them up to new as- The advent of pluralism af- vail. In this way the upholding pects of the human experi- fects the way in which of a Catholic specific nature is ence.3 Catholic health care personnel a consequence of our social an- In this way Western Chris- live out their identity. When thropology. This last, in prais- tians and those who belong to the CICIAMS was established ing responsible freedom, can- other cultural traditions find it was possible to limit reflec- not accept that imposition of themselves faced with the tion about Catholic identity to norms which is attempted by same problem. The challenges questions concerning profes- certain forces which exert which they have to address sional competence and good pressure. themselves to is fundamentally approaches towards the sick or of the same character. This is towards colleagues because b. The Crisis of Values this was a time when society in Non-Western Societies was prepared to see in Chris- tianity the founding vision of A large number of societies its unity. The adherence of the do not accept the idea of the populations to the ideals that person, or, being within the Christianity proposed justified Muslim line of development, the hierarchy of values that dispute its role as an innovator legislation established in such which is given to it in the West. societies. This type of stable The Asian countries, for exam- society was led to insist upon ple, which are based upon the contents of the activity of Confucianism, Hinduism or the nursing staff in relation to Buddhism, base their unity up- professional competence, tak- on values which do not have ing care of sick people, con- connections with Christian cul- cern with families, and rela- ture. From this it results that DH n.45 ing 1-68 2.8.2001 15:41 Pagina 40

the angle from which the iden- care workers in their conduct ideas. Truth is not subjective, tity of Catholic nursing staff and behaviour: they are not the what each person perceives is a must be considered in a world only people to be concerned partial understanding of an ob- in which the various cultures with the lives or the health of jective truth. Existence is a fact are based upon values different sick people. The associations whose meaning all cultures in- to their own. which have generated these quire into and ask themselves concerns, and make of these about. c. The Crisis Caused by the concerns the centre of their ac- The Catholic has an interpre- Diversity of the Spiritual tivity, attract non-Catholics tation of existence which dis- and Religious Families who, indeed, ask to belong to tinguishes him from everybody them. The Catholic nurse and else. He does not call it an in- The analysis which has just the associations to which he or tellectual theory or a philo- been undertaken has often led she belongs must be the basis sophical doctrine or a religion to people speaking about of a counter-culture. If culture which he has constructed in his Christians who have become can be defined as an integrated wisdom in order to understand or who were minorities in their and hierarchical bloc of values what is incomprehensible. The own societies. This view can around which the members of Christian is a person who fol- be justified from a quantitative a society move, if this synthe- lows Christ. He sees in Christ a point of view because they are sis excludes others and impos- model, and he imitates him, not or are no longer always the es what is ‘politically correct’ rather than copying in today’s majority and can have the im- or only one line of thinking life the approaches of two pression that that they are dom- within the geographical area thousand years ago. He con- inated and even discriminated where it dominates, the coun- forms himself to Christ, he 40 against. However, this is not terculture will be that which drinks in his feelings and senti- precisely true. One of the char- tries to achieve a new integra- ments. He walks along the path acteristics of modernity is the tion of values around those of which Christ walked along (1 freeing of spiritual forces. the person. Jn 2:6). As St. Paul said, bear These are no longer to be iden- This is the challenge which within you the feelings of Je- tified with a political regime, now faces Catholic health care sus Christ. He bases himself, bestow less importance on personnel. How can we meet therefore, on Christ’s method their sociological dimension, it? Correct thought within the in order to make others discov- and in this way acquire a more nursing world often imposes er what the professional rela- vital awareness of their specif- living in a contradiction. On tionships lived out by the be- ic mission within society, that the one hand, the approach is liever can be. of being the advocates of a vi- universalist and generous but I remember a visit that we sion of existence which is open on the other there is silence in made during the African semi- to higher values, and for Chris- relation to the economic logic nar held last December in the tians such as ourselves this which regulates the profession basilica of Yamousoukro in the means divine transcendence. and ensures that the rich are Ivory Coast, where there was a Every religious tradition people who reserve to them- statue of the Virgin which had draws its meaning of the hu- selves the possibilities of hav- been sculptured out of wood man future from the conse- ing the most advanced and so- by a prisoner. This man, we quences of the moral behav- phisticated forms of care and were told, had been a Muslim. iour of its members within so- treatment. On the other hand, However, he had managed to ciety. All such traditions have the sick person is treated and so fill himself with the feeling in common the fact that they looked after but a culture of of Mary that he could carry out do not close man up in a space death is fostered and encour- this work to its conclusion, which is only political or eco- aged. which in the end led him to the nomic. They all have the voca- faith and to conversion. The tion to develop this spiritual di- process undergone by this mension which is present in 2. The Legitimacy artist clarifies to us the way in each and every man. This of the Upholding which the Christian bears wit- shared concern explains why of a Catholic Identity ness to Christ in his profession- relationships of neighbourli- al life. Allowing those who ness and dialogue are formed, The dangers of an approach surround him or her to know most often at the roots, that is of indifference caused by the him or her as a male nurse or a to say in professional teams, fact that doctrinal statements female nurse who has entered between spiritual men of dif- have fuzzy associated configu- the civilisation of love, he or ferent religious traditions.4 The rations is often condemned. A she allows them to discover in meaning of life, the meaning of real uncertainty exists in rela- their contact with him or her a moral responsibility which tion to the word ‘truth’. Classi- that one can be of this world leads to a recognition of each cal philosophy, Thomist and and at the same time live in an- and every man, draws people Aristotelian philosophy, per- other place and live in line with together, whatever their reli- ceives in truth the fact that a a logic thanks to which the dif- gion may be. There exists, be- thesis conforms to beauty, ficulties and the travails of cur- ginning with Vatican Council good, truth, and justice. All the rent life are overcome. To be II, an ecumenical dimension to judgements refer the particular Christians does not liberate us action which by now should be cases which they have to ex- from the evils which accompa- included by Catholic health amine to these transcendental ny the lives of each and every DH n.45 ing 1-68 2.8.2001 15:42 Pagina 41

person on this earth but makes the Church and for the his experience of life in diffi- it possible for us to liberate non-Christian through accept- cult conditions. These are new ourselves from them in a spiri- ing openness to the needs and for him, immersed as he is in a tual sense, dominating them by the requirements of a civilisa- pluralistic society. Forced to adopting a new approach tion of love. Seeing, judging recognise the legitimacy of the which comes from attachment and acting, to employ the position of others and the value to that Lord of life who is words of Cardinal Cardijn, are that this position may have, he Christ. the columns on which there asks himself what the justifica- It can happen that the follow- rests every form of participation for his own faith is. It can ers of Christ come to take diffi- tion in the life of society. seem to him that reasons alone cult and painful decisions. The explanation of the or mere natural reason can take These are an opportunity to Christian life which has been its place. Do we not today demonstrate that the new logic presented here corresponds to boast of the value of traditional into which the believer enters the reality of human life. cultures? Do we not give the Knowledge of it is not only ex- impression that we put them all planation, it is also based upon on the same level as that social experience. There is a commu- behaviour which is based upon nication through actions rather Christianity? In this way there than speech. Our actions reveal becomes inserted in insidious the deep feelings which move fashion into the minds of our us. A spontaneous reaction in contemporaries the idea that the daily life of the profession- before them a new epoch is al is often an opportunity for opened up in which religions the non-believer to perceive will no longer play the found- 41 the depth in which a profes- ing role which they have sional life is rooted. The person played in the past. who wants to live as a Christ- The Catholic professional is ian in his professional life must not the only person who wants know that his daily forms of to make society develop or behaviour and conduct are also wants it to stop on the road on signs that he sends to those which it seems to be travelling. who are near to him and mes- The representatives of other sages that he communicates to social forces have the same them. ambition. The structure of the It is necessary to examine behaviour of both is the same. cannot be reduced to an ab- the conditions in which the For both it is a matter of writ- stract discourse but is some- Catholic decides to write his ing their representation of the thing which corresponds to re- imitation of Christ into reality. ideal order of the world and ality and embodies it. Such are He does not fight for an alter- their interpretational system of the origins of the counter-cul- native society proposed by a existence into reality. In this ture of which the Christian and political programme or ideolo- way the Catholic encounters the Catholic nursing personnel gy but, like each and every other people who, without hav- are the agents. It realises that man, as a prisoner of a set of ing his faith and his vision of the follower of Christ is not conditions which weighs upon the world, share his concern to bound to the observance of pre- him, his task is to make such give priority to the religious di- scriptions as though Christ had conditions ‘more human’.5 mension of existence. He must left his disciples a code or a rit- The Christian affirms that the live as a believer in a new con- ual to be followed. The libera- criteria proposed by him are text; for centuries his en- tion brought by Christ is that of those which are most suitable counter with other visions of the conscience. It invites the in- to make the society in which the world has been conflictual, dividual to feel responsible for he lives advance and he and often violent. It was making the world more human demonstrates that this is the thought that truth was on one through initiatives adopted in right course not so much with side and that error was on an- complete good faith. The arguments which are rarely other. Both parties were in Christian life is spontaneity. It accessible to those who work good faith when they con- is an answer freely given in full with him but with an appeal to demned the other but they saw responsibility to the appeal that instinct for truth which is the solution to the conflict only made by Christ. The person present in each and every indi- in imagining a victory of one who lives out these truths push- vidual and which directs him over the other. ‘Truth above the es others towards freedom. He towards the good, the beauti- Pyrenees; error below it’, said challenges them to place them- ful, the true, and the just. The Pascal. Greater knowledge of selves in relation to the gospel Catholic professional dis- the human condition no longer of Christ in the various situa- charges his obligations and in allows us today to maintain tions in which they find them- discharging them he strives to this dichotomy. If every man selves, discovering what their improve society according to and every civilisation are obligations are and judging the his actual possibilities of do- searching for truth, this means ways in which they should re- ing so. that they do not possess it en- spond to them Ð for the Christ- The Christian faces up to the tirely but only in part, and they ian according to the teaching of encounter of his own faith with do not manage to achieve it in DH n.45 ing 1-68 2.8.2001 15:42 Pagina 42

its entirety. All people have the God. Hence the rejection by value in itself, and it is on this same aspirations and these Christians of abortion and eu- terrain that we find ourselves. transcendental goods Ð the thanasia. Our professional approach true, the good, the just and the The struggle for life has to- should reveal to them that their beautiful Ð but they grasp them day taken on a new breadth. esteem for life can become only in proportion to their spir- The development of technolo- deeper. They must learn itual elevation, their courage to gy now allows us to dream of a through contact with us to dis- concretise them, and their free- profound transformation in the cern how the new scale of val- dom of action. All people are condition of human existence. ues spread by modern civilisa- the prisoners of the cultural in- Thus the habit of engaging in tion favours or otherwise the heritance that they have re- experiments on man, of development of life. The value cloning, of accepting mothers of man does not come from for hire, and post-mortem in- what he consumes, otherwise semination...has already en- he would have value only in tered into the health care pro- relation to what he possesses fessions of certain countries. or can purchase. The poor per- Such forms of ‘progress’, as son, the handicapped, the un- some people maintain, have born child, the elderly person... been facilitated by the fact that would see their right to life in- the nursing staff is today a part creasingly called into question of a team which is itself an in- when respect for them because strument of a policy defined a source of disturbance for from outside. That staff feels those who hold power. 42 exonerated from responsibility towards itself and society; it no Ð The Dignity longer writes a transcendental of the Human Person end into its activity. The need for respect for life At the present time there is is not a slogan. It has conse- underway a struggle about the quences for the daily work of meaning of existence between health care workers who are ceived given that they are not the Church and the dominant asked to strive to ensure that it used to distinguishing in rela- currents of opinion of contem- is a reality for an increasing tion to it what is the essential porary society. Catholic nurses number of people. substance of the contribution know this Ð they have heard It requires among other of history and are thus tempted speak many times of the ab- things that health care workers to confer the same absolute solute opposition of the respect it in their professional across the board. Church to a certain number of life and do not abandon their practices. right to make a moral judge- * A first question is that of ment on their conditions of 3. The Catholic Nurse knowing if every person has work and to live in line with and the Daily Realities taken initiatives to change this this. The upholding of a status of Existence knowledge into a conviction. for the professional who is a Behind the offences such as conscientious objector springs Four chief directional lines those which have taken place from this principle. As the De- seem to influence the behav- in Cairo and which take place claration on Religious Free- iour and conduct of Catholic every day in clinics or labora- dom, Dignitatis Humane, lays health care personnel who tories, the civilisation of love down and specifies, nobody wish to practice their own proof Christianity is called into must be forced to act against fessional activity in a spirit of question. It is not enough to the right prescriptions of his Christian witness. Two of these say that all men are brothers, own conscience. We find a concern values, and the other that they must help each other similar position outlined in the two involve means. and love each other. We need Universal Declaration of Hu- to push this requirement to the man Rights of 1948. Values very limits and see in every at- In their work health care tack on life, however tenuous it workers must respect the right Ð Respect for life may be, a limitation on the uni- of others to live according to Life is the most valuable versal union of all men wanted the religious dimension of ex- good that man possesses but by Christ. istence Ð they must ask them- not everybody gives the same * A second question is that selves about their own respon- definition to it. For the Christ- of knowing what we should do sibilities towards ensuring the ian, life is a gift received from to make our environment more provision of religious assis- God, it is the moment at which respectful of life. We are not tance to patients, providing the every individual fulfils his the only ones who see it as be- highest number of people with personal destiny by conferring ing something sacred, that is to care and treatment of quality, upon it a meaning. It is sacred say that it cannot be manipu- and helping those with whom because this faculty cannot be lated as we wish and recon- they are in contact to develop a taken away from anybody be- structed according to our sense of family Ð which is, in- cause this would interfere be- ideas. Many other currents of deed, the fundamental nucleus tween the conscience and thought believe that it has a of society. In a few words they DH n.45 ing 1-68 2.8.2001 15:42 Pagina 43

must be filled with the idea forms a part of a team engaged al level. Although its member that their mission is to lead in providing treatment or pur- associations are not organisa- those whom they encounter to suing research in which the tions of a trade union charac- a better understanding of their tasks of each member are es- ter, they must strive to have an dignity and to grow in humani- tablished without there being a audience in the health care ty. Health care workers con- possibility to take part in the worlds where they represent tribute to this through their definition of the general poli- the wish of most men to have professional activity because cy of the service which is pro- the religious dimension of this is a material, spiritual and vided. their existence recognised. psychological help for individ- This is not possible for an in- The question of the identity uals and is at the basis of civil- dividual but it is possible for of Catholic health care workers isation. those who unite their efforts in is raised particularly in the so- order to obtain changes in in- cieties of the twentieth century. The Means stitutions or practices. Suffi- They do not make faith in God cient emphasis can never be the basis of their social institu- Ð Commitment within placed upon the importance of tions. In the answer which will Structures associations which are strictly be provided to them there is a Service to life requires a professional in character in need to define a new Christian person to take an active role in matters relating to health care culture, something which thirty the development of suitable and the duties of those who years ago Vatican Council II health care structures. Those take part in the provision of defined through its Constitu- who are engaged in care and such care. Such associations tion of the Church in the con- treatment, whether they are in interpret the wishes and the temporary world. Observing a hospital or do so privately, claims of the ordinary workers. the new conditions in which 43 can know better than anyone It is within them that the com- Christians found themselves else what is not going right in plaints about the poor function- (or would find themselves) in the health care services. They ing of the structures and the order to be witnesses to Christ, must point this out and at the remedies which are proposed the Council appealed for a same time work to modify the can be studied. They must re- deeper inner life in order to conditions in which they are member that the aim of health perceive the meaning of the called upon to take care of the care policies is the develop- dignity of man given to us by patients. ment of each and every man the Gospel in daily actions. Identity manifests itself in and of the whole man. But the This mission will be the mis- the concrete reality of occupa- philosophy of life that they sion of the third millennium. It tions. We have to know how to spread is not, and cannot be, in pre-supposes, in order to be discuss respect for life, good a pluralistic world that which achieved, that Catholic associ- work relations, care for the moves men and women who ations will be strong minorities very poor...but the Christian are religious. Isolated, they can which will act within societies staff are those who are con- do nothing. For this reason to help their members to up- cerned with truth in their be- they must gather together in as- hold their faith in Jesus Christ haviour. They will thus ask sociations which can give them and to communicate that faith themselves: in this situation a voice. to other people. what can I do and what do I do The question of the collabo- to promote life, to create the ration of Catholic health care Rev. JOSEPH JOBLIN, SJ, conditions for the receiving of workers with non-Christians Ecclesiastical Adviser life? Are the institutions in who share a vision which is to the CICIAMS which I work sensitive to these near to theirs cannot be avoid- (International Committee of Nurses and Medical-Social Assistants), concerns? What can I do on ed. From various countries in- France. my own or in a group to main- formation is arriving to the ef- tain, defend or change the ex- fect that nurses belonging to isting conditions? The health religions different from the care worker is Catholic in pro- Christian religion are taking portion to the extent to which part in the activities of our as- he is personally committed and sociations. When such con- can write greater benevolence tacts take place these must be into his own professional life seen as an opportunity be- Notes through institutions. cause they increase the possibilities of achieving our objec- 1 CARDINAL PAVAN, ‘Attualità della Pacem in Terris’, in F.BIFFI (ed.), I Ð In Particular through tives in relation to sick people Diritti Fondamentali della Persona Professional Associations and because they make the Umana e la Libertà Religiosa (Vati- Active participation in the member associations of the cano/Lateranense, 1985), pp. 149-154. 2 The case of traditional religions is transformation of health care CICIAMS in this field the pio- different because each of them does not may appear a little utopian to a neers of a counter-culture of constitute the raison d’etre of modern large number of health care life. The need to represent reli- states. 3 PIUS XII, radio message, Christmas workers. This objective is be- gious aspirations can in this 1956. yond the capacities of an iso- way be satisfied. Contacts 4 A.DUPRE-LATOUR, ‘Théologie des lated individual above all with non-Catholics broaden Religions Non-Chrétiennes et l’Islam’, Studia Missionaria, 1999, 48, pp. when he does not occupy a po- the representative character of 215-230. sition of responsibility and he the CICIAMS at a profession- 5 Populorum Progressio, ¤¤ 19-21. DH n.45 ing 1-68 2.8.2001 15:42 Pagina 44

Challenges for the Third Millennium

1. Introduction bers of, the CICIAMS? What is tackle these changes? there that is new about the As Rev. P. Joblin, the Ecclesi- As General Secretary of the twenty-first century? Through- astical Adviser of the CICI- CICIAMS, it is a great pleasure out the world those who provide AMS, observed in Taipei in for me to take part in this meet- health care find themselves up 1998, we are invited to move ing and to extend to you all a against monumental challenges. from the second to the third mil- warm welcome. But this is something which lennium as though this was a This is the first time that they have always done, as in- sign of the challenges of the health-care personnel, and in deed Dr. Shirley Dooling ob- present time. particular nurses, obstetricians, served in Taipei in 1998. We members of the CICI- and medical-social workers like The health of a nation is AMS are invited to reflect upon ourselves, have been able to strongly linked to its economic our duties and to ensure that gather together in this magnifi- status, to its health care policies, everyone of us moves from less cent hall of the New Synod in to whether there are conditions favourable conditions of life to 44 the Vatican. of peace, and to quality of life. better conditions of life. We are I extend this welcome to you The system of health care of a called upon by the Pope to face here in Rome, this magnificent, culture, society or nation is up to the crisis of the sector of historical and central city of strictly connected to its values health care brought about by Catholicism, coming as you do and its religion, and as a result progress in the medical field. from far away to participate in to every change which might We are called upon to re-exam- this important and indeed his- take place. ine the traditional concepts of toric congress. What, then, are the changes care and to adopt new values in The whole world now looks which mark out the twenty-first our own cultures and societies. forward to the third millennium century? We must face up to the pres- and like a large number of other 1. An explosion in knowledge sures of public opinion and not Catholic associations, the mem- and information. accept technical and technologi- bers and leaders of the CICI- 2. The development of tech- cal innovations without asking AMS have carried out a number nology, communications, and ourselves about their impact on of readings of the tasks and travelling. human life. We must face up to challenges of nursing during the 3. The impact of the environ- the spread of values which com- third millennium. The member ment on individuals and on so- promise the dignity of man. The associations of the CICIAMS cieties. CICIAMS must have the know their tasks and in general 4. Changes in the role of courage to proclaim its own the challenges which they are women and the family. Christian vision of man. faced by, and as Mons. Lozano 5. New illnesses and infec- Implementing and putting in- Barragán observed during the tions (Megatrends 2000: J.Nais- to practice all of this in the Sixteenth World Congress of bitt and P. Aherdene, 1970). world of nursing constitutes the CICIAMS held at Taipei in How should the members of what is certainly an important 1998, they know the mission the CICIAMS face up to and challenge. and the responsibility of nurses, obstetricians and medical-social workers. At the end of his message, Mons. Lozano Barragán exhorted the CICIAMS to spread out wide, in particular in those countries where it is not yet present, so that the largest number possible of Catholic nurses, obstetricians and medical-social workers will decide to join it and so that the culture of life will shine forth in the field of nursing the whole world over. The question which presents itself is the following: how can we apply this magnificent idea in the form of an effective and efficient strategy and how can we motivate our colleagues to adhere to, and to become mem- DH n.45 ing 1-68 2.8.2001 15:42 Pagina 45

The nursing and obstetric health care workers have had to b. The Position of Health professions have acquired new face up to great difficulties, and Care/Obstetric Workers importance, and technological this will also be the case in the in a Multidisciplinary Team and scientific advance have future, in relation to the work transformed them over a very environment, social rules, and The members of a team are short period of time (some laws and other forms of inter- able to work together at the twenty-give years). ference on the part of public au- same level in the interest of the Traditionally, nurses were the thorities. This is the case in patient to define the specific as- primary assistants of medical every continent of the world. pects of their profession at the doctors but their image, and the The authenticity of nursing also interface of three worlds Ð as image of obstetricians, has since requires a development of a vi- colleagues, medical doctors and totally changed. They no longer sion of management Ð we must auxiliary medical staff, and pa- see themselves as assistants of become more involved at a di- tients. The difference between medical workers but as part of rect level in the processes of these worlds are many in num- their team, as their co-workers. care and treatment of patients ber when it comes to power, in- The contemporary tendency and in organisation. terests, knowledge, ability, and can no longer be halted. The opinions. world of nursing and obstetrics is face to face with an enormous 2. The Challenges of Nursing b.1. Issues in the Relationships challenge Ð that of unifying and and the Lifestyle of with Medical Doctors supporting technical knowledge the Twenty-First Century a. The nursing staff are subor- and capacities to being ‘near’, dinated to the medical doctor in to care for patients, to commit- a. The Specialisation and the professional and organisa- ment (which for some is voca- Fragmentation of Service in tional fields. The nurse can at tion), and all this should be Health Care and Treatment times act in an autonomous way 45 based upon Christian principles. in relation to the treatment to be In recent years economic In a large number of societies administered to the patient. questions have become increas- and cultures being in good b. The medical doctors fol- ingly important in Europe, in health is seen by many people low the information about the Africa, in Asia, in South Ameri- as the greatest of blessings. The care and treatment given to the ca, and in Oceania. It is more decrease in financial resources patient and about the nursing than evident that hospitals can- and a growing questioning in staff. They must receive this in- not survive if the economic as- relation to the ethical implica- formation or insist strongly up- pect of things is not taken into tions of this requires greater on having it. This emphasises consideration. However, eco- thought and reflection. As an the importance of the position nomic realities are only applica- answer to this, we propose the of the medical doctor. ble in a certain way Ð ethical creation of a health care system c. The nursing staff are al- and human considerations limit which is even more efficient ways ‘near to the patient’. This and constrain the economic ap- and the creation of every type of approach is not limited to cer- proach. Health care workers medical and nursing specialisa- tain rites, and their field of ac- have always been placed in tion. However, specialisation tion should always be very ac- front of an enormous task, and implies independence. Every cessible in terms of what they this will remain the case during form of specialisation functions have to do. the course of the next century. with its own structures, its own Those who belong to the cat- way of thinking, its own meth- b.2. Issues in the Relationships egory of health care workers are ods, and its own forms of tech- with Patients privileged in the sense that they nology. The patient is no longer The patient must be seen as a can put into practice such val- the central figure Ð this destiny ‘regal client’ and be the subject ues as solidarity, generosity, and falls instead to the specialist. of care and treatment. There is a spirituality. In a secularised The specialist has become the certain discordance in the posi- world they must behave like central factor in treating and tion of the nursing staff in rela- Christians, today and in the fu- caring for the patient. He deter- tion to the patient. They have to ture, and this is something mines the way of thinking, the be emotionally and socially in- which is expressed in their pro- methods and the technology of volved with the patient and fessional and religious ap- health care. (An example: the have to take care of him or her proach. pattern of self care of OREM, at every moment of the day. The authenticity of nursing integrating nursing). The care The nursing staff is not able will be the great imperative of which is provided must be sup- to maintain that distance which health care workers in that such ported by the activity and initia- is necessary in a professional authenticity will be based upon tives not only of the various approach. They run the risk of the autonomy of nursing and kinds of health care workers but becoming too involved with upon its ethical kindness. also by the patient himself. their patients, of suffering Health care workers cannot be Inter-professional collabora- stress, and the danger of mental indifferent towards their neigh- tion has always been the most wear and tear constitutes a very bours and even less so towards important characteristic and real threat. those who suffer. Their neigh- feature of team work. The pa- bours call upon their real good tient is the central figure and in- b.3. Issues in the Relationships will. deed the very reason for the with Colleagues This has a price but man be- team’s existence. Here stress and emphasis comes better when he displays Interdependence is a third im- should be placed upon the his goodness. In recent years portant concept. method of nursing and the way DH n.45 ing 1-68 2.8.2001 15:42 Pagina 46

in which this method functions. caring for and treating those in tions of the nursing staff. Politi- There are two types of nursing, need as an essential value, an cal notions have also changed: and these are different from essential value of life and what has happened to quality each other. The nursing of tasks morality, something which is in- and solidarity? This moral vo- and integrated nursing. The dispensable in a human society. cabulary and these notions are nursing of tasks involves each On the other hand, since the no longer applicable in politics. person knowing his or her tasks eighteenth century, when in Eu- This is something which afflicts and striving to perform them to rope care and treatment was the approach of the nursing staff the best of his or her ability or above all else an act of philan- towards patients. The submis- capacity. Integrated nursing in- thropy and then became well or- sion of the patient and his grati- volves each person acting as an ganised charity work, it has be- tude have disappeared. Today’s autonomous expert, and, after a come a matter of professional norms and values are a compli- process of consultation, in activity. This kind of care and cated question, and the solution co-ordinating those forms of treatment has a fundamentally to things is to be found in ‘en- care and treatment which negative aspect in the sense that gaging in ethics’. In this way, should then be provided to the the patient is in a position where for many nurses, obstetricians patient. there is less respect for him and and medical-social workers the It sometimes happens that the his dignity. How can this ambi- leit-motif of the NVKVV (a nursing staff is not sufficiently guity be overcome? member of the CICIAMS) is involved with other members of applicable, for example the dif- the team looking after the pa- c.2. First of all Changes ference between profession and tient, or that the cohesion of the without Human vocation. Of what does this team is not strong enough. Here Health Care consist? the role of the head of the team a. Patients deciding on treat- Profession requires that paid 46 is of primary importance. The ment. work is done by oneself in the method of leadership, based up- In a large number of Euro- best way possible; vocation in- on the group, is a favourable pean countries (for example in volves performing one’s work factor in the employment and Belgium and Holland) the pain a way which is based upon utilisation of the health care tient himself decides the kind of love, charity, and faith in the staff. care and treatment he will re- Holy Bible. ceive and a price for this is then One can say that the leit-mo- c. Changes in the Concept agreed upon. The patients and tif of the NVKVV is based upon of ‘Human Care their families, and this is espe- the vision of the Nobel-prize and Treatment’ cially the case in the geriatric winner Mother Teresa of Cal- field, purchase care and treat- cutta, but with this difference Ð What is care and treatment? ment in medical institutes and all the members of the CICI- In our times care and treatment clinics, which, indeed, they AMS are professional people. It is a concept, but it is also a prac- themselves choose. is more than evident that the tice. Care and treatment define Specialisation and profes- idea of love-charity-faith is not the relationship between the sionalisation of every kind in in contradiction with profes- medical doctor and the patient. relation to those who provide sional care and treatment. They It is a means by which to enter care and treatment means that a into a relationship in a certain large number of such people set of circumstances. can co-operate in the planning As a result, the approach of and assessment of the various ‘care and treatment’ in terms of forms of care and treatment a product of the market and of which are provided. The move the ‘patient’ in terms of being a towards this kind of contract for customer or consumer enters the care and treatment is rapidly ac- picture. Care and treatment is a complished. practice which is different in na- b. Changing the Business of ture from business. To receive Care and Treatment in Europe. care and treatment is something In Europe, hospitals, institu- which is different from buying a tions, and health care centres motor care. Care and treatment etc. function in line with the is a complicated process. The mechanisms of the market. The needs of the patient are central provider of care and treatment to this process and the patient meets the patient’s demands and participates in it actively. The needs, although it should be goal is not profit or a product stressed that these latter are at but a reduction of suffering and the centre of this approach. if possible the recovery of c. Changing the Notions of health. This means that in the Care and Treatment. are, rather, the basis of the fun- provision of modern care and The moral vocabulary of damental values and approaches treatment there are distinct char- health care workers has embraced by health care work- acteristics and changes, which changed. Religious notions ers who are Catholics. may be listed as follows: such as love, charity and respect Before ending this section no longer form a part of that vo- with ideas and proposals about c.1. A Fundamental cabulary. Such notions are now the challenges for the human Ambivalence individualised and are simply a provision of care and treatment, On the one hand, we can see part of the professional motiva- I would like to return to the am- DH n.45 ing 1-68 2.8.2001 15:42 Pagina 47

biguity to which I referred sion of care, and this is some- 5. Good health above: care and treatment and thing which means: This approach does not in- the reduction in respect for one- a) that human existence is involve a positive appreciation of self and the dignity of the pa- carnated existence; suffering but allows it to be con- tient. In order to clarify this am- b) that incarnated existence trolled. To dominate the fear of biguity we must identify the expresses itself in two ways, for suffering establishes the condi- two dimensions of care and example in vitality-passion, tions within which it is possible treatment Ð care and treatment strength, energy in the face of to ascertain and understand the as activity and care and treat- fragility-dependency-vulnerabil- value of life in all its expres- ment as listening to the meaning ity. All this characterises the hu- sions. What, speaking from a of the human being. Health care man existence; medical point of view, is a workers provide human care c) that care as listening is the handicap, can from this point of and treatment, as the title of this mutual way of responding, en- view bring about good health. paper makes clear. Care and gaging in dialogue, and com- When this view of health is treatment as activity has disap- municating. It is fundamentally accepted in medical practice peared in Europe in recent cen- a social process because it is and nursing there will be a place turies. In many cultures care based upon the higher interest for an approach which links the and treatment is a holistic and of the other person. meaning of care and treatment integral part of life, and often We can affirm that Mother to the meaning of life. connected to sacred activity. Teresa, the poorest of the poor, To conclude this section on Care and treatment is a family well understood this fundamen- human care Ð all the nursing question and thus the responsi- tal basis of care Ð that it was, for staff must find their own profes- bility of all the members of the example, a fact involving a per- sional identity and their own family and of sacred people. I manent interest in the other per- profile must be the Catholic refer here to almost all the soci- son. idea. I am referring here to what 47 eties of Africa, and to the previ- How can we, professionals of His Holiness Paul VI and later ous systems of care and treat- health care throughout the His Holiness John Paul II have ment in the Western world, in world, interpret the dimension upheld Ð a civilisation of love. Latin America, and in Asia. of care as listening in the con- In referring to the Catholic Ever since the last century the cept of care as activity? health care institutions such as health care systems of the West- the CICIAMS, the strength of a ern world have defined care and 1. The Goals of professional attitude based upon treatment as an activity, and the Health Care Activity Christian principles lies in an provision of care and treatment Often nursing staff direct their extraordinary mission. The is a paid activity. own activities towards dealing Catholic professional organisa- The social sector, to which with dependency, vulnerability, tions offer to the religious di- care belongs, occupies the third illness, or poverty. Catholic mension an opportunity to have position in the Western world. health care workers associate a valid place and to be integrat- Statistics and trends indicates care with the activity of individ- ed into the whole framework of that this will advance to the sec- uals in order to give a meaning health care and treatment. ond position at the beginning of to people’s existence, their ill- the next millennium. ness, and their poverty. With Studies carried out in Holland Mother Teresa I refer to the pas- 3. The Emancipation show that 11% of the popula- toral letter Salvificis Doloris of of the Profession tion in that country works in the His Holiness John Paul II. health care sector, which is re- a. The health care personnel sponsible for 11% of the nation- 2. The Responsibilities must develop its own al product. In Holland and Bel- of Patients professional identity gium, countries close to each In receiving care and treat- other which have the same lan- ment, patients express their A model of health care, such guage and a similar culture, sense of independence and of as integrated nursing, offers an 60% of care is provided by not being governed by other opportunity which leads to the women. One in three women people, and can interpret their emancipation of the profession between the ages of thirty and illness, handicap, age and even and to the demarcation of its sixty provides care. These sta- death as being a part of life. The own territory in relation to other tistics include the professional dignity and responsibilities of health care workers. and voluntary health care work- patients must be incorporated a) The model which defends ers, and 20% of them receive a into the provision of care and the patient in relation to the care kind of salary which varies ac- treatment. and treatment which is offered cording to conditions of work, is a response to the fragmenta- the ordering of the social sys- 3. Possible Options tion of the health care system. tem, etc. The ethical care espoused by b) In their role as mediators, We can conclude that in the the philosopher Friedrich Niet- the nursing staff are the right West care as an activity is ac- zsche. hand man of medical doctors as cepted as a framework of refer- well as being the advocate of ence. 4. Poor health the patients. What has happened to care as A human being resists illness, c) The health care staff must listening to the meaning of hu- handicaps, suffering and death. carry out negotiations, that is to man life? It has its roots in tradi- All of his energy is directed to- say evaluate and assess its own tion. One is dealing with the rewards avoiding these attacks on work and the work carried out alities of the ontological dimen- life. by other people. DH n.45 ing 1-68 2.8.2001 15:42 Pagina 48

death, the transplanting of or- care has been provided to the gans, AIDS, etc. The time has poor Ð first it was provided by come for them to develop their members of religious orders etc. own ethical standards which and then by nursing staff. conform to their own culture. We must offer a politically Nurses, obstetricians and solid and implementable strate- medical-social workers must gy in order to bring about a learn to listen to the human per- calm revolution. Prof. Maraldo son. This is possible only if they (USA) suggests that in order to pay attention in a systematic achieve this goal we must fol- way to religious questions and low the following strategy made realities. It cannot be expected up of three points: that everybody will be able to 1. As nursing staff in the hold a religious conversation world we must first of all in- but they should be able to find voke what Thaillard de Chardin an opening through which to ex- calls the Gospel of the human press religious questions and re- effort. We must develop in those alities. The training of nurses who believe in Christ, and in and obstetricians should offer those who do not believe in holistic references in which pa- him, full awareness of the uni- d) The leaders of the nursing tients of every kind, including verse which surrounds us and in staff must combine two styles of religious patients, can be helped. particular of our power to influ- leadership. One style should be The health care staff and per- ence their development through directed towards work which sonnel feel at times that it is not our action. Our collective spiri- 48 brings about the good perfor- their role to engage in such tual passion, which lays down mance of the members of the things and thus they display lit- that a world in good health must team, their effectiveness, and tle enthusiasm in openly ex- prevail, must be nourished and corrects the limits to their auton- pressing their own vocation. made systematic. omy. Another should be directed Christ said: ‘the tasks are many 2. The nursing staff of the towards the person and should but the workers are few’. His whole world has the responsi- emphasise the mutual relation- answer is still valid today: ‘pray bility to search in a forceful way ship which is present. The nurs- that the Lord sends workers to for a professional status and ing/obstetric staff should help his tasks’. jobs of independence, authority, the patient to be as independent and responsibility to accompa- as possible. Health care and ny that status. Jobs of higher treatment require the staff to Suggestions for the management, of executive func- identity with the perspectives Education and Training tionaries, and of government and points of view of the patient. of Nurses, Obstericians, will advance the paradigms and This means identifying with and Medical-Social Workers the models of nursing. what helps the patient in the life It is equally to be recom- that he or she has chosen. As Martin Luther King, the mended that each nation en- defender of civil rights, af- gages in a re-evaluation and re- b. The Training of the firmed: ‘social progress will assessment of the resources Health Care Staff, never come on the road of the dedicated to its nursing staff. Obstetricians, and inevitable’. States must invest resources in Medical-Social Workers How can we draw up a plan education and the strengthening which can implement health of leadership in nursing and ob- Training must produce staff care which is suitable to the stetrics. Leaders must have a and personnel who are expert third millennium? knowledge of the economics of and fully qualified. The sector of health care must health and the development and Not only knowledge, ability ensure a leadership which will evolution of health care policies and capacities within the pro- allow us to shape and mould our in order to contribute to a solu- fession should be acquired. The vision of a better system of care. tion of the problem of human basic principles of the profes- As Prof. P. Maraldo (USA) has resources in their country, and sional contents of the other observed, what we need, and to take on a role of consultation health care workers should also what the world’s nations also and management at the highest be absorbed. Knowledge of need, is a calm revolution in re- level of government and the pri- their own professional identity, lation to health care throughout vate sector. Regional co-opera- and of suitable instruments of the world, which is conceived tion between the leaders of work, contributes to the autono- and implemented by the nursing nursing (and in particular in de- my and emancipation of the staff. We have a great deal to of- veloping countries where the profession. fer to the world’s health care groups of leaders are small and Health care workers must systems. Nurses, obstetricians relatively isolated) is an effec- learn to be flexible in order to and medical-social workers tive and efficient strategy for manage realities of employment must take part at all levels in the the development of leaders in which are always different, and sector of health care. nursing in these countries. be as effective as possible in all This revolution must be calm An improvement in educa- circumstances. During their because there already exist nu- tional opportunities and in fi- training and their daily activity merous theories and models nancial rewards, and a concern they have to deal with bioethi- which can revolutionise this for the working conditions of cal problems at all levels Ð brain sector. For some time health nursing staff and obstetricians, DH n.45 ing 1-68 2.8.2001 15:42 Pagina 49

are important if we want to systematic reform on our own. ragán has said, Catholic nurses, maintain a team of nurses all We can educate other people, in obstetricians and medical-social over the world. particular our colleagues, and workers must be trained so that Educational programmes in show them the path to the hu- they can develop their faith all countries must prepare stu- manisation of care and treat- within their environment and in dents for work and supervise ment as a process through particular within the ethics of ‘nursing helpers’ who are re- which a new and radical form of nursing. sponsible for formal, traditional health care can be appreciated Catholic nurses must under- and informal care such as assis- by everybody. stand that their faith leads them tants, healers, herbalists, fami- In educating other people in to protect the basic principles of lies and friends. the humanisation of health care their professions, beginning The basic education of nurs- it is important to understand with: ing must provide a general what health care really is. In the Ð the principle of benefit Ð grounding. An advanced educa- context of a new paradigm, always helping the patient; tion in the form of clinical spe- health care is a positive emo- Ð the principle of not doing cialisation at a post-basic level tional support and a response to wrong Ð never harming the pa- given by the traditional pro- the conditions and the situation tient; grammes and by a ‘from a dis- of another person, a response Ð the principle of autonomy tance’ education is fundamental which must uphold our commit- Ð leaving the patient to decide for educators and professionals. ment to their well-being, our things on his or her own as There must be constant high- concern, our sensitivity, devo- much as possible; er education for the nursing tion and patience. At the centre Ð the principle of sincerity Ð staff. This is also an instrument of care and treatment, as Calla- the patient must be honestly in- by which to achieve the han (1990) makes clear, there formed; progress of minority groups. must be a commitment to never Ð the sacred principle of life 49 Education is essential for the shift our gaze to abandon or to Ð human life must always be de- advancement of nursing. become uninterested in those fended; Our nations increasingly ask who suffer, the handicapped or Ð the principle of justice Ð all for nursing staff who are able to the mentally retarded, the alien- people must be treated in the provide a service of complex ated, or those who are afflicted same way and receive what they care and treatment. As a result, by AIDS. have the right to receive. nursing education has reached a Our mission as nursing staff, Nurses, obstetricians and critical point. Education must educators, researchers and ad- medical social-workers must be directed towards students ministrators, is the humanisa- address themselves to the sub- more than towards an internation of the health care system lime task of proclaiming the tional health care plan. The through the humanisation of our culture of life. They must show nursing staff of every nation Judeo-Christian values of jus- that life and care are a gift of must open the road to ensuring tice, compassion, quality, man- God, which we must provide as that the prevention of illnesses agement and co-operation with such. becomes a priority. those we look after, our pa- Of essential importance, also, tients, our families, and our is an international policy of ill- communities. In this process we IV. CICIAMS: ness-prevention directed to- will become a nation of healing Catholic Organisations wards fighting drug and alcohol people dedicated to reducing of Nurses, Obstetricians, and abuse, adolescent pregnancies, the suffering of all our brothers Medical-Social Workers childhood mortality etc. Such a and sisters wherever they may political policy of prevention be found. Is this not a part of Origins and History would have an impact on fiscal our vocation as Christians? In 1928 and benefit programmes for em- order to apply the reforms In 1928, at an international ployed people and the financial which are necessary to the im- meeting held in Basle, the presi- structure of the health care sys- plementation of our mission we dents of the Catholic associa- tem. must help each other and in par- tions of various countries decid- A national policy of preven- ticular help our colleagues, the ed to create an international tion would not only achieve members of the other health Catholic professional organisa- what is obvious but would also care professions, to have the tion. improve the care and treatment, courage to see the face of Christ and indeed the well-being, of in the face of the congenitally 1933 the nation, and would have the deformed child whose mother In 1933 the first congress benefit of reducing the costs of uses crack, in the face of the took place at Lourdes and it health care. young black man who is an al- brought together nurses from 3. As I.Perkins (Kentucky) coholic and cannot find work, ten countries. On that occasion has observed, for centuries we in the face of a homosexual af- the ‘study committee of the as- as nursing staff have demon- flicted with AIDS, in the face of sociations of Catholic nurses’ strated our skill and our com- a woman who is homeless and was established. Its statutes mitment in relation to providing mentally handicapped who were approved and the members service wherever sick people sleeps in the tunnel of a metro of the committee were elected. have been encountered Ð in hos- beneath the city, in the face of a pitals, at home, in schools, in seasonal agricultural workers, 1933-39 the street, on battle fields, in the in the face of a weak and lonely From 1933 to 1939 the inter- metro, and in our centres. We elderly person. national committee extended its cannot, however, carry out a As H.E. Mons. Lozano Bar- work to various continents of the DH n.45 ing 1-68 2.8.2001 15:42 Pagina 50

world and brought together under its banner a notable number THE NETWORK OF THE CICIAMS of Catholic nursing associations. THE UNITED NATIONS/DIP INTERNATIONAL CONFERENCE OF ICO 1946 AGENCIES: In 1946 the committee re- UNICEF newed its activities and spread WHO LONG-STANDING MEMBER OF THE widely in most of the countries DIP ECOSOC PERMANENT COMMITTEE where it was active. Faced with ILO the complex development of preventive and social medicine, COUNCIL OF EUROPE PONTIFICAL COUNCIL and the appearance in every FOR HEALTH PASTORAL CARE country of qualified personnel in the medical-social sector, in PONTIFICAL COUNCIL FOR THE addition to those engaged in LAITY nursing care, the committee decided to adopt the name of ‘in- PONTIFICAL COUNCIL FOR THE ternational Catholic committee FAMILY of nurses and medical-social assistants’ (CIACIAMS).

The Objectives of the CICIAMS STRUCTURES OF THE CICIAMS

1. To encourage in all coun- STATUTARY GENERAL COUNCIL 50 tries the organisation and development of Catholic professional EXECUTIVE COUNCIL associations in order to provide EXECUTIVES a moral and spiritual support to INTERNATIONAL PRESIDENT Catholic nurses (and nurses in FIRST INTERNATIONAL VICE-PRESIDENT public health), and to help them GENERAL SECRETARY to advance their skills and ex- TREASURER pertise. REGIONAL PRESIDENTS

2. To co-ordinate the efforts DAILY EXECUTIVE COMMITTEE of Catholic professional associ- GENERAL SECRETARIAT ations (with full respect for their autonomy) in order to study and REGIONAL SECRETARIATS express Christian thought in the professional world in general. THE ELECTION OF DELEGATES TO: WHO 3. To take part in the general UNITED NATIONS/DIP development of the profession UNICEF of nursing and to promote ECOSOC health care policies and social ILO well-being in line with scientif- THE INTERNATIONAL CONFERENCE OF ICCO ic progress and in accordance with Christian principles, there- COMMITTEES OF THE CICIAMS by ensuring the health and the THE TECHNICAL COMMITTEE well-being to which every hu- THE FINANCE COMMITTEE man being has the right, and at THE STATUTES COMMITTEE the same time respecting the re- THE OBSTETRICIANS’ COMMITTEE ligious beliefs held by each and THE PUBLISHING COMMITTEE every individual. Activity of the CICIAMS Publications The CICIAMS is governed by: The publication of the journal Congresses ‘CICIAMS Nouvelles-News- The General Council International congresses are Noticias-Nachrochten’ and cir- The General Council is made organised every four years. Re- cular letters. up of the presidents or the offi- gional congresses are also or- Participation cial delegates of the member as- ganised to study the health care The delegates of the CICI- sociations. questions and issues of each re- AMS take part in numerous gion in a more specific and de- meetings and initiatives of the The Council of Administration tailed way. various international organisa- The Council of Administra- tions with which it has connections is elected by the General Study tions. Council. This is carried out by the technical committee and by var- The Solidarity Fund The International Secretariat ious commissions in order to Help to support, and partici- The daily questions are the draw up reports and documents pate in, the activities of the as- responsibility of the Interna- for members and international sociations of Catholic nurses in tional Secretariat. organisations. developing countries. DH n.45 ing 1-68 2.8.2001 15:42 Pagina 51

Guides in Bioethics refer to the words of His Holi- non-confessional organisations ness Paul VI and John Paul II on the basis of Catholic princi- Texts prepared and produced on ‘the civilisation of love’. ples. by the technical committee with b) Collective reaction must Our vocation as a Catholic the help of experts. be ensured by Catholic profes- professional organisation is sional organisations, in this case based upon the demonstration The Regional Secretariats the CICIAMS. More than ever of faith and of attachment to the before, the Catholic profession- Church. This is what upholds These have been created in: al associations have an extraor- the meaning of the CICIAMS in AFRICA dinary mission as a driving the world, today and in the fu- The Francophone region and/or leading force of the pro- ture. The Anglophone region fessional skills and expertise of The CICIAMS must also ASIA the members of this profession, meet the hopes of the single EUROPE and this is something which members when these seek a col- NORTH AMERICA should be based on Christian lective and public resolution of principles. difficult ethical problems and Official Relations During the Fifteenth World issues, and in this it can bear of the CICIAMS Congress of the CICIAMS, in witness to the greatness of God. September 1994, all the speakers The organisations of the nurs- The CICIAMS has official laid strong emphasis on the fact ing staff united within the CICI- relations with the following in- that through the cohesiveness of AMS are an engine of energy at tergovernmental organisations: groups and collective action a local, regional and world lev- ideas should be more strongly el. They are: WHO upheld through the professional Ð places of encounter: open Consultative statute with the activity of nursing staff, obstetri- to those who are interested in 51 World Health Organisation cians and medical-social work- the humanisation of the health since 1954 ers. care professions. The concerns Catholic nursing staff, obste- and reactions of other people ECOSOC tricians and medical-social should be shared in order to cre- Member of the Economic and workers are not different from ate a common awareness of the Social Council of this body their colleagues when it comes problems and issues of profes- since 1954. to the question of professional sional life and to contribute to skill and expertise. The quality this common awareness by be- ILO of care and nursing differs ac- ginning with the promotion of On the list of the Internation- cording to societies and cul- movements of opinion which al Labour Organisation since tures. In industrialised countries can change our professional 1956. nursing and the profession of world. obstetrics are of the very high- Ð Places of reflection: friend- UNICEF est quality. Catholic profession- ship is important, it is the basis Member of the United Na- al organisations offer the possi- of every solid group, but it is tions International Children’s bility to the religious dimension not in itself sufficient. Catholic Emergency Fund since 1956. of things to have a valid role nursing staff need to reflect to- and to be a full part of overall gether on the problems and is- Council of Europe health care. sues that they encounter in the Consultative statute Cat. II Although it seems difficult to exercise of their profession be- for social and health care ques- motivate colleagues to become cause the exchange of superfi- tions since 1956. members of a Catholic profes- cial comments is not enough. sional association, the need to Facing up to the changes which The CICIAMS is a member act together is greater than ever are proposed and imposed, we of the International Conference before because of the increase must remember that a service of of Catholic Organisations and in secularisation and the loss of care which is really human must has regular contacts with a large basic values. include the poor and the social number of international organi- The members of a Catholic integration of the victims of ill- sations. professional organisation find nesses linked to drugs, family the strength to continue their or- breakdown etc. and who are re- ganisation but also the strength jected by society. The associa- Future Activity to help other people. tions of the CICIAMS must This is the essence of nursing know how and when to speak In order to meet the chal- and of the profession of obstet- about these problems and is- lenges of the year 2000 it is now rics. sues. To this end they will find necessary to react to the prob- It is more than evident that all in the social doctrine of the lems and difficulties faced by the members of the CICIAMS Church those teachings on nursing staff. are aware of the fact that organ- which to base their commitment a) Nursing staff must react isation is a part of the Church. and the reasons behind the ap- and it is important for them to The strong existing traditional proach which we expect of understand their own profes- link between CICIAMS, the them. sional identity and for the Church and the Vatican must be Ð Places of prayer: each and Catholic idea to be emphasised maintained and even strength- every association has its own and promoted for nurses, obste- ened. The challenge of the CI- tradition in this sphere which tricians and medical-social CIAMS is to differentiate itself matches the context within workers. To begin with we can from the other professional which it has developed. This DH n.45 ing 1-68 2.8.2001 15:42 Pagina 52

must be conserved because it is are worried by the fact that such should strive: human dignity, essential for the members of the people do not have access to respect for the freedom of con- CICIAMS to acquire a familiar- care. science, care for everybody, sol- ity with God which is suitable Our solidarity goes towards idarity, a solidarity that unites to them. This is an essential families in order to make them the human fabric, which is very point. For this reason, we have stronger or to bring them back often destroyed by health care an idea of God which helps a together again because our reli- policies Ð all these are signs of large number of sick people gious experience tells us that the integration of the human with whom we are in contact to they are the basic structure of masses into social and econom- discover the transcendental society. We therefore link them ic life. meaning of their lives, to assess as much as possible to the forms With their eyes fixed upon their illness, and one day their of therapy that we exist to pro- God, the source of compassion death, mobilising all their spiri- vide. and salvation for everybody, tual energies and accepting the As we cross the threshold of Catholic nursing staff will draw truth of their human condition. the third millennium the mem- near to the third millennium They will feel that they are the ber associations of the CICI- aware of their mission. objects of an infinite love and AMS must face up to the chal- The Gospel says that love, af- for this reason they will have an lenge which awaits them. As fection and care have a healing infinite value. members of civil society, they effect. Perhaps this is felt by the Ð Place of solidarity: we say share its hopes but they also nurses, obstetricians and med- that Christians are united with know that the path which is ical-social workers to whom those who are materially, psy- chosen is not always suitable. courage to continue will be giv- chologically and spiritually the Their faith in Christ gives them en by the Gospel. poorest among us. Solidarity is a clear view of the transforma- 52 the sign of our faith that we give tions which are taking place in AN VERLINDE to the world; it is our identity society. They do not seek to im- General Secretary the CICIAMS card. Our solidarity expresses pose a model which should be (International Committee of Nurses itself by paying attention to the applied as such to reality. They and Medical-Social Assistants) victims of life, to drug-addicts, offer a catalogue of successes Belgium or to the victims of AIDS. We towards which every society

The Identity of the Catholic Pharmacist on the Threshold of the Third Millennium

The subject which together an insistent and unequivocal draw from this extraordinary we must examine and investi- manner, has indicated the pur- event new light on these funda- gate does not require discussion pose of this extraordinary his- mental human experiences’.3 or research about a particular torical and spiritual event that Our meeting, therefore, will problem which has arisen re- we are now going through: not be an exploration of ‘you cently in the sphere of activity ‘Everything should aim at the cannot, it’s forbidden’ etc. but a which we have been carrying primary objective of the Jubilee search for, and an encounter out. Rather, it touches deeply on which is the reinvigoration of with, the history of salvation, the existence of each one of us the faith and the witness of the irruption of God who ‘sent as a professional man in a quali- Christians ...to foster a strong his only begotten Son into the fied and sensitive sector of hu- wish for conversion and per- world so that we could have man society, having the free sonal renewal.’2 Catholic phar- life through him’ (1 Jn 4:9). choice to live at one in Christ macists are celebrating the We will follow the following (cf. Gal 3:27) in a daily progres- ‘Great Jubilee’ and the ‘VIII points: sion of conforming oneself to World Day of the Sick’ in com- the meaning of what it is to him always and everywhere munion with the sick and with be Catholic; (Rom 8:29). those who dedicate themselves the promotion and the de- I believe that those of us who to the world of health and fence of life; are here, are here because we health care. In the message of the Good Samaritan. are convinced that the ‘Great the Holy Father they find well Before proceeding I would Jubilee does not only involve a outlined the path on which they like to bring out the ‘presence’ series of tasks to be carried out must travel, fully convinced of of the pharmacist in Holy but also a great experience to be this providential opportunity Scripture and the ‘esteem’ lived. The external initiatives which ‘will see the Christian which the Church feels towards have meaning to the extent to community committed to revis- his profession. that they are an expression of a iting the reality of illness and deeper commitment which suffering from the point of In Holy Scripture touches the hearts of people’.1 view of the mystery of the In- In the Book of Sirach one His Holiness John Paul II, in carnation of the Son of God, to reads that ‘The Lord created DH n.45 ing 1-68 2.8.2001 15:42 Pagina 53

medicines from the earth, and a cists over the last fifty years, we a positivistic mentality took sensible man will not despise frequently encounter the appeal hold which not only abandoned them... And he gave skill to ‘to be Catholics’ in the carrying the Christian vision of the men that he might be glorified out of this professional service. world, but more especially re- in his marvellous works. By John Paul II has been especially jected every appeal to a meta- him he heals and takes away forceful in this regard: ‘the physical or moral vision. It fol- pain; the pharmacist makes of forms of aggression towards lows that certain scientists, them a compound... There is a life and its dignity are becom- lacking any ethical point of ref- time when success lies in the ing increasingly numerous, in erence, are in danger of putting hands of physicians, for they particular through the use of at the centre of their concerns (physicians and pharmacists) medicines and drugs, whilst in something other than the hu- too will pray to the Lord that he fact these should never be used man person and the entirety of should grant to them success in against life, either directly or the person’s life. Further still, diagnosis, and in healing, for indirectly. It is for this reason some of these, sensing the op- the sake of preserving life’ that the Catholic pharmacist portunities of technological (chap. 38: 4; 6-8; 13-14). has the duty Ð in agreement, it progress, seem to succumb not may be observed, with the im- only to a market-based logic, The Esteem of the Church mutable principles of natural but also to the temptation of a Because of the ‘esteem felt by ethics proper to the conscience quasi-divine power over nature the Church’ Ð something which of man Ð to be a careful adviser and even over the human be- is particularly important Ð I for those who purchase reme- ing’.10 would like here to recall a dies... For the Catholic phar- The Catholic pharmacist is at thought of Pius XII, of venerat- macist the teaching of the the centre of the challenge, and ed memory, who after quoting Church in relation to respect for he will find himself involved 53 some verses from Virgil said: the life and the dignity of the again in even more dramatic ‘You belong to that truly worthy human person from his concep- situations for his conscience category of citizens who, conse- tion until his last moments is of during the course of the third crating time, intelligence, ener- an ethical and moral nature. It millennium. At one in Christ gy and the whole of yourselves cannot be subjected to varia- one can observe with St. Paul to alleviating human misery, tions in opinion or applied ac- ‘nothing is beyond my powers, heal illnesses with treatment in a cording to shifting options’.6 thanks to the strength God second and fend off, with wise But can there be a ‘Christian gives me’ (Phil. 4:13). The and methodical prevention, medical science’, asked Pius strength on the basis of which those illnesses which threaten XII. And he answered this one can face up to, and live, health. Yours is an onerous task question in the positive in a such situations is not rooted in because of the care which it re- broad sense ‘not so much be- ourselves but is to be found quires and the responsibilities cause of the science itself but above us. Technological man which it imposes. And yet your because of the representatives does not know how, and is not dedicated activity, distant as it is and experts in which it exists, able, to accept such a vision be- from the eyes and the applause takes place and expresses it- cause he wants to examine and of the public, confined to the re- self’.7 And in opposing the demonstrate everything scien- cesses of a laboratory, silent and opinion of those who wanted to tifically and he thus falls victim faithful witness to your demand- link it to mere immanent laws, to the temptation of feeling that ing work, is as though it were Pope Pius XII observed that the he is the real lord of this world. veiled in silence. You lack those receivers and the objects of St. Paul, on the other hand, consolations which sweeten the every science do not exist in a frankly recognises his radical so often harsh work of medical vacuum ‘but constitute a part of dependence on God and refers doctors and nurses when their the universal world of beings; to him in an absolute way. This patients and infirm are re- they are in permanent contact frees a new strength which de- stored’.4 And after saying that with the objects of other sci- rives from the divine primor- Christ the Redeemer was the ences and in a special way are dial strength of the Creation ‘physician of all humanity’ he under the law of the immanent present in the universe. During went on to say ‘to you pharma- and transcendent goal which his days as well there was a cists he has commissioned in binds them into an ordered challenge with regard to the particular the theoretical and whole’.8 way of thinking about life, giv- practical study of our bodies’. Thus we come to the rub of en that he writes: ‘And you This esteem has been confirmed the question. This is the worry- must not fall in with the man- by the Popes up till now, and in ing cross-roads of this time ners of this world; there must particular it is pleasing to recall which ferries us from the end be an inward change, a remak- that John Paul II believes that of one millennium to the begin- ing of your minds, so that you pharmacists are ‘evangelisers ning of another Ð the drama of can satisfy yourselves what is precisely because your profes- the separation between faith God’s will, the good thing, the sion presumes trust in your art and reason, which John Paul desirable thing, the perfect and your humanity’.5 faces up to in Fides et Ratio, thing’ (Rom 12:2). where he condemns the baleful The Catholic pharmacist abyss which awaits humanity.9 who, in imitation of St. Paul, Being a Catholic It is opportune to read here a places his strength in the passage which touches us in strength of Christ, will face up In the search for the words our professional activity: ‘In to the challenges of the third addressed by Popes to pharma- the field of scientific research, millennium courageously, with DH n.45 ing 1-68 2.8.2001 15:42 Pagina 54

consistency, and without appre- does not always safeguard the This is the reality of the hension. In this era of technolo- rights of the person. Suffering, challenges encountered by the gy, and of the ancestral fear of illness, and death are funda- Catholic pharmacist. The invi- who knows what unknown dis- mental ‘human’ events, and the tation to rediscover new light asters the immediate future has primary concern of everybody on these fundamental human in store for us, the Christian, should be to collaborate with experiences during the year of open towards the world, and each other in order to solve the Great Jubilee from the per- drawing strength from God, their problems in a human way. spective of the Mystery of the will faithfully carry out the cre- Helping the sick person to Incarnation of the Son of God13 ative mission entrusted to him overcome his own trial with requires consistent and coher- by God. The Catholic pharma- dignity is certainly the service ent forms of behaviour Ð new cist can well consider himself a which humanity expects from light which Evangelium Vitae ‘helper of God’ in the work he science, technology and phar- radiates widely with argu- performs of restoring and re- macology. But this will not be ments of faith and of reason. constructing the ‘sick man’.11 possible without a clear vision This is a document which Incorporated within the of absolute respect towards the every Catholic working in the Church through baptism, human being who on his own field of health and health care Catholic pharmacists, like all transcends the value of all ma- should have and whose con- Christians, ‘are called upon to terial realities. This is the contents he should study. I will profess publicly the faith re- stant point of reference which now provide some outlines of ceived from God through the should never be lost from sight those contents. Church’ (LG, n. 11), and if we want to avoid conse- strengthened by the sacrament quences which degenerate into 54 of confirmation with a strong the tragedy of great social evils, Life is Sacred and Inviolable presence of the Holy Spirit the subject of your endeavours ‘they are more closely obliged of study. In the Christian ap- Any man who is open to to spread and defend the faith proach, man, created in the im- truth and to good, if he sincere- as real witnesses to Christ in age and likeness of God, is the ly listens to them, can, with the word and in deed’ (ibid.). highest expression of the life of light of reason, reach the in- Under the guidance of the the universe. He is directed to- alienable principles written into Magisterium of the Church, wards God and the universe is the nature of man. Indeed, St. Catholic pharmacists must ac- directed towards man. Just as Paul tells us that: ‘As for the cept ‘not the word of men but the Creator of all things has Gentiles, though they have no what it is in reality Ð the Word placed in the secrets of nature law to guide them, there are of God’ (cf. 1Thess 2:13) hidden strengths to be discov- times when they carry out the (ibid.), remaining incorporated ered so as to draw from them precepts of the law unbidden, within her not only in their the means by which to protect finding in their own natures a bodies but also in their hearts and develop life, so He has also rule to guide them, in default of (cf. ibid., n. 14). written into the nature of man any other rule; and this shows To be a Catholic pharmacist those principles of universal that the obligations of the law does not require a journey norms of behaviour which are are written in their hearts; their marked by fences and negative not left to the subjective arbi- conscience utters its own testi- signs but a reinvigoration of trariness of interpretation or to mony, and when they dispute faith, a personal renewal Ð variations in contemporary with one another they find even a conversion if necessary mentality’.12 themselves condemning this, Ð to bear witness to the world Nine years before Evangeli- approving that’ (Rom 2:14-16). that they believe in Christ the um Vitae John Paul II expound- Now, one of the untouchable Saviour who assured us: ‘if you ed the thought and the position values of man which has al- continue faithful to my word, of the Church with regard to ways been perceived is that life you are my disciples in earnest; this whole area that we are is sacred, and that the right to so you will come to know the studying. From his words we this primary good is the foun- truth and the truth will set you can draw the following guide- dation of every form of living free’ (Jn 8:31-3). lines: together and of the political Ð The world of health care is community itself. a place of struggle for man. For the believer in Christ this The Defence and Ð The rights of the person fundamental pillar of human Promotion of Life and his dignity are attacked by society is erected into a sacred technology. truth in the Mystery of the In- On the front of the defence, Ð Man is created in the image carnation of the Word of God and the attacks on, life, the role and likeness of God and tran- which, as Vatican Council II of the pharmacist is not mar- scends all material realities. puts it, floods ‘the mystery of ginal but of primary impor- Ð God has written into human with real light...also fully tance, on a par with other roles man nature principles of hu- reveals man to man and makes which are equally dedicated to man behaviour which are not him observe his very high vo- this essential good of man subject to arbitrary interpreta- cation...with the Incarnation of where encounter is not peaceful tions influenced by the fluctu- the Son of God every man is in because ‘the world of health ating current mentality, and in a certain sense united’ (GS, care is a place of struggle for the secret of nature he has also n.22). man where technology is tend- written the remedies for his The historic event of our sal- ing to gain ever more space and health (cf. Sir 38:4). vation revealed the infinite love DH n.45 ing 1-68 2.8.2001 15:42 Pagina 55

of God who ‘so loved the between Elisabeth and Mary of Even with reason alone one world that he gave his only be- Nazareth: ‘Why as soon as ever can recognise that in man there gotten Son’ (Jn 3:16). And in the voice of thy greeting sound- is a natural law (see Rom the Son the life of every human ed in my ears, the child in my 2:14-15) which convinces the person is raised to an incompa- womb leaped for joy’ (Lk political community of men rable and untouchable value 1:44). These are arguments of that the foundation of living in (cf. EV, n. 2). Faith, of accepting the revealed peace without injustices and in- The life of man springs from Word of God, which can make equalities finds its unassailable the omnipotence of God – ‘Let dialogue to an even greater ex- foundation only in the recogni- us make man in our image and tent something which cannot tion and upholding of the right our likeness’ (Gen 1:26) Ð and be communicated with those to the inviolability of the life it finds its sacredness and invi- who are on the other side. One which belongs to every individ- olability in Him. When the life encounters those who proclaim ual member.15 of Abel was violated by Cain, ‘individual freedom’ which ‘Faced with so many oppos- God asked him for an explana- should be recognised and pro- ing points of view, and a wide- tion and condemned him with tected as a real and proper spread rejection of sound doc- the following words: ‘What right, the absolute lord of his trine concerning human life, have you done? The voice of own life and of unborn life Ð we can feel that Paul’s entreaty your brother’s blood is crying this last being seen as a wrong- to Timothy is also addressed to to me from the ground, which ful aggressor. us: ‘Preach the word, be urgent has opened it mouth to receive But ‘reason’ does not ask in season and out of season, your brother’s blood from your questions about the absurd convince, rebuke, and exhort, hand’ (Gen 4:10-11). contradiction of human society be unfailing in patience and And after the flood Noah’s which at the end of the millen- teaching (2 Tim 4:2)... we 55 absolute lordship was con- nium which has just come to a must not fear hostility or un- firmed by God with the follow- close, while it boasts of having popularity, and we must refuse ing words: ‘For your lifeblood I solemnly proclaimed the invio- any compromise or ambiguity will surely require a reckoning; lable rights of the person, and which might conform us to the of every beast I will require it the value of life publicly, and world’s way of thinking (cf. and of man; of every man’s activates initiatives and pro- Rom 12:2). We must be in the brother I will require the life of mulgates legislation at a world but not of the world (cf. man’ (Gen 9:5), and the basis world-wide level to promote Jn 15:19; 17:16), drawing our of this is in God ‘for God made health and defend life, at the strength from Christ, who by man in his own image’ (Gen same time codifies the elimina- his Death and Resurrection has 9:6). God is the absolute Lord: tion of the human person at the overcome the world (cf. Jn ‘I kill and I make alive’ (Deut beginning of his existence and 16:33).’16 32:39).14 justifies and protects those people who provide help in the car- In the Mystery of the rying out of euthanasia. The Good Samaritan Incarnation Inviolability How can the person who en- from the Beginning of Life trusts himself to reason alone, On of the objectives which drunk with a Promethean ap- the Holy Father indicates for During the never-to-be re- proach, become master of life this Great Jubilee is the redis- peated historical occasion of and death and decide upon covery, and renewed witness celebrating two-thousand years them, when every day he accu- to, ‘solidarity-inspired wel- since the Incarnation of the mulates defeats and feels the coming of one’s neighbour, es- Word of God, the exaltation of weight of a death without any pecially he who is most in the sacredness of still unborn perspective of meaning and need’.17 In his Message for this life comes from the encounter hope? day he wrote to us: ‘To those who are involved, either pro- fessionally or because of voluntary choice, in the world of health, I direct a warm invitation to fix their gaze on the Good Samaritan so that their service can become a prefigu- ration of definitive salvation and proclamation of new heav- ens and a new earth ‘in which the just will have their fixed abode’ (2 Pt 3:13)... The example of Christ, the Good Samari- tan, must inspire the approach of the believer, inducing him to make himself a ‘neighbour’ to his brothers and sisters who suffer through the demonstration of respect, understanding, acceptance, tenderness, compassion, free self-giving...’18 DH n.45 ing 1-68 2.8.2001 15:42 Pagina 56

The spectrum of the profes- not only to be welcomed Ð have an opportunity to add to sional involvement of the phar- they are also a ‘conditio sine your profession a dimension of macist is wide and goes qua non’. And not only for be- authentic Christian solidarity, through various stages of re- lievers but also for those who where the image of the Good search, of creation and produc- describe themselves as being Samaritan is present, which tion, in order to reach through secular, those who trust to does not only offer immediate distribution at a local ground ‘pure reason’. help but accepts the prospect of level the pharmacy of the hos- The individual present in the taking care of one’s brother in pital and private practice. This parable of the Good Samaritan the future as well (cf. Lk last is a real and personal point of Jesus Christ is a heretic of 10:29-37). of contact with the sick person. his time from whom one could Dear pharmacists! The pro- I would like here to turn our normally expect hate but cer- fession which you practice re- attention to the pharmacy to be tainly not obedience to the law quires deep human, ethical found in the streets and the of charity. Here the Divine and spiritual qualities. It re- squares of our cities, without in Master wanted to exalt the law quires wisdom and prudence any way, however, wanting to of compassion and solidarity linked to an alive sense of diminish the importance of written into the nature of man, honesty and probity. Your those in the public health care and his action raised it to a uni- workplace is not the video structures and the private versal parameter of love for screen of a production chain sphere, because I believe above one’s neighbour (see Lk where the commercial compe- all else that here the message of 10:29-37). tition of industrial complexes the Good Samaritan finds its greatest and most privileged 56 form of application. What I am saying is not something new but I would like to stress that a visit to a pharmacy generates an engine of tranquillity in the spirit and ensures that there will be somebody to whom we can entrust ourselves when there is need. It is like an anchor of salvation ready for possible unforeseen needs in relation to health. A secure point of reference in the area and for the foreigner who, in whatever capacity, finds himself in a land which is not his. And in the small centres, where the hospital structures are outside the territory where people live, pharmacies are a ‘life-saving’ health care emer- For the Catholic pharmacist is at work. It must be, instead, gency centre. If we take it for Pope John Paul II indicates a a place where suffering finds a granted that in these pharma- broader horizon which has remedy for the body and en- cies the professional skill of the greater dimensions: ‘Your counters comprehension for pharmacist is evident and high, work, however, is not limited the wounds of the soul’.20 it is to be hoped that he also to dispensing products destined Keeping present the ‘image of dedicates himself to ‘on-going to achieve physical-mental the Good Samaritan’ is to refer training’. ‘The pharmacist is, well-being. As Catholic work- to Christ, who is the Love of and must be, a professional of ers, who work in the sphere of the Father incarnated in our health. Given that he is in con- health care, you are called to history. Love is the fundamen- tact with citizens he can and play an important human, so- tal law of the Church and of must be an educator, an infor- cial and ethical role. Through the Christian. For this reason, mation provider, and a promot- contact with those who turn to it is in the Church, and for the er of a health care conscience your skills and knowledge you Church it is always something with suitable professional ad- also have an opportunity to be- of today, something always re- vice with regard to the taking come advisers and even evan- quired, something always un- of prepared drugs and medi- gelisers, precisely because your fulfilled, something always cines. And thus you understand profession pre-supposes trust in subject to an encounter-con- what formidable responsibili- your art and your humanity. flict with the new challenges ties and immense moral prob- The moral and psychological of the world. To be a Christian lems your work involves, so comfort which you can offer to means to be alive in the love of that the pharmacy absolves those who suffer is great if it is Christ, and there can only be with loyalty and nobility the the fruit of a human maturity one life, that of love. Without aims of its sensitive mission’.19 and a richness of values which love one cannot develop in Of the qualities referred to derive from the immutable conformity with Jesus Christ. by the Holy Father the quali- principles of natural and evan- In a ‘world which increas- ties of the Good Samaritan are gelical ethics. In this way you ingly moves towards unifica- DH n.45 ing 1-68 2.8.2001 15:42 Pagina 57

tion’ (Gaudium et Spes, n. 24), mental rights of the person: en- And thus if a member suffers love for one’s neighbour is of tire populations do not have the there suffers with him all the great importance for the devel- possibility to employ even pri- other members; if a member is opment of peace and justice, mary and urgently needed honoured all the other mem- and for the defence and uphold- medicines and drugs while bers rejoice with him (cf. 1 Cor ing of the rights of the human elsewhere people abandon 12:26)... we share in the same person (see ibidem, nn. 25-32), themselves to the abuse and charity of God and our neigh- and it is the sure way by which waste of even expensive drugs bour and we sing to our God to ‘find oneself again to the full and medicines’. the same hymn of glory. All through a sincere giving of A condemnation carried out those who are of Christ, having oneself’ (ibidem, n. 24). by the media for its own sake the Holy Spirit, form a single ‘Every man is a Good because after this there did not Church and they are united Samaritan when he stops at the follow any outline of the reme- amongst themselves in Him side of the suffering of another dies which the Holy Father (cf. Eph 4:16)’.24 man, whoever he may be. That strongly indicates in his Mes- The Catholic pharmacist Ð stopping does not mean curios- sage in order to solve these from those who produce to ity but readiness to help. It is great inequalities. We ourselves those who hand over the medi- the opening up of a certain in- take note of this and filter it cine or drug to the sick people ner inclination of the heart, through the communion of Ð who really wants to live the which also has its emotional goods of the first Christian Great Jubilee is invited to ‘re- expression. The Good Samari- community. visit from the perspective of the tan is every man who is sensi- The Acts of the Apostles tells Mystery of the Incarnation’25 tive to the suffering of other us that ‘All the faithful held to- this mandate of the Lord ‘of people, the man ‘who is gether and shared all they had, solidarity-inspired welcoming 57 moved’ by the misfortunes of selling their possessions and of one’s neighbour, especially his neighbour... their means of livelihood, so as he who is most in need’26 and The Good Samaritan of the to distribute to all, as each had ask the Holy Spirit to make parable of Christ does not stop need’(2:44-45).22 him understand that ‘a sign of at mere consolation and com- This was the fruit of the shar- the compassion of God, which passion. For him these become ing of the Gospel and all the today is especially necessary, is a stimulus to actions which goods received from God that of charity which opens our seek to bring help to the through Jesus Christ, as the eyes to the needs of those who wounded man. The Good whole passage well narrates. It live in poverty and marginali- Samaritan, therefore, in defini- was certainly not a mutual help sation...situations which range tive terms, is he who brings limited to social elements, and today over vast social areas and help in suffering, of whatever even less the product of a com- also cover whole peoples with character it might be. And help, munitarian ideology or a feel- their shadow of death.’27 where this is possible, which is ing of human solidarity. It was The Church has always been effective. living God amongst them. In- sensitive towards the poor and In such help he puts his heart deed, the attempt by the hus- has not failed down the cen- but he does not stint on natural band and wife Anania and turies to call attention to this re- instruments. One can say that Saphira to keep a part of the ality as well. The words of Pius he gives of himself, his own proceeds from the sale of an es- XII may be quoted for every- ‘self’, opening this ‘self’ to the tate ended up with the dramatic one: ‘We know how much acu- other person. We here touch death of both in front of the men of intelligence is required upon one of the key points of community which had gathered by scientists for the accurate the whole of Christian anthro- together Ð something which creation of medicines, how pology’.21 generated great fear in all of much long hard work your for- Here this paper must em- them.23 mulas require, how rare are the brace the whole of the pharma- Their guilt lay in lying to the elements which you use. How- ceutical spectrum. From indus- Holy Spirit through the Apos- ever, on the scales on which try to the point of the consign- tles out of a love for money. you weigh the drops of your ment to the recipient, that is to They had not adhered to the medications place also the say the sick person. full to such communion in the drops of the sweat of the people On the same day as the re- Holy Spirit or perhaps they who in mines, quarries, work- lease of the Message of the wanted to engage in a compro- shops or in other hard work Holy Father for this Day of the mise between heaven and the earn bread for themselves or Year 2000, the mass media give world. their dear ones. Put the tears of prominence to only one aspect, With the spread of the parents ready to give every- to be found in section 4: ‘I am Church the communion of thing in order to save their dear thinking in particular of the goods had to adapt itself Ð for children from death, and ensure grave social inequalities in ac- obvious reasons Ð to increas- that your tariff on the goods is cess to health care resources ingly new forms of expression. not heavier than what is right... which are still today to be But it was always based upon You will forgive us, in truth, if found in vast areas of the plan- the faith which ‘the Holy Spir- something less sensitive has es- et, above all in the countries of it, Himself unifying the body caped our mouth: but it is our the South of the world. Such with his virtue and with the apostolic duty to be concerned unjust unfairness affects, with whole connection of its mem- with, and defend, indefatigably, an increasingly dramatic char- bers, produces and stimulates the cause of the poor’.28 acter, the sector of the funda- charity amongst its members. Our Pontifical Council held DH n.45 ing 1-68 2.8.2001 15:42 Pagina 58

its fourteenth international con- term, of the body and the soul. for the Catholic pharmacist Ð ference in November on the This is because ‘the life which and they are to be found in the subject of ‘the economy and God gives to man is much vision of St. Paul who pro- health’. And its President, more than existing in time. It is claimed the Crucified Christ Mons. Javier Lozano, has pub- a tendency towards a fullness and challenged the mentality of lished in recent days a book en- of life; it is the seed of an exis- the world, always the same titled ‘theology and medicine’ tence which goes beyond the over time, because he strongly in which he dedicates the four- limits themselves of time: ‘if believed that the Cross is teenth chapter to the same sub- God has created man for incor- ‘God’s power. So we read in ject. I invite you to consult ruptibility; he has done so in Scripture, I will confound the these two weighty publications the image of his own nature’ wisdom of wise men, disap- in order to gain a wider and (Wis 2:23).’30 point the calculations of the deeper knowledge of what can Certainly, consistency with prudent’ (1 Cor 1:12-25). And be done today in this meeting such a style of life produces by we do not fear encounter. Even of ours. no means slight problems and Paul at the Aeropagus of As has already been ob- complications in certain con- Athens felt dismissed with de- served in this paper, the phar- texts and countries. It is not our rision and with a fine ‘we must macy has always been a centre intention here to open a debate hear more from thee about this’ of immediate health care. But upon such cases. We will recall (Acts 17:32). in these requests and demands simply that ‘give to Caesar We should welcome the ‘pharmacists can be called up- what is Caesar’s and to God words of the Holy Father who on to engage in non-therapeutic what is God’s’ (Mt 22:21) is tells us: ‘nothing remains to ends which are susceptible to a profoundly rooted in the build- me, therefore, than to warmly 58 transgressing of the laws of na- ing of the earthly city, and one invite the whole Christian com- ture, and this to the harm of hu- cannot exclude that it deserves munity to begin with ideals the man dignity. It is therefore to enter into the sphere of the journey of the Jubilee Pilgrim- clear that the distribution of working and associative plan age... Everybody must anyway drugs and medicines Ð like of man. Man can attempt to carry out that inner voyage their invention and their utilisa- achieve the blasphemous pro- whose goal is to detach oneself tion Ð must be supported by a ject of building a world with- from that which in us and rigorous moral code which is out God but this will come around us is contrary to the law carefully observed. Respect for back to hurt him.31 of God, in order to enable us to this code of behaviour pre-sup- encounter Christ fully, confess- poses faithfulness to certain in- ing our faith in him, and receiv- tangible principles that the mis- Conclusion ing the abundance of his mer- sion of the baptised and the du- cy...32 I thus invite pastors, ty of Christian witness make Certainly what has been ar- priests, male and female reli- especially relevant to today’s gued so far in this paper is a gious, the faithful and men of world’.29 language which is incompre- good will to face with courage Reference has already been hensible for those who do not the challenges which present made to the behaviour which have Faith. For the pharmacist themselves in the world of suf- the pharmacist must follow who does not have faith in fering and health.33 with regard to the defence of Christ and his Church what has life. Here one should recall that been said here has no sense; in- Rev. FELICE RUFFINI, M.I., being a Good Samaritan also deed it is absurd and could give Under-Secretary of the Pontifical implies an obligation of the rise to approaches which are Council for Health Pastoral Care, conscience to safeguard one’s not very benevolent. the Holy See own salvation and that of other But we have presented these people Ð in the full sense of the views for those who believe Ð

Notes

* Paper given during the celebration of the Jubilee of the Sick and Health Care Workers, 9 February 2000. 1 JOHN PAUL II, Lettera sul Pelligri- naggio ai Luogi Legati alla Storia della Salvezza (Vatican City, 29 June 1999), n. 1 (hereafter PLS). 2 JOHN PAUL II, Apostolic Letter, Ter- tio Millennio Adveniente (Vatican City, 1994), n. 42 (Italian edition). 3 JOHN PAUL II, Messaggio per la VIII Giornata Mondiale del Malato Castel Gandolfo 6 agosto 1999, Transfigu- razione del Signore, n. 1 (hereafter 8GMM). 4 ‘Udienza ai Participanti al Congres- so Internazionale di Storia della Medici- na, Castel Gandolfo 11 settembre 1954’, DH n.45 ing 1-68 2.8.2001 15:42 Pagina 59

in S.E.R.Mons. F.Angelini (ed.), Pio XII tondo, Vaticano 9 maggio 1956’, in OM, 1984), n. 28, (Italian edition). - Discorsi ai Medici (Ediz. Orizzonte p. 448 (reference note 4). 22 See also ibidem, n. 4, pp. 32-37. Medico, 6th. edition, Rome, 1960), pp. 12 ‘GIOVANNI PAOLO II, Udienza ai 23 See ibidem, n. 5, pp. 1-11. 342ss (hereafter OM). Participanti del Congresso della Feder- 24 Lumen Gentium, nn. 7, 49. 5 ‘Udienza per il Congresso azione Ordine Farmacisti Italiani, Vari- 25 8GMM, n. 1. Nazionale della Unione Cattolica Far- cano 26 aprile 1986, nn. 3-4’. 26 TMA, n. 42. macisti Italiani, Vaticano 29 gennaio 13 Cf. 8GMM, n. 1. 27 JOHN PAUL II, Incarnationis Mys- 1994’, n. 3. 14 See JOHN PAUL II, Apostolic Letter terium, bull for the Great Jubilee of the 6 ‘Udienza alla F.I.P.C per il 40.mo Evangelium Vitae (Vatican City, 25 Year 2000, the Vatican, 29 December Fondazione, Vaticano 3 novembre March 1995), nn. 39-43 (hereafter EV). 1998, n. 12 (Italian edition). 1990’, nn. 3, 4. 15. Cf. ibidem, nn. 2, 15, 18-24, 45. 28 ‘Udienza ai Participanti al Congres- 7 ‘Udienza ai Membri della Unione 16 Ibidem, n. 82. so Internazionale di Storia della Medici- Italiana Medico-Biologica di “San Lu- 17 TMA, n. 42. na, Castel Gandolfo 11 settembre 1954’, ca” 12 novembre 1944’, in OM, p.50, I 18 8GMM, n. 9. in OM, p. 346 (reference to note 4). (reference note 4). 19 ‘GIOVANNI PAOLO II, Udienza ai 29 ‘GIOVANNI PAOLO II, Udienza alla 8 Ibidem. Membri della Federazione degli Ordini F.I.P.C. per il 40.mo di Fondazione’, n. 9 Lettera Apostolica Fides et Ratio dei Farmacisti Italiani, Vaticano 2 mag- 3 (reference to note 6). (Vatican City, 14 September), ‘Chap. IV gio 1981’, n. 4. 30 EV, n. 34. - Il Relationship between Faith and Rea- 20 ‘Udienza alla U.C.F.I. del 29 gen- 31 Cf. JOHN PAUL II, Reconciliatio et son’, nn. 36-48 (hereafter FDR). naio 1994’, n. 3 (the reference is in note Paenitentia, the Vatican 3 December 10 Ibidem., n. 46. 5). 1984, nn. 14, 18 (Italian edition). 11 Cf. ‘Pio XII ai Participanti al Sym- 21 JOHN PAUL II, Apostolic Letter 32 PLS, n. 12. posium sulle Malattie a S.Giovanni Ro- Salvifici Doloris (Vatican City, 11 Feb. 33 8GMM, n. 15.

59 The Challenges for Pharmacists during the Third Millennium

This third millennium, which We are loved and invited to us to be called children of God, is about to begin, begins offi- love, to love each other, so that and we are really such’(1 Jn cially on the first day of Janu- the history of man can become 3:1). ary 2001, taking advantage, af- a symphony. Ð Our hope ter a certain fashion, of this spe- The Jubilee is a challenge, In eternal life, in the contem- cial year 2000, the Jubilee Year, that of achieving reconciliation plation of the divine, as chil- the move to which has been with ourselves and each other dren of God. The twentieth cen- opened up to us by the Holy so as to draw near to our broth- tury has been a century of sci- Door, in a new Christ... er and our neighbour, and in entific progress but also a cen- This Holy Year of the Great particular to those who suffer in tury of terrible events and de- Jubilee must be for all Chris- illness. velopments which have gener- tians and for pharmacists in The year 2000 is a special ated scepticism in all contexts. particular a year of celebration, year, a year to remember, and a This Jubilee should be an occa- thought, and reconciliation. To year to prepare ourselves to live sion for the substitution of scep- the joy of this anniversary must in daily life with the Christ of ticism by hope. be added the hope of penetrat- yesterday, today and tomorrow. The year 2000 must be at the ing Ð so as to live it out and ex- In the spirit of the Great Ju- centre of our journey as phar- perience it in a better way Ð the bilee and the context of the macists. mystery of God. Jesus is God’s third millennium, what are the How have we prepared for greatest gift to the world. We challenges which pharmacists, the Jubilee? What work has share this gift together in this and in particular Catholic phar- been carried out to walk to- anniversary, in the Great Ju- macists (who are particularly wards the Jubilee? bilee of the Holy Year 2000. near to us), must address them- We have sought to be in- selves to? spired by solidarity, not only by proclaiming the need for a re- How have we mittance of the debts owed by Addressed Ourselves This Year of Reflection the countries of the third world, to the Great Jubilee? Must Direct our Attention and allocating the value of such Towards Certain a remittance to supporting and We have prepared for this Ju- Essential Points promoting health and educa- bilee with the discovery of Je- tion programmes, but also sus, the Son, the Spirit, and the Ð The fact that we are chil- through direct aid in the form of Father. This is a path of love dren of God drugs and medicines and help and triune contemplation. Jesus came to give us the and support for many different Love includes forgiveness possibility to be ‘reborn’ countries: Bosnia, the Congo, and reconciliation. Reconcilia- through water and the Holy the Cameroon, Burkina Faso, tion can take place only in jus- Spirit in baptism, and in this Ruanda, Poland... and a number tice, solidarity, and brother- way to be generated into the di- of specifically targeted forms of hood. This is the message of vine nature and life: ‘What aid and assistance. love of Jesus given to all men. great love the Father has given It is in the spirit of illuminat- DH n.45 ing 1-68 2.8.2001 15:42 Pagina 60

ing saints, our patron saints flections of the past, but for forms of discrimination. Cosma and Damiano, that we pharmacists this challenge will Drugs and medicines pro- must live out our solidarity with be multifaceted and will con- duced by genetic engineering sick people within the tradition cern the following areas: and invention are provoking of the oath which we take as Ð drugs and medicines; very great hopes. But what pharmacists. Ð the direction of research; costs lie behind these promises We have become aware of Ð a positive approach to- of success? And who will be the drama provoked by the ab- wards the resources of local flo- able to meet these increasingly sence of basic medicines and ra and pharmacopoeias; high costs which, in the case of drugs and the damaging effects Ð the ways by which drugs European countries which have of counterfeit and false drugs and medicines are supplied and a highly developed system of and medicines which kill so made available; social insurance, will have to many people in poor countries, Ð the training of experts in operate within a context of an and we are striving to develop a this field, that is to say pharma- imposed reduction of expendi- programme which will ensure cists; ture? access to essential life-preserv- Ð an absence of discrimina- Medicines and drugs for el- ing drugs and medicines for tion towards sick people on derly people, following the in- everybody, everywhere. Our joy grounds of race, religion, creasing rise in life expectancy, will be very deep if we can wealth, age, sex etc.... will require trustworthiness and achieve this before the end of – the ‘commercialisation’ of safety in order to add quality of the Jubilee Year. Such a hope is the human person (cloning, life to quantity of years. The not groundless. transplants, the trade in organs, drugs and medicines of the We have also pointed out the grafting, blood, spinal fluids, third age are a challenge when 60 risks and the dangers of experi- and so forth). This is a chal- it comes to maintaining cere- mentation on humans where lenge for the field of ethics and bral vitality, independence, and ethics do not exist. We have in bioethics. the muscle-bone structure. the same way developed a se- Ð the demand for the recogni- ries of ways of raising people’s tion of the IFCP by the great in- awareness and concern about ternational bodies. The Challenge the need to elaborate bioethics of the Direction by which to defend the dignity to be Taken by Research of the sick person who is made The Challenge of Drugs subject to clinical experiments. and Medicines The tendency continues to We have spread knowledge grow of concentrating the pro- about the ‘Charter for Health This is, in paradoxical fash- vision of benefits in increasing- Care Workers’ and the encycli- ion, linked to the question of ly narrow spaces. The concen- cal Evangelium Vitae both access to all essential life-pre- tration of pharmaceutical giants amongst pharmacists and the serving drugs and medicines. in concerns whose turnovers general public as well. With twenty-five drugs we are greater than the budgets of a We want to give a soul to could solve the health care number of national states raises health care workers, a hope to problems of 80% of the sick a number of important ques- the sick; we want to promote people of the world. There is a tions. the Spirit of the Good Samari- great inequality which involves The direction of research into tan amongst people who treat 15% of the population consum- diseases and illnesses which af- and care for others. ing 83% of drugs and medi- flict the population of the West- Lastly, we have raised the cines and the rest of the world, ern world, which is rich and awareness and concern not only that is to say 85% of the popu- able to finance expensive forms of our pharmacists, but through lation (five milliard people), of treatment, will continue, and the mass media also of every having a 17% access to the this will run the risk of further person concerned with respect healing powers of drugs and expanding the gap of access to for life, from its conception to medicines. By way of example, drugs and medicines and of en- its natural close, by providing it may be observed that Africa couraging increasing forms of clear and precise information has 11% of the world’s popula- discrimination. on abortion, abortients, and eu- tion but receives only 1% of the The increasingly high ex- thanasia, and by requiring re- drugs and medicines which are penses of research and develop- course to the conscience clause available in the world. ment will diminish the role of for all health care workers, in- The question of ‘orphan universities and centres of pub- cluding pharmacists...Every- drugs and medicines’ is becom- lic research unless these latter thing that becomes legal or ing increasingly worrying and a are (partially) financed by the technically feasible (such as source of concern. The bodies pharmaceutical multinationals. abortion, euthanasia, and clini- concerned with public health, This will be mean that there cal experiments, traffic in or- the special foundations etc., will be a risk that basic research gans, etc.) is not necessarily should be concerned about the will be controlled in its direc- moral. It is for this reason that danger that people struck by tion and will thus lose its free- the encyclical Evangelium Vi- rare diseases will be refused dom. The independence of re- tae proposes the objection care in the form of the thera- search and development is an- based on conscience. peutic means which are avail- other challenge. The challenge of the third able. The principle of equality It is thus of primary impor- millennium will clearly be amongst human beings must tance that international institu- marked by the actions and re- lead to a rejection of these tions such as the World Health DH n.45 ing 1-68 2.8.2001 15:42 Pagina 61

Organisation, UNESCO and plant kingdom, the mineral The medicine or drug which the Catholic Church raise their world, and the animal kingdom, has become a pharmaceutical voices in favour of research be- indeed, can still help us in the special object has left its places ing carried out into orphan ill- achievement of new pharma- of official preparation, and for nesses and diseases and the pro- ceutical developments and dis- some ‘charlatans’ or ‘mer- duction of high quality basic coveries. chants’ it has become a source life-preserving drugs and medi- Not only aspirin, quinine, cu- of quick and easy profit be- cines. raro and the digitals come di- cause of the credulity of sick The Universal Declaration of rectly from nature. Recent drugs people and their hopes of the Rights of Man of 1948 de- and medicines against maladies achieving a cure. Such prac- clared itself in favour of access of the prostrate (serenoa repens, tices can never be condemned to health for all and access to prunus africanus) and even enough. scientific progress for all. The against cancer (vincristine, vin- To the usual official pharma- challenge of the third millenni- blastine, platinum) come from ceutical circuit which guaran- um will involve the implemen- the plant and mineral worlds, teed at the same time the quali- tation of these aspirations, and and others such as the enzymes ty of the drug or medicine and this is all the more the case become from the animal kingdom. advice on its use, new networks cause private foundations (Bill Nature is still full of possibili- have sometimes been added Gates, Rockefeller, etc.), which ties and the World Health Or- which have various kinds of have enormous financial re- ganisation suggests the imple- consequences for patients and sources available to them, may mentation of research pro- sick people. well interfere in the path taken grammes to engage in a more Socio-economic obligations by research and development effective exploration of the po- at times restrict the freedom of and in the enactment of human- tentials of natural resources. choice of the sick person. Thus 61 itarian programmes. There are still species which in the United States of America remain to be discovered and integrated systems (research drugs and medicines which can and development laboratories, The Challenge be taken from nature. Access to systems of production, distribu- of the Positive Assessment the knowledge of traditional tion, and direct supply, includ- of the Resources of Local medicine and the study of its ing hospitals and health care in- Flora and Pharmacopoeias remedies can enrich the treat- surance companies) force those ment and therapy of tomorrow’s they help to obtain their drugs The century which is now world. Such treatment and ther- and medicines from within their drawing to a close has wit- apy will be more accessible be- respective systems. ‘Privacy’ nessed the triumph of synthetic cause of their availability and (that is to say respect for private medicine and the end of this their economic costs. life, and respect for medical se- century (which is now leaving crecy) and freedom of choice us) has established the bases for thus no longer exist. If the pa- the new forms of biotechnology The Challenges of the Ways tient cannot find his drug or produced by genetic engineer- by which to Supply medicine within the confines of ing. The contribution of these and make Available these systems he orders it (by two branches of research is im- Medicines and Drugs telephone, by fax or by Inter- portant and noteworthy, and a net) and he then receives it by very large number of sick peo- Until a short time ago the post (mail order). This system ple owe to them either relief or sick person in the West pur- does not act to defend the pa- their cure, or both. chased his drugs and medicines tient against the pursuit of prof- Biomedicine is now making in a pharmacy, and an inhabi- it, which is, in contrary fashion, giant strides forward, but these tant of the third world Ð who the case with the pharmacist. must be evaluated and assessed could not of course come across The health care risk is increas- in terms of morality and bioeth- pharmacies Ð went to the near- ing and is beginning to provoke ical criteria, and for Catholic est clinic. a great deal of international re- pharmacists such as we are this flection and concern. must be done in the light of the In Africa sales networks of teaching of the Church’s Mag- false, expired and counterfeit isterium. medicines and drugs are flood- But we must not, however, ing the public markets. These forget that ever since the world are the so-called underground has existed man has found pharmacies which are also within nature remedies which called street pharmacies. The he has adapted and made into same thing is happening in the preparations. The Code of bazaars of Asia and the Middle Mammurabi, the Bible, and the East. This is the kingdom of voice of Ben Sirach the Wise, anarchy, deceit, fraud, and all bear witness to this fact. anti-public health. Many civilisations still pos- It is therefore urgently im- sess knowledge which is un- portant that the world of health known to most people about the reacts to this situation and that medicinal and therapeutic prop- competent and skilled people Ð erties to be found in plants, namely pharmacists Ð are or- minerals, and animals. The ganised into a medicinal ser- DH n.45 ing 1-68 2.8.2001 15:42 Pagina 62

vice of quality which is acces- The Challenge of the people. We can now observe sible to everybody throughout Equality of Sick People in certain political regimes, certain the world. While waiting to be Relation to Access to Forms nation-states, sterilise handi- able to have available a suffi- of Treatment and Drugs capped people, practice eu- cient number of pharmacists in and Medicines; thanasia on pseudo-incurable all the ACP countries, there is Non-Discrimination sick people, or make women the good possibility of pharma- who are in a ‘state of need’ en- ceutical missions for young The Jubilee is an opportunity gage in abortion on the basis of members of our brotherhood to remember solidarity. This personal comfort, pregnancy who are interested in helping must be lived out in the practice tests, genetic tests, etc. and promoting growth and de- of non-discrimination towards We Catholic pharmacists velopment. sick people. In the West forms must proclaim the right to the The provision of medicines of discrimination already exist respect of the differences be- and drugs must be like a chain which are based upon age (for tween patients and to non-dis- where every link is safe in order example in Great Britain be- crimination whatever the pa- to guarantee each patient the yond a certain age some drugs tient’s age, sex, physical state, safety, effectiveness and quality and medicines, or forms of psychic state, psychological of the drug or medicine which treatment, are not the responsi- state, mental state, social sta- is employed. bility of the social state-admin- tus, religious loyalty, philo- istered health care service). sophical attitude, or socio-eco- Some categories of sick peo- nomic position may be. The Challenge of Training ple, afflicted by rare illnesses or maladies, do not have a right 62 In addition to basic knowl- to the coverage of social care The Challenge of Ethics edge in chemistry, physics, ana- (for example in Great Britain lytics, galenics, pharmocodyna- those suffering from phenylke- Side to side with the presence mucs, pharmocology, pharma- tonuria). of conventional drugs and med- cotherapy etc., the pharmacist The poor and the excluded icines, we are face to face with must also possess general and do not always have access to the development of therapeutic local legal and ethical knowl- care and drugs and medicines. responses based upon the graft- edge. We have recommended a mini- ing of homologous or heterolo- Every pharmacist, in ideal mal level of care for everybody gous organs, surgery, trans- terms, should possess knowl- because such access forms a plants, attempts at cloning, and edge concerning: part of the rights of man (cf. the all the rest. Ð communication with sick ABPC/NVKA congress which Tomorrow’s pharmacist must people so as to be able to listen was held at Ghent in 1998). reject the commercialisation of to them in an effective way; The figures on the differ- some or all of the human per- Ð health care economics or in ences between the North and son. As a subject the human pharmaco-economics in order the South of the planet and the person is increasingly becom- to organise treatment which West and the rest of the world ing an ‘object’. The ‘commer- corresponds to the best are very striking. One sixth of cialisation’ of, and the trade in, cost/benefit ratio; the population consumes 83% organs (eyes, kidneys, lungs), Ð local illnesses and diseases of drugs and medicines where- blood, and spinal fluids is en- (infections, parasites); as five-sixths of the population riching individuals who are Ð basic care and treatment; consumes only 17%! Discrimi- people without scruples. Ð bioethics (respect for the nation also afflicts those suffer- The pharmacist of the third dignity of the sick person what- ing from AIDS, or those who millennium must uphold re- ever his or her physical or men- are seropositive, and this is a spect for the human person, his tal state may be); fact which arises from the cost inviolability and integrity, the Ð health care team work of the treatment involved. principle of non-commerciali- (medical doctors/nurses) where At the time of the Great Ju- sation, the rejection of cloning, he can adapt his drug or medi- bilee of the Holy Year the and also enlighten the patients cine to the diagnosis which has Catholic pharmacists will offer on the risks run by all of us by been carried out. to the Holy Father a symbolic the ‘commercialisation’ of oth- For this reason, we recom- gift and the bearer of hope for a ers. mend ‘training schools’ or thousand newly-born children. ‘schools for the application of We will strive to break the pharmaceutical practice’ for all chain of transmission of AIDS The Challenge of the pharmacists, not only with a from the mother to the child by Health Care Adviser view to permanent on-going giving the Pope a new medicine training but also so that they Ð viramune Ð which acts to The pharmacist, that dis- can always serve their patients block this transmission, and we penser of drugs and medicines, in the best way possible. will do this with a view to sav- will always have the role of be- The pharmacist, who is an ing innocent children from this ing an adviser of the patient, not expert in drugs and medicines, fatal disease. only with regard to the suitable should also become an expert in The final discrimination to be use of the drug or medicine but advising the patient so that he mentioned here involves the at- also in relation to health care or she can gain access to the titude of public services towards prevention, hygiene, small most suitable and accessible the physical or psychic, or men- symptoms, self-medication, forms of pharmacotherapy. tal, state of certain categories of what drugs and medicines cor- DH n.45 ing 1-68 2.8.2001 15:42 Pagina 63

respond to, and so forth. Bioethics for Africa (OUA). pharmacist in research and de- A training in the ‘human sci- This challenge is important be- velopment, the pharmacist in ences’ will complete his train- cause over four hundred NGOs the hospital, the pharmacist in ing as an expert in medicinal affiliated to the United Nations the pharmacy, the pharmacist as matters. have signed a petition to ask for a teacher, the pharmacist who In this challenge for the the exclusion of the Holy See as holds the power of the adminis- Catholic pharmacist the chal- an observer member until it ad- trative police, and the pharma- lenge of his pastoral role also mits the case for abortion! cist as a biologist Ð the pharma- enters the picture. cist must always be a bearer of Among the many people who hope. In the emblem of the every day visit a pharmacy (the Conclusion Great Jubilee there is the cross, average number in the European and this could be the cross of Union is eighty) some have For the pharmacist of the Christ the pharmacist. problems where moral and ethi- third millennium there are a The three arms of this cross cal considerations bear upon large number of challenges. remind us of the Trinity Ð the health care matters (abortion, Knowledge of drugs or medi- Father, the Son, and the Spirit euthanasia, serious personal or cines requires ever greater ex- united in love. family illnesses). The Catholic pertise, and this implies the The emblem is in different pharmacist should add to his ad- need for constant training and colours. There is green, the vice the evangelical approach of an on-going revision of what symbolic colour of the pharma- the Good Samaritan and should the pharmacist already knows. cy and of the IFCP. There is strive to implement guidance, The new forms of technolo- red, the symbolic colour of an accompanying of his patient gy will modify the usual phar- medicine, but also the episcopal who is in a state of difficulty. mo-therapeutic spaces, and the colour and the colour of cardi- 63 Recourse to pain-alleviating management of health care nals. There is the blue of female forms of treatment, within a spe- risks will be give rise to greater nurses, and there is yellow cialised team, must form a part worry and concern that is the which, together with white, of the pharmaceutical response. case at the present time. constitutes the papal colours. Paradoxically, research and And finally there is the white of development will be directed health care workers considered The Challenge of Taking towards traditional pharmo- as a whole. The emblem, there- Part in International Bodies copoeial remedies, and this is a fore, is also an emblem of phys- and Institutions for the course of action which has been ical and spiritual health dedicat- Purposes of our Expert suggested by the World Health ed to Christ and to men. Testimony and our Organisation. The future and May this emblem, in the Humanitarian Action (the the past, therefore, will consti- form of a challenge, encourage World Health Organisation, tute the present of the pharma- pharmacists (and other health UNESCO, the Council cist of tomorrow. care workers) to be actors of of Europe, the European His role within the state and solidarity, of listening, and the Union, OUA) will be one the political community will be bearers of hope for the sick of our First Priorities increasingly necessary so that people of the third millennium! orphan illnesses and diseases We have already collaborated are not neglected and people Prof. ALAIN LEJEUNE with the genome project (UN- are not excluded because of all President of the IFCP, ESCO), the Convention of kinds of discrimination. the International Federation Bioethics (the Council of Eu- Wherever and in whatever of Catholic Pharmacists, rope), and the Charter of capacity he is to be found Ð the Belgium.

The Celebration of the Eighth World Day of the Sick in the World

During the Holy Year of basilica of St. Peter’s. the Catholic associations in- 2000 the World Day of the In the days immediately be- volved in pastoral care in Sick was solemnly celebrated fore 11 February, the date es- health. In this publication the as the Jubilee of the sick and tablished by the Holy Father reader will find due weight health care workers. for this celebration, there were given to this important event. In a special way in Rome, very special days, such as The World Day of the Sick the culminating moment took prayer vigils, the meetings was also celebrated in various place with the Eucharistic Cel- with the bishops responsible parts of the world in different ebration which was presided for pastoral care in health in ways and in ways which took over by the Holy Father John the various countries of the into account local customs, Paul II on the parvis of the world, and the conference of both at the level of health care DH n.45 ing 1-68 2.8.2001 15:42 Pagina 64

structures and parishes. Many gal and Hungary) this pam- the Message of the Holy Father religious, cultural and scientif- phlet was translated into the lo- for the World Day of the Sick, ic initiatives which involved cal language. with liturgical observations sick people and health care Numerous initiatives were and suggestions for the cele- workers were organised and also organised which were bration of Holy Mass and spe- engaged in, and everywhere equally respectful of local tra- cial prayers to be said with sick the presence of parish priests, ditions. Often, together with people. This kit was speedily hospital chaplains, nuns who medical doctors, nurses and sent to all the bishops of the work in hospitals, and volun- voluntary workers, the political dioceses of Canada and all the tary workers, greatly helped to authorities were also present, Catholic hospitals and nursing promote the strong sharing of who thus wanted to emphasise homes in the country. prayer and the bringing about the value and the importance In the city of Hamilton the of a strong moment of spiritu- of the suffering of sick people. local association of Catholic ality. Sick people also received vis- doctors organised a special The efforts made in some its, took part in meetings, were evening of prayer to coincide countries, such as for example given presents, and therefore with the World Day of the Cuba, Ghana and Kenya, they, too, felt that they were re- Sick. A conference on elderly where difficulties of all kinds al ‘protagonists’. sick people was also held. were encountered and which It was also to be observed had to be addressed in order to that some bishops’ conferences Colombia achieve a successful outcome pointed to the existence of infor the World Day of the Sick, tense co-operation with the The National Secretariat for are very much to be appreciat- parish priests who often helped Pastoral Care in Health printed 64 ed. hospital chaplains in the ad- a pamphlet on the Message of The Apostolic Nunciatures, ministration of the sacrament the Holy Father and this was like the bishops’ conferences, of the anointing of the sick or sent to all the dioceses of the engaged in a speedy diffusion in the celebration of the Eu- country. In another pamphlet, of the Message of the Holy Fa- charist or vice versa. also the work of the section re- ther which was sent by this In this paper we want to offer sponsible for pastoral care in Pontifical Council on 11 Feb- general information on every- health belonging to the bish- ruary, the date chosen by the thing that this World Day ops’ conference of Colombia, Holy Father to celebrate this meant in the local Churches. ten subjects for thought and re- day. The ready and concerned For this reason, all the bishops’ flection were presented as involvement of bishops, and in conferences were asked to pro- points of departure for possible particular those responsible for vide a summarising account of discussion meetings. pastoral care in health in the their celebrations and the corre- On 12 February, at Bogotà, various bishops’ conferences, spondence which we have re- the first meeting of health care ensured an effective raising of ceived has been used to pro- workers was held to define in a awareness in local health care vide all the information for our more accurate fashion their structures. readers, which now follows. systems of training and to en- An illustrative pamphlet with Naturally, for reasons of sure that those who work in the the title ‘Curate Infirmos’ was space, we cannot provide com- world of health and health care sent to the above mentioned re- plete versions of the accounts see their work as authentic ligious authorities at the time of that we received, all of which Christian vocation. the celebration. This pamphlet are equally rich and relevant. was a support for the gaining of Furthermore, from some bish- Cuba the Jubilee indulgence within ops’ conferences we have not the context of pastoral care in yet received detailed informa- The World Day of the Sick health, in the spirit of the Bull tion. From others, such as for was celebrated in this for the summoning of the example that of Australia, the Caribbean island with a great Great Jubilee of the year 2000 information has been of a gen- deal of enthusiasm, especially – ‘Incarnationis Mysterium’. In eral character given the com- in the capital city, and was this pamphlet suggestions and plexity of the problem of ob- marked by three essential fea- ideas were given for visits to taining information from the tures: preparation, celebration, hospitals, to nursing homes, grass-roots. For this reason, we and follow-up. The celebratory and to the home of a sick per- will confine ourselves to offer- part reached its culminating son living with his or her fami- ing, if even only briefly, the point with the Holy Mass ly, etc. so that, upheld by soli- news which emerges from the presided over by His Eminence darity and fraternal commu- material which we have re- Cardinal Jaime Ortega, togeth- nion, it would be possible, to- ceived. er with a large number of gether with the sick person, to priests, at the ‘Sanatorio de promote a spirit of penitence Rincòn’ in Havana on 11 Feb- during a time so favourable to North, Central ruary. Over two thousand peo- grace and blessing. and South America ple were present, together with The pamphlet was distrib- people who accompany the uted in a capillary fashion Canada sick and health care staff and throughout the world and in personnel. Religious celebra- some countries (for example A special kit was prepared in tions took place throughout the Mali, Ecuador, Poland, Portu- English and French containing country, both at a parish and a DH n.45 ing 1-68 2.8.2001 15:42 Pagina 65

diocesan level, often presided ceses and archdioceses of the Ghana over by local bishops and al- country celebrated the Jubilee ways with a substantial partici- Day of 11 February in a A fine religious celebration pation on the part of sick peo- solemn way, and in a way was held in Abease, in the re- ple and those who accompany which respected different cul- gion of Brong Ahafo, with the them. tural traditions and locally spo- participation of a large number The cultural side of things ken languages. The National of priests who represented the was also followed with care, Association of Catholic Chap- various dioceses. During the with the organisation of local lains prepared a kit with infor- ceremony the poor people and meetings on the training of vol- mation material which was dis- sick children who were present untary workers and extraordi- tributed to all the bishops of were given medical treatment. nary ministers of the Eucharist. the country and to the national The state television was pre- To give practical expression to associations involved in the sent and broadcast the whole the wishes of the Holy Father, health care world. of the event on a channel concrete initiatives were also Attention was also paid to watched very widely in the organised such as visits to hos- the schools where an attempt country. The director of the re- pitals and to places of care for (especially in the archdiocese gional health services gave a elderly people. In this way an of New York) was made to speech in which he strongly attempt was made to raise raise the awareness of students appreciated the work carried awareness and concern within and teachers about the need to out by the Catholic Church in communities and districts in celebrate the World Day of the every field of service for the relation to sick people, even Sick as a moment of thought poor and the suffering. though the difficulties which and reflection with and about In the parishes of the dioce- had to be overcome were not sick people. ses of Navrongo-Bolgatanga 65 few in number. Reference, for an attempt was made to link example, should be made to Venezuela the celebration of the Holy the lack of means to hand for Mass with home visits to elder- the preparation and the printing The celebration of the World ly people and the sick. In the of information material and an Day of the Sick helped to fur- Catholic clinic of Wiaga a rep- inability to gain access to the ther stimulate love and care for resentative of nurses spoke to official means of communica- the infirm and also to make emphasise to those present the tion. people understand the impor- importance of prevention and tance of the sacrament of the care in relation to certain fatal Ecuador anointing of the sick as a sign of sanctification and purifica- Throughout the country, tion. The World Day was also both at a diocesan and a parish an occasion to carry out actions level, the World Day of the of solidarity, such as the taking Sick was celebrated with great to homes of food, shoes and intensity and strongly-felt par- clothes for sick people and ticipation. At a national level a their families. Unfortunately, study-seminar was organised the dioceses which possess few for health care workers in order means of communication en- to examine certain issues and countered a great deal of diffi- questions of especial rele- culty in promoting these kinds vance, and in all the dioceses of initiatives. of the country the Jubilee of the Infirm had its most meaningful moment with the cele- Africa bration of a Holy Mass by the diocesan bishops and the ad- The Ivory Coast ministration of the sacrament of the anointing of the sick to The solemn celebration was infirm people present in the brought forward to Sunday, 6 churches. Lastly, many volun- February, and was held at teer workers and priests en- Abidjan in the parish of the diseases for children and invit- gaged in activity to comfort ‘holy families’ where a proces- ed mothers to follow the ad- sick people in their homes or in sion of sick people took place vice given to them to achieve the various hospitals of the together with the people who greater hygiene in the environ- city. accompany them, priests, and ment and in relation to individ- health care staff and personnel, uals. The United States of America who represented the other In another large diocese of parishes of the city. Ghana, Sunyani, the nurses of According to the news we Beforehand, both the radio a large hospital of the city vis- received from H.E. Mons. and the television provided ited various schools and places Charron, the bishop responsi- capillary information on the of care in the outlying villages ble for pastoral care in health event, with specific broadcasts in order to bring practical help in the United States of Ameri- on the subject, personal testi- to very many families with ca, a very large number of dio- mony, and interviews. sick people at home and to in- DH n.45 ing 1-68 2.8.2001 15:42 Pagina 66

struct families in how to pro- companied by a delegation of meeting organised at the vide care and treatment every the World Health Organisation, Camillian general surgery ‘Re- day to their sick relatives. also made a speech. demptor Hominis’ in Tbilisi. In the ‘St. Teresa’ hospital Members of the Georgian Car- special attention was given to The Central African Republic itas also took part in this meet- future mothers, and in particu- ing. lar to very young mothers, From the programme which through the organisation of an we received one can observe Ireland educational and prevention the intense plan of meetings or- programme in relation to the ganised for various groups in ‘The Circle of Care’ is the ti- most serious illnesses which order to raise the awareness of tle of a book which was pub- can afflict expectant women. the ecclesial community as to lished in the diocese of Dublin In the diocese of Sekondi- the importance of sick people to commemorate the Jubilee Takoradi as well there was an in the light of the Message of and it listed a number of differ- intense celebration of the the Holy Father. The social ent liturgical celebrations World Day of the Sick, with a mass media gave major space which had taken place in previ- programme which took place and coverage to the event. ous years, each of which was over a week (7-13 February) On 11 February, in all the characterised by a different and which involved the active parishes of the archdiocese, theme. The publication also participation of health care liturgical celebrations were contained certain additional workers, voluntary staff, and held, together with the admin- sick people. This was especial- istration of the sacrament of ly followed in the hospital of the anointing of the sick. In the 66 St. John of God in Sewi-Asafo, cathedral of Bangui a solemn run by the Order of the Eucharist was held presided Fatebenefratelli. over by the diocesan chaplain for the sick and in the presence Kenya of the Apostolic Nuncio, H.E. Mons. Joseph Chennoth. The Message of the Holy Father was published in the newspapers and distributed in Europe all the hospitals. In Nairobi, in the basilica of the Holy Family, Georgia a holy mass was celebrated for sick people and an attempt was On 11 February 200 the made to raise the awareness of World Day of the Sick was cel- the dioceses about the impor- ebrated solemnly in all the tance of drawing up strategies Catholic parishes after careful of prevention and treatment for preparation which involved the most serious health prob- members of the various com- ceremonies which had been lem which is now facing the munities addressing them- celebrated on special occa- country Ð AIDS. selves to existing problems. sions. Every hospital and Special importance was given parish in the city received the Madagascar to the celebration of the Holy Message of the Holy Father as Mass which was held in the re- well as a number of sugges- The World Day of the Sick stored cathedral of the Assump- tions about the holding of vari- had an especially high profile tion in Tblisi, Georgia. H.E. ous celebrations in order to in- because it coincided with the Mons Pasotto, the Apostolic volve the sick, the people who Holy Year 2000. In all the hos- Administrator ‘ad nutum Sanc- accompany them, and medical pitals of the island encounters tae Sedis’ of the Caucasus of staff and personnel. and events took place, of an ec- the Latins, surrounded by a umenical character as well, large number of priests and in Italy with sick people, their rela- the presence of many nuns, tives, and health care workers. presided over the Holy Mass The celebration of the World The Secretary of the Com- and performed the sacrament Day of the Sick is increasingly mission for Pastoral Care in of the anointing of the sick for being established as a strong Health secured a broadcast by a number of sick people. For feature of pastoral care in radio at a national level. the first time there was also a health in all the Italian dioce- In Antananarivo, H.E. Cardi- major presence of medical doc- ses and the various structures nal Razafindratranda adminis- tors and paramedical staff, both of the country. In the Jubilee tered the sacrament of the Catholics and non-Catholics. year this was especially felt anointing of the sick to a num- The World Day was prepared and the object of marked par- ber of sick people. The chap- for with meetings on the sub- ticipation. lains of three hospitals, togeth- jects of the value of life, health, In a large number of dioce- er with other priests from the and the meaning of the Jubilee. ses the celebration took place capital, concelebrated at the The participation of health in the presence of the bishop in event, and the Minister of care personnel and staff was the cathedral churches and in a Health, Mrs Rahantalalao, ac- intense and extensive at the number of Marian sanctuaries, DH n.45 ing 1-68 2.8.2001 15:42 Pagina 67

in addition to health care struc- dulgence. The other bishop re- age of the Prime Minister and tures and the parishes. An at- sponsible for pastoral care in the Primate of Poland, Cardi- tempt was also made to raise health, H.E. Mons. Lanneau, nal Josef Glemp, a conference the awareness of all communi- the auxiliary Bishop of Ma- was held on ‘the dignity of ties about the fact that ‘in Jesus lines-Brussels, stressed that al- man as a basis of the rights of Christ suffering is redeemed’. though not on 11 February it- the sick person and the pa- With the supports prepared by self, the Message of the Holy tient’. the National Office for Pastoral Father was nonetheless distrib- At a religious level it should Care in Health, the Jubilee of uted in the parishes, and in the be stressed that the preparation Health Care Workers was cele- month of September a pam- for the day was capillary and brated with sick people. Forms phlet was published with the ti- carefully organised. In hospital of ‘adoption’ by parish com- tle ‘Listening to Loneliness’. structures, and often in the munities of sick people who presence of the local bishops, were alone or in need, and of Luxembourg Holy Masses were celebrated disabled people, were suggest- with the administration of the ed as concrete gestures of soli- The Catholic daily newspa- sacrament of the anointing of darity. per ‘Luxemberg Wort’, which the sick. Vie crucis were organ- All of the printed material is also the most widely read ised in many churches and (pamphlets, illustrative leaflets, newspaper in the country, pub- places of care and treatment, and the Message of the Holy lished for the occasion a spe- and the blessing of the sick Father) was sent beforehand to cial page on the World Day of with the most holy sacrament the dioceses to help them to or- the Sick which contained long was engaged in, along the lines ganise the World Day of the passages from the Message of of what takes place in Lourdes. Sick in a more effective way. the Holy Father as well as the Where possible, sick people 67 In the official bulletin of the inaugural speech of the Arch- were accompanied without National Office for Pastoral bishop, H.E. Mons. Fernand charge to the various churches; Care in Health, news was pub- Franck. For over sixty-five otherwise, visits to the homes lished on the celebration of the years the Holy Mass celebrated of the sick were organised, World Day of the Sick in a for sick people has been broad- where the administration of the number of Italian dioceses. cast by radio to the whole of sacraments of the Eucharist, of Everywhere it was possible to the country and during the reconciliation, and of the see how the Jubilee of the sick week of 11 February special anointing of the sick was also was really a special appoint- space was given to this reli- organised. ment of the Holy Year 2000, gious initiative. The pamphlet ‘Curate Infir- something which further em- mos’, produced and published phasised that our brothers and Poland by the Pontifical Council, was sisters in need are really at the published in Polish and distrib- heart of the mystery of Christ An interesting and detailed uted to all the health care cen- and of the life of the Church. paper was sent to the Pontifical tres of the country, together Council by the archbishop re- with a special publication of Belgium sponsible for pastoral care in the ‘Letter to the Sick’ and var- health, H.E. Mons. Wadlislaw ious publications on the subject The bishop responsible for Ziólek, which describes a large in the journal ‘The Apostolate pastoral care in health of the number of initiatives, both at a of the Sick’. Flemish region, H.E. Mons. diocesan and a national level, The World Day of the Sick Vangheluwe, the Bishop of which were promoted in a way was thus for the local Church Bruges, observed that in Bel- which sought to give emphasis an event which mobilised not gium there is no special day to three specific elements: the only priests, those responsible dedicated to the sick but he al- religious aspect of the day, the for pastoral care in health, and so pointed out that during the cultural dimension, and the sick people, but also a large month of September, on the practical achievement of cer- number of health care workers, ninth and tenth of that month, tain initiatives. The Sunday be- teachers, and workers. Partici- religious celebrations and fore the celebration of the pation was very extensive, meetings are held in many World Day of the Sick homi- thanks not least to the mass parishes and hospitals in the lies were given in a significant media which made the whole country. However, the bishop, number of parishes on ques- nation aware of the various ini- in an article which appeared in tions and issues connected tiatives which were being pro- a local newspaper on 2 Febru- with the imminent celebration. moted. ary, exhorted the faithful to fol- The sermon given by Arch- Practical successes, the fruit low the solemn celebration bishop Ziólek was broadcast of the generosity of members held in Rome and to join them- live on the national radio chan- of the faithful, such as the pur- selves spiritually to the Holy nel. chase of a van with a machine Father, perhaps by carrying out Conferences and sympo- for diagnostic tests, were also an action of love on the estab- siums were organised for those evident. lished day Ð 11 February Ð responsible for pastoral care in such as a visit to a handicapped health, and this was done in a The Czech Republic person, to a sick or a lonely el- special way in Poznan and derly person, and this with a Warsaw. In the capital city on The Apostolic Nunzio, H.E. view to gaining the Jubilee in- 11 February, under the patron- Mons. Coppa, was present in DH n.45 ing 1-68 2.8.2001 15:42 Pagina 68

one of the very few Catholic Bishops of the Bishops’ Con- hospitals in the capital city to ference for Health. Both the ra- emphasise the goals and the in- dio and the television took part tentions of this celebration, with a large number of broad- which had been called for with casts and a live broadcast over so much solicitude by the Holy the whole of the country of the Father. H.E. Mons. Coppa cel- Holy Mass held on 11 Febru- ebrated Holy Mass in the hos- ary. pital/rest home for elderly peo- Home visits to sick people ple in Repy on the outskirts of and the elderly who had not Prague, run by the Sisters of been able to be take part in the Mercy of St. Charles Bor- religious functions were also romeus. In addition to mem- organised, and in hospitals and bers of the Order there were al- nursing homes collective cele- so present representatives of brations were held to adminis- the sick, the director of the ter the sacrament of the anoint- hospital, and the medical and ing of the sick. paramedical staff and personnel. Asia The Republic of Slovakia clothes and shoes; organising a India cheerful moment with games; The World Day of the Sick listening to good music; and 68 was celebrated in solemn fash- ‘Jubilee – a call to renewal’ watching films chosen for the ion in the two Marian sanctuar- was the subject chosen in India occasion. ies of Sastin and Marianka, al- for the celebration of the In this way an attempt was though the important event ‘Health Sunday and Healing made to join spiritual relief was observed in various ways Week’ organised by the Com- given by prayer, by receiving in all the cathedral churches mission for the Apostolate and and listening to a Holy Mass, and in the parishes. In addition, Care of Health. The Message with that relief provided by of- on 5 February, the Auxiliary of the Holy Father was trans- fering a World Day which was Bishop of Trnava, H.E. Mons. lated into the five regional lan- different for sick people, and Stefano Vrablec, gave a talk guages of the country and was for the health care staff and on the importance and mean- sent to all the dioceses, parish- personnel as well. ing of the World Day of the es and health care institutions. To conclude this brief ac- Sick during a nationally broad- A fine poster on the chosen count we can say that from the cast television programme. subject was also distributed. news which has been received Four regional meetings were from the various countries it is Spain organised for the co-ordinators clear that everywhere an at- of diocesan pastoral care in tempt was made to put the per- The Department of Pastoral health, and an inaugural semi- son (especially if he or she is in Care in Health of the Bishops’ nar was held in New Delhi. In a condition of illness and dis- Conference invited all the dele- addition, the celebration of the ability) at the centre of the gations to organise a day of Holy Mass was for everybody, World Day of the Sick, not on- prayer on 11 February together in various places, a strong mo- ly in words but also in facts. with various groups interested ment of encounter and spiritual We have tried to implement in the field of health in the light renewal. the words which the Holy Fa- of the Message of the Holy Fa- ther John Paul II clearly enun- ther John Paul II. Korea ciated in the Message which Beforehand, three days of was addressed to all of us on reflection and deliberation on An interesting and detailed the occasion of this Eighth the subject ‘the word was report was sent to the Pontifi- World Day of the Sick: ‘Just made flesh’ were organised for cal Council from the Korean as the resurrection trans- delegates and health care Bishops’ Conference, in which formed the wounds of Christ workers. The acts of these in addition to specific religious into a source of healing and meetings were published in the initiatives for sick people such salvation, so for every sick journal of the Hospiteller Or- as the administration of the person the light of the risen der of the Fatebenefratelli, La- sacrament of the anointing of Christ confirms that the way bor Hospitalaria, n. 254, 1999, the sick and the opportunity to of loyalty to God in the giving and they were also distributed engage in confession before of oneself until the Cross is to all the diocesan delegates for listening to the Holy Mass, ref- the winning way, and can pastoral care in health. erence was also made to an at- transform the illness itself into On the basis of this material, tempt to unite the initiatives at a source of joy and resurrec- pamphlets and leaflets were a practical level Ð for example tion’ (n. 7). published, in addition to providing assistance and help prayers composed for the occa- to the infirm; helping them, at Dr. A. CIATTINI sion, and these were distrib- least for a day, to be well Official of the Pontifical Council uted in a capillary fashion to- washed and well turned out at for Health Pastoral Care, gether with the Message of the an external level; giving them the Holy See. DH n.45 ing 69-144 2.8.2001 15:44 Pagina 69

Seminar Day on Leprosy ‘Reality and Prospects’

Organised by The Friends of Raoul Follereau Association of Italy - AIFO (Organisation for International Health Cooperation) and the Pontifical Council for Health Pastoral Care

15 January 2000 The New Synod Hall The Vatican DH n.45 ing 69-144 2.8.2001 15:44 Pagina 70

Opening Speech by the President of the AIFO

I must express my gratitude for this honour, which indeed is a very great privilege, of opening the deliberations of this special world day. I should thank above all else the President of the Pon- tifical Council for Health Pas- toral Care, His Most Rev- erend Excellency Monsignor Javier Lozano Barragán, because the practical realisation and bringing to fruition of this meeting has been the work of 70 that Pontifical Council, and the taking on, the burden, and the weight of its organisation have been the responsibility of its President. It is a very great honour for the Friends of Raoul Follereau Association of Italy, in this missionaries looked after them an early medicine for this mal- place and in the context of the through their mission, they ady which had partial effects Great Jubilee, to offer some lived with them, some of them but which was nonetheless the important words and com- also shared their lives and paid first step on the road towards ments on the whole question for this with their deaths, with healing these sick people. of those who are afflicted by self-sacrifice. Subsequently, this medicine the disease of leprosy. I would like to remember was developed and made more During the century which here the Blessed Father incisive. has just come to a close (at its Damien who is also the pro- Today those who are afflict- beginning and for many years tector of some of our associa- ed by leprosy can recover thereafter) the question of tions which today are involved from the disease. Indeed, they those afflicted by leprosy was a in looking after those afflicted recover quickly, and they re- question which was little heard with leprosy and who was de- cover once and for all. in this Western world of ours. clared blessed not many years Today, however, the problem Nonetheless, it was a very seri- ago by His Holiness John Paul of leprosy is still not solved. ous question. It was very seri- II, precisely because after liv- Health care networks with ous because these sick people, ing amongst these leprosy vic- health centres and profession- who did not have any possibili- tims in the conditions in which ally trained staff and personnel ty of being cured, were above they found themselves from have been established in order all else abandoned, margin- the outset, he fell ill from lep- to find sick people who are still alised Ð marginalised indeed in rosy and then died as a result in the early stages of the dis- an active way Ð because their of this disease. ease so that the subsequent condition was considered a But together with him others mutilations which arise from sacrilege, it was seen as being have shared this self-sacrifice, the malady can be prevented, outside civic society as well as this martyrdom. and so that these sick people being outside religious society. And I believe that it is pre- are not further marginalised Follereau points this out in cisely these examples of sacri- because of their mutilations his writings: ‘I have seen them fice which built the foundation and their forms of disability. in prison, I have seen them in stones so that Follereau could Today these organisations, concentration camps, I have launch his message and his these structures, have the sup- seen them isolated’. campaign in favour of these port of civic society, of civic And the people who first sick people. society at both a local and an took care of these victims of Follereau Ð the person who international level. leprosy were the missionaries. is our reference point Ð spent Today, these beneficial new In their religious mission, the whole of his life in organ- steps and initiatives for our meeting these people who ising and finding solutions to sick brothers and sisters reach were so reduced and beneath this very great problem. In this many of them and teach them the lowest human condition, he was helped by science and very speedily. DH n.45 ing 69-144 2.8.2001 15:44 Pagina 71

At a certain point, the sur- place, the opportunity by hand to and help these people. vival and persistence of many which to make a contribution We want all those who are other situations of great diffi- to these realities, and a contri- connected with and have rela- culty, new diseases, hunger, bution which is beneficial? tions with our brothers and and wars, rather diminished the We thought that this place, sisters who suffer from lep- level of attention which was this Jubilee context, were the rosy to know that this problem paid to this subject. And this place and the opportunity. must still be faced up to and was also extended somewhat And together we have been tackled, to know that we want to our missionaries, who we able to hold this meeting of to address ourselves to it with have helped ever since the be- ours where, if you take part in the same will and the same ginning of the creation of our the various sessions, you will readiness to help displayed by association and with whom, as be able to understand the pre- Follereau when he was alive, well, we have worked jointly. sent state of the situation, the and by you now. Our association was born in scientific state, and the social We want to inform every- Bologna and its first president state, but above all else you body that the problem exists was a Colombian missionary will be able to understand that and that we want to solve it. who was the special delegate we must not in any way what- We only hope that all those of Follereau for this activity. soever close down the subject. who manage to hear us through And today we find our- Many hundreds of thou- these possibilities that we have selves in the following kind of sands of individuals, some to communicate will be with situation. Those afflicted by millions of people, still suffer us, will help us, and will above this disease are not many in from this disease, an affliction all help our brothers and sisters number, they are not the tens which has been forgotten by who suffer from leprosy. of millions of individuals of everybody and which every- 71 some time ago. But they still body indeed tries to forget Dr. ENZO ZECCHINI exist. The tendency now is to about. President of the AIFO, forget about them. We have made this choice, a (The Friends of Raoul Follereau What, then, is the point, the voluntary choice to lend a Association of Italy)

Speech of Greeting by H.E. Mons. Javier Lozano Barragán

I greet all of you who have name of Raoul Follereau who which you will do after me. Let gathered together for this meet- in such an admirable way dedi- my witness help you in this. ing which is fighting against the cated the whole of his life to ef- This is my last wish, my will disease of leprosy in the world. fective care for lepers, and this and testament. The greatest ill It is fighting not only against to such an extent as to interest that could happen is this: that the disease but also against self- the whole of the world as never of not being useful to anybody ishness, consumerism, and the before in the fight against lep- and of not loving and serving worship of money which place rosy. Today Raoul Follereau is anybody”. many things in the front rank no longer with us, but there are This is true. He did not reach rather than dwelling upon his followers, the young people the year 2000. He died a Chris- where real values lie Ð in love to whom he said: “And now it tian in Paris on 16 December for other people. This confer- is up to you to fight, struggle, 1977; lepers were on his lips ence is taking place at the start young people of the world. Be and in his heart, a wish and a of the Jubilee year, a year of intransigent in relation to the hope: “I want only one thing – grace, of forgiveness and of duty to love. Do not yield, do that young people take my reconciliation, a year in which not descend to compromises... place!” in visiting Christ in those who Above all believe in the good- This is a reason for being are most sick, most in need, and ness of man. Because in the present at this conference, for especially in lepers, we really heart of each man there are coming to continue the very increase charity, and increase wonderful treasures of love...” great work of Raoul Follereau, amazed love when faced with Before dying Raoul Folle- to love lepers, to see how we the great mystery of the Incar- reau uttered the following can eradicate this terrible dis- nation of the Son of God, who words: “I do not think that with ease from the face of the earth. mysteriously extends himself in my health I will see in the year With reference to the solidarity lepers, in this period of Christ- 2000. That does not matter. I of those not infected with this mas, which is to be found pre- say to everybody: in making disease towards those infected cisely at the beginning of the others happy become rich... the with it the Holy Father John third millennium. wealth which I leave you is the Paul II said: “they show that We are all grateful for the good that I have not done, they grasp in an increasing way great work carried out in the which I wanted to do, but the dimensions and the serious- DH n.45 ing 69-144 2.8.2001 15:44 Pagina 72

ness of the question and with I will continue to proclaim to tion which the Holy Father ad- exemplary generosity they sup- the world the need for greater dressed to scientists and report public and private initia- awareness of the fact that searchers concerned with tives, and institutions and or- through suitable help this dis- Hansen’s disease: “continue ganisations, which are specifi- ease can be effectively defeat- your research and your treat- cally dedicated to the fight ed. For this reason I ask every- ment, and be certain that the against leprosy. Thanks to this body everywhere to support Church fully supports your tangible proof of solidarity and with ever greater intensity the work because, like you, she Christian charity it has been courageous efforts which are has received the command- possible to limit in a decisive made to dominate leprosy and ment of Christ, written in the way the spread of the contagion effectively treat those that are Gospel, to ‘heal lepers’, and even in those areas of high risk, still afflicted by this malady” she knows that the lepers who and this to such an extent that it (Manila, at Radio Veritas, when are healed are a sign of the is now possible to envisage, at meeting a group of lepers from kingdom of God (cf. Mt 10:8; least on the horizon, the possi- the leper colony of Rala, Satur- 11:5). Help to build the king- bility that this disease will be day, 21 February 1981). dom of God, which is also the finally and definitively defeat- Thanks to the initiatives of kingdom of humanity. Be dis- ed’. (‘Message for the World Raoul Follereau today we are pensers of justice and love to- Day of those Suffering from celebrating the world day of wards all those who, in the Leprosy Given in Cumura, leprosy, and together with us it most desolate corners of the Guinea-Bissau, Sunday, 28 is being celebrated in one hun- world, are waiting to receive January 1990’). dred and fifty countries the message of hope from to- We know how much medi- throughout the world. This is day’s society. May God bless 72 cine has advanced, and how to- an appointment which as the you who are at the service of day this disease is in practice founder himself said is an ‘im- His people” (to the Pontifical treatable and also curable, and mense appointment of love’ Academy of Sciences, Vatican how in most cases it is due to which provides those who are City, Friday, 1 June 1984). the presence of dirt and an ab- afflicted with this disease, more sence of hygiene. And we than the notable material aid H.E. Mons. JAVIER know how this group is a faith- and help, with the joy and the LOZANO BARRAGÁN, ful follower of the apostle pride of actually being treated Archbishop-Bishop Emeritus of Zacatecas, against leprosy, Raoul as men. President of the Pontifical Follereau. The Holy Father I would like to finish these Council for Health Pastoral Care. John Paul II said: “For my part brief words with the exhorta- the Holy See

Speech of Greeting by Minister Rosy Bindi

I most willingly accepted terises the world and the rela- These instruments, which your invitation because I be- tions between the peoples of are the fruit of research, of the lieve that celebrating the the globe. commitment and endeavour of World Day against Leprosy At a simple level these institutions, of the scientific means to have the opportunity 800,000 active cases which are world, of the medical-health to engage in a wider reflection to be found in the world could care world, and of the world of on the questions and issues of be eliminated if there were a voluntary work, allow us to health, of the dignity of man, political commitment to use believe that the eradication of of justice, and above all to the resources which are avail- this disease is near to hand. have the opportunity to reflect able to us in a correct way. The protagonists of this bat- together on how the right to And how can we not re- tle, as I mentioned earlier, health is linked to fairness and member the words of Raoul have been many in number; on how leprosy may well rep- Rollereau: ‘we can eliminate and these results have also had resent a symbolic issue in rela- leprosy in the world for the a large number of protagonists. tion to inequality in the world cost of a bomber!’? But it is certainly the case of health. It has been demonstrated, that it is voluntary work which The 800,000 cases of lep- furthermore, that leprosy can has been, and is, the chief pro- rosy which are presently to be be defeated. tagonist in the struggle against found in the world are in large The striking success of the leprosy. part attributable not merely to WHO’s anti-leprosy project The Church has always been the problems or causes con- bears full witness to this. in the front line against this nected with the subject of Today we have new instru- disease, and above all religious health but also to poverty, in- ments to hand by which to heal and secular associations; the justice, and the marked in- this disease and avoid future experiences involving success equality which still charac- contagions. which has been achieved DH n.45 ing 69-144 2.8.2001 15:44 Pagina 73

thanks to the commitment and endeavour of the world of voluntary work have been very many in number. Your association is perhaps the clearest and most limpid example of this, not least because of its capacity to believe that leprosy is a symbol of the inequality which exists in the world of health. And it is precisely from this sensitivity which joins together the commitment and endeavour of institutions, of the scientific world, of the Church, and of voluntary work, that perhaps comes the ability to overcome the principal obstacle. This obstacle is to be found in the lack of a real international commitment on the which come from countries for the creation of special re- part of rich countries which where this disease is wide- gional centres and a real and have been able in large mea- spread. authentic surveillance labora- 73 sure to defeat this disease in Once again the great migratory dedicated to looking at the their territories and which tory glows remind us that ei- arrival of new cases. must today commit themselves ther the battles are won But the Italian health ser- to achieving this objective throughout the world or in the vice, which has been recently throughout the world. long term each one of us, in reformed in order to be nearer This is because, once again, one way or another, is called to, and more effective for, the leprosy, together with other upon to share not only the re- ordinary citizen, above all else diseases, is an evident sign that sults but also the defeats. wants to be characterised in either we manage to defeat it, Recently the Ministry of addition by the taking on with- and to defeat it throughout the Health has drawn up new in its own confines through world, or the battle is not real- guidelines for the monitoring great national solidarity of an ly won at a deep level. and control of Hansen’s dis- even greater commitment to Of crucial importance, ease. ensuring that the right to health therefore, becomes the mobili- This has been done with full is really respected throughout sation of people’s consciences respect for its own institutional the world and to ensuring that so that the subject is not for- rules and regulations and in all forces Ð including those of gotten about, so that resources co-operation with the various institutions, of society, of the are mobilised, and so that the and complex responsibilities Church, and of States, come attention of governments is di- of the Italian national health together to fight all the causes rected towards this fundamen- service, above all in the special behind this scourge and to ob- tal problem of fairness in the administrative regions of the tain those results which we all world of health. country. hope for and would like to For some time Italy has been But this has also been done achieve. in the front line in the fight always and at all times bearing I can remain with you only against leprosy, as I believe is in mind the epidemiological for a few more minutes. testified to here by the com- and scientific data which are I want, however, to stress mitment and endeavour of the present in relation to the world once again the importance of co-operation of the Ministry as a whole. this day and the importance of for Foreign Affairs, in addi- The characteristic elements the way in which you have tion, naturally enough, to those of these guidelines are the def- sought to celebrate it Ð with a many people who adhere to inition of the disease and its meeting of reflection, study, the Raoul Follereau Associa- clinical data, diagnosis, the investigation, and the ex- tion and other voluntary asso- management of those who are change of experiences. To all ciations. afflicted by it, the groups at of this we look with great in- In addition to working in risk, prevention, epidemiolo- terest and we believe that the countries where the incidence gy, and the monitoring of its results of this day will be valu- of this disease is high, Italy has development. At the present able, and all this so that we can been, and is, committed to time, because of the increase perform our task to greater ef- fighting against those small in the number of cases which fect. outbreaks of leprosy in our have emerged in recent years Thank you all. own country, the remnant of a because of the migratory flows past which was often badly from countries where this dis- ROSY BINDI managed but which today is ease is still well rooted, a new Minister of Health. augmented by new cases measure is being implemented Italy DH n.45 ing 69-144 2.8.2001 15:44 Pagina 74

The Raoul Follereau Association of Benin (ARFB)

Within the framework of this 4. Areas of Interest because of financial and logical prestigious meeting, whose reasons, but today our activities participants I here greet with Ð Those suffering from lep- display a certain vigour. great respect, I have been asked rosy and above all those who For three years, thanks to the to present a paper on the Raoul have been cured of leprosy. logical means which we have Follereau Association of Benin Ð Buruli’s ulcer for which acquired, local committees (of which I have the honour to this year a treatment centre at have been created at a ground be President) and on similar as- Allada will be established in level, and at the present time sociations to be found in the department of the Atlantic, there are eight of them. Thanks Africa. in the south, through our prin- to these local committees, cipal collaborator of the north, which are departmental copies 1. The Association the Luxembourg Raoul of the National Executive Follereau Foundation. Council which once had ubiq- The Raoul Follereau Associ- uitous control, there is now a ation of Benin (ARFB) was 5. Sources of Finance happy division of work which created on 28 March 1968 at in turn brings about more effec- 74 the instigation of the French Ð the subscriptions of mem- tive action in the field. Raoul Follereau Association, bers; In addition to the annual and was registered at the Min- Ð gifts made over at the time General Assembly and the istry for the Interior on 16 No- of the World Days of Lepers; statutory three-monthly meet- vember of the same year. Ð grants given by the Lux- ings of the Council of Adminis- embourg Roaul Follereau tration, the management of the 2. Organs Foundation for the drawing up business of normal administra- and implementation of pro- tion and the implementation of The following organs make jects. activity are guaranteed by an up the Association: office limited to five members Ð the General Assembly; 6. The Partners from the National Executive Ð the Council of Administra- Office. This smaller office is tion; Ð the Luxembourg Roaul required to meet once a week. Ð the National Executive Follereau Foundation which Our activities are engaged in Office; provides grants and financial throughout the whole year and Ð the local committees. support, as has already been include the following principal All the members of the Na- pointed out, and which has giv- initiatives: tional Executive Committee en us two 4x4 vehicles for our Ð visits to centres for and the Council of Administra- trips around the country; anti-leprosy treatment to which tion Ð people who come from Ð the French Raoul every year gifts are sent within different contexts Ð are volun- Follereau Association which the framework of the World teer workers. has given us material for the Day of Lepers; Only the secretary, the dri- World Days of Lepers, that is to Ð the launching and supervi- ver, the rural supervisor, and say calendars, posters, works of sion of projects and micropro- the consultant accountant re- love, Raoul Follereau post- jects entrusted to groups of ceive salaries. cards, and charity boxes. people cured of leprosy who manage them through co-oper- 3. General Objectives 7. Collaboration atives; Ð the training of members of 1. To promote the socio-eco- Ð in the South this takes the offices of local committees nomic reintegration of people place principally with the sister and patients involved in pro- who have been cured of lep- associations of the sub-region, jects and microprojects such as: rosy. and in the North with the agro-pastoral farms, gardening, 2. To support the action of UIARF (the International and the manufacturing and or- public authorities or private Union of Raoul Follereau As- ganisation of various different bodies in the struggle against sociations to which we belong); kinds of materials which can leprosy and all the great social Ð the French Raoul then be rented out; evils suffered by Benin, and in Follereau Association; Ð supervision and annual particular Buruli’s ulcer, a new Ð the Luxembourg Raoul work meetings with the local emerging illness. Follereau Foundation. committees; 3. To initiate and support all Ð the annual organisation of projects of community devel- 7. Activities the World Day of Lepers with opment, in particular in the the National Raoul Follereau field of food self-sufficiency, At the outset these were very Committee to which our Asso- hygiene, and education. difficult and on a small scale ciation belongs and which DH n.45 ing 69-144 2.8.2001 15:44 Pagina 75

works in close co-operation Cameroon, were greatly helped edge of the sensitivity of pa- with the relevant Ministry, the at the time of their creation by tients in their relationship with Ministry for Public Health. the French Raoul Follereau As- the people who care for and sociation and by other helpers treat them; 9. The Other African from the North. But such is no Ð those at the top of these lo- Associations longer the case and today many cal associations are near to African associations suffer their authorities, both local The presentation of facts from a lack of funds and thus councils and the national gov- which I have just offered to you from a lack of logistic and or- ernment. They thus have a has been concerned largely ganisational means Ð typewrit- greater knowledge of politics, with the Raoul Follereau Asso- ers, telefaxes, and means of strategies for planning, laws, ciation of Benin. transport (and this is something and the requirements and feel- In the continent of Africa, which greatly diminishes their ings of such authorities; where, I would like to observe, activity). Perhaps there is a Ð they create and foster local our founder began the possibility of launching an ap- committees in their countries world-wide battle against lep- peal in favour of these Associa- and organise teaching seminars rosy and all other leprosies, tions which in the end will run ad hoc. there are many associations the risk of disappearing if the They meet absolutely the which bear the name Raoul situation does not change. In- right requirements to provide Follereau, with his message of deed, the majority of the popu- help amongst and with the peo- peace, freedom, brotherhood lations of these countries are ple of their countries. and love, a message that be- continuing to grow poorer and Founded in the name of came an appeal to deal with the are developing other forms of Raoul Follereau, these Associa- acute poverty of the world so leprosy given the selfishness tions adhere to the Union of 75 that the rights of the poor could and the stench of money which Associations and choose a be defended and upheld. is to be encountered in these form of adult and responsible countries. partnership. This formula is the only one which works in an ef- 10. Future Prospects fective way for a long-lasting development achieved through It can be said that today the help which in the future will no African Associations have longer need to be long-lasting. achieved a secure stage of maturity and a clear idea of the di- 11. Conclusion mensions of the work which has to be done. They will have In conclusion I would like to to go ahead and at the same say: time increase their field of ac- it seems that the French rev- tion and their performance. olutionary, Louise Michel, and If identification, treatment the great poet, Vicor Hugo, and re-education are engaged died during the last century af- in then Hansen’s disease will ter proclaiming that the twenti- be defeated thanks to poly- eth century would be a century I will only speak here about chemiotherapy, an area where of peace and happiness. Some the Raoul Follereau associa- Benin has been the most judgements of the twentieth tions of Francophone Africa, prominent field of implementa- century have defined it as being which are members, as we are, tion. It will be even more im- a century of war, barbarity, of the International Association portant to be concerned from selfishness and genocide. All in of Raoul Follereau Associa- now onwards with the all, evil has prevailed over tions, most of which came into socio-economic re-integration good. existence long before the Benin of people who have been cured The twenty-first century Association, which, indeed, is of leprosy. This is the area of which we have just welcomed only eleven years old. I am reaction of the African National with faith and fervour will not ferring here to the Raoul Associations whose impor- fail to present individuals and Follereau Associations of Mau- tance is destined to grow even institutions with various chal- ritania, Senegal, Mali, Burkina greater in the future. lenges. Faso, Nigeria, Guinea Bissau, These National African As- May the generosity and the Guinea Conakry, the Ivory sociations have the following nobility of people’s hearts pre- Coast, Togo, the Cameroon, characteristics: vail over everything and with Chad, Congo Brazzaville, and Ð they have the advantage of our Associations may a new Madagascar. living amongst and with people spring flower for the victims of All these Associations have in need; leprosy and all leprosies, as the same objectives and engage Ð they have a better knowl- Raoul Follereau hoped and in the same activity but they are edge than anyone else of real wished! not equally successful. The needs, and engage in constant Prof. HENRY VALERE first, such as those of Senegal, listening to the local population T. KINIFFO, Mali, Nigeria, Guinea Conakry, and its legitimate aspirations; President of the Raoul Follereau the Ivory Coast, and the Ð they have a greater knowl- Association of Benin DH n.45 ing 69-144 2.8.2001 15:44 Pagina 76

Poverty and Health

We have just left a century Surviving on less than US$ tion. Evidence now shows of remarkable human progress. 2 per day is a reality for al- that better health translates The health gains of the 20th most half the people on the into greater, and more equi- century count as one of the planet. Aggregate figures for tably distributed, wealth by biggest social transformation economic growth disguise the building human and social of our times. Living conditions fact that the number of people capital and increasing pro- have dramatically improved in absolue poverty is still ris- ductivity. Healthy children for the large majority of peo- ing. are better able to learn, while ple. But the century also left a The resulting inequalities in healthy adult breadwinners legacy. More than a billion health outcomes are stark. To are more able to work and people have been left behind take some examples: those provide for their families. in the health revolution. living in absolute poverty are The significance of the 76 With vision, realism and five times more likely to die findings is clear: to move commitment, the world could before reaching the age of from a vicious to a virtuous end the first decade of the five, and two-and-half times cycle, means focusing re- 21th century with some no- more likely to die between the sources on improving and table accomplishment. It will ages of 15 and 59, than those protecting the health of the take global leadership to set in higher-income groups. Dif- poor. The process of globali- the process in motion, and ferences in maternal mortali- sation means increasing eco- WHO is ready to play its role ty are even more dramatic: nomic, political and social in- Ð working to the best of its the lifetime risk of dying in terdependence as national ability, linking up with its pregnancy in parts of sub-Sa- and global levels are closely partners, linking up with all haran Africa, where almost interconnected. of you, to unleash a global so- 50% of the population live in There are many examples cial movement for health and absolute poverty, is one in 12, of how health already bene- the role of health in develop- compared to one in 4,000 in fits poor people: the cam- ment. Europe. paign to eradicate river blind- We know the critical role of ness, the strategy of directly health in the forging of sus- observed treatment, short- tainable development. Health Why is better health course (DOTS) to combat tu- needs trigger economies to an important component bercolosis, implementation of grow. We know how impor- of poverty reduction? essential drug policies, MDT tant it is to focus on the right and early case-finding to interventions. Health systems Ill-health is both a cause fight leprosy Ð to cite just a need to reach all and not only and a consequence of pover- few. Since 1985, for example, the fortunate few. ty. Illness can reduce house- the prevalence of leprosy has We need a shift in our hold savings, lower learning been reduced globally by thinking and a shift in the ability, reduce productivity nearly 85% by curing 10 mil- way resources flow. Whereas and lead to a diminished lion leprosy patients. 90% of the disease burden is quality of life Ð thus creating Over the past decades, the in the developing countries, or perpetuating poverty. The international development these countries have only got poor in turn are exposed to community has given top pri- access to 10% of the re- greater personal and environ- ority to poverty reduction. sources going to health. This mental risks, are less well Today the overarching goal cannot change overnight, but nourished, have less exposure is to halve the number of peo- it has to change. to information, and are less ple living in absolute poverty able to access health care. by the year 2015. The other They are therefore more at three development goals are: What are the challenges? risk of illness and disability. Ð a two-thirds reduction in As a result, the socio-eco- under-five mortality rate; The basic facts are increas- nomic development of many Ð a three-quarters reduction ingly well known. About countries is substantially in maternal mortality; 20% of the world’s popula- threatened. Ð reproductive health ser- tion, or 1,300 million people, The other side of the coin Ð vices for all. live in absolue poverty with that better health can prevent The challenge now for the an income of less than US$ 1 or offer a route out of poverty United Nations is to use its per day. Ð has been given less atten- authority and influence to DH n.45 ing 69-144 2.8.2001 15:44 Pagina 77

mobilise the whole interna- funded health initiatives. monia, diarrhoea, malaria and tional community behind the However, resources available measles. international targets for for such support are relatively Ð Childhood vaccinations poverty eradication. There is small. have proven extremely effec- now a strong impetus, and an tive in reducing deaths from important opportunity, to measles and other pre- make health more central to Which health strategies ventable diseases. economic and human devel- are effective Ð Last but not least, one of opment, and to provide lead- in reducing poverty? the most important interven- ership within the community tions in interrupting the link of organisations committed to Selecting health strategies between malnutrition and in- improving the health of the to reduce poverty requires a fection is vitamin A supple- poor. sound understanding of why mentation. Routine supple- the poor suffer greater mor- mentation in the age range 6 tality and morbidity. Inter- to 72 months can reduce Investing in ventions which rely on the overall mortality by almost health development health system for their deliv- 25%). ery will be inadequate if the A health strategy to reduce Today effective medicines poor do not have access to or- poverty should include the and control strategies are ganised services. Moreover, components described below: available to dramatically re- even if universal access to Ð Acting on the determi- duce ill-health. Yet many health services were possible, nants of healths by influenc- governments are failing to it is unlikely that this in itself ing development policy. ensure that these strategies would be sufficient. The rea- Ð Reducing risks through a 77 receive enough funding to son is that many of the deter- broader approach to publich succeed. In some cases, this minants of ill-health, and thus health. is because health budgets are the means for bringing about Ð Focusing on the health unrealistically small. In other significant improvements in problems of the poor. cases, it is because health the health of the poor, will de- Ð Ensuring that health sys- spending is poorly prioritised pend on developments be- tems serve the poor effective- to address the most urgent yond the health sector. ly. health threats. An approach is needed 1 - Equitable distribution of Some of the poorest coun- which combines investments the benefits of economic tries have no more that £27 a in health more broadly with growth is central to reducing head to spend on health care better focused investment in poverty. Similarly, it should annually Ð making it difficult health systems. be our ambition to maximize to ensure that even the most Just to mention some effec- the health benefits of policy basic health needs are met. tive interventions which for labour, trade, agriculture, Low-income countries spend could prevent the spread of micro-credit, environment 4% of GDP per capita on infectious diseases world- and other aspects of develop- health, half the amount spent wide: ment. Success will depend on by wealthier countries. In Ð DOTS (Directly Ob- strenghtening the capacities many poor countries, spend- served Treatment, Short- of Ministries of Health to ing is even lower. In Cameron, course) can prevent 60% of take the lead in cross-sectoral Indonesia, Nigeria and Sri all tuberculosis deaths. initiatives. Lanka, for example, it is less Ð IMCI (Integrated Man- 2 - The challeng facing than 2% of their GDP. agement of Childhood Ill- governments is to improve Donor assistance has nesses) can prevent most the access of the poor to basic helped supplement under- childhood deaths from pneu- public health services, including safe and adequate food, clean water, and sanitation. Beyond the traditional domain of public health, however, the poor are more exposed to violence and environmental hazards, and are likely to suffer more during conflict and natural disasters. 3 - A small number of conditions affect the health of the poor disproportionately. In- formation on the costs and benefits of interventions can also be used to influence the spending of national governments and development agencies. In the first instance, the design of a set of core inter- DH n.45 ing 69-144 2.8.2001 15:44 Pagina 78

4 - Beyond assuring the ca- Conclusions pacity to deliver essential services, there are several other Poverty undermines devel- characteristics of a pro-poor opment. Poverty is an attack health system. At a minimum, on human rights and human it is one which ensures access dignity. Poverty creates polit- irrespective of income, and ical and social instability. treats clients with dignity and Countries cannot afford mas- respect. It protects poor peo- sive poverty. The goal of ple from unwise practices and halving the number of poor financial exploitation in both people by 2015 is achievable. public and private facilities. It But it will require broad ef- should also protect people fort from all of us. We have a who are not already poor window of opportunity. It from impoverishment due to may not remain open for the high costs associated with long. The world cannot afford major illness. WHO has a role it. Sustainable development in advising governments on for future generations will be the reforms needed to achieve a non-starter unless poverty is these objectives. In addition, radically reduced, and pover- ventions would bring together there are several strategies, ty eliminated. work in such areas as immu- for example, the targeting of nization, the integrated man- services, improving outreach, Dr. MARIA NEIRA 78 agement of childhood illness, and involving the poor in Director Communicable Diseases adult lung health, the integrat- health care governance, in Control, Prevention and Eradication, ed management of pregnancy which the analysis of different WHO - Geneva and childbirth, and reproduc- experiences across countries tive health. would be of particular benefit.

Leprosy: Past, Present and Future

Thank you for inviting me cobacterium leprae, was es- This fall inspired the World to participate in this Interna- tablished by Armeur Hansen Health Assembly in 1991 to tional Seminar and to speak in Norway in 1873, but it was resolve to ‘eliminate’ leprosy about the situation of leprosy not until the 1940s that effec- which means to reduce the in the past, present and fu- tive treatment was discov- prevalence of leprosy to less ture. ered. Major developments in than 1 in 10,000 by 2000 I work at the University of re-constructive surgery for through detecting cases early Aberdeen which was founded leprosy took place in the and MDT treatment. by the Bishop of Aberdeen on 1950s. In the 1960-70s efforts Present Situation: there has the authority of the Bull of began to control leprosy in been a 85% reduction in reg- Pope Alexander VI in 1495. the community using dap- istered cases and over 70 It was modelled on the Uni- sone. countries have reached the versities of Paris and Bologna In 1964 resistance to dap- target of reducing the preva- and established the first chair sone treatment was first iden- lence of leprosy to less than 1 of Medicine in the English tified and by 1977 dapsone in 10,000. At the beginning of speaking world. resistance was reported in un- 2000, there still remain about A historical view of leprosy: treated patients. Multidrug 10 countries which have not The first descriptions of lep- therapy (MDT) was recom- reached the target and a com- rosy can be found in ancient mended by the World Health mitment has been made to India and Egyptian writings. Organisation in 1982 to com- achieve this by 2005. Howev- Leprosy spread throughout the bat the problem of drug resis- er, does this mean that all the world and reached a peak in tance. This not only proved problems of leprosy been Europe in the 14th century Ð successful but the shorter solved? Is every patient being then gradually reduced up to treatment led to a fall in the detected and treated? Does the twentieth century. number of patients registered MDT answer all the needs of The cause of leprosy, My- for treatment. those affected by leprosy? DH n.45 ing 69-144 2.8.2001 15:44 Pagina 79

Are there any new cases still have increased in the last few but that has not yet happened. occurring? I shall try to pro- years. This presents the inter- The global trends in new vide information about all esting but confusing pattern Ð cases detected covers up im- these aspects. Figure 1 shows falling prevalence of regis- portant differences between the global trend in registered tered cases of leprosy and countries. India shows a simi- cases (Prevalence) between constant or increasing inci- lar pattern of increase as in the period 1985 to 1998. dence in new cases. Why is the global picture, with a this happening? What is go- larger increase in the last few years. India represents more than 80% of the global cases and therefore has a great influence on the world picture. Let us look at the patterns of new case detection in a number of countries. There has been a considerable decrease in new case detection in China Ð more than 50% in the last 10 years. This contrasts with the global pattern. In contrast Bangladesh shows a rapidly increasing trend in new cases detected. This would not have been 79 predicted from the changes in prevalence in Bangladesh, Figure 1 ing on? What is the explana- which has fallen. This is due The implementation of tion? to the expansion of leprosy MDT world wide has led to a What is happening is that control activities to areas of reduction in the numbers of with MDT we are shortening Bangladesh which were not registered cases as seen in the duration of disease by us- previously covered. this graph. This can be seen ing short course therapy. Brazil shows a very consis- in all countries throughout MDT is used for 6 or 12 or 24 tent pattern of increasing the world. The decline has months, much shorter than numbers of cases detected, as been by about 85%. However dapsone therapy which could seen in Bangladesh. This is a the decline has levelled off in be more than 10 years. If du- large effect over a short peri- the last four years. ration falls, then prevalence od of time. Again it is due to Now let uslook at the trend (number of active cases regis- improvements in the leprosy in the new case detection rates tered at the end of a year) can programme in Brazil and an in the same period in figure 2. fall without any change in in- increase in coverage in the incidence of new cases. dividual States. Figure 2 If we think of complete The trend in new cases in Colombia shows a downward trend over the same time period. I spoke to the leprosy programme manager in Colom- bia who described the difficulties for leprosy activities

The success of MDT and victory over leprosy, which the reduction in registered means disease eradication, cases might lead us to expect that would be aimed at reduc- that the incidence of new cas- ing new cases, in reducing the es would be falling too. This transmission of the disease. It graph shows the trend in new had been hoped that by treat- cases since 1985. Clearly we ing all new cases with MDT see that there is no reduction, the incidence of new cases of indeed the numbers appear to leprosy would eventually fall DH n.45 ing 69-144 2.8.2001 15:44 Pagina 80

caused by the civil disruption associated with an increase in pairments and disabilities. in that country. the numbers of new cases de- Future Priorities: this leads This shows that new case tected. us directly into the important detection is strongly influ- We can see this clearly in questions of the future priori- enced by operational factors the data from India Ð the in- ties in leprosy. There are and does not necessarily rep- crease in new cases is three obvious issues which resent true incidence. Case matched by a decline in dis- directly arise from the present finding methods affected the ability in new cases. The in- situation: numbers of new cases detect- crease is therefore likely to be Ð The continuing occur- ed. Earlier case detection in- due to better case detection rence of new cases means creases the numbers. Im- methods in India. that the first priority is the proved geographical cover- This is not the case if we need for these cases to be de- age also results in an increase look at the global data with- tected early and treated effec- in new case detection rates. out India. Here we see that the tively to cure leprosy and pre- Better information systems numbers of new cases who vent disability. If we fail to and data collection also re- are visibly deformed at the do this then the prevalence of sults in increased new case time they are first detected is leprosy will start to increase detection rates. markedly increasing Ð three- and all that has been achieved To have a real picture of fold. The world data hide a will be lost. The importance the disease transmission, we large variation between coun- and the scale of this must not have to look at some other tries which is important to be underestimated Ð it re- factors like the number of recognise, as shown in figure quires the availability of new cases in children which 4. It shows that in many coun- MDT drugs, and the efforts of 80 reflects the risk of disease tries the number of persons health care staff reaching transmission in a community. with visible disabilities at the hard to reach people, and the Figure 3 shows the trends in time of diagnosis is increas- participation of their commu- new case detection. ing and this means that case nities. detection activities are de- Ð Leprosy is a disease Figure 3 layed. which has physical, social and economic consequences for those affected. So rehabilitation is the second priority. Ð The third priority is research. Research in leprosy had reduced in the last 10 years but in the last few years the importance and relevance of new research has been appreciated. The Genome Project, sequencing the genetic material of mycobacterium leprae will be completed at the end of January 2000 Ð this is already opening up new poten- Changes in new cases in Figure 4 tial for research. children has been considered an indicator of trends in transmission. If transmission of disease stopped then we would see the affect on reduced cases in children. These are difficult to understand as the number of new cases in children increased between 1989 and 1994 while after this period the numbers have gone down but this may be also due to changes in school surveys. Another fact which may give us an idea about the real situation of new cases is the One of the greatest achieve- In the past few years re- trends in visible disability in ments of the past decade is search into nerve damage in new cases. Globally these da- that over 10 million patients leprosy has improved our un- ta show a downward trend. have successfully completed derstanding of this and there This means that cases are be- MDT. However most of these is the prospect of preventing ing detected earlier now than people are still alive and sev- nerve damage in leprosy. 10 years ago. This would be eral million of these have im- Finding ways of preventing DH n.45 ing 69-144 2.8.2001 15:44 Pagina 81

transmission of leprosy is a If we continue with MDT selves Ð they need to work in critical research priority. treatment, when can we hope alliances at all levels with New research methods are for victory against leprosy?: other agencies, other health being developed and vaccine The following figure (Figure care workers, social services, and chemoprophylaxis op- 5) shows that it may need up communities, patients them- tions are being studied. to 20 years to have significant selves and their families. We need to understand the decrease in new case detec- 3. Anti-leprosy services factors which can influence tion rates of leprosy. need to be integrated with the transmission of leprosy general health and social ser- incidence. There are 3 groups Figure 5 vices Ð this includes training, of factors which influence transmission of leprosy: Ð Agent factors Ð mycobacterium leprae. Ð Environmental factors. Ð Host factors Ð people. There are many environmental factors which can influence the incidence of leprosy. Socio-economic development is linked to falls in leprosy as we have seen in many countries. These may be the factors which led to the 81 disappearance of leprosy from Europe. Some believe there This graph is based on the primary health care, hospital may be environmental reser- SIMLEP disease model pro- care, and community based voirs of leprosy but there is duced by colleagues in Rot- rehabilitation. little evidence for this. terdam. It uses existing un- To summarise this presen- There are also host factors derstanding of leprosy and tation: which influence the incidence predicts a gradual effect of 1. The PAST has been char- of leprosy like: immunity drug therapy and BCG vac- acterised by caring for those such as vaccines or infections cine in reducing the incidence affected by leprosy without with other mycobacteria; sus- of leprosy over a long period any effective treatment. ceptibility Ð so far HIV-AIDS of time. Research is needed 2. The PRESENT era has has not been shown to be a into ways of increasing the seen the development of major factor; exposure to lep- fall in transmission and the highly effective treatment for rosy bacilli in households and incidence of new cases. leprosy and millions of pa- other contacts. Drug treat- The three important princi- tients successfully treated. ment is another factor which ples for leprosy work in the This has led to the dramatic may influence the incidence future are: reduction in the prevalence of of leprosy. 1. Sustainability Ð new registered cases but so far no Others factors include drug cases of leprosy are continu- reduction in new cases at a resistance and relapse rates ing and many of the conse- global level. and the survival time of the quences are lifelong so our 3. The priorities for the FU- organism outside the human approaches need to be sus- TURE are: that all new cases host. So far there is little evi- tainable. of leprosy are detected early dence that these are important 2. The leprosy workers and treated properly; the problems. cannot do everything them- physical, social and economic rehabilitation of those affected by the consequences; and research into reducing transmission of leprosy and the prevention of nerve damage.

Prof. CAIRN SMITH President of the ILEP Medico-Social Commission, University of Aberdeen, UK DH n.45 ing 69-144 2.8.2001 15:44 Pagina 82

The Creation of the ILEP

In order to understand how idea of organising an encounter character of their own countries the movement created by on the subject of ‘the common (such as the powerful DAHW Raoul Follerau is organised it is market of leprosy’. He went to of Wurzburg, Redda Barnen in necessary to engage in a little meet Raoul Follereau and ex- Switzerland, FOPERDA in Bel- history. plained his project to him. gium, or the Leonard Wood Raoul Follereau was a born Raoul Follereau, listening to Memorial in the United States orator, one of the greatest of the him, had the impression that he of America), and others had re- century. He placed his im- had finally found the man who sponded to the appeal of Raoul mense talent at the service of could implement his project Ð Follereau (such as the associa- the causes he held dear. First the joining together of the tions of England, Belgium, and foremost for the ‘defence forces of leprosy at an interna- France, Italy and Luxembourg). of Christian civilisation against tional level. In those years (thirty years all forms of paganism’, then for Raoul Follereau, who knew have since passed by) there was am exaltation of the memory of Pierre well and trusted him, a great deal of talk about the Rev. Charles de Foucauld, and agreed to preside over this en- construction of Europe. We finally to know ‘what the world counter and to direct the de- wanted to construct the Europe 82 owes France’ through a famous bate. In this way, in Brussels on of leprosy. In order to succeed conference given thousands of 2 October 1965, there took we sought to know each other. times before, during, and after place the first European meet- This was not easy because we the war in France and various ing of the associations engaged had fought a war against each other countries of Europe. All in the struggle against leprosy other and with each other. We the men of my generation lis- and it provoked such a level of wanted to overcome all of that tened to this conference and it enthusiasm amongst the associ- in order to help build a society was in listening to it at the age ations which were there that it which was based upon love. of sixteen in 1941 that I discov- was immediately decided to This is what Raoul ex- ered Raoul Follereau. create a European body to pressed in his message to the A meeting with the female struggle against leprosy and to VIII general assembly of the religious of Our Lord of the elect a committee to prepare ELEP held in Rome in 1973: Apostles led him to abandon the ground for the formation of “beyond all the national, politi- his political-religious struggle such a body. cal or spiritual barriers, without and to dedicate himself to char- This is why on 25 September vanity, without ambition, with itable action. It is certainly the 1966 there was held at Bern, a perfect selflessness, you re- case that until his final breath under the presidency of Marcel main at the service of those of he remained loyal to the ideals Faine (President of Aide aux whom you are the benefactors, of his youth but from 1942 he Lépreux Emmaus-Suisse), the the protectors, but above all the placed his talents at the service first general assembly of the friends”. of lepers who were for him the European Federation of the In the spring of 1975 the Eu- most suffering and oppressed Fight Against Leprosy (ELEP). ropean Federation of the Asso- minority that existed. Its essential aim was the fol- ciations against Leprosy During the whole of the lowing: to co-ordinate the ac- (ELEP) ceased to be European 1940s he fought alone. Then tion of its members so as to and became international with during the 1950s, given the avoid overlapping, competition the entrance of an American success of his conferences, he and demagoguery. member, the American Leprosy asked his friends to create local Pierre Van den Wijngaert Mission, and a Japanese associ- committees, entities which are made these comments on the ation, the Sasakawa Fund. called ‘gruppi’ in Italian. In the goal which we had set our- What we achieved in the 1960s he asked us to create na- selves: ‘although the raising of ILEP was exemplary. Seen tional and international struc- funds is a difficult task, their from the outside as the Paris tures which could respond to intelligent distribution involves Club of Leprosy (that is to say the dimensions which his work even more serious responsibili- as its financial backers) the had taken on. ties’. members of the ILEP have In 1956, during an audience, But it was not easy to make been the only people to fi- His Holiness Pius XII support- the associations collaborate, be- nance the struggle against this ed him in his project of bring- cause although they had the disease over the last forty ing together within a single same task they were in fact very years. The success achieved in federation all the associations different: some were many cen- the struggle against leprosy which were fighting against turies old (such as the Order of over the last decades is thus leprosy in the world. Malta), others had an estab- something which should be at- Pierre Van den Wijngaert, the lished religious character (such tributed to us. Belgian polyglot who had just as the Leprosy Mission of Lon- This has meant, every year, created the ‘Friends of don), and others were national 1,190 projects financed by the P.Damien’ in Belgium, had the associations marked by the member associations of the DH n.45 ing 69-144 2.8.2001 15:44 Pagina 83

Federation for a total sum of If the organisation of the bat- greatest leprosy of our time. about seventy million dollars. tle against leprosy has been I hope and wish to the full Thus it was that from the be- conducted in an exemplary that the ILEP achieves the goal ginning in order to heal mil- way, the principal credit for this for which it was created. I hope lions of lepers almost two mil- must go the idea of Raoul and wish that its members nev- liard dollars has been collected Follereau and Pierre Van den er forget that they owe the vic- from generous people from the Wujngaert, who established the tory they are about to achieve countries of the North of the International Federation of As- over leprosy to the co-ordina- planet for their unfortunate sociations against Leprosy, tion of their activity, and I hope whose chief aim was to co-or- and wish that at the time when dinate the activities of its mem- this success leads them to other bers. struggles they will employ the This seems so simple when same spirit of co-ordination in writing that one asks oneself these new fights against other why it was necessary to create forms of leprosy. an organisation for something In the message which I have so elementary as the co-ordina- already cited Raoul Follereau tion of the activity of associa- told us in 1973: “perhaps one tions which fight for the same day you will be called upon to goal. Co-ordination assumes, extend your struggle against on the part of the associations other forms of leprosy! It which accept it, not a subordi- seems that by now you need to nation to the agent which exer- prepare yourselves for this... cises it but a leadership which Remember doing good does 83 is freely accepted and naturally not mean imposing good... received. but... very simply and humbly The agent which exercises it offering oneself...” must provide proof of compe- In his message of 1974 to the tence and knowledge of the ter- general assembly held in Bern rain and of men. In this way it he added: “don’t allow your- brothers living in the South. is possible to avoid the forms selves to be hypnotised, that is One of the principal aims of the of competition which arise to say anaesthetised, by the fig- ELEP was that of organising a from a rivalry which is no ures of our budgets. The con- chain of solidarity between longer healthy emulation but siderable sums which you dis- those who had and those who something which compromises tribute are essential, certainly, had nothing. We are, howev- the drawing up and the devel- to carrying out and winning the er, far from being mere finan- opment of programmes and in- Battle against Leprosy. But cial backers Ð we are partners volves expenditure which can their sole and impressive value and as such we want to operate create problems with the coun- is that of being made up of an on a footing of equality with tries concerned. almost infinite number of ac- the States that we help and with One can thus better under- tions of love carried out by the World Health Organisation. stood the positive step of Raoul poor, humble and at times sub- The co-ordination of our ac- Follereau and Pierre Van den lime hearts which have drawn tivities is the only way by Wijngaert in creating a Euro- from the necessary, that is to which to avoid competition be- pean federation. It is true that at say from the indispensable, between the associations and the time when the European in- cause a smile illuminates, in overlapping with regard to stitutions were created a desire the heart of the savannah, faces those who receive. I remember to draw near to each other ex- which they will never see”. that at the moment of the cre- isted within all the European The following year, in 1975, ation of the ELEP a nurse who peoples. Those who took part he gave us his last message in had helped our initiatives wrote in the creation of all these insti- Bonn: “this very happy devel- to us all about the same thing: tutions well knew that this opment should not make the ‘I have thirty-two lepers to take drawing near would have in- beating of your hearts less per- care of and feed and nobody is volved a certain loss of free- ceptible... or involve emulation helping me’. Each one of us dom but they unanimously be- giving way some day to rival- acted on our own without con- lieved that this was a modest ry... Everything that is achieved sulting the others and this able price to pay in order to avoid a without ideals is destined to nurse thereby received the sum return of conflict. failure... Our real strength, our of thirty-six million francs. The associations which bear secret weapon, is our friend- I well know that those who the name and follow the work ship...” receive are wounded in their of Raoul Follereau thus have May this friendship amongst dignity and I understand them. an important role to play today the members of the ILEP last But in order to be effective, in in the world in order to ensure for ever! I hope and wish this order to be just, in order to be that the kingdom of love tri- with all my heart. generous, charity, which is es- umphs, that is to say mutual sentially a question of the heart, understanding, the forgiveness ANDRÉ RECIPON, must nonetheless be organised of offences, mutual tolerance, President of the with specialists and profession- so that intolerance ceases, ‘Raoul Follereau Group’, al people. something which is perhaps the Paris. DH n.45 ing 69-144 2.8.2001 15:44 Pagina 84

Raoul Follereau: An Extraordinary Witness of the Twentieth Century, A Look of Love Towards Others

‘I have tried during my life them, pressed them, often all cious, to free the lepers from as a man, with the strength of a at once. the forms of ostracism and in- man, with the instruments of a And he became for history justice which had always been man, to put into practice what I ‘the man who took lepers in imposed on them. He would wanted to bring about’. his arms’. dedicate ten years of his life to The Wanderer of Charity Eating with them, drinking the realisation of this project. made this lapidary observation with them, were for him acts at the end of his life. of communion, like those of In 1954 I would to thank very warm- the Last Supper. ly our friends of the AIFO who Pierre Fresnay, a member of He created the ‘World Day at the beginning of the new the Comédie Française, said of of Lepers’. This would be his millennium have wanted to re- him: ‘this man unleashes such most spectacular action in the 84 member in this hall one of the a warmth that on touching him sense that since its creation its most important voices to char- you feel better’. success has grown and grown, acterise the twentieth century. Raoul Follereau was born and today this day is celebrat- The organiser did me the ho- on 17 August 1903 in Nevers ed in 152 countries. nour to entrust me with this to a family of industrialists. difficult if not impossible task. The framework of my paper In 1952 How can I communicate to does not allow me to outline you in the short time which is the history of his life. For this He asked the United Nations available to me the innumer- reason I will confine myself to for a kind of international con- able and fruitful experiences of a short biography. vention for the defence and the life of Follereau, and how History will remember him dignity of lepers. This action can I make you grasp the as one of the most extraordi- would have a follow-up. vigour of the thought of this nary witnesses of the twentieth effective idealist whose entire century. In 1959 life, indeed, was one single battle against human misery? In 1943 The medical congress of However, this undertaking is Tokyo recognised that he had a cherished duty for me be- Hiding with the Sisters of achieved a new chapter in lep- cause I believe that it was an Our Lord of the Apostles he rology Ð sociology. His fa- honour for my life to win the began his battle against lep- mous letters to Roosevelt, favours of his esteem and his rosy by planning the construc- Eisenhower, Kruschev, U. friendship, to work for eleven tion of a centre for lepers in Thant and many others form a years at the side of this great Adzopé in the Ivory Coast. part of history. He was the man Christian humanist, this vi- This was his first step, which whom young people saw as a sionary, the singer of love and was spectacular and tena- guide and example. Three mil- charity, and the tireless de- lion young people responded fender of the rights of man, to his initiative in favour of ‘a which for him were, above all day of war for peace’ and sent else, the rights of poor people. letters to the United Nations Who was Raoul Follereau? supporting his appeal. I believe that I met a saint of modern times. In 1966 Not a saint who fled into the white zones of metaphysics, He was to be found in Berne not a figure of glass, but a saint amongst those who in 1966 in blood and bones, devoted to founded the ILEP, which today other people with a rare pas- is the world co-ordinating sion which lived within him body for the fight against lep- and devoured him. A giving of rosy and whose honorary all of himself, like that of life-president he would later Christ on the path to Golgotha. become. Follereau loved those he was speaking to with his body, In 1967 he touched their shoulders, he took them by the arm, shook I had the pleasure of organ- DH n.45 ing 69-144 2.8.2001 15:44 Pagina 85

ising his visit, and accompany- figure of great force. Raoul ing him, to our Minister for Follereau was such a person. Foreign Affairs, M.Gaston In a world shaken by vio- Thorn, who was then President lence, in this reverse Adzopé, of the United Nations. I was where man feels that he is able to bear witness to the ease without warmth, and despite and conviction he displayed the disappointments, Raoul when he spoke in favour of the Follereau created a lineage of adoption of the Universal Dec- generosity and culture. laration on those Sick with From 1942 onwards Raoul Leprosy, the logical sequel to Follereau, the writer, the the request of 1952 which had philosopher, the journalist-re- remained a dead letter. porter, the man of adventure, the nonconformist, became the In 1971 man who understood that the scourge of leprosy not only The Constituent General As- condemns man to a slow and sembly of the International terrible death but also afflicts Raoul Follereau Foundations. him with cruel, unjust and the disinherited who made him The first President of this body scandalous ostracism. This a Wanderer of Charity. As a was André Recipon. leprosy which gave rise to so man of action he communicat- A compelling orator, a poet much fear was nonetheless a ed and drew out a whole pacif- of adventure, a journalist, a re- disease like any other after Dr. ic army from his experience. porter, a dramatic author, he Armauer Hansen had discov- His horror of conformity 85 used words, and modern ered the leprae microbacteri- meant that he was openly means of communication, in um. Men and women of extra- scandalised, that he did not ac- order to conduct his battle ordinary courage Ð amongst cept the cruel condition of the against leprosy and all lep- whom the leading figure was leper, and that he did not want rosies. Padre Damien de Veuster (the to be at one with abandon- 4,000 conferences, 44 books patron of our Belgian friends) ment. and pamphlets, round the Ð fought tirelessly against this This personal experience world thirty times, frontiers disease. But who in actual fact was not a fine theory con- crossed thousands of times to knows their efforts, their hero- ceived in an empty white hunt out leprosy wherever it ism? space but a location for engag- was to be found and to combat In the opinion of Raoul ing in direct contact with evil, selfishness, that more power- Follereau it was necessary to with misfortune, and the ful leprosy. apply a whip lash to scientific wicked behaviour of man. Lastly, the publication of the research, to those at the head This contact with decompo- ‘Book of Love’ Ð a condensed of the state. And to achieve sition made him understand version of the thought of this it was necessary to mo- that leprosy is within us as it is Raoul Follereau Ð the fruit of bilise public opinion and place within them. Leprosy attacks fifty years of reflection and in contemporary eyes this everybody, some visibly, oth- work at the service of the poor. scourge which had been ers invisibly. At first glance it This work was printed in eight known about since ancient is not noticed but deformations million copies during his life- times. He placed the modern exist. Yes: it is too often the time and was translated into means of communication to case that our hearts, our char- thirty-four languages. work. acters, our spirits and our souls Together with his wife he are in decomposition. And In 1977, 6 December went round the world God does not love putrefac- thirty-two times in order to tion. God does not accept the The apostle of lepers left us discover his sick people in the cowardice of declaring that the for another world. most forgotten corners of the causes of our repugnance are We are ready to receive world of the poor, and thus he incurable and the effects of our these historical facts but it may was in permanent contact with laziness are irremediable. In happen that the essential char- the physical decomposition of His eyes our obstinate rejec- acter of his message will really an abandoned minority. In de- tion alone is incurable after we elude us: scending into the abysses of have engaged in the imple- Follereau Ð a madman who human misery he measured mentation of our best efforts. thought he was Follereau? their real scale. TO LOVE Ð TO SAVE: Or, He shouted his truth into the these were the key words of Raoul Follereau Ð one of the face of the world which was Raoul Follereau. most extraordinary witnesses increasingly insolent in its de- Through his front-line expe- of our epoch? nials. rience, physical contact with There are movements which In these abysses of human the cruellest kind of misery, he can be explained only through misery, in these leper colonies established the right the person who gave the initial as they once existed, Raoul counter-weight to this SUF- impetus to them and which can found his chosen people. And FERING. TO LOVE Ð TO be understood only through a it was this chosen people of SAVE. And from these beliefs DH n.45 ing 69-144 2.8.2001 15:44 Pagina 86

was derived his axiom which Damien de Vuester with lep- Follereau deduced this phi- sprung from his heart like a ers. losophy from his relationship wave which presses upon an Mother Teresa with the dy- with God. over-full vase. ing of Calcutta. In his relationship with God ‘The only truth is that of lov- Abbot Pierre with the home- we find the three key words of ing Ð Nobody has the right to less. his faith and his thought: ‘God be happy alone!’ P.Tritz with children of the is love’. He uttered this phrase In this way Raoul Follereau, street. at the age of fifteen and fin- through his experiences of Jean Vanier with handi- ished his life with the certainty fighting against leprosy, fol- capped children. that ‘God is our ULTIMATE lowed a path which would Frédéric Ozanam with the FRIEND’. give him access ‘to all other poor. God is love: Raoul Follereau leprosies’: hunger, miserable Sister Emmanuelle with rag deduced this truth from the dwelling places, despotism, sellers. EIGHT WORDS which Jesus the madness of insensate ar- The look is the same. of Nazareth pronounced on the maments, all the exclusions of It is a look of love directed slopes of a mountain in the our time: drugs, the tyranny of towards others. month of June of the year 28, a lack of work, and finally words which marked the page those hard-skinned leprosies Ð If Descartes was able to af- of the great book of the world. selfishness, scandalous riches Indeed, the text of the Sermon and insulting contempt, and on the Mount would be the visible and invisible forms of most important of the New injustice. On the contrary, it Testament because it was di- 86 enabled him to discover with rected towards believers and others all forms of exclusion those who do not believe, and and injustice. His message be- would be according to the Hin- came richer from that moment du, Ghandi, twenty centuries onwards endowed as it was later, the only light to shine in with a vaster dimension. the shadows of violence, fear, Those who carefully study and loneliness in which pride the thought of Raoul Follereau, and selfishness have immersed as expressed in his work ‘The us. Betrayal of Intelligence’, can Raoul Follereau had the faith observe in the work of his life of a coal seller. He was a posi- the presence of a constant tive man. struggle against every su- These eight words were for premacy of negation. He Raoul Follereau the Code of fought against all those spiritu- the New Covenant between al forces which degrade man firm in his famous phrase ‘I God and men. For Follereau and which destroy his deep or- think therefore I am’, I am cer- the Gospels were the inner ex- der and eliminate authentic hu- tain that Follereau defended his pression of Christianity and the man happiness. For this rea- own truth with equal convic- Beatitudes were the summary son, Raoul Follereau was in re- tion: ‘I love therefore I am’. of the meaning of the Gospels. ality concerned with all forms Here is to be found his criteri- For Follereau, a positive man, of leprosy. on of truth. these decisive eight words This at the time was a con- The philosophical idealism were all positive. He read in stant theme of the philoso- of Descartes REDUCED man them the opposite of the Cru- phers Bergson and Raissa and to a disembodied thought; sades, the Inquisition, and Jacques Maritain. It was his Marxism often reduced him to anathemas. answer to the philosophers of a sum of economic relations; It is easy for me to imagine positivism which at the time Freudianism reduced him to a Raoul Follereau amongst the became the religion of the in- cluster of passions, and Sartre crowd which surrounded Jesus telligentsia. reduced him to freedom with- on those slopes twenty-five Was not the real fight of out reference to ideal values. leagues to the north of Follereau a burning desire, a Structuralism reduces him to a Jerusalem which go down to ferocious wish to save in man mere toy in the hands of imper- the lake of Genazaret in a tran- that which makes him a man? sonal systems. quil countryside WHERE An ethical approach which we This ‘I love therefore I am’ THE THUNDER SOUNDED can trace back to the following allowed him to make man ap- EIGHT TIMES. Follereau felt formula: absolute respect for pear a subject, a ‘me’, an active that the essential had been said human life. For Follereau hu- and irreducible centre of initia- and that the great PROVOCA- man beings were all equal in tives, the end and not an instru- TION had begun. This is the dignity from their conception ment at the centre of things and way I want to discover him until their natural death, an forms of modern technology reading the Gospel. He re- equality in dignity which did which threaten to devour him, alised at a stroke that for two not mean dignity. to annihilate him, and to rele- thousand years humanity had Follereau with lepers and gate him to a mere secondary possessed the key to truth and the excluded. level. had left it in the bottom of its DH n.45 ing 69-144 2.8.2001 15:44 Pagina 87

pocket. Everything that that him he had the right to warn world the small fears which provoker dressed in white who them through his famous ten render us stupid, young people came down towards the lake of ‘Appeals to Young People’. committed themselves to serve Genazaret as twilight fell said Raoul sought to understand a Christianity which does not had already been felt by Raoul their bewilderment, something worry whether the glass of wa- Follereau within himself. characteristic of them and the ter is repaid or otherwise, of a For him Christianity was a century. The most serious fact, Christianity which does not ‘brotherhood on a journey’. in the opinion of Follereau, search to manoeuvre God, and ‘We should love poor peo- was that young people had of a constructive and conquer- ple, happy people, love been put in a world in which an ing Christianity. strangers, love our neighbour attempt had been made to They served it in an attic, a who is at the top of the world, eliminate the existence of God. garage, and a factory as much love the foreigner who is near For them a civilisation had as in a mobile clinic. to us, love...without love there been created of disgust and ‘Ozanam is always twenty are no genuflections, bells or desperation. Nothing before years old’. Lents which resist over time; if life, nothing after. What, then, ‘To live means to help to you do not love you are not is the point of life? live. To be happy means to Christians’. He warned them about ‘not make other people happy’. We do not have time to becoming prey to the snares of Such were the words of speak about his social beliefs intelligence which leads them Raoul Follereau on 7 Novem- and real charity. For him, the along roads without flowers ber 1976 when he attended for sharing of the wealth of this which in turn brings them to the last time a meeting of the world in a fair way was some- nothing’. associations which bear his thing which meant taking part He warned them about drugs name. I quote: 87 in the creation of God. and accused the world of “In this way the ‘Battle It is, however, important to adults which closed its eyes, against Leprosy’ bears wit- analyse the richness and wealth and condemned ‘this civilisa- ness, first of all and above all of the thought of Follereau in tion of waste, incapable of else, to the supremacy of love. order in a few words to look at freeing itself from its own Remain faithful to it. The man the relationship which linked residues’. who receives is helped. But it Raoul Follereau to his young Faced with a drugged youth is he who gives who is en- people. which had killed itself he riched. This was a relationship of spoke about the murdered child Leprosy, which for millions trust. Young people do not like of his century and rebuked so- of men has been a martyrdom people who wear masks. ciety: ‘behind the murdered and a curse, should, in a future Follereau fought with an un- child is the dark cohort of those which I believe very near, covered face; he did not dis- who have deserted’. cease to be an exceptional evil. simulate, and did not betray. He understood the void Leprosy will cease to be re- He accepted this relationship which provoked dizziness in venge. But the battle which has as though he was one of them. young people and which ex- defeated it will always be an ‘After fifty years I am still pressed itself in rejection and example and witness: ‘without twenty years old’ he said with- violence. However, Raoul love nothing is possible. With out any fear of being in error Follereau, a positive man, a love nothing is impossible’. on his seventieth birthday. philosopher of hope, invited This success should encour- Who could say such a thing in adults, the witnesses to the pu- age us to struggle, tomorrow, front of young people without trefaction of the twentieth cen- against other evils and wicked- appearing ridiculous? He could tury, and young people, to ness, against other forms of de- do it because he could attest build a city on a human scale generation. through the work of his life to so as to serve the human being With the same dynamism the authenticity of what he without oppressing him, to and equal fervour continue preached to young people. build an open Christian city, your battle against all the He made young people ‘the disinfected of its superstitions, forms of leprosy of which, as I universal heir of his work’ and of its testimony, and of its have often repeated, this is on- invited them to say ‘no’ to the forms of cowardice: a loyal life ly a chapter in a united whole”. suicide of humanity faced with with God. Dear Father Raoul, may God the Great who continued their He wrote that we see young hear you! monstruous armaments indus- people return to a theology of From on high in heaven may try. The treasure which Raoul renewed love. Often in trou- you continue to beseech your Follereau left to them is the bled, indignant, hearts the brothers and sisters of the ILEP good which he did, which he naked Christ has found refuge to remain united in order to wanted to do to young people, and faith has flowered, and this meet other challenges! of the Right, the Centre, and is a virgin faith. the Left, those who have re- Rejecting the way of practis- JOS HILGER, ceived the gift of the faith and ing constantly re-cooked reli- President of the Raoul Follereau those who act as though they gion, entrusted with ensuring Foundation of Luxembourg. believe, those that believe and that we avoid the hard blows of those that do not believe. the other world, and anxious, And because they trusted above all else, to calm in this DH n.45 ing 69-144 2.8.2001 15:44 Pagina 88

The Figure of Padre Damien

The Damien Foundation In order to understand what ical-social field because of his ‘Association for the Fight the figure of Padre Damien rep- struggle against exclusion and Against Leprosy’ always refers resents in the world, in Bel- his pain-reducing approach to back to Padre Damien, as is gium, and for the Damien incurable illnesses; and at a re- borne out by our statutes and as Foundation, we should bring to ligious level as a pioneer of ec- is demonstrated by the reality mind the life of this Belgian umenicalism’. of our actions. Our most recent priest who dedicated himself to The world of the nineteenth day of promotion, which took the lepers of Molokai, one of century was very different from place in November 1999, de- the islands of Hawaii, from today’s world. The Belgium of clared: ‘with Damien we will 1873 to 1889, the date of his that period was very different enter the year 2000’. death, which took place after from the Belgium of today. With regard to the statutes we many years of suffering caused And lastly, and above all else, should mention article 4 which by being infected by the bacil- leprosy presented problems says: ‘the Association has the lus of leprosy itself. and challenges which are no aim, following the example of A large number of biogra- longer known to us. Padre Damien and basing itself phies have been dedicated to Padre Damien was born on 3 88 on his work, to contribute to the Damien, whose heroic actions January 1849 with the name of fight against leprosy in the were already known through- Joseph De Veuster, and as a re- world and other medical-social out the world when he was still ligious he would become problems through action at dif- alive thanks in particular to ‘Padre Damien’. He was born ferent levels...’ writers in the English lan- to a family, a region, and a ‘The Association encourages guage. One should however country in which the Catholic equally all the forms of activity give pride of place to the mon- tradition was very deeply root- directed towards information umental work of Hilde Eynikel ed. It was therefore almost nor- and the raising of the aware- which is a revised and much mal for the young Joseph to ness of the Belgian popula- re-written version of the first have thought of the priesthood tion...’ edition published in Holland in and to have engaged in studies ‘It follows these goals and 1993.2 We now have a set of to fulfil his vocation. At the age aims in all independence and data which enable us to place of seventeen he entered the free from every consideration the history of Damien in a vari- congregation of the Fathers of of a political, religious and ety of contexts, and map all the Picpus who were still called the racial character’. stages of his life, in particular Fathers of the Sacred Hearts. It is known that a certain during his apostolate in He took this opportunity to number of countries turn to us Molokai. The work is intro- leave as a missionary for the in an increasing way in order to duced in the following terms: Hawaii islands before being or- control tuberculosis, among ‘After staying for seven visits dained as a priest. He said other things. The present-day in Hawaii and the island of adieu to his parents, which at objectives of the Foundation Molokai in order to explore all that time was a real adieu, and are therefore those of ‘taking the places in which Damien embarked on a ship which part in the uprooting of leprosy lived from 1863 to 1889, and brought him within five and the control of tuberculo- in order to look through the lo- months from Bremehven to sis’, and this is something cal civil and religious archives, Honolulu, the capital of the which involves a very fruitful Hilde Eynikel was in addition Hawaii islands, travelling via energy. But leprosy remains the the first person to gain access Cape Horn. principal concern of the Foun- without limitations to the From 1864 to 1873 Padre dation because it has not yet archives of the congregation of Damien engaged in a classic been weakened and many years the Fathers of Picpus, the order apostolate but one which was will still be required for this to which Damien belonged, in marked by a no means ordinary disease, and its consequences, Lovanio’. dynamism. In the immense re- to be completely eliminated ‘This biography is the result gions which were entrusted to from the face of the earth.1 of an unprecedented investiga- his care he constantly went In the year 2000 we will be- tion. There emerges a figure of around on horseback in order to gin a new intensive campaign truth of exceptional breadth keep in contact with all his to identify the presence of lep- which because of its universal faithful, perform baptisms, rosy in Bihar, a state in the dimensions reaches those of a maintain or build places of north of India where 25% of all Gandhi or a Mother Teresa of worship, etc. the cases of leprosy in the our age’. During the course of those world are to be found and ‘Damien appears not only as years the authorities of the where we identified and sub- a heroic missionary but also as Hawaii islands, which at that jected to treatment about a fighter in conflict with the hi- time made up a kingdom, 120,000 new cases in 1998. erarchy, a pioneer in the med- raised the question of how the DH n.45 ing 69-144 2.8.2001 15:44 Pagina 89

lepers should be treated. Their and himself acted in this sphere 1994. It was observed that in numbers were increasing, an without stopping even to the the ‘thick’ forest of the ‘heroes epidemic was underway, and a point of performing amputa- of charity’ ‘we know above all general contagion was feared. tions. At the price of tireless else the giant trees... the illus- The Health Council of the is- work, and without forgetting trious Padre Damien’.6 Many lands acquired a territory on the his own obligations of prayer others, in reality, have lived peninsula on the north of one of and evangelisation which today with lepers and some of them the islands called Molokai Ð a make up a large part of his pro- died from leprosy, like Padre rocky outcrop of 600 metres gramme, he gave a new impe- Damien himself. high on one side, and a rough tus to this centre for lepers. The figure of Padre Damien sea on the other three. The lep- For hundreds of lepers who has been the object of special ers were deported to this place were under his protection Ð regard, especially in Belgium. compulsorily and confined to from 580 to 1166 in number ac- The return of his remains to this narrow space. cording to an official report Ð that country in 1936 was a na- From 1873 to 1889 Damien he often became a ‘doctor, tional event. A large number of passed sixteen years in this nurse, organiser, carpenter, gar- articles and books have been place amongst the lepers. The dener, and undertaker’.5 There devoted to him. His beatifica- superior of the missionaries has often Ð inevitably? Ð been tion in a certain way began a had asked for volunteer priests emphasis in an excessive way new era which Cardinal Dan- for Molokai and Damien had on the multifaceted character neels characterised as follows: accepted immediately. He left and the exceptional qualities of ‘Brothers and sisters for a long for the leper colony, he became this action. To believe a num- time we have admired Padre bound to them, and finally he ber of texts and cartoons Ð yes: Damien as a hero. The moment decided never to leave them. Padre Damien exists in car- has come to pray to him as a 89 toons Ð Damien himself built a saint’.7 large number of coffins, some- With regard to the Damien thing, however, which has not Foundation the example given been corroborated. With regard by him has often been remem- to this fine story, we should bered in numerous articles and without doubt prefer to keep publications. The image of close to historical truth. Padre Damien often appears in Damien knew perfectly that our texts and it always returns he on his own was not up to the us to the reality of exceptional task and for this reason he action which the Foundation asked for help on more than seeks to translate into modern one occasion from 1873 on- terms but with the same dedica- wards Ð female religious, mis- tion, the same force, and the sionaries, medical doctors, and same realism. lay support finally arrived in Lastly, mention should be the end. Various people carried made of the film by Paul Cox on his work when leprosy ‘Padre Damien’ which has been In all those years he acted claimed him as well in 1889. shown on the screens of Bel- with the dynamism, the force Padre Damien lived amongst gium and which is continuing and the independence of action the lepers and did not refuse its career in the world. Filmed which were his great qualities. contact with them in any form. on location in Molokai with the For him it was a matter of a He contracted the disease it help of H.Eynikel, in realistic continuation of his activities as would appear during the first fashion it narrates the principal a missionary and, for example, years of his stay in Molokai. aspects of the activity of of presenting Jesus to his The diagnosis was carried out Damien and helps to make him parishioners as ‘the physician in 1884 and from that moment better known and better under- of the body and the soul, the onwards the famous phrase stood. companion’. In 1874 he drew used by him ‘we lepers’ ac- As was agreed, I have limit- up his first balance of what he quired full meaning in that ed my paper to the figure of had achieved Ð one church, 116 place and in the world. Padre Damien. But our Foun- baptisms, 30 funerals, and 10 The action of Father Damien dation willingly also remem- marriages.3 was always noticed and attract- bers the great figure of the Bel- But he did not confine him- ed some suspicion and some gian doctor, Hemerijckx, who self to taking care of souls. jealousy, in particular on the took care of lepers in the Con- Given that he had before him part of the Protestants, but it al- go and in India, and of course very painful situations, from so provoked admiration and the great figure of Raoul both a physical and a moral help, especially on the part of Follereau. Finally, and in or- point of view, he sought to im- such Protestants as Rev. Chap- der to guide possible reflection, prove the conditions of the lep- man of London.5 I would like to quote from two ers. He thus concerned himself Padre Damien was famous classic texts: with their housing, food, and during his life, a fame he had – the first is from J.Leclerq’s medical treatment. For exam- never sought, and after a centu- ‘Saints of Belgium’: ‘the saints ple, he was very interested in ry he is increasingly famous. of Belgium are the best the various forms of treatment Indeed, he was beatified in amongst us, but they are DH n.45 ing 69-144 2.8.2001 15:44 Pagina 90

amongst us, and if they do not English’ G.Bernanos writes: Egalement “Santé du Monde”’, journal of the WHO. have the defects of many of us, ‘the cult of saints scandalises 2 Le Père Damien (Cerf/Racine, they have certain failings’. ‘To many of you, and you think Paris, 1999), 351 pp., original edition in express this in a word, they they are prisoners of the Dutch, 1997. English version: Molokai. The Story of Father Damien (Alba lack greatness. Holiness re- Church. But it is the Church House, New York, 1999). quires virtue pushed to the which is their regal prisoner. 3 Eynikel, op. cit., p. 170. point of heroism. No people Alive, they gave everything. 4 Ibid., p. 175. Most of our data come from the fine book by H.Eynikel. gives people who are more Dead, they provide living wit- 5 From Chapman to Damien, 4 Feb. honest and admirable but we ness, they are her witnesses and 1886: ‘receive this letter as a weak are rebels against magnifi- her judges’. homage of my affection for you; you cence. And these are moral have revealed to me what heroism is’. 8 From Chapman to Damien: ‘allow me to forms of magnificence’. The ANDRÉ DE SCHUTTER, pray for you and for myself, united in whole of the last chapter of the the Damien Foundation, the same faith and the same church, we Belgium. will receive one day the same crown’, book, entitled ‘the debate about Paris, 1940, pp. 204-206. holiness’, develops this idea, 6 Histoire Universelle des Missions dwelling upon a certain num- Catholiques (Grund, Paris), Vol. 4, p. 40. ber of our saints. It is right to 7 Damien, un Portrait (Service de think that the prestige of Presses de l’Archeveché, Brussels, Damien is to be found precisely Notes 1994). Who still remembers St. Alicee in this magnificence to which di Schaerbeek in Brussle who died of 1 Work of reference: La Lepré, coord. leprosy in 1250? he bore testimony in Molokai; Université Francophones (Ellipses, 8 Casterman, Paris-Tournai, 1953, p. – and in his ‘Letter to the Paris, 1995). H.Sansarricq, ‘38431 185. 90

The Lok Seva Sangam

Our commitment to combat- During this period our co-ex- They remind us that the ing leprosy in Mimbai began in istence with the lepers has Kingdom of God is founded up- the early 1970s. There were brought out needs other than on a discarded stone. three of us, all missionaries of care and treatment, and these Ð The ‘lepers who have been the PIME (the Pontifical Insti- are as follows: healed’ remind us that the King- tute for Foreign Missions) - a Ð the need to look after el- dom of God is near. medical doctor, a nurse and my- derly people and the deformed; Ð The lepers, with their faith, self, a social worker. Ð the rehabilitation of those have pointed out to me the path In 1976 we registered an as- who have been cured. of religious dialogue. sociation called the ‘Lok Seva For this reason, a new project I realised that the most radi- Sangam’ (the association for became necessary and this we cal rehabilitation of a person service to the people) and the launched forty kilometres out- does not so much involve giv- health authorities of Mumbai al- side Mumbai. We called it ing him work but rather in located to us two districts of the Swarga Dwar (Gate of Heaven). making him aware of the fact city which at that time had a This is not only a rehabilitation that he has a mission. If they un- population of a million inhabi- centre and a hospice. We also derstand that as lepers they are tants. Because these areas were call it an ashram, that is to say a prophets with a message they on the outskirts of the city the place for reflection and prayer. will also have a reason for liv- population doubled in the space After realising that lepers, as a ing. of thirty years. With the help of category, have messages to give about thirty paramedics we ex- to society, I thought it was a Rev. CARLO TORRIANI, plored all the poor areas entrust- good idea to prepare a place Missionary of the PIME ed to us in order to discover the where these messages can be first symptoms of leprosy and given voice to and diffused. by the 1980s we were looking after about four thousand lepers. With the arrival of refampacine What are the Messages and multiple treatment the num- of the Lepers? ber of lepers registered with us as being under our care was re- Ð Death, of which deformed duced to about eight hundred. lepers are the image, is not the This was without any doubt a end, but only the gate to the fu- success, even though of course ture, the gate to heaven. This is it had its limitations because the why our ashram is called Swar- number of new cases has not di- ga Dwar. minished and until an effective Ð Lepers have always been vaccine is available it will not ‘discarded stones’ and thus refer be possible to prevent the dis- us back to the ‘discarded stone’ ease. par excellence Ð Jesus Christ. DH n.45 ing 69-144 2.8.2001 15:44 Pagina 91

Leprosy in Mozambique

I would like first of all to thank the organisers of this symposium for having defined me as being a ‘leprologist’, but I would not like to usurp titles which do not belong to me: I must therefore make clear that I am simply a voluntary medical doctor who has spent the last ten years in Mozambique, chiefly as an ‘adviser’ to the ‘National Programme for the Fight Against Leprosy’. I have, therefore, an experience of management, and a little clinical experience gained in the 91 field, but I believe that this is not enough to define me as being a ‘leprologist’. Other friends and colleagues here present have a human experience which is certainly of the approximately 19,000 ing of these nurses and their much more interesting than my people suffering from this dis- ‘relevance’ (at that time) to the own and much longer in dura- ease who had been counted. programme. Most of the nurses tion which they can present to We were thus faced with the were (and still are) at a basic you and share with you. I need to find a different strategy level, that is to say they had would like, rather, to take ad- in order to reach as soon as reached the sixth elementary vantage of these ten minutes to possible all the people suffer- class and followed a health care share with you certain reflec- ing from this malady, to assess course for a year and a half. tions on the recent past and on them clinically, and to begin a Many of them had difficulties the present state of leprosy in suitable treatment for all those in reading and writing correctly Mozambique, the programme who were clinically active. in Portuguese. Furthermore, for the fight against this dis- At the beginning of the year many nurses attached to the ease, and a number of concerns 1991 we were able to partly programme had been sent to about the future of those afflict- change the regulation of the join it as a punishment because ed with leprosy at the begin- Ministry on Health on the em- they were alcoholics or because ning of the third millennium. ployment of antibiotics for they had committed serious dis- When I started working in these sick people. Whilst previ- ciplinary errors or because they Mozambique in 1999 other col- ously the ability to prescribe were not reliable at work. This leagues before me had already such drugs was confined to was the human material which over the previous six years car- medical doctors who were lep- was available at the outset. ried out very qualified work rologists (there were only two I should say that a large part which was very important for in the whole of the country) of these people are still at- the organisation of the ‘Pro- and to the provincial supervi- tached to this programme even gramme for the Fight Against sors (eleven in number), from though at the present time they Leprosy’ and in the introduc- April 1991 onwards these have completely different moti- tion of polychemiotherapy in drugs and medicines could also vations for being a part of it. extremely difficult conditions Ð be prescribed by ‘nurses suit- On the other hand was it not a country in a state of civil war ably trained’ in making a diag- said that ‘the stone thrown in which it was often very diffi- nosis and providing forms of away by builders has become a cult to satisfy even the most el- follow-up treatment to people cornerstone’? ementary needs of survival. afflicted with leprosy. For such personnel, there- However, the work carried out The basic condition imposed fore, we had to ‘invent’ simpli- by these colleagues, both from by the Ministry of Health was fied diagnostic and classifying Mozambique and abroad, per- the existence of qualified nurs- methods (even at the cost of a mitted the implementation of es Ð in August 1991 we thus be- certain loss of quality). We thus the programme and the begin- gan national training courses on decided in drawing up the first ning of the polychemiotherapy leprosy of four weeks in dura- reference book for the pro- suggested by the World Health tion for district nurses. A gramme to abandon the Ridley Organisation. Unfortunately, it premise is required with regard and Joplin system of classifica- was possible to reach only 7% to the level of academic train- tion and adopt the simplified DH n.45 ing 69-144 2.8.2001 15:44 Pagina 92

classification based upon ‘pau- the country, and to establish the tain a contemporaneous in- cibacilli’ and ‘multibacilli’ in- conditions for a further expan- crease in the discovery of new fected people which had been sion once the civil war was fin- cases Ð in the nineteen eighties proposed by the World Health ished and the conditions for less than a thousand cases were Organisation. The difficulty lay moving about the country had discovered each year but in the in providing clear (and in a cer- become even minimally secure. middle of the nineteen nineties tain sense Salomonic) indica- From 1995 onwards all the more than 4,000 new cases tions as to what was meant by districts of the country had a were discovered each year. paucibacilli and multibacilli. A nurse able to diagnose (at a rea- This suggested that these cases publication by a group of lepro- sonable level of reliability) and were really new cases and were logists from Adis Abeba came to treat leprosy, and at the end discovered at what was a rela- to our help indicating a good tively early stage in the devel- system (even though to the opment of the disease. detriment of specific determi- It was however already evi- nation) whereby it was estab- dent in 1997 that Mozambique, lished that the PB were cases like the other countries of the with a maximum of five hy- world, would not be able to popigmented marks and that the reach by the year 2000 the ob- MB were all the other cases. jective of the ‘elimination’ of With regard to the peripheric leprosy (defined as a reduction nerves, the PB were those with to a level of incidence of less a maximum of affected nerves. than one active case every Please forgive me if I am 10,000 inhabitants Ð a level at 92 boring you with such technical which it is believed there is no information but such informa- threat to public health). The ex- tion is of help in demonstrat- trapolations which we made al- ing to you the level of simplifi- lowed us to envisage a possible cation which we had to adopt ‘elimination’ of this disease by in order to implement the pro- the years 2003-2005. gramme given the conditions In the meantime, in 1997, the which prevailed (and to a cer- World Health Organisation tain extent still continue) in the summoned a group of leprosy country. experts to assess the existing This kind of classification, of 1996 100% of the registered situation in the world and to which has been adopted by us cases were receiving MDT in produce a strategy for subse- since the beginning of 1992 conformity with the schedules quent years. This group of ex- and was initially criticised by a of the World Health Organisa- perts advanced a number of ob- number of experts of the World tion. These schedules envis- servations and proposals, one Health Organisation, was sub- aged polichemiotherapy treat- of which, in my opinion, is of sequently officially accepted ment with two drugs for PB pa- fundamental importance for the by the World Health Organisa- tients over a six-month period future of those people who are tion itself in 1995 with the pub- and three drugs for MB pa- afflicted with leprosy. lication of its ‘Guide for the tients over a period of I will try to summarise it and Elimination of Leprosy as a twenty-four months. A certain make a number of observations Problem of Public Health’. In corpus of clinical studies had about it to the members of this this guide there was expounded clearly demonstrated the effec- symposium. exactly what the programme in tiveness and safety of this sys- It was said that the clinical Mozambique had been apply- tem of treatment, which, in- classification which is em- ing for a number of years, that deed, provided for the cure of ployed (that to which I recently is to say the bacilloscopy of 100% of the people infected referred) ‘exaggerated’ in its leprosy. It was NOT essential with leprosy, with a relapse rate classification of leprosy pa- for the diagnosis and classifica- of 1% after ten years. tients. Most of the sick people tion of those afflicted with the These very effective systems clinically classified as MB sub- disease. The diagnosis, and I of treatment allowed us to heal jects, it was asserted, were in emphasise the point, the classi- about 14,000 patients and to fact PB cases and could have fication, and the choice of the progressively reduce the total been treated with a system of form of treatment, could be number of people with this af- shorter duration, that is to say made exclusively on a clinical fliction who were being treated not with a treatment which last- basis (the type and number of from more than 19,000 in 1990 ed twenty-four months but with skin lesions and affected to about 10,5000 in 1997. The one of twelve months’ dura- nerves). improvement in the ‘image’ of tion. The adoption of these and the programme, together with I completely agree with the other simplified norms allowed research into patients who had statement of the World Health us to be able to use to the ut- previously been registered and Organisation that most of the most the personnel and the re- a clinical assessment of their people classified as MB are sources which were available, condition, and the active probably PB. Our experience to progressively expand our di- screening of, and provision of shows that 86% of the MB cas- agnostic and therapeutic activi- health care education to, the es have in fact very few bacilli ty to all the accessible zones of population, enabled us to ob- in their bodies (that it so say DH n.45 ing 69-144 2.8.2001 15:44 Pagina 93

they have a bacilloscopy at the der to facilitate access to treat- a treatment which has been time of diagnosis of 0, 1, or 2) ment and their engagement in demonstrated to be effective in and only 14% can be defined as treatment) are from between practically 100% of cases and being ‘highly bacillary’. The re- twenty-five to a hundred and to introduce a shorter treatment al problem lies in the suitable twenty kilometres from each which deliberately leaves out identification of this sub-group other. For this reason it is not (or runs the risk of not healing) of patients who have to be con- possible to identify this 14% of these afflicted people. tinued to be treated for sub-group of high bacillus inci- I have a few doubts which I twenty-four months (or at least dence patients, who, and I re- would like to share with you, for more than eighteen, as is peat the point, in actual fact and they are as follows: demonstrated by a number of cannot be cured by the twelve- Ð What was the use of short- clinical studies), for if they are month treatment which is pro- ening the duration of the MDT not so treated they run the risk posed by the World Health Or- less than three years from the of having relapses after a num- ganisation. difficult year 2000 by which ber of years, perhaps with bacil- In 1997 we were preparing a time leprosy was to have been li which are resistant to the an- new version of the handbook ‘eliminated’? tibiotics which have been used. on leprosy, which at that time Ð Was it perhaps useful to ar- It should be said that no con- had run into trouble over the tificially reduce the total num- trolled clinical study exists to- question of the duration of the ber of those suffering from lep- day which demonstrates the ef- treatment of MB patients. A se- rosy in order to achieve the fectiveness of twelve months of ries of letters from the World aimed-for goal on paper? treatment for MB patients. A Health Organisation (three to Ð Or was there a need to re- study is currently underway but be precise) to those in charge of duce the cost of the treatment we are not aware that its results the programme in Mozam- provided to these sick people, 93 have been published. In an bique, and a seminar which was something which depends on epoch which is considered ‘sci- held in Abidjan, convinced the international donations? entific’ every change in a sys- Minister for Health of Mozam- I would not like these ques- tem of treatment should be bique to accept the treatment of tions to appear as malevolent matched by scientifically con- twelve months’ duration. inferences during a Holy Year trolled clinical studies, unless, Together with other factors, when on the contrary we that is, the third millennium this event was what led to my should strive to identify posi- means a return to a pre-Galilean decision to resign as a consul- tive elements. But I am worried form of science. tant to the leprosy programme about our brethren who are af- In the situation which now in Mozambique. flicted by leprosy. For thou- reigns in Mozambique (and I I find the decision to reduce sands of years they have been believe in many other develop- the length of the treatment demoted, isolated from society, ing countries) a separation of which was promoted (if indeed and hidden from view. Perhaps high bacillus incidence patients not imposed) by the World we have today found a new from the others is absolutely Health Organisation does not in system of segregation by de- impossible because it would re- the least take into account the claring that all of them are quire the systematic employ- needs of those people suffering cured within twelve months, ment of a bacilloscope at the from leprosy, and sees at least a eliminating them from the reg- moment of diagnosis. Only one percentage of these people con- isters, and leaving them to a microlaboratory exists in each sidered as a whole as an epi- destiny where in five or ten district in Mozambique and the demiological quantity and not years they will present relapses various outlying health care as people with a right to effec- when the various national pro- centres chosen for the organisa- tive treatment. grammes of the fight against tion of the diagnosis and treat- I believe that it is neither sci- leprosy have been dismantled, ment of leprosy victims (in or- entific nor ethical to substitute given that leprosy will have been removed from the number of problems for public health. I would like the forty-seventh World Day of those Af- flicted with Leprosy which we are now preparing for (the first such day to take place in the new millennium) to be not only the celebration of a regular event but something which conserves its purpose Ð that is to say the stimulation of consciences in relation to the problems which society still creates for these afflicted people.

Dr. LEONIDA COMPOSTELLA Head Medical Doctor, the Homoine Project, Mozambique. DH n.45 ing 69-144 2.8.2001 15:44 Pagina 94

Rehabilitation Needs in Leprosy

Introduction muscle in the leg, he/she may their optimal physical, senso- not be able to stand or walk ry, intellectual, psychiatric To discuss the rehabilitation properly, and this is called dis- and/or social functional lev- needs of persons affected with ability. The disabilities can els, thus providing them with leprosy, let us first look at the have physical and/or social the tools to change their lives present situation of leprosy. At consequences leading to towards a higher level of inde- present, every year there are handicap, for which physical, pendence (UN standard rules about 800,000 persons with cultural and social barriers 1994). the active disease while the posed by society are very im- Leprosy affects the periph- number of persons who had portant. eral nerves in the whole body the disease in the past and producing loss of sensation who have been cured of the and even muscle paralysis, bacterial infection are about though it does not involve the 94 11-12 Million. It is difficult to central nervous system (brain say how many other persons and spinal cord). The nerve there are in the world who damage can be slow and di- have the infection, either in a rect or it can also be sudden sub-clinical phase or with and indirect through compli- clinical signs of the disease, cations like leprosy reactions. who have yet to be diagnosed. As there is no primary pre- A second important aspect vention for leprosy, the only which needs to be understood way to prevent the physical is the concept of prevention disabilities caused by leprosy continuum for rehabilitation. is through early detection of If the disease can be prevent- new cases and their proper ed, before the onset of infec- treatment through MDT. At tion, for example through the same time, the leprosy re- vaccination, this is called pri- actions need to be treated ear- mary prevention. At present, ly and adequately. However we do not have any tool for studies have shown that new the primary prevention of lep- disabilities may arise even af- rosy. Once the infection takes ter starting MDT and this may place, and if we can prevent In the case of leprosy, it is indicate the lower priority the onset of disabilities, this known that social disabilities given to prevention of disabil- would be secondary preven- caused by stigma play an im- ities and rehabilitation activi- tion. Finally, if the disease has portant role in the disabling ties in a leprosy control pro- already caused disabilities, it impact of this disease in the gramme. It is important to re- is still possible to promote lives of persons. Thus, even in member that leprosy reactions tertiary prevention so that ex- persons without any physical and related disabilities can oc- isting disabilities do not wors- consequences of leprosy, there cur even after the completion en and no new disabilities may be negative social impact of MDT when the person is arise. In the case of leprosy, on the lives of persons. Even already “cured”. both secondary and tertiary the family members of per- Apart from persons having prevention are possible and sons affected with leprosy a visible disability due to lep- needed. may face social disabilities. rosy, there is another risk The third general concept It is estimated that there are group of leprosy affected perfor understanding the issue is about 2-3 million persons sons, persons with only a loss that of impairment, disability with visible physical conse- of sensation in the feet, hands and handicap. The disease quences of leprosy. At least and eyes. These persons are at can lead to a physical or phys- theoretically, all the 10 mil- a high risk of developing dis- iological malfunctioning of lion or so persons who have abilities and they need life- the body, for example, the completed MDT can be at po- long care to prevent these paralysis of a muscle and this tential risk to the social conse- complications. It is estimated is called impairment. Due to quences of leprosy. that there may be 2 million the impairment, the person The term “rehabilitation” persons in the world with may be unable to carry out refers to a process aimed at Grade 1 disability (loss of some activities, for example, enabling persons with disabil- sensation without visible dis- if a person has a paralysed ities to reach and maintain abilities). DH n.45 ing 69-144 2.8.2001 15:44 Pagina 95

Physical disabilities caused physiotherapist must be that of for Self-employment: A for- by leprosy affect the hands, a teacher in self-care skills. mal job placement for a lep- feet and eyes Ð Orthopaedic Appliances rosy-affected person is not and Mobility Aids: Persons easy and can benefit only a Ð In feet starting with loss having drop-foot or amputa- limited number of persons. of sensation, toe clawing and tions need orthopaedic appli- Thus major emphasis is given foot drop progressing to loss ances and mobility aids. to promoting loans for self- of toes and bones with defor- Sometimes even simple appli- employment. mities, which may need am- ances like gloves can play an Ð Special Needs of Old Lep- putation. important role in preventing rosy-Affected Persons With Se- Ð In hands starting with development of serious dis- vere Disabilities Living in Lep- loss of sensation and clawing abilities. rosariums: Old persons with of fingers progressing to loss Ð Surgery Ð Corrective, De- chronic disabilities living in of fingers and bones with de- molative and Cosmetic: If the leprosariums may not be able formities, which may need disability is not long standing to become self-sufficient and amputation. and if the person has been able need life long care in institu- Ð In eyes, starting with loss to maintain flexibility of joints tions. of corneal sensation and in- through proper exercises, ability to close the eyes, pro- surgery can be useful. Though The changing situation of gressing to complete loss of surgery may be seen as too leprosy-affected persons and vision. costly for the amount of bene- their needs Ð The situation of It is important to remember fit it can provide to a limited leprosy has changed radically that this progression of dis- number of persons, it may over the last few years. Previ- abilities in hands, feet and play an important role in rais- ously the number of active 95 eyes is not inevitable and can ing awareness about the lep- cases needing drug treatment be prevented by early diagno- rosy programme in the area, so was high and less importance sis, and self-care of body parts that new cases of leprosy can was given to ex-patients and with loss of sensation. Even be detected in an early phase, espcially to those living in old after the disabilities have set before the onset of disabilities. leprosariums and leprosy in, they can be reversible in There are also the socio- colonies. Now, in some places, the early phase and worsening economic rehabilitation needs the numbers of ex-patients can of disabilities can be prevent- of leprosy-affected persons be much higher than the regis- ed through adequate self-care which can be summarised as: tered cases. For example, the and referral services. Ð Psychological Support following information (1998) and Counselling: These can be from Vietnam illustrates this related to poor self-image as situation: Main rehabilitation needs well as to social taboos related Ð 20 Old Leprosariums of leprosy affected persons to leprosy in the community. with 3,971 Leprosy Affected can be summarised as: Ð Vocational Training and Persons Occupational Rehabilitation: Ð Total Registered Cases Ð Life Long Self Care: For persons who have lost 2,876 Once a person has chronic their job or who cannot carry Ð Total New Cases During loss of sensation or disabilities out their previous work, voca- 1998 1,751; of whom, 29% are already there, the person tional training and occupa- with visible disabilities and needs life long care. tional rehabilitation can play 12% with Grade 1 disabilities Ð Protective Footwear: This key role. at the time of diagnosis. This is useful for persons with loss Ð Job Placement and Loans is in line with what Prof. of sensation in the plantar sur- face of feet, so that plantar ul- cers can be prevented. Ideally, persons having loss of sensation in the feet should be is- sued with protective footwear, before the appearance of first plantar ulcer, though in practice this does not happen often. Ð Plantar Ulcer and Wound Care: Once a person has a plantar ulcer, he/she needs care in healing it and preventing it from getting deeper and reaching the bones. Ð Physiotherapy: This is indicated for taking care of paralysed body parts and in pre-operative and post-operative phases. Given the need for life-long care, the role of the DH n.45 ing 69-144 2.8.2001 15:44 Pagina 96

affected persons live in their Global Alliance for communities also imposes Rehabilitation: this kind of choice. Working Together for the Ð Primary health care ser- Consequences of Leprosy vices are supposed to address the main health problems in Some Ideas for the Near Fu- the community, including pro- ture: Given the present situa- motive, preventive, curative tion of the rehabilitation needs and rehabilitative services for of leprosy-affected persons, disabled persons. (1978 Dec- Amici di Raoul Follereau laration of Alma Ata). Still, a (AIFO) proposes the launch- lot needs to be done to ing of another global alliance achieve this goal. involving all other NGOs Ð The term equalization of working for leprosy affected opportunities means the persons and with WHO and process by which the various other partners, so that strate- systems of society and the en- gies can be defined to obtain vironment, such as services, more information about reha- activities, information and bilitation needs and to pro- documentation, are made mote sustainable rehabilitation available to all, particularly to services focusing on the self- Smith said earlier. If we con- persons with disabilities. This sufficiency, development and sider the number of ex-pa- is important to ensure that lep- human dignity of leprosy-af- 96 tients living in their communi- rosy is not seen as something fected persons. AIFO proposes ties, outside the leprosariums, special only for a few persons to organise an international the number of persons with but that leprosy-affected per- workshop in collaboration rehabilitation needs is quite sons have the same rights as with the Disability and Reha- significant. all other persons. The principle bilitation Team of WHO, be- of equal rights implies that the fore the end of 2000, in order needs of each and every indi- to: Rehabilitation Needs: vidual are of equal importance, Ð Verify the existing mate- some Key Issues that those needs must be made rials related to rehabilitation the basis for the planning of of disabilities due to leprosy. Ð Information about per- societies and that all resources Ð Prepare teaching materi- sons with grade 1 disabilities must be employed in such a als for promoting specific re- (only loss of sensation and no way as to ensure that every in- habilitation through PHC. visible disability) is not avail- dividual has equal opportuni- Ð Prepare teaching materi- able. Even for persons with ties for participation (UN stan- als for promoting socio-eco- grade 2 disability (visible dis- dard rules 1994). nomic rehabilitation through ability) the information avail- Ð Community based reha- CBR. able at national level is very bilitation (CBR) is a strategy Ð Field test the teaching often incomplete. Thus, with- within community develop- materials and rehabilitation out knowing the different ment for the rehabilitation, the strategy. needs, it is not possible to plan equalization of opportunities adequate interventions for an- and social integration of all Dr. ENRICO PUPULIN swering those needs. people with disabilities. CBR Chief Medical Officer Ð Mainstreaming: Like all is implemented through the Disability and Rehabilitation Team the other disabled persons, combined efforts of the dis- (DAR) World Health Organisation (WHO) persons with leprosy-related abled people themselves, their Geneva , Switzerland disabilities should receive re- families and communities, and habilitation services from ex- the appropriate health, educa- Dr. SUNIL DEEPAK isting medical, social and oth- tion, vocational and social ser- Medical Director er services rather than having vices. CBR can play an impor- Amici di Raoul Follereau (AIFO separate services. The fact tant role in reaching those per- Bologna, Italy that the majority of leprosy- sons living in the community. DH n.45 ing 69-144 2.8.2001 15:44 Pagina 97

The Newsman and those Suffering from Leprosy

This is not a conference, it a very good friend of mine. So I do not want to go on too is witness. This is not a paper you could stay there, taking long. I had a meeting with on Follereau, esteemed the guise of a medical doctor. Padre Pio, which was very teacher of good and sharing. Pepe agrees because it would special. I listened, and felt Many people have spoken be a matter of giving a hand to with a mixture of amazement, about him, and they are far those poor unfortunates.” on the brink of fainting, that more authoritative than I am. I answered my editor: my finger entered the palm of This is purely and simply, and “very well, but on a condition his hand. I received the bless- I repeat the point, an act of Ð I do not want to go in dis- ing of this rough but holy Ca- witness. I am an old news- guise. The sick people there puchin and I then went off to man and I have travelled must know that I am a jour- that leper colony. round the world for fifty nalist who respects their suf- I reached Miulli hospital. years, above all in the third fering, but a journalist. If they Now I will read you a piece world. This old newsman has accept, all well and good, if from my report of that time, encountered leprosy and I not, we will not do anything”. of a half a century ago: ‘the 97 have seen lepers live and die. They accepted the idea and hospital of Acquaviva delle I have drawn from this so it was that I began my Fonti rises in the heart of this unique experience a great les- journey to that leper colony. I ancient and kind city where son, which is even banal in its have to say, I have to confess, theft and crimes never take immensity, and that is, dear that at that time I had a bibli- place (at least so far) and the friends, that life, the gift of cal vision of the disease as people speak an imaginative God, should be lived until the something which was mon- and communicative dialect. last day, whatever our physi- strous and terrible. I ex- The right wing of the build- cal conditions may be. pressed my fears before ening is isolated from the rest of The previous paper on dis- tering the leper section to of- it and has fifty-three sick peo- abled people struck me a fer my service to a very dear ple who are not ordinary great deal. This is a curse of friend of mine, Vittore Fiore, types Ð lepers! They are our society and as the speaker a historian and eminent soci- fifty-three humble and serene rightly said, we should make ologist from Bari. And he an- individuals Ð thirty-one men them feel as we are, above all else in psychological terms. I was young, very young, a sort of enfant prodige when, during the 1950s, let us say half a century ago, I worked for a newspaper which in those times was a great newspaper and it was called ‘Il Tempo’, founded and edited by an extraordinary person, Renato Angiolillo. One day he said to me: “do you feel like going to a leper colony, to live there for a few days and write an article on ‘leprosy experienced from within’? I answered: “where, in Africa?” “No, not in Africa, in Italy”, replied Angiolillo. “You do not know that at Ac- quaviva delle Fonti, near Bari, at the Miulli hospital, there is swered with great simplicity: and twenty-two women’. a ward reserved for leprosy “why don’t you go to see And here I say how they victims”. “To be precise”, my Padre Pio and get yourself are entrusted to the care of editor of those days said to blessed?” Just think, already the professor of dermatology me, “there are fifty-three lep- then, in 1949, and here we are etc. etc. and to Prof. ers”. “The secretary of that at the end of February 2000, Francesco Pepe, the secre- leper colony”, continued An- Padre Pio had a reputation for tary, a romantic and active giolillo, “Prof. Ciccio Pepe, is saintliness. man who had been living (I DH n.45 ing 69-144 2.8.2001 15:44 Pagina 98

was writing then in 1949) but the excellent and inflexi- the least devastated”, Prof. amongst the lepers for ble legislation inspired by Dr. Pepe warned men. “It is they twenty-two years and who for Hansen, who discovered the who are greeting you because them is a friend. In my report bacillus in 1871 (I have seen in this way you can get used I went on: ‘In Italy itself, it it under the microscope, it is to things slowly”. So much should be borne in mind, and like a bunch of cigars), has sensitivity moved me, and this can serve as information greatly reduced its incidence. still moves me. They drew for scholars of statistics and And with absolute isolation near to me and bid me wel- medical doctors, in Italy the and the latest scientific dis- come. I was led by instinct to only real and authentic leper coveries, sulphon and strepto- give my hand to the woman colony is here at Acquaviva mycin, a leading doctor told who was nearest to me, but delle Fonti. In Messina, me, we can hope to make fur- she stepped back. “Be care- Cagliari and Genoa there are ther progress.’ ful”, said the woman leper, “it isolation wards for lepers in I had made a whole host of can be dangerous”. And she the local hospitals. notes when the secretary said smiled as though she wanted Since 1927, the day of its to me: “Do you want to see to apologise. creation, that is to say the na- them? Do you feel like it?” And with these words the tional leper colony, two-hun- “Certainly”, I replied. He secretary, Ciccio Pepe, drew dred and forty-six sick people made me put on a coat and near to the woman, took her have passed through Acqua- we went off. Before opening hands in his, shook them af- viva delle Fonti Ð one hun- the door which led into the fectionately and shaking dred and forty-five men and leprosy section the secretary those fencing gloves, her one hundred and one women. waned me: “control yourself hands, which were deformed 98 In the whole of Italy the num- even if you have a sense of and horrible, in the sight of ber of official leprosy cases revulsion. The lepers are that woman, placed a kiss on which require compulsory good people but they become her forehead. This was a fore- hospitalisation are not above bad if they realise that they head covered with nodules. I four hundred and fifty.’ Then disgust you. Leprosy is an ill- asked him if he was ever I went on: ‘the most recent ness which even leads moth- afraid of catching the disease. forms of treatment (this again ers to reject their children And the good Prof. Ciccio is half a century ago) of sul- with disgust. A similar inci- Pepe answered my question phone with streptomycin are dent happened here. Once a with a single word – “no”. providing remarkable results, leper put his finger in his And he immediately added: according to what I am told. nose, wet his nails, and at- “thanks to Follereau”. But not It is still too early to say that tacked a nurse by scratching knowing who he was I said: leprosy has been defeated but her face”. “They are good”, “what is it. An antidote? A science does not despair of said the secretary, “but they remedy?” This was in 1949. being able to contain it. The can become bad”. And Pepe, looking at me with bacillus of Hansen, imported a mixture of tenderness and into Italy at the time of the compassion, answered with a holy wars, as was the case in certain pride: “No Igor Man, Scandinavia where it dis- it is the name of a saint, a sec- played exceptional virulence, ular saint, Raoul Follereau”. cannot be cultivated and “He is a lay missionary”, he hence the impossibility of continued, “somebody in- carrying out studies based up- spired by God, a messenger on secure experiments are not of Christ. He and his wife de- possible’. cided to alleviate the suffer- There was another interesting of leprosy victims, to ing thing for me. ‘Medical abolish the medieval image doctors usually distinguish, that we have of them, a cruel (or at least such was then the and superstitious vision of the case), between three forms of leper who has to go around the disease Ð nodular tuber- with his face covered sound- culin leprosy, anaesthetic or ing a bell to warn people that nervous leprosy, and leprosy he is coming. Follereau has made up of both these previ- de-mythologised leprosy”, ous forms. It is a contagious We went in and some this gentleman continued. disease, especially in its women in white blouses met This was fifty years ago. “It is nodular form, carried through us, about five or six. They a disease like any other and nasal mucous, hence the need had a ribbon in their hair. you can recover from it.” for strict isolation. Indeed, the They had done themselves up Dear friends, this is what the leprosy pandemic, from the in my honour, but their hands simple and very human Don Middle Ages until today, that were like fencing gloves. And Ciccio Pepe, the generous is to say 1949, has lost its in- their faces were contracted. secretary factotum of the hos- tensity and diffusion. The Because leprosy is a merci- pital of Acquaviva delle most important outbreaks are less disease and strikes the Fonti, said to me. to be found in Scandinavia face first of all. “These are And thus it was that I heard DH n.45 ing 69-144 2.8.2001 15:44 Pagina 99

for the first time in my life of rina’s arms Ð two formless dured by Christ and those Follereau. I think that at this bagfuls of squashy flesh. which mankind inflicts every point it would be a good idea They explain to me that the day? “The Cross unites me to to tell you about a single nerve form of leprosy makes Him, I suffer for Christ and I episode of that unique experi- the tissue retract. The fingers am not embittered”. She suf- ence of 1949. To be exact withdraw like those camping fers in a serene way, to expi- there have been three mo- beakers which boy scouts ate her sins and those of the ments which have shaped my have, in aluminium, which world, waiting, she con- working life: the meeting they can fold up and put in cludes, for the shining dawn with the lepers, intimately their pockets. of the day which will not end. connected with Padre Pio; the Vietnam war; and being put up against a wall in the Sudan and not knowing for a full half hour if they were going to kill me and if I would be able to return to my home and my wife and children. And thus, to go back to my experience at the leper colony, at a certain moment a female nurse came up to me and said to the secretary: “Professor, Caterina is wait- 99 ing for you”. Don Ciccio Pepe then said to me: “you see Igor Man, yesterday I spoke to you about a person who is really saintly. Now you will meet her”. This person was Caterina Herr. Now I will speak to you in the present tense because I want to The nurse also tells me that I came near Follereau, and reproduce exactly what I the feet are the same. Cateri- brushed close to him a num- wrote at that time. This saint- na has not stopped smiling, ber of times, but we never ly person is Caterina Herr of on her face there passes a met. But travelling in Africa Cuneo. She is seated on a shadow of indulgence which in particular and in India, we deckchair, her hands on her is imperceptible. She did not brushed close. I, too, visited lap, a black cap on her head, ask me to look at her former the famous Dr. Albert her eyelids down Ð the only hands. She wants to tell me Schweitzer, an extraordinary human trace on a face which that she has composed a po- person, the comforter of the has dried up like a prune. em on the victory of the afflicted, but at the same time “Good morning, Caterina”. forces of good over the an- a colonialist, a kind of Bis- And she comes out of a sort ti-Christ. Caterina was eigh- marck, rough in his manners, of hibernation, moves, leans teen years old when she fell disdainful, there at Lam- forward because she is blind victim to the malady. At that barenè. I remember that when Ð leprosy has corrupted time I wrote: “she has lived he brought us breakfast in the everything in her frame. And dying for forty-seven years”. morning the servants were all she answers: “good morning, She did not know how to read bound up, they had marks un- welcome!”, with the usual or write when she arrived at der the coverings Ð they were acute falsetto voice of lepers delle Fonti. She learnt before lepers. By then I knew about who are most struck by the she went blind. Now she this, I had had similar experi- disease. One thing always spends her dark and silent ences, and the thing did not struck me when I met lepers Ð days composing verses by make any impression on me. their voices. There is obvi- heart. This is the force of life! But there was an English ously a scientific explanation She provides light, awakens journalist from ‘The Sunday because the vocal chords are the sounds within her, with Times’ who was terrorised Ð clearly affected by the dis- her poems. She recites one of he peeled his papayas with ease. them to me. It is made up of a his own hands. (It is said that Her voice stridulates, I few verses, a sonnet, simple the incubation period for this would say that it is a voice stuff. Elementary but ab- disease is five years Ð by now which cuts you, it cuts into solute verses. “When the I have escaped it!). your heart like a bad knife. cross was given to me, bend- Schweitzer played the piano She is horrible and pathetic. ing myself, I took it in my at night and Mr Schweitzer A nurse takes here by her arms”. Resignation was won the Nobel prize in 1952, forearms and shows me with transmuted into joy. What are if I am not mistaken. And a professional movement, my sufferings, she asked her- Follereau, in his infinite and turning over her wrists, Cate- self, compared to those en- childlike goodness, was DH n.45 ing 69-144 2.8.2001 15:44 Pagina 100

greatly affected by this. With was amazed at the enlight- that we are not engaging in all respect for Schweitzer, I ened charity of this mission- ideal chatter and we need to prefer the anonymous saint ary and gave her half of his become aware that we are not Follereau. temple so that she could like all these people attached Mother Teresa was very at- make what she called a hospi- to sick people, sacrificing tached to Follearau. Both had tal for the dying, that is to say themselves day after day. We seen and experienced how a decent warm room for the must become aware and per- there was, as there is today, a living”. haps, I do not say be ashamed sinister marriage between lep- You know that Mother of our way of being, but of rosy and hunger. On 2 March our shallowness, of our ne- 1963 in Turin Follereau held a glect”. conference at the Carignano “Well”, said Follereau, “I theatre. Among other things was in Calcutta when Sister he said: “In Calcutta miser- Teresa telephoned me at able people are dying on the Kalinga and said that in a street in their hundreds, do ‘hospital for the dying’ a not tell me that it is revolting. young leper girl was about to The first time I went I was die. I went there. She was a terrorised at the idea that I had woman who according to the to tread over these dying peo- birth register was twenty-two ple and these corpses. But yet, years old. She was more or and this is the worst thing, af- less my height, she was a nor- ter fifteen days I was doing mal woman and she had had 100 the same as everybody else”. two children. I saw her there, The same thing happened powerless as I was, exit from to this humble old newsman her existence with convul- in Benares. I walked over car- sions. When she died I had pets of lepers who in the Teresa was often attacked in the impulse to weigh her. Sis- place of their noses had a various places with the ter Teresa and I took this kind of warped mandarin. “In words: “what is she doing, small body in our arms and Calcutta”, he continued in his helping people who are dy- put her on the scales. This famous speech which shook ing?” Well, does that seem to woman, who was twenty-two the whole of Turin, “there is you nothing. From that mo- years old, as high as me, cold, and this is a good thing! ment Mother Teresa, helped weighed twenty kilos.” There the police must take by young Indian women, has “I realised”, Follereau went the dying people from the walked the streets of Calcut- on, “that in this world, in this streets and take them to three ta, collecting dying people twentieth century of Chris- hospitals, one after the other. and taking them to that place tianity” – because that was If these hospitals refuse to where they die not like dogs the century – “there are un- take them in, and they always but like men. And here I fortunately other forms of refuse because they are would like to add to the leprosy, and not that to which jam-packed, the police have words of Follereau that the I had consecrated my life. orders to take back these un- great thing about Mother There are other forms of lep- fortunate people to where Teresa was that she washed rosy which are more conta- they found them, and these the dying person, she gave gious and more terrible than people end up by dying on him something to eat, and so leprosy and for which there is the pavements or in the gut- did her sisters, she helped no comfort except our love. ters.” When Mother Teresa him to experience his religion And the first of these lep- went in 1965 the situation at every second. That is to say rosies is hunger. Hunger was the same, and I believe she did not try to prevaricate. means that today two-thirds that it is still the same. This, I am told by very au- of mankind” (this was a con- And Follereau went on by thoritative people, struck and ference held in 1963) “just saying that Sister Teresa had amazed the Holy Father when think Ð two-thirds of humani- said: “No, I cannot sleep he went down there to visit ty, two men in every three, do without nightmares, I cannot Mother Teresa. And Mother not have enough to eat. eat well knowing that every Teresa took him by the hand Hunger means that every year night, in front of my door, in and together they went to per- people die, not perhaps my street, there are our un- form this service. That is to weighing twenty kilos like happy brothers in God who say, they allowed the Son of the poor leper of Calcutta, but are dying”. So Mother Tere- God to die with the ritual because they do not have sa, went on Follereau Ð by the words of his religion, as a enough to eat. Thirty-five way I think this conference is sign that there is one God, million people die of hunger. an extraordinary, incredible, unique, one, compassionate I calculate that a child dies account! A person of the pro- and merciful. every thirty seconds Ð either fession can make the obser- Follereau went on and re- killed by a bullet or killed by vation. Well Mother Teresa, ferred to an episode. “I want hunger.” Follereau went on, “went to to read it to you because it is Now I ask myself, and I the high priest of Kalì, who really terrible but will show apologise to you if I have di- DH n.45 ing 69-144 2.8.2001 15:44 Pagina 101

gressed too much and I would as Padre Pio and Mother self to those who met him, like to thank you for your pa- Teresa, the so-called process and I say this with a feeling tience, I would like to ask in of beatification? of sweet envy, is something conclusion why this person of With all respect I think that which is worthwhile up to a contemporary history who somebody should reflect on certain point. Because dear has been so widely and so this question and I will go friends, excellencies, ladies much spoken about, this sec- back to the subject in my and gentlemen: people, the ular saint who went round the newspaper, on television, and humble, the dying of hunger, world thirty times in an impe- in the column which I write lepers, the people of God, tus of love and charity to- for “Lo Specchio”, the maga- have already made Raoul wards his derelict brothers, zine of our newspaper ‘La Follereau a saint. lepers, and those dying of Stampa’. Professor IGOR MAN, hunger, why does this man But to reflect on the ques- Journalist, not deserve, on the same level tion, and here I address my- Italy.

Leprosy: A Word Synonymous with Marginalisation 101

It is not my intention Ð and udices which today still exist dark visions of life, is still pre- indeed here there would not be in Christianity’. I would like sent amongst us. space enough for such an un- to add that often hurried read- It is quite clear that in per- dertaking Ð to propose a his- ings of the Bible, moralistic petuating this rejection of torical excursus on the role interpretations, and inadequate those who are afflicted with which leprosy, even in relation scientific knowledge of the this disease the external mani- to its exceptional linguistic malady linked to forms of festation of the disease of lep- connotations, has played down popular superstition, perpetu- rosy has always played an im- the centuries as a generator of ated this discriminatory ap- portant role. The deformations exclusion, of abandonment, proach for centuries. Indeed, and mutilations have generat- and of condemnation. A rich even today news items report ed in the popular imagination bibliography on the subject cases in countries, and even in and in literature and cheap brings out how in distant histo- advanced countries, where the writings images and descrip- ry and also in that history segregation of those suffering tions which are not matched in which is near to us, the term it- from this disease, who are iso- any other form of pathology, self, used to indicate someone lated from every kind of hu- even though a number of such who was afflicted by the mala- man relationship, is still a pathologies are real and au- dy (today more correctly practice which is the order of thentic scourges in the poorest known as Hansen’s disease), the day. At times we have the countries of the world. One or the mere suspicion of the impression that the medieval need only think of malnutri- disease, was sufficient to ex- period, with its fears and its tion, blindness, childhood mal- clude the victim from civil belonging as though he were afflicted by divine punishment, affected my moral impurity, and by sin. And for this reason he was condemned to isolation and thus to a certain death, when indeed this was not actually decreed ex lege by the community itself. I would like to quote from the work by Stanley Browne ‘Leprosy in the Bible’ published in Italy by the Friends of Raoul Follereau Associa- tion: ‘the harshest measures of persecution, of forced segregation, of the denial of legal and social rights, of forced separation from families, left their mark in many of the prej- DH n.45 ing 69-144 2.8.2001 15:44 Pagina 102

it offends human dignity. public attention in an emotion- What should we say when al way to the situation and we see at the stadium banners condition of so many unfortu- which attack the other side’s nate people. fans in an offensive spirit as It is certainly the case that ‘lepers’? Or when a French people are struck more by the member of parliament speaks suffering image of the person about those sick with AIDS as who is wounded by the dis- ‘kinds of lepers who provoke ease of leprosy than by the or- the infection through breath- ganised efforts of science ing, contact, and saliva’? Or which are carried out in the when certain exponents of lo- anonymity and the silence of cal authorities in the North of the laboratory in order to de- Italy publicly launch the ‘lep- feat leprosy. This is something rosy alarm’ amongst immi- which is normal; it is some- grants on the basis of certain thing which is human. newspaper stories in order to But unwittingly perhaps we support a policy of expulsions have ended up by perpetuating and restrictive measures in the the idea of an unavoidable re- granting of residence permits? ality which is more concerned And what should we think with the field of charity than formations, to give only a few when we read in newspapers, with the world of scientific re- examples. Leprosy remains for as happened a short time ago, search and human advance. It 102 many people the malady of re- of an inquiry opened by the is true that many things are jection and exclusion despite district attorney’s office of An- changing because of the joint the efforts of those many peo- cona into a company which efforts of a very large number ple Ð Follereau taking pride of distributed a game for children of health care workers, associ- place Ð who have striven to which to say the least was ations, and missionaries who show the baselessness of so worrying Ð the game involved dedicate themselves to fight- many fears, if not in the name the creation through small ing leprosy and everything of charity then in the name of models of a sort of identikit of which is connected with it at common sense and reason. people who had to be isolated the level of prejudice. But it is The person who is address- because they were dangerous essential to continue with an ing you now cannot forget the and who were characterised educational endeavour aimed welcome I received from cer- by the colour of their skin, at cancelling the taboo which tain colleagues of mine a few their clothes, and their social is at the base of an erroneous years ago after returning from condition. Amongst these peo- relationship with this malady. a journey of work to an ple, in the company of mon- The provision of rigorous and African leper colony Ð I was sters and international crimi- correct information on the so- received by some of them as nals, there were also lepers. cial context in which it devel- though I was already infected Comments are superfluous ops, making people aware of by the disease, and I was even but we should think about the the seriousness of certain situ- deprived of a simple hand- possibility that our society has ations, and this without any shake, you might like to know, before it of neutralising these concessions to rhetoric Ð this if I did not ‘purify’ my hands forms of marginalisation and is possible and is not some- first. What, therefore, should racism and of transforming a thing which is in contradiction all those who spend their culture of rejection into a cul- with charity, indeed it grafts it- whole lives looking after lep- ture of welcoming and solidar- self onto it as a natural com- ers in hospitals and prevention ity. As ‘one who belongs to the plementary element. centres do? trade’, as a journalist, I believe I believe that the real chal- Fear generates monsters that a role and special respon- lenge, in addition to that of and monsters feed the culture sibility also lie with the world treating and preventing this of exclusion, something of communication understood disease, is that of eliminating which is sinister and irrational in its various expressions: within today’s culture and and which goes beyond any printed paper, images, and ad- world of communications that kind of logical judgement to vertising. Let us all together sense of fear which still binds become a form of uncon- engage in an examination of us as though in chains and scious rejection, the homolo- our consciences, and in a which generates forms of ex- gation of a stereotype which serene way: perhaps at times clusion. feeds on ignorance and a lack we have exaggerated, with a of charity. And which offends good purpose in mind, with a Dr. CLAUDIO RAGAINI, the intelligence of the person pietistic and sentimental com- Journalist, who embraces it even before munication aimed at calling Italy. DH n.45 ing 69-144 2.8.2001 15:45 Pagina 103

The Pontifical Council for Health Pastoral Care

The Pontifical Pastoral Institute ‘Redemptor Hominis’

Study-Seminar ‘The Sacraments in Pastoral Care in Health’

The Pontifical Lateran University 2-3 June 2000 DH n.45 ing 69-144 2.8.2001 15:45 Pagina 104

Introduction to the Deliberations

I would like to warmly thank pects, but also and principally show us the bases upon which the Lateran Pontifical Universi- to the spiritual aspect. Spiritu- we must act, that the dogmatic ty and in a special way its Mag- ality in health sees the harmo- theological approach will nificent Rector, H.E. Mons. ny and deep unity of man, and deepen our knowledge of the Angelo Scola, for its generous illness is to be seen in terms of sacraments and lead us to- Ð participation in the delibera- a lack of harmony and unity. wards authentic wisdom con- tions of this study-seminar on All the sacraments and espe- cerning the richness of the the subject of ‘the sacraments cially the Eucharist and the sacraments in pastoral care in in pastoral care in health’. This anointing of the sick tend to health, and that the pastoral study-seminar has great impor- give man this harmony, ensur- theological approach will offer tance for our Ministry, the Pon- ing thereby that the redemption us practical pathways by which tifical Council for Health Pas- of Christ reaches sick people. to act in this field which is so toral Care. Temporal health is a part of necessary for the work of our The subject of the sacra- eternal health, and it is obvious Ministry. ments in pastoral care in health that in this sense it is not to be I would like to warmly thank will be discussed from the merely identified with an ab- all the very eminent and distin- 104 point of view of its cultural an- sence of illness but presents it- guished professors who will do thropological, fundamental an- self as a move towards human us the honour of helping us to thropological, dogmatic theo- unity, towards its full harmony. reflect upon this most impor- logical, and pastoral theologi- The sacraments are the action tant subject. We are sure that cal aspects. This is a complete of Christ which leads man to with their evident expertise study which corresponds to one this abundant life. they will lead us to the desired of the sectors of the programme One does not have before goal. of our Ministry - the sector of one a simple so-called religious I would like to thank the Sec- sanctification. And which cor- therapy in which external ex- retary of the Ministry, H.E. responds to the specific task of amples are proposed which Mons. José Luis Redrado Mar- directing the important aspects should be imitated so that the chite, and our Under-Secretary, of our activities as a Ministry in illness can be borne more easi- Rev. Felice Ruffini, for the line with the doctrine of the ly, even though this example is work that they have carried out Magisterium, and which could the example of Christ. In in preparing this seminar. I be of great help for pastoral speaking about the sacraments thank Mons. Jean-Marie Mpen- care in health throughout the we do not have before us some- dawatu for having co-ordinated world. thing which is external and re- the programme. I also thank Indeed, recently we have mains outside patients but Don Krzysztof Nykiel, the Of- witnessed a major change in something which is linked to ficial of our Ministry, for all his pastoral care in health: many their deep being and is a part of work in organising this semi- chaplains have begun to aban- them as a received internal nar. My thanks also go to all don the sacraments in favour of force of health. those who at the Lateran Uni- the presentation of the biblical It is true that we must all versity, in addition to its Mag- word, or to provide psychologi- avoid so-called ritualism and nificent Rector, H.E. Mons. cal advice conceived as treat- that in addition where this is Angelo Scola, have contributed ment which is also religious possible a suitable catechesis to the celebration of this event, and which often emerges as must be engaged in with regard and especially to Rev. Mons. something influenced by the to the value and meaning of the Sergio Lanza, the Dean of the evangelicals from an irenical or sacrament before that sacra- Pastoral Institute ‘Redemptor aconfessional point of view. ment is received, but this does Hominis’, with which we have We need to insist upon the not mean that we should deny promoted this seminar. Catholic doctrine of the sacra- the sacrament when such a cat- And I also thank very warm- ments and on its deeply thera- echesis is not possible. ly all those assistants who peutic reality in the field of Whatever the case, we hope through their active participa- pastoral care in health. that this study, which we are tion contribute to a greater illu- The sacraments are the prac- about to begin, will lead us to mination of sacramental pas- tical signs of the healing which enlightenment and a more suit- toral care in the world of health Christ gives to us to carry out able practice with regard to the and health care. the mission that we receive to receiving of the sacraments in preach the Gospel and heal the the field of health. We hope H.E.Mons. JAVIER sick. Health belongs to man in that this cultural study will LOZANO BARRAGÁN, his wholeness, and in this open up new horizons towards Archbishop-Bishop Emeritus of Zacatecas, wholeness one must not only the sick and the sacraments, President of the Pontifical Council pay attention to the physical or that the approach of fundamen- for Health Pastoral Care, psychic, mental or social, as- tal anthropology will really the Holy See DH n.45 ing 69-144 2.8.2001 15:45 Pagina 105

The Sacraments in Pastoral Care in Health

If we have faith, the sacra- seems to me encouraging to see oneself go. A sick person needs ments are miracles. They renew that the reasons which make it tenderness, he likes to lean on our lives and all those things difficult are the same which somebody, and this is a very which surround our lives. They make it increasingly necessary. natural thing. But in Oran the express nothing less than the Ever since the world has ex- excesses of the climate, the im- concrete reality of salvation. To isted, and however one wishes portance of the business which summarise: they have some- to interpret it, illness Ð especial- is carried out there, the insignif- thing to do with what is on a ly when it is serious and per- icant environment, the speed of grand scale, much greater than haps afflicts innocent children Ð the sunset, and the kind of plea- health or the consolation which has always represented a sort of sures to be encountered, all we so need when we fall ill. source of scandal, something these require good health’.1 Taking the argument to ex- that weakens even the strongest You get into trouble, there- tremes Ð and to remain within hearts which are most animated fore, if you fall ill in Oran. You the subject of our encounter by faith. Notwithstanding this get into trouble if you fall ill in a here today Ð we could even say fact, we know how specifically world which seems pro- that the sacraments are what re- faith is able to project it into a grammed only for the goal of ally gives meaning to health and new light, to endow it even with ‘good health’. This is the first 105 illness. But, as we know, today the meaning of a ‘positive’ point around which I would like all this is increasingly taken less sense of sanctification. ‘You are to organise my reflections in and less for granted both by the powerful of the earth’ Ð this paper. medical doctors and by patients. these are the beautiful and terri- Among the many effects of The culture of our age, our ble words addressed by John modern secularisation we can way of being and feeling, inter- Paul II (I do not remember without doubt list that progres- acts only with difficulty with where or when) to a group of sive rise of health to a position the sacramental dimension. I terminally ill people in order to where it is placed amongst the would say that it has almost dis- exhort them to pray. But how most important values. We need missed its assumptions, en- can we accept illness in a world only look around us to under- veloped as we are increasingly which, having abandoned every stand that the ‘importance of within relativistic, functionalis- idea of beyond this world salva- business’, ‘the insignificant en- tic, and immanentistic dimen- tion, seems by now only able to vironment’, and the ‘kind of sions. It is, however, my opin- think about health? pleasures’ have gradually pro- ion that we must not lose heart There is something which is duced a kind of substitution of at the fact that the folly and the sinister and very real in the de- salvation by health. Dr. Rieux, inhumanity of this envelopment scription that Albert Camus in the doctor of the plague of Ca- are beginning to manifest them- the prologue of one of his most mus, in a famous dialogue with selves almost everywhere, and famous novels offers of the city another protagonist of the nov- in a striking way precisely of Oran, the city of the plague. el, the Jesuit father Panelaux, where we have to deal with ill- It is a passage which seems to tells him clearly: ‘the salvation ness. By this I certainly do not have been written to introduce of man is a phrase which is too mean to diminish the dramatic our discussion: ‘it is never high for me. I cannot see so far character of the cultural situa- pleasant to be ill but there are ahead. His health interests me, tion in which we live. I merely cities and countries which sup- above all his health’.2 But in re- wish to observe that with regard port you in illness, in which one ality it is also the case that most to ‘pastoral care in health’ it can, after a certain fashion, let of the men of our time seem interested only in health. If in the Latin word ‘salus’ there was implicit both the meaning of physical health, the health of the body, and the meaning of the health of the spirit, that is to say something which in a certain sense refers to salvation, today the two meanings have become separated to the point of a kind of alienation. All this, as is easy to perceive, has come about above all with consequences which damage salvation. If however we reflect well Ð and such could not otherwise be the case Ð this has come about above all with effects which damage the good of man, who, DH n.45 ing 69-144 2.8.2001 15:45 Pagina 106

by the simple fact of thinking contemplate, and those effects, differentiation), and on the oth- only about health, has certainly indeed that part, which although er an increasingly large number not defeated illness and death. we are alive we experience. of patients who go to the doctor Quite the contrary. We fall ill And vice versa’.3 as if he were a wizard of ancient and die because of an illness Nobody, obviously enough, times. In theory, obviously and a death which are increas- wants to deny the enormous ad- enough, nobody wants to con- ingly without meaning and vantages that the modern epoch fuse the medical system with without hope. has brought us, while little by the religious system but in fact ‘When you have health you little the spheres of ‘salus’ as the health has become real salva- have everything’ our grandfa- health of the body and the tion, illness real damnation, and thers declared. But they said it spheres of ‘salus’ as salvation the medical doctor the real animated for the most part by have been differentiated. It priest. the wise knowledge that it is not seems however that the radical The situation is without doubt worthwhile worrying too much separation between these two paradoxical and has something about the affairs of this world spheres has meant that in the to do, in my opinion, with the and neglecting thought about long term the sphere of salva- very nature of the phenomenon the things which really matter tion has become almost redun- of differentiation. This is a phe- (we can accumulate all the riches and all possible and imagin- able pleasures but nobody can ever guarantee us that this very night, for one reason or another, we will not be carried away 106 from this life). Here the health which was invoked was something connected to ‘salus’. It also had within it the idea of salvation. It was both the health of the body and the health of the spirit. Today, however, when we say that health is everything we are thinking exclusively about the health of the body. We say this because we are convinced that without it our lives would not have meaning, rendered incapable as we would be of en- joying to the full its innumer- able opportunities. In a few dant with negative repercus- nomenon which, given its im- words, once health is lost, the sions as well for our ability to portance, deserves to be de- health of the body that is to say, exploit to the full the undeni- scribed, at least in general terms, no hope is left. Everything has able advantages of better health. especially in relation to its Luh- been lost. Hence the bewilder- I would like to explain myself mannian-systemic variant. What ment which we encounter dur- better with regard to this point. is for Luhmann a differentiated ing our epoch in relation to ill- Speaking in Luhmannian and complex society? It is a so- ness and death (what is the real terms, and without any nostal- ciety which has lost, precisely purpose, the latent purpose, of gia for the times when the med- because of this reason of its the very expensive national ical doctor overlapped with the complexity, its very centre. health service?), but perhaps al- magical and mysterious figure There is no longer anything, no so the increasing inability, espe- of the wizard, it should be rea- religious, ethical or political val- cially on the part of young peo- sonably clear that today’s med- ue which can represent the rea- ple, to give a really satisfying ical science is concerned with son for being of a society. There meaning to their lives. the health of men and religion is merely exist a large number of To this nexus between bewil- concerned with their salvation. problems (hence the complexi- derment about death and the in- If, however, we look at the ty) which can be solved only by ability to live a meaningful life, facts, we must agree that health selecting them, by specialising Giacomo Leopardi called our has been endowed with ‘ulti- that is to say a suitable social attention in an almost prophetic mate’ meanings and the medical system (hence the differentia- way in an extraordinary passage doctor Ð a medical doctor who tion) which can solve them. from his work Zibaldone: ‘And is increasingly specialised, in- Each social system has its own overall one can say that the an- creasingly inclined to look at function of reducing them. The cients in living did not fear the person of the patient and in- political system has its rules, its death, and the moderns, not liv- creasingly technically concen- codes, its functions, in the same ing, fear it. And that the more trated on the illness Ð has per- way as the economic system, the life of man is similar to dy- haps become despite himself the religious system, and the ing the more death is feared and the real bearer of these values. health system have. Only diffi- fled from, it is almost the case Thus we have on the one hand culties emerge if they are con- that we are frightened by that medicine and medical doctors fused. No system, in fact, can constant image which in our of a highly technologicalised interfere with another given that very lives we have of it and character (an effect of modern the system is by its nature DH n.45 ing 69-144 2.8.2001 15:45 Pagina 107

closed within itself, ‘auto-refer- If we look at the health sys- ways we live today with the il- ential’, capable that is to say of tem I do not believe that it is lusion that everything is possi- seeing only the problems for difficult to see how greatly it is ble in technical terms. Even which it was created. For new permeated by this functionalist when technological and scien- problems there will be new sys- logic. Man seems really to be tific development provokes tems, in a sort of continuous and relegated to the ‘sphere’ of the concern, in reality we tend to unstoppable process of differen- system. Both the medical doctor think that science and technolo- tiation. and the patient become the gy will nonetheless provide a As I have written elsewhere,4 poles of an apparatus that func- remedy to our problems. This however much the systemic tions more or less well in line increases the assumption that theory is false we cannot, un- with whether it manages to de- the things of this world depend fortunately, exclude it becom- part from the ‘humanity’ of above else on us, on our power. ing ‘true’ at the level of facts, both. During the 1950s Karl It exasperates our wish to be that is to say that today’s social Jaspers was already placing em- happy on this earth; it takes realities rends to really take on phasis on concern with certain away the ground from under our the form that Luhmann attribut- ‘dangers of scientific medicine’. feet, where there are the things es to them. Whatever the case As he wrote: ‘between the med- of heaven. Health, from this may be, we have before us a ical doctor and the patient are point of view, is no longer a gift, dynamic which, in my opinion, placed clinics, insurance, re- the most valuable gift that God becomes more perverse the search laboratories. A world can make to men, but becomes more it touches upon those so- arises which makes possible a instead a ‘right’ to be claimed at cial systems in which the hu- form of medicine which has any cost. You must get better. If manity of man is most in- greatly grown in terms of its ef- you do not get better it is the volved. If indeed it is possible fectiveness but which contrasts doctors’ fault. The situation is 107 to think that urban traffic can be with the very condition of the rather like that with earth- organised in a systemic form, medical doctor. The medical quakes: the first thing we do is the same cannot be said with re- doctors become functions: gen- to get indignant at an event gard to hospitals and schools, to eral practitioners, specialist which we perhaps think is un- give just two examples. And yet doctors, hospital doctors, spe- just, but we then hunt down such is the case. In order to deal cialised technicians, laboratory those who have not built the with the complexity produced doctors, and radiologists’.6 As houses in line with anti-seismic by its constant differentiation, for the patients, they are in- criteria. contemporary society seems to creasingly reduced to being the With a rather pointed witty really support the functional as- mere ‘customers’ of a ‘compa- remark, we could say that our pects of its various partial sys- ny’ (the ASL) which treats them mentality is producing a sort of tems without much concern for in an increasingly impersonal ‘re-enchantment’ of the world what we could call the ‘human’ way in line with standardised upon a technological basis. It is aspects. Expressed in highly procedures (the famous proto- no accident that precisely today, summarising terms, however cols) which are applied in a me- in the so-called advanced West- much his autonomy and liberty chanical way to the illness and ern societies, we are encounter- may be invoked, the individual not to the sick person. Thus it ing a great revival of magical seems no longer to constitute happens that what is gained in rites and practices. As Max the centre or the reason for be- terms of effectiveness, which is Scheler well perceived at an in- ing of society, and is rather rele- certainly obtained from such a stinctual level, magic should not gated to the margins or if one health system, is paid for in be classified amongst the forms prefers to the ‘spheres’ of the terms of ‘humanity’ because of of metaphysical or religious above mentioned social sys- the ways in which this system knowledge but amongst the tems. It is increasingly taken for functions. ‘Great successes at forms of technological knowl- granted, to give just one exam- the level of treatment’, contin- edge. Indeed, if we want a clear ple, that the market, science, ued Jaspers, ‘are achieved every idea of what this practice en- politics, the mass media, and day in relation to sick people tails, we go to the magician or the health system all have their but, and this is an amazing wizard above all else because it specific logics, their functional thing, there is a growing dissat- is unbearable to recognise that, codes, with which nobody is al- isfaction, both amongst the doc- for example, nothing can be lowed to interfere. This is why tors and amongst the patients’.7 done about a certain illness. It is man has no other choice than to An epoch such as ours, which unbearable to us not to know adapt himself (if he can, other- is increasingly technologi- beforehand if this or that con- wise a bad end awaits him). calised and functionalised, takes cern will turn out well, if we With the words of Niklas Luh- away with one hand what it will fail or pass an exam, if we mann, the author who has theo- manages to give with another. It will manage or otherwise to win rised with the greatest radicality certainly offers great opportuni- the heart of that beautiful girl the functionalist position, we ties to tackle and heal illnesses etc. etc. What does not depend could also say that ‘man is no which until yesterday killed on us (that is to say most of the longer the yardstick of soci- people without even being decisive matters of our lives) is ety’.5 Here we encounter, in known about but at the same increasingly difficult to accept. summarised form, the meaning time it leads to an exponential Thus, by a kind of power mania, which from certain points of increase in our needs, our hopes we are losing the meaning of review is most disturbing about for health, and this to the point ality, the meaning of our real what is an increasingly func- of transforming illness into an good. tionalised society. unbearable scandal. In varying In a socio-cultural context DH n.45 ing 69-144 2.8.2001 15:45 Pagina 108

such as the one to which refer- ality. They certainly become an relying so much on an ordered ence has just been made, and re- intervention of God in the hu- life without breakages, of an al- turning to the chief argument of man sphere in order to save man most ‘scientific’ character, this paper, you do not need from illness and death. But be- when faced with death no much to understand how diffi- cause they too are based upon longer accepts even the logic of cult it is to speak about the the cross they force us not only the most elementary syllogism. sacraments. The sacraments in- to never lose sight of suffering Socrates is about to drink the deed, when they are not ex- but to become so ‘mad’ as to ac- hemlock and is still so loyal to pressly rejected, run the risk of cept them. reality as to enjoin his disciples being received in a magical and Those who have looked after not to forget ‘the debt of a instrumental way, with thought a sick person at least once know chicken to Asclepios’. being directed primarily to to what extent faith can provide I know that the sacraments ‘health’ and not to ‘salvation’. serenity and courage in facing are much more. But I would be Despite this fact, as I observed up to illness and how much all satisfied if in an evasive, fleet- at the beginning of this paper, this has real beneficial repercus- ing and cruel world such as our we should not lose heart. We all sions, at a physical level as own clearly is, they helped us to know that behind the fleeting well. I believe however that the bear illness and death as wish for health and happiness, acceptance of what I referred to Socrates bore them Ð as men. something that is typical of our above is the greatest miracle epoch, there is for the most part which faith can perform in a Prof. SERGIO BELARDINELLI, the frustration of a culture im- world such as ours, a miracle Professor of Philosophical pregnated massively at all lev- which contemporary man great- Anthropology, els with ‘artifices’, ‘artefacts’, ly needs and to which, perhaps, the University of Bologna, and ‘cunning’, which has grad- he is far more often open than is the ‘John Paul II’ Institute of the 108 Pontifical Lateran University. ually lost its sense of reality. believed. But as Aristotle knew, happi- ‘All men are mortal, Socrates ness ‘is a certain way of living’. is a man, Socrates is mortal’. Health itself, as Hans-Georg Ivan Ilic, the famous protago- Notes Gadamer recognised among nist of the tale by Tolstoy, re- others, is not a ‘product’ of the flected upon this syllogism, ob- 1 A.CAMUS, Le Peste, in by the same author, Opere (Classici Bompiani, Mi- medical doctor but ‘what is nat- sessed as he was by imminently lan, 1974), Vol. I, p. 133. ural in itself’.8 Whatever the felt death. ‘But I am not 2 Ibid., p. 306. case, one does not take a pill in Socrates!!!’ the same figure 3 G.LEOPARDI, Zibaldone, 3031. 4 Cf. S.BELARDINELLI, Una Sociolo- order to be happy, not does one seemed to shout out, almost to gia senza Qualità. Saggi su Luhmann choose to fall ill or to die. We flee at any cost from the hard (Angeli, Milan, 1993). can only hope that we will be reality which faced him. Yet we 5 N.LUHMANN, Sistemi Sociali (Il Mulino, 1990), p. 354. happy despite illness and death. should observe that this com- 6 K.JASPERS, Il Medico nell’Era della This is the authentic, albeit from ment is both beautiful and em- Tecnica (Raffaello Editore, Milan, certain points of view dramatic, blematic if we think about the 1995), p. 48. realism of our faith. At this lev- death of Socrates as related by 7 Ibid., p. 45. 8 Cf H.G.GADAMER, Dove si el, at the level of faith, the Plato’s Phedone. Ivan Ilic, as a Nasconde la Salute (Raffaello Cortina sacraments acquire a divine re- good modern bourgeois, after Editore, Milan, 1994), p. 42.

The Sacraments: Anthropological Approaches

Introduction the dimensions of his life which spread in our Western countries are reached by divine grace. over recent decades Ð the phe- In this paper of an anthropo- This double approach as- nomenon of the regression of logical character we will try to sumes that the major facts of the religious practice. Such a reali- engage in a sort of outgoing and doctrine of the sacraments are ty, indeed, would suggest that incoming: known, as well as the attempts the sacraments are of little inter- Ð on the one hand, the hu- which have been undertaken re- est to contemporary man. Is this man condition, that is to say its cently to re-insert the sacra- really the case? Can we grasp nature and its insertion in the ments into the economy of the what this reveals in a negative history of salvation, illuminates redemptive incarnation and into sense about the relationship be- the mystery of the sacraments, the ecclesial body. On these tween man and the sacraments? throwing light upon their co-ex- bases, we will try to place these istence and their meaning: facts in relation to the mystery Ð on the other, the sacra- of man and thereby to enrich Whi is a ‘Non-Practicing ments, both with regard to their our understanding of it. Catholic’? internal structure and their mu- For this reason we will begin tual relationships, illuminate the with a pastoral difficulty which For many baptised people mystery of man and bring out has become really quite wide- contacts with the Church take DH n.45 ing 69-144 2.8.2001 15:45 Pagina 109

place only at the times of the ness of the filial heart in the to the crucified Christ. great moments of family exis- flesh and the world. It is certain- Those who do not practice in tence Ð chiefly birth, the cate- ly the case that interior sincerity general have a very attenuated chism of children until the still finds expression in a certain sense of this living presence of threshold of adolescence, mar- concern with leading a moral Christ and his divine friendship riage, and death. To these should life but this concern is not to be found at the heart of the be added the festivals of ‘all specifically Christian (it can be events of their practical lives. saints’, of Christmas, and of found both in Buddhists and ag- As for what remains of their Easter. It is precisely at these nostics, and indeed in atheists). sacramental lives, a shadowy times that the priest hears the fa- If there is still faith in God or in sacredness often takes the place mous declaration: ‘Father, I am Christ it is no longer expressed of living faith in Christ which Catholic, but I am not a practic- in actions or specific and ex- works through the contempo- ing Catholic’. This declaration plicit words Ð this is true with rary power of his resurrection. is at times surrounded by a num- regard to the sacraments but al- Membership of the Church ber of other observations: ‘this so in relation to public and visi- tends to become reduced to a does not prevent me from trying ble prayer, in being concerned not very attractive legal formal- to do good, or to pray on my with expressing one’s own faith ity. The tissue of daily life, fam- own; it is better to have inner around one, or in daily life in ily life, work, society or being a sincerity than outward and hyp- the wish to act not only honestly neighbour no longer seems, ocritical practice, etc.’ When a but also out of explicit love for within the context of freedom, deeper dialogue is possible it is Christ. as the practical place for the ex- realised that the problems are to 2. This fracture in the dynam- pression and the realisation of be found at completely another ic of exteriorisation takes on the the choice and call of God. It level. The phrase ‘a non-practic- dynamic of the movement of tends to become reduced to al- 109 ing Catholic’ is intended to spiritual interiorisation. This ternating between stressing so- make us believe that the person means the ability to recognise cial constrictions and compul- is still essentially Catholic but sive distractions. The need for that his attendance at external God or the sacred is no longer Christian actions has merely di- manifested in certain precise minished somewhat. But in fact opportunities. does not non-practice perhaps 3. All of the spontaneous rep- reveal rather a substantial aban- resentation of the real and of donment of faith itself? What life is thereby touched upon. In does a ‘non-practicing Catholic’ a context of non-religious prac- believe in, and live out, we tice God loses the concrete, his- might ask, at a religious level? torical and incarnated counte- Without wanting to judge peo- nance that He has in Jesus ple case by case, the experience Christ and his Church, and He of pastoral dialogue enables us becomes the object of a shad- to detect a certain number of ba- owy belief, ‘a power above us’. sic tendencies. Every act of man no longer con- 1. The non-practicing cerns hic e nunc his love for Catholic sees his or her life in Christ: what is needed is a posi- general from two points of tive overall moral balance. This view: the inner level, that is to is not Christianity but deism. In say sincerity (which can include fundamental terms it is the mys- a certain life of individual tery of the redemptive incarna- prayer), and the external level, and to internally integrate the tion which is lost from sight. Al- that is to say concern with a presence and the initiatives of though it is historically true that minimal moral life (thou shalt Christ in the same way as they the Church and the sacraments not kill, being generous, etc.) present themselves in me in are the valuable gifts which For the non-practicing Catholic practical externality; Christ paid for on our behalf such indeed is the essence of the Ð in the sacraments which with his own life, I cannot Christian life. What is primarily have a visible, hearable and pal- therefore withdraw myself from absent here is the explicit exer- pable character, and which take them of my own free will with- cise of the theological life. It is place in my personal and social out wounding him in his love certainly the case that it is not history; for me, and without wounding necessarily absent, especially if Ð more globally in ecclesial his Church because of my ab- the individual concerned has life, that is to say in belonging sence: in the sacramental hic et maintained a certain life of to a community which means nunc, indeed, this love is of- prayer (something which is not and realises belonging to divine fered to me and it has that much unfortunately always the case). communion; more burning presence because But what remains tends to be re- Ð and also in every type of of Christ that my mission and duced to an intimate individual event, call and encounter my eternity keep it for ever in sphere and no longer finds through which Christ speaks my heart and are at work in the space by which to express itself and acts: for example, this poor present. If I am indifferent to outwardly. The personal dy- person on my path, this oppor- this reality (perhaps without this namic of the theological action tunity to serve my brothers and being my fault) this means that I of the interior towards the exte- sisters, my profession, this en- have not perceived the concrete rior is wounded, the expressive- dured offence which likens me reality of this mystery which, DH n.45 ing 69-144 2.8.2001 15:45 Pagina 110

however, constitutes the specif- lations Ð it tends to reduce the death and his resurrection for all ic centre, indeed the beating other person to the status of a of us and each one of us. The heart, of the Christian faith. mere instrument of egocentric context of this balancing is 4. Connected with the mys- satisfaction. In contrast, the ma- found in ecclesial mediation: tery of the incarnation, what is terial and ecclesial objectivity the sacrament manifests itself at play in this area is the percep- of the sacrament which I must not only as individual grace but tion of the concrete reality and receive as it is given to men as grace through the Church and the otherness of the Person and manifests a grace of which for the Church, which is the the love of Christ which is so Christ himself, and not my feel- concrete place of communion. much greater than our own. To ings, is the origin and the mea- Where the practice of the sacra- the non-practicing Catholic it sure. ments disappears one cannot be appears that the perception of This fact is very clear in the surprised at the undoing of this his moral good will is enough. example of the sacrament of balancing between a closed sub- Compared to the very strong forgiveness. My sins are in his- jectivity and an insignificant love of Christ towards him, it is torical terms participants in the objectivity, between an ‘in- here at a very low level indeed, crucifiction of Christ, and I can- timist’ individuality and a and is almost disappointing. As not reduce forgiveness to a grat- Church which has become ex- St. Augustine says: ‘the mea- ification or to a fact to which I traneous, between a secularised sure of love is to love without have a right through uttering a historicity and an abstract God. measure’. This measure cannot small prayer. In relation to be reached by man if he does every person who is offended not receive it from He who ‘still by me, but even more in rela- The Sacraments loved those who were his own, tion to Christ, to ask forgiveness and the Sense of the Sacred 110 whom he was leaving in the pre-supposes a moment of ef- world, and he would give them fective vulnerability. It shows We have so far not addressed the utmost proof of his love’(Jn that my sin makes me unworthy ourselves to a point which we 13:1). At the same time the of what I am asking for, and that should now look at more close- non-practicing Catholic has no forgiveness is everything, the ly. The regression of religious interest in his religious actions total unmerited gift of Christ non-practice has often been in- other than with reference to ‘who loved me and gave him- terpreted only within the con- ‘what they bring him’, some- self for me’ (Gal 2:20). It also text of secularisation: when thing which is understood from shows that he, and not me, is the sacramental life disappears only a subjective and immediate judge of the interior arrange- profane life remains. Now it is point of view. He does not take ments which enable me to re- increasingly evident that such is into consideration whether ceive his forgiveness. Because not the case, at least in the long these actions are concretely sen- it integrates the confessions term. For some years reference sitive to the Heart of Christ, or with the minister sent by Christ, has been made to the ‘return of if they bring something in an the structures of the sacrament the religious’. Only our lack of objective sense to the Church of forgiveness permits this vul- vital contact with real culture and the world. It is certainly nerability, this glance of truth can explain the fact that we did true that the approach of onto my life received from the not realise this earlier Ð non-practicing Catholics is not outside, and the unexpected joy spiritism became fashionable at insignificant Ð if 95% of young of the unmerited gift which has the end of the nineteenth centu- people who receive catechesis been received. All the attempts ry; from the 1960s onwards ori- distance themselves from reli- to by-pass this moment are in entalism invaded the world of gious practice because in their this respect insufficient, both in songs (the Beatles amongst oth- view it does not bring them any- objective and in subjective ers are a good example of this); thing, we have to conclude at terms. and the spread of esoteric and the least that in a number of Let us now conclude this se- parapsychological themes was years of catechesis we have not ries of observations. What does already very advanced by the been able to give them in an ex- religious non-practice reveal in 1970s (to become aware of this istential sense what the sacra- negative terms from an anthro- it would have been enough dur- ments actually bring them. pological point of view? It ing these periods to look at the Here there is a real pastoral brings out how the sacraments bookshelves of libraries cater- question. When it becomes ex- are for the person the important ing to a large reading public). cluding, however, this percep- factors of spiritual balance in These phenomena have become tion of the sacraments reduces the relationship with God and massive in scale. In weakening them at times to a psychological with Christ. The objective char- the visible reference points of gratification, and thus to disap- acter of the sacraments allows Christian actions, secularisation pointment and to withdrawal the dynamic balancing between creates only temporarily a reli- when this gratification is not the interior and exterior worlds gious vacuum Ð this emptiness present. Here there is probably a of the person who receives is very quickly filled by profane logic of immediacy which is them. This balancing has its idols (progress, Communism, generated by a part of the envi- fundamental reference point in science, fashion, youth, and ronment of consumerism in the mystery of the incarnation Ð health etc.), and when faced which we find ourselves. It im- the sacrament is the event of with their inability to make man pedes seeing Christ as transcen- salvation in the history of the happy these last are followed by dent in relation to my desires. person, an initiative of Christ explicitly religious idols. Today This very logic weakens the who actualises the central event the problem is not that of mak- whole field of interpersonal re- of salvation, that is to say his ing a rationalistic world accept DH n.45 ing 69-144 2.8.2001 15:45 Pagina 111

the fact that Christian miracles position to conceptual and ratio- vine there remain these failed exist Ð it is rather to show that nal thought. Whether cosmic or attempts to take possession of it, they are not a particular case of anthropological in character, all and these are characteristics of what is strange in general (men- symbolic experiences become both ancient and new paganism. tal powers, UFOs, etc.). immediate ‘hierophanies’, that One cannot attribute to the What is this ‘sacred’ which is to say possibilities by which sacraments the same kind of takes the place of the ‘Christian to engage in direct communion ‘sacredness’ as that which we sacred’ of which the sacraments with the divine. We are thus are currently witnessing as be- are the centre? In overall terms, here in full-blown pantheism Ð ing on the increase. The sacra- it corresponds to a stepping a divine All of which every man ments situate us as people be- back from the personal counte- is supposed to be only one as- fore a personal God, and the nance of God: one has less to do pect, a Totality (‘whole’) whose fundamental grace which they with ‘somebody’ than with particular element can enable us give us is not a fusional experi- ‘something sacred’, with an in a certain sense to enter into ence of the divine but a real and anonymous and multiform mys- resonance with symbolic expe- distinct person, namely Jesus tery. There then follows a rience. Christ. However, if what we search for experiences of the sa- Here one can recognise the have just observed is accurate cred which no longer have the figure of the first sin: the at- then their relationship with the form of a personal encounter tempt to take possession imme- human sense of the sacred with God but with an immer- diately of the absolute by reduc- should not be conceived solely sion in a great ‘everything’, or ing it to something (the fruit in terms of opposition. For the with a handling of energies of a near to hand), an attempt which non-practicing Catholic the is rewarded with a reduction of sacramental questions appear oneself and that very state (men first and foremost as wishes for 111 become things to each other or a sacralisation of the great things jostled by the forces events of his or her existence. In which are above them). Now, other terms, the absence of reli- this figure of sin is understand- gious practice has progressively able only in relationship to the led their sense of the sacred original grace which repudiates from its personal and relational it – ‘the human being in the im- form in Jesus Christ to its pagan age of God’. Now, the ‘image’ form which is co-extensive with in its biblical sense is a reality the life of man, and weighed which is almost sacramental: it down more or less with imme- is not only the ‘representation’ diacy and anonymity. However, of something but after a certain sin wounds nature but does not fashion its effective presence destroy it, and the grace of (this explains the Old Testament Christ does not deny it but heals prohibition with regard to mak- it and raises it up – as a ‘new ing images of God). If this is the birth’, baptism engages in an original condition of man, then authentic relationship with hu- magical kind. In New Age every action of his becomes an man birth; as ‘Christian maturi- ‘channelling’ there is still an at- effective sign of the loving ac- ty’ confirmation has a real link tempt to enter into contact with tion of God Ð the sexual polarity (to be made clear) with human ‘spiritual entities’ but it is not is an effective sign of the pres- maturity. This means that the important who or what they are ence of the Creator towards his questions posed to the Church Ð interest is found in experi- creature: called ‘to grow and with regard to the sacralisation ences which introduce us, in re- multiply’, man and woman be- of the great events of life results or in powers, to that which come, through the very gift of main humanly legitimate. And through them it is possible to human life, ministers of the di- in the economy of grace which gain access. After all, the ques- vine life of their children. And belongs to us only the Christian tions ‘who is God’ or ‘who am the relationship which they en- sacraments correspond to it ade- I’ acquire diminishing impor- gage in with the Creation which quately, and even transcend this tance the more people are un- must be ‘filled and governed’ is answer. derstood as bundles of energies called to be the place of the gift Far from being something which should be harmonised, of God. The ‘sense of the sa- which should be despised, the and it is not to be excluded that cred’ which is symbolically in- ‘sense of the sacred’ which these they can fuse, indeed divide herent in the great anthropologi- sacramental questions manifest themselves, into ‘sub-personali- cal events and in the relation- is thus to be taken seriously: it is ties’. This way of seeing things ship with the creation is inter- the place of a religious wish also implies a stepping back preted as that which remains, which on the one hand is legiti- from a sense of freedom, and an after the sin, of a sacramental mate and on the other, if it is not oscillation between a feeling of order which should have been evangelised, will return to pagan being subject to flows of time co-extensive with acting hu- forms which are naturally de- and attempts to dominate them manity. What remains is a set of rived from the first sin. The and manipulate them (‘gratu- human experiences which sug- whole of the challenge of the ities’). It should be added, last- gest and recall the divine but parish ministry is to be found ly, that this sense of the sacred which no longer communicate here. We cannot be satisfied also corresponds to a strong re- it. And in a context where man with unilateral solutions: in turn to symbolic thought in op- searches blamelessly for the di- sacramentalising them system- DH n.45 ing 69-144 2.8.2001 15:45 Pagina 112

atically, the sacraments are re- comes afterwards?) And this way in the parishes is also trans- duced to what is sacred in a pa- without taking into considera- planted into the context of pas- gan sense, but in rejecting the tion the special world in which toral care in health Ð what in sacraments out of a purist oppo- these questions resound around concrete terms will the relation- sition to what is sacred in a pa- the staff who are engaged in ship which we have sought to gan sense one commits an error providing care and treatment. identify between sacramental against man, and against the On the one hand, these are hu- pastoral care and the urgent mystery of the incarnation man experiences which place need to evangelise or to which renders man divine with- man in front of his radical pow- re-evangelise (I am thinking out denying him but by healing erlessness to save himself, and here of the sick, families, and him and taking him upon itself. no place seems more suited than the staff engaged in care and The key to this challenge is that of the heaviest human treatment) actually mean and called ‘new evangelisation’ Ð in crosses if we want to proclaim involve? this case it involves welcoming the victorious Cross of Christ. In this context the sacraments the sacramental questions as On the other hand, it is also a which are most immediately in- they are, that is to say in their field which the ‘New Age’ volved are those which concern initial pagan state in order to neo-paganism seeks to occupy the sick, forgiveness, the Eu- make of them a place for a vig- by proposing, for example, psy- charist, holy orders (the pres- orous proclaiming of the salva- cho-spiritual therapies, or by ac- ence and role of priests and dea- tion which is only to be found in companying the dying with a cons), and at times baptism Christ ‘because there is no other view to achieving a ‘soft’ death. when death threatens. What are name in heaven or on earth by And I have not referred to the the means available to us by which we can be saved’. practices of certain companies which to express in a clearer 112 of undertakers which, with a fashion what they are? Events view to achieving a more attrac- of salvation embodied in human Conclusion tive service for their customers, suffering, actualisations of the seek to obtain ministers of wor- Cross and the resurrection, the A short observation to con- ship who are used almost as em- passing near of Jesus Christ in clude this paper on the special ployees in order to by-pass the Person, an ecclesial event? Sim- context in which pastoral care parishes (this phenomenon is ilar questions I entrust to your in health represents is required. very advanced in the United discussions, which will now A certain number of anthropo- States of America and is begin- follow. Thank you very much. logical realities acquire a partic- ning to appear in France). These ular weight Ð suffering and at are the elements which should Prof. DENIS BIJU-DUVAL, times the prospect of death, the be taken into consideration or Professor of Special Pastoral questions about blameworthi- which will be taken into consid- Theology, ness and sin (Why him? Why eration in the short or medium the ‘Redemptor Hominis’ me? The question of AIDS), but term. The question which we Pastoral Institute, also about salvation (What have seen raised in an acute the Lateran University.

A Sacrament for Suffering. Faith in God and Hope of Life

The ritual action of sacra- stracted from time and space. is destined for man when man ments is that special way of The divine truth, to which man decides on his own, and the acting of the Church thanks to corresponds in his approach of way, which allows each and which she turns to man so that faith, possesses in itself a di- every person to be conformed he, opening himself to God mension of universality but to the truth, is a way which is in who saves, responds to the di- without thereby being identi- every instance special. And it is vine initiative and can thus be- fied with an abstract principle precisely to that special experi- lieve.1 Man is affected by or even less with a generic ele- ence, which is defined by the sacraments in an existential sit- ment. Divine truth is extended condition of illness-(death) and uation which is in all cases con- to all men with the invitation of suffering, that the Church cretely qualified, in such a way for each and every one of them has paid full attention through- as to require him to organise to implement a taking of a posi- out her whole history, with a his answer of faith within a sit- tion which is justified in the continuity which in the light of uation of life which is well de- light of truth, that of God, research into the phenomenon termined. The decision of faith which, far from eliminating the of history appears more than does not represent a choice singularity of each and every evident.2 which takes place separately person, knows how to effec- Beginning with her early from the path undertaken by tively motivate and steward stages the Church has thus existence and is thereby ab- him. By this route divine truth shown that she takes seriously DH n.45 ing 69-144 2.8.2001 15:45 Pagina 113

the risk and the dangers which not therefore delegate (James sation and obtained its visibili- a situation of suffering bears in 5:14-16). ty in the answer that was given relation to the fulfilment to The presence of the ‘pres- to it by man, who is invited to which man is destined because byter’ is the sign and at the believe, bringing thereby fruit of the creation. From the begin- same time the guarantee of the against every hope through the ning of the history of the Chris- quality that the witness of the fact that God himself came to tian community care for those community of Christians must visit him in order to achieve a who are sick has been ex- possess in order to be at one completion which does not dis- pressed through an action with what Jesus made appear appoint.4 The seal of the answer which is known and which is through the economy of his ac- which is given by man has al- clear in its essential aspects, tivity. In the personal history of ready been presented and given even though, at the present Jesus Christ there is indeed the to him because of the cross of state of inquiry, it is not always last ‘time’ of the history which Christ since Jesus Christ him- fully known at a detailed level. is to appear within the history self ‘has to’ offer all of himself Its end has been the salvation of humanity, placing in the so that the salvation which God of the person who is subject to heart itself of history the dy- knows how to give to him who suffering. The invocation of namism which animates it. The remains faithful, faithful to the the community, completely concern demonstrated by the end, may manifest itself. It is certain of the power of the Lord community for the sick person thus of extreme importance that sought to be, and was in factual Jesus declared with his words terms, the expression of the full and made evident through his association of Christians with style of life how the beatitude what Jesus had realised with of God was already present and his moments of healing and working amongst men. What 113 miracles. The episodes of heal- he moves to specify is the form ing made their appearance in in which, uniquely, ‘happiness’ the narrative of the New Testa- can be the ‘completion’ of man ment in a measure undoubtedly and what was, as a result, the more abundant than is the case motivation which should in- with the Old Testament.3 In the spire him with a view to choos- Old Testament only three ac- ing between real and false hap- counts are given, which are piness, between having life and perfectly detailed, of miracu- losing it irremediably (Mt 5: lous healings in instances of ill- 3-12). In this way Jesus places ness: the event of the serpent of himself against that belief, bronze in the desert (Num which was certainly more com- 21:9); the healing of Naaman, mon and widespread, which the head of the army of the king believed that it could see in because comforted by what it of Aram (2 Kings 5:10-14); and happiness the task to which the had been able to see in the the healing of Herezekiah the action of man must be directed. ‘reawakening’ and liberation son of Acaz the king of Judah Happiness, more than being from death on the cross, turns (2 Kings 20:1-11). The more placed at the end of the action, to Him in order that He can than evident increase in the and thus more than being the benevolently answer the prayer number of miracles of healing consequence which in acting of faith. The action of the com- is wanted by the New Testa- man would be able to reach, is munity reveals in a totally ment in order to the place the in reality what comes to him transparent way the continuity value of the definitive nature of through being given because it which must subsist between the the event of Jesus Christ in a is at the origins of the actions task, to which the community suitable light. In healing is which must be carried out. The of Christian dedicates itself, recognised the gift with which only possibility for happiness, and the mission, of which Jesus the coming of the final time is in which the authentic comple- was the protagonist, in a com- accompanied, that grace by tion of man must be perceived, pletely unique way. The action which God introduces the irre- does not define that for which is a part of the witness of the versible completion of the his- and towards which man works, community which reaffirms tory of men. but rather the impetus that sup- during the course of the events The completion, while it ports and the factor which ani- of humanity what Jesus Christ works to cover man with divine mates the work of man. The committed himself to achiev- benefits, also involves the evangelical promise introduces ing once and for all to the bene- judgement of total condemna- by this the news of a reward fit of men (cf. Mk 6:13 and 16, tion on those who directly op- which is certain for all those 17-18). In the carrying out of posed the success of man, and who live in the freedom of the this task it is the whole commu- in challenging it obtained only faith, since faith, in not spring- nity which must feel involved threats and dangers for man. ing from itself, can nourish in- but in order for the carrying out The definitive work of God is terest in others. The gift re- and the meaning of the shared the same that Jesus lived and in ceived is the root of the service task to be consistent with the the name of which he spoke destined for all people because original and founding moment with a level of authority which in the service which is given of the faith, the ‘presbyter’ has immediately appeared different there is no reason for contradic- to perform a role which be- to that of other teachers. This tion or an impediment to the longs to him and which he can- work of God found its actuali- completion of ourselves. The DH n.45 ing 69-144 2.8.2001 15:45 Pagina 114

man of faith encounters the be carried to God, and to what complaints of the suffering per- Lord in the needs of the materi- are the contents of the divine son.6 I am referring here to the al body of this world and with will in relation to man as he is Book of Psalms which from a reference to how the encounter in the concreteness of his daily completely exclusive approach, in matter is structured will be life. but thanks to which we come to pronounced the judgement on Indeed, an alternative would re-read the entire message of the behaviour which has been seem to arise between divine the revelation of Scripture, re- engaged in (Mt 25:35-6). For goodness and divine power: if lates the complaints of he who this reason, God does not annul God is good why does He not is subject to suffering. the wish for happiness and for direct himself towards warding In the Book of Job, what life felt by man but ensures that off evil and if He is powerful myths have tried to repeatedly the wish becomes fully corre- why does He then tolerate evil minimise, that is to say the spondent to the truth of living. and the influence of evil on need to begin with the divinity In this sense, even if only in man and the world?5 The the discussion about evil, is this sense, the suffering of ill- wickedness of evil, in the proposed as an inevitable ques- ness can be said to be a proof, judgement of man, reaches its tion, when there is not an at- to the extent to which it impos- most evident expression when tempt to banalise or underval- es on man the process of decid- misfortune hits the ‘innocent ue the suffering of man. Job is ing in relation to life and to that person’, and the ‘innocent’ neither calm nor resigned and meaning for which Ð that is to child, in a particular way, be- for this reason he does not say in the specific nature of his comes a victim of it. The exten- withdraw himself from prob- personal being Ð he is not lost. sion of the threat of evil is in ing what is usually maintained The sacramental rite is thus this way without confines Ð not by other people and which his 114 something which allows the only because evil comes to friends are ready to recall, sick man to actualise his deci- strike suddenly but above all making it have the value of a sion in relation to existence because it does not display any shared opinion. What is inter- since the property of the ritual respect at all for anybody or esting in the account of Job is act of the Church consists in even has some attenuating ap- the particular form of ‘submis- bringing into play what the proach in relation to anybody. sion’ which the person of the God of Jesus guarantees and In the case of the child, man text reaches and because of makes possible to the total ben- seems deprived of the very which, although he does not efit of each and every person. possibility of words and action abandon raising his protest to That one is dealing here with through which he can at least God, he does not, however, an authentic decision which distance himself from evil, come to a denial of God. In must be taken, and not a mere pointing out the level of being other words, the accusation putting off of things which outside in relation to which the and the protest of Job are not leaves to one side the possible wish for life exists and propos- placed beyond the horizon of elements responsible for the es. In this regard, and thus with faith but it is precisely within presence of evil, leaves howev- respect to the clear certainty of faith that an attempt is made to er the state of things unchanged the clearly destructive profile reach a clarification by which in an overall sense. This is also of evil, the most critical voice to find once again and under- demonstrated by the suggestion stand in a more pertinent way that the philosopher Boetius that in which he believes. This makes in relation to the ques- same objective is to be ob- tion of evil and guilt. As a pris- served working in the formula oner and waiting to be execut- of the psalm which, according ed he insists on declaring: “if to the judgement of certain God exists where does evil and scholars, has the same function impiety come from. And where as the ‘ex voto’. Prayer, indeed, does good come from, if He formulates it once the goal of does not exist?” The only for- salvation of which the psalm mula which can seek to identi- speaks is reached. But in this fy the right place for the ques- way, in giving a strong rele- tion of evil thus takes on the vance to the language of com- configuration of the question to plaint, man, who prays with which one responds only on the the psalm, clarifies how being condition that one is exposed to subject to the impetus of evil it in first person. In the answer cannot be considered by man which is always and in all cases as being ‘natural’. personal, in line with what The spontaneous request is Boetius emphasised, it is God which is raised against the thus to put an end to all those Himself who is called directly overbearance and the weight of forms of religion and to all into question. The appeal to evil which can in no way be those systems of reflection someone else, who is not to be by-passed is that to be found in which want to present evil as identified with God, would the texts of Holy Scripture. The the normal expression of the transform the role of evil pre- Bible does not envisage pre- quality of finiteness of man sent within suffering and blame senting who God is and what and of the characteristic of in- into something which is clearly His action of redemption in- completeness of the world in insignificant. The process un- volves by seeking to place whose space man lives. Evil is derway in relation to evil must them in safe refuge against the not the mere sign of man’s be- DH n.45 ing 69-144 2.8.2001 15:45 Pagina 115

ing in the world and the simple solve the cause of pain so in ticular on the capacity for cult instrument by which his iden- the same way it does not know of contemporary man because tity is ascertained. Evil is ex- how to distance or even at the through the projects which he actly that which attacks man least to attenuate the level of cultivates he ensures the preva- by striking him in his entirety difficulty and perplexity which lence of the figure of a humani- without confining itself to the presence of evil itself intro- ty of facts deprived of tradi- putting one of his features in duces. The same reference to tions, the figure of a humanity difficulty or calling one profile the quality of fragility, which which is both fluctuating and into question, leaving his other infertile. What is at stake is not components intact. This means man’s capacity for cult taken in that there is no necessary rea- itself or rather considered in son for the entering of evil into terms of its essential con- the scene of life of the individ- stituent, but the possibility of ual or the world of men. There entering into the singular logic is no pertinent motivation for of the ritual symbols of faith. the corroboration of the decla- Now the sacramental rite of ration which maintains that anointing must not be engaged evil must of necessity exist. in separately from he who pre- Rather, the definition of evil is cisely through this determined that which sees it as that which way, that of the action of the in itself must not in any way rite, expresses his will for sal- and for any end exist either in- vation and offers man the crite- side or outside man.7 In mani- rion in the name of what he be- festing his counterposition to lieves. The rite of the Church in 115 evil, the praying man of the distancing from evil places the psalms manifests at the same approach of the Crucified One time the ultimate criterion of in the history of the Church in the assertions that prayer pro- links men in a sole set and un- favour of the man of every time poses, identifying it in the der the same genus, therefore and place. proud and resolute declaration leaves each and every man to The Crucified One is he who of existence. That it is possible go towards a destiny that is not distances the possible suspicion that man comes to have his up to the level of the fulfilment of man that there is a perverse name, that which belongs to which man perceives that he and powerless God, to reveal, him in a way which is natural- bears and on which he makes rather, a God, who although he ly exclusive and specific to walk his thought and his will. is not responsible for evil him Ð here is the essential fact Evil is in itself and by itself nonetheless does not withdraw of the prayer of the psalms everything that comes to inter- from the encounter that man raised in cases of suffering and rupt the path of existence of engages in with evil. The ritual evil. man, making it so profoundly action of the Church allows Thus prayer, that is to say unintelligible as to force every each and every person to place the special language of the hu- person to remain distant from his own condition as a suffer- man relationship with God, is any possibility of refuge in a ing creature in the fire of this fixed and defined in its subject loneliness which for each and singular event, that of the Cru- matter and can be easily con- every one cannot but be the cified One. The sacrament is sidered as the characteristic most complete loneliness. not therefore the simple educa- and root which are typical of In this regard, the in- tional instrument which seeks evil and suffering. It is injus- escapable question about the to prepare the consciences of tice which defines the central contemporary practice and Christians so that their behav- feature of the experience of thought of the Church concerns iour is up to the level of the re- evil and thus the feature with the way by which it renders quests made by the will of God. which such experience impos- feasible the encounter with the The sacramental action allows es itself on the perception, but secularised experience of evil an effective taking part in the in definitive terms on the resis- which is characteristic of this divine force which sets in mo- tance, of man. The complex of season of the contemporary tion that in which it itself be- discourses which seek to deci- epoch. Even the return into comes effective and manifests pher in a speculative approach play of the sacred does not its power. The nature of this the essence of evil, and the seem to change the prevalent force remains concealed until complex of projects which re- tendency to secularisation but, man dedicates himself to it quire instead a limitation of the rather, it flanks it, ending up by without compromises, allowing power of negation in a practi- restating in substance its ten- him to pass through it integral- cal perception, are soon in dif- dential line. The last part of the ly. The statement ‘do not be ficulty since they are largely century which has just passed afraid’, with which God ac- insufficient in setting out a was Ð and not without a certain companies his own manifesta- clarification in relation to what relevance Ð defined as a reli- tion to man, becomes fertile the human experience of evil gious time but such a definition when in the ‘now’ of the deci- brings into play. The affirma- is awaiting a suitable evalua- sion man does not withdraw tion, according to which men tion and explanation beginning from it. The completely Christ- are indistinctly and constantly with the completely special ian paradox of a ‘gain which is exposed to the overbearance of meaning of the behaviour of in itself only freely-given’ of injustice, just as it does not dis- faith. The question falls in par- personal existence is what the DH n.45 ing 69-144 2.8.2001 15:45 Pagina 116

ritual action of the Church 88), C.L.V. (Edizioni Liturgiche, Rome, Testament, 14), (Neuchatel, Delachaux 1996), pp. 13-28; Idem, ‘Il Sacramento e & Niestlé, 1981), Italian edition: makes possible for each per- la Fede’, La Scuola Cattolica, 127 L’Apocalisse di S.Giovanni (Commenti son. It is this which brings out (1999), pp. 313-314. Biblici) (Rome, Borla, 1985). to man the essential conditions 2 For the results at which in the mean- 5 P.RICOEUR, Le Mal. Un Defi à la for his unconditional adherence time theological inquiry arrived, giving Philosophie et à la Théologie (Geneva, full importance to the instruction that the Labor et Fides, 1986), Italian edition: Il to the God of Jesus who listens teaching of Vatican Council II sought to Male. Una sfida alla Filosofia e alla Re- without hesitation to those who offer on the question, see S.UBBIALI, ‘La ologia, Postfazione di Paolo DeBenedet- invoke him in faith. Teologia dell Unzione degli Infermi’, ti (Il Pellicano Rosso) (Brescia, Morcel- Teologia, 10 (1985), pp. 229-271; ; liana, 1993); A.LACOCQUE and P.RO- Idem, ‘Penitenza – Unzione degli Infer- COEUR, Penser la Bible (‘texte d’Andre SERGIO UBBIALI mi’, La Scuola Cattolica, 114 (1986), LaCocque traduit de l’anglais par Aline Professor of Dogmatic Theology pp. 565-571; P.ADNéS, L’Onction des Patter et revi par l’auteur, La couleur des at the Faculty of Theology Malades. Histoire et Théologie (Théolo- idees’) (Paris, Editiones du Seuil). gie Nouvelle) (Paris, FAC-Editions, 6 P. BEAUCHAMP, Création et Sépara- of the University of Milan, 1994), translated into Italian by Mirella tion. Etude Exégétique du Chapitre Pre- Italy Magnati Fasiolo: L’Unzione degli Infer- mier de la Genèse (Bibliothèque de Sci- mi. Storia e Teologia (Universo teologi- ences Religieuses) (Paris, Aubier Mon- ca. Dogmatica, 51) (Cinisello Balsamo, taigne, 1969); Idem, L’Un et l’Autre Milan, San Paolo, 1996). A.BÉRARD, Testament. 1, Essai de Lecture (Parole L’Onction des Malades. Sacrament de de Dieu) (Paris, Edition du Seuil, 1976). Guérison ou de Préparation à la Mort, Italian edition: L’Uno e l’Altro Testa- preface by Cardinal Paul Poupard, mento. Saggio de Lettura, translated by (Paris, Téqui, 1996). The dogmatic doc- Alfredo Moretti, edited by Lorenza Ar- trine approved by the Council of Trent is righi (Biblioteca di Cultura Religiosa, Notes outlined and explained by A.DUVAL, 46) Brescia, Paideia, 1985); Idem, Des Sacrements au Concile de Trente Psaumes Nuit et Jour (Paris, Editions du 1 On the subject of the general ques- (Rites e Symboles) (Paris, Cerf, 1985). Seuil, 1980). Italian edition: Salmi Notte tion of sacraments see S.UBBIALI, ‘La 3 G.CRESPY, La Guérison per la Foi e Giorno, translated by Giampaolo Na- Riflessione Teologica sui Sacramenti in (Cahiers Théologiques, 30) (Neuchatel, talini (Orrizzonti Biblici) (Assisi, Cit- 116 Epoca Moderna e Contemporanea’, in Delachaux & Niestleé, 1952). tadella, 1983). Celebrare il Mistero di Cristo, Manuale 4 On the relationship between 7 S.UBBIALI, ‘Teologia, Salute e di Liturgi a Cura dell’Associazione Pro- faith-hope and liturgy see P.PRIGENT Salvezza. La Rivelazione di Dio e i Beni fessori di Liturgia, Volume I, La Cele- Apocalypse et Liturgie (Cahiers dell’Uomo’, in A.N.Terrin (ed.), Litur- brazione: Introduzione alla Liturgia théologique, 52) (Neichatel, Delachaux gia e Terapia. La Sacramentalità a Cristiana (= Biblioteca “Ephemerides & Niestlé, 1964); U. VANI, La struttura Servizio dell’Uomo nella sua Interezza Liturgica”. “Subsidia” 73), C.L.V, (Edi- Letteraria dell’Apocalisse (Aloisiana 8), (= ‘Caro Salutis Cardo’, Contributi 10) zioni Liturgiche, Rome, 1993), pp. (Rome, Herder, 1971); Idem, Apoc- (Messaggero Ð Abbazia di Santa Giusti- 303-336; Idem, ‘Il Sacramento Cris- alisse. Una Assemblea Liturgica Inter- na, Padua, 1994), pp. 271-312; Idem, ‘Il tiano’, in Celebrare il Mistero di Cristo, preta la Storia (Leggere Oggi la Bibbia Male e la Libertà. La Sovrabondanza del Manuale di Liturgia, Volume II, La Cel- LOC. 2, 15) (Brescia, Queriniana, Bene a la Contrarietà della Perversione’, ebrazione dei Sacramenti (= Biblioteca 1982); P.PRIGENT, L’Apocalypse de La Scuola Cattolica, 126 (1998), pp. “Ephemerides Liturgica”. “subsidia” Saint Joan (Commentaire du Nouveau 433-464.

Signs of Salvation: The Sacraments in the Health Care Ministry

Taking care of the suffering had a primary position of im- person, it has expanded its hori- man in a situation of illness be- portance in the apostolic life of zons to the questions and issues longs to the very substance of the Church. Hospitals were cre- connected with medical ethics, the Gospel (cf. Lk 9:16; 10:19; ated by religious will and de- the environment, the quality of Mt 10:58; 67-13...). This mis- sign. According to an inquiry life, and the organisation of the sion, which is the impulse be- carried out by the Pontifical health service. hind, and the form of, pastoral Council for Health Pastoral This is not only a question of action, involves the whole of Care in 1988, there are more substitution or secondary sup- the work of Jesus Ð his preach- than 22,000 health care institu- port. Ten years or so ago Cardi- ing, the healings, the calling tions in the world which were nal O’Connor, the Archbishop and the building up of the be- founded by the Church and are of New York (in that diocese lievers. In the same way as it still administered by her. the budget of the health care in- did for the Master, so, too, for This ancient root has devel- stitutions exceeded a milliard his disciples does this have a oped and grown in a consistent American dollars every year) global dimension: ‘the Lord Je- way in various forms and asked himself about the reason sus Christ, physician of our shapes depending upon the for so high a level of ecclesial souls and bodies, wanted his context and the situation in commitment and involvement: Church to continue, in the pow- which it has found itself. Never was it not perhaps a good idea er of the Holy Spirit, his work before has the health care min- to leave such undertakings to of healing and salvation, even istry acquired such a broad and government? The answer, em- among her own members’.1 inclusive set of horizons. From phasised the Cardinal, was sim- From the early Christian cen- being the exercise of charity at ple and straightforward: be- turies taking care of the sick has the side of the bed of the sick cause the Church believes in DH n.45 ing 69-144 2.8.2001 15:45 Pagina 117

the sacred value of each and being defined by the clothes he dismay, the madness of various every human being who is nei- wears, by the furniture and the forms of loneliness. ther a number nor an object but objects with which he is sur- Dispersion in the supermar- a person who should be treated rounded, by the music he lis- ket of sacred, anthropological, as a person, and because man is tens to, by the sport he plays, cosmic and superstitious Ð but the way of the Church, it is and by the words that he uses. above all else do-it-yourself Ð through this care for man that The smallest practices of daily religiosity; the selective and there also necessarily passes the life have become the minuscule weak reception of the Christian new evangelisation. signs in which are written so- faith with a marked tendency to However, this ancient propen- cial classifications Ð distinctive syncretism. A religiosity sepa- sity is today subjected to dis- signs which are distributed ac- rated from socio-economic re- pute. cording to the generalised laws ality. of the market economy’.3 The institution of the Church An increasing disorientation is the element which is most in- The Questions and the Issues for the individual, therefore, but volved in this crisis... but it is also the aura of an indepen- also the most ‘resistant’. Reli- 1. The Cultural Drift dence which he does not wish gious practice decreases. Reli- to abandon. A mixture of toler- gious observance pre-supposes We have before us foreseen ance and uncertainty, relativism above all permanence. Today disenchantment (Max Weber) and fanaticism. This is paradox- cities are from every angle and the dismay which has re- poles of mobility. sulted from it, with its mixture Rapid urban development, of secularisation and supersti- which does little to favour the tion, doubt and credulity, with adaptation of individuals to ur- 117 the aphasia of great tales (F.Ly- ban life, is a factor which ag- otard) and the subtle attraction gravates the decline in religious of the orientalising theosophi- practice. But in the countryside cal aura. This is a varied and as well, which has been trans- complex panorama which im- formed into the outskirts of ur- pairs every metaphysical inflec- ban life, religious practice is tion (and every eschatological ceasing to be a dimension of perspective), and brings with it collective life and is becoming the relativisation of all norma- instead a clearly fragile individ- tive contents (the ethical as- ual or private choice. pect): the idea of an intrinsic The parish tends to disappear moral quality to things and within a frame of undifferenti- forms of behaviour disappears, ated topography... it can also be and this comes to be substituted a place for coming together for by a pragmatic reference to social and/or cultural activity, ‘self-interest’ which is at the ba- but it has a weak or absent rela- sis of social control.2 A greater ical, but really not so much so if tionship with the surrounding (apparent) freedom, paid for Berger is right: ‘the completely urban reality: ‘in less than thirty with a marked subjectivism tolerant individual is ipso facto years this parish civilisation, which closes up everything in a an individual for whom nothing which is derived directly from disappointing narcissism... is true, and in the final analysis post-Tridentine Catholicism, It follows that identity, rather an individual who is nothing. has disintegrated’.5 than being realised through the And it is from this terrain that The prevailing of the world following of prescribed codes fanatics spring’.4 Tolerance un- of systems over the world of (the knocking down of the derstood as disengagement and life leads to the privatisation of mechanisms of social control, a culture of ‘anything goes’; a religion, or to its mutilated pub- ethical emancipation...), is built narcissism which oscillates be- lic role Ð it becomes an agency not in but as biography Ð identi- tween the Promethean (great- of services in response to spe- ty is no longer something which ness, omnipotence, isolation...) cific (socially useful/culturally involves social roles and rela- and the parasitic (shallowness, irrelevant) needs and require- tions. In becoming one, none vacuity, lack of planning). ments. This observation leads and a hundred thousand, man Even the return of the sacred, directly to the subject of health: must search for his identity in a proclaimed with empty hope, in this field as well the historic self-referential ego. The jour- stretches between hypertrophy role and contemporary commit- ney which was begun with the and evanescence. Indeed, it ment of ecclesial realities is ap- Cartesian ‘cogito ergo sum’ seems to many analysts that the preciated. But this is not true in thus ends up with its most dis- very future of Christianity in relation to the cultural perspec- turbing result: ‘not being able the modern world is now a mat- tive which faith involves, both to be designated by the name ter of doubt. at the level of the way in which that he bears, by the lineage The transition from the civitas looking after health is con- from which he descends, by the to the megalopolis, the rise of ceived and at the very sensitive country he comes from, by the the ‘global village’, and then the level of certain crucial bioethi- land that he occupies, by the virtual city, produces that dissec- cal questions. language that he speaks, by the tion between the world-of-life The era of massification is at religion that he professes, each and the world-of-systems which the same time the era of subjec- and every person ends up by generates disappointment and tification. Hegel’s instinctive DH n.45 ing 69-144 2.8.2001 15:45 Pagina 118

perception throws light on this rary depression, a mere acci- The removal of illness and area and demonstrates a surpris- dent on a journey. It requires health from systemic, ‘efficien- ing and lucid foresight: ‘Con- that new evangelisation which tist’ and ‘culturalist’ society on formism and individualisation the Pope has been calling for the one hand, therefore, and on both have their roots in the fact now for quite some time. the other, a ‘healthist’ hypertro- that social bonds and relations Taking care of health is an phy. This is what we are faced have weakened and become less essential chapter in this, both with. ‘Industrialised society has cogent... that the mobility of in- because the human suffering individualised man as a produc- dustrial society facilitates adap- caused by industrial society es- er and a consumer and has bro- tation to models of behaviour sentially involves social isola- ken down his belonging to orig- that are socially accepted and tion and takes the form of ‘so- inal communities. The family, equally favours withdrawal into cial death’ and a lack of rela- the tribe, the village community the sphere of private and per- tionships Ð taking care of health are no longer his natural ‘social sonal things far from social con- in a situation in which the per- associations’ in the situations of ventions and constrictions’.6 son is absent Ð and because the childhood, illness, disability In this society, understood as mystery of evil and the power and old age. As a result, the a ‘system of needs’, men come of redemption are manifested in modern state is compelled to together to associate, of necessi- the taking care of health. organise the state system of ty, only as the bearers of needs The loss of cultural relevance welfare provision. Its services as producers and consumers. of Christian practice in the tak- have to compensate the individ- Everything that completes hu- ing care of health and its intrin- ual for the disintegration of the man life Ð culture, religion, tra- sic connection with the gift of dition, nation, morality, etc. Ð is salvation Ð in other terms the 118 excluded from social relation- dimming of the overall sacra- ships and left to each person’s mental value of the taking care individual freedom,7 unless peo- of health, as an effective sign, ple do not bend before the same even if only proleptic, of salva- logic and form a society of ser- tion Ð brings with it the subject vices. In this sense, religion no of the purported therapeutic longer has anything to do with claims made by the new reli- the principal goal of society but gious movements. Most of the is instead recognised as having people who take part in semi- a function of relief and compen- nars of study, workshops, and sation. This also explains the group meetings aim at the marked scarce social relevance health of the body and the spirit, of the Christian approach. This and their starting point is an ex- increasingly appears to be a set perience of deep existential dif- of ethics which is only ex- ficulty. The ever increasing pressed as an abstract need Ð number of esoteric religious or- Christian love is emigrating ganisations which claim that from the sphere of justice and they lead people to higher levels the social order... of consciousness also promise For a religion, the critical secure and effective therapeutic pre-existing living communi- moment arrives when it is sub- action. Located between gnosti- ties. But because the industrial ject to civil society rather than cism and syncretism, they invite system does not take into ac- being its source of inspiration. people to fuse with nature and count the national, cultural or In this profile all the diagnoses the cosmos in order to grasp the other limits to society as a which are overly centred upon spark of great universal and whole, the organisation of state the existential and upon man spiritual Energy by means of an services cannot but adapt itself must be corrected and supple- immediate and direct contact to the disintegration of commu- mented. One can say, in a cer- with the divinity to be found nities. This can clearly be seen tain sense, that the Christian within us all. This is a new culin the mass movement of man- faith is socially irrelevant not tural paradigm which promises ual labour, capital and industri- because the world has become health and well-being in the im- al plant from industrialised non-believing but because there mediate present. countries to countries which is no longer a need for it in this They offer answers to the have low labour costs etc. But arrangement of society Ð mod- need for identity and harmony, if the state as a ‘welfare state’ ern societies have learnt to keep and social safety, recognition does nothing else but follow the themselves in equilibrium so and acceptance, through an at- changes in people’s lives that ‘the functions of a norma- mosphere of warmth and near- caused by industrialisation, it tive culture, characterised by ness – so-called ‘love-bomb- cannot in the least be said that it ideas shared by everyone, are ing’ Ð and the guidance of a is the state which guides the becoming increasingly super- teacher. Some of these move- destiny of the people’.9 The ‘eu- fluous’.8 ments, such as Christian Sci- genic temptations’ which are The prognostications of the ence, influence not only the re- coming forward in the sphere of prophets of secularisation ligious life of people but also assisted procreation manifest a should not be agreed with or as- their approach to illness and to propensity to yield to the temp- sented to. However, it would be health, and they do this to such tation of utopia through seeking ingenuous to think that the con- an extent as to also become a to achieve a biological perfec- temporary situation is a tempo- ‘religion of healing’. tion which eliminates the finite- DH n.45 ing 69-144 2.8.2001 15:45 Pagina 119

ness of man and thus illness and turns out to be especially am- tures of reference are formed in death as well. biguous. Although on the one a way which is more or less un- hand it is a privilege, on the conscious, and precisely for this 2. The Difficulties other it is at the same time a reason in a way which is more of Pastoral Care trap. A mental trap Ð how many rooted. ‘Reinhardt Koselleck neuroses have been fostered or has identified as a feature of a. The Numerical Reduction sustained by pious presence at modernity the reduction of the in the Number of Presbyters the ‘holy sacrifice’ of the Mass, space of experience and the and New Forms of Ministry by the ‘theophagy’ of the Eu- lowering of the horizon of ex- The spread of non-ordained charist communion, or by the pectations. This means that with ministries in the taking care of wish ‘to say and reveal every- the progressive acceleration of sick people (hospital chaplain- thing’ in the hidden secrecy of historical advance the past no cies...) involves the risk Ð not in the confessional...! A social longer throws significant light itself but because of the con- trap: how many social and po- on the present, and the future is comitance of the reduction in litical strategies in the liturgical deprived of models on which to the number of presbyters Ð of assemblies have not acted as an lean and thus becomes difficult bringing about a thinning of the alibi (maintenance of the estab- to foresee and imagine. Expec- celebration of the sacraments in lished order, of the civil or reli- tation in this way experiences a hospitals and in care for the gious hierarchy, defence of double transformation: on the sick. There is an accentuation privileges...)!’10 But rather as a one hand with the distancing of of the tendency to place the gift result of an always pending the imprint of acquired experi- of salvation within the cate- aporia between objective mean- ences people are encouraged to gories (which are useful, where ing and subjective reception; direct themselves towards a they are suitable, but which are not only as a correct and good search for the indeterminate, the 119 always radically insufficient) of ‘disposition’ at a conscious lev- unknown, and the new; on the psychological support (that is to el but as a real conditioning at other, faced with the complexity say ‘clinical pastoral coun- an unconscious level. At this of events which are seen as un- selling’). level both the symbolic capaci- governable, they are pushed to ty of the faithful and the capaci- drastically moderate their aspi- b. A Half-Way Liturgical ty and symbolic congruity of rations in relation to the future Reform the ‘celebrant’ are called into and to not engage in exorbitant The fate of the liturgical re- play: one is not dealing only requests with regard to it. The form promoted by Vatican with the productiveness of the propensity towards the future as Council II, with its difficulties sacrament but also with its ob- a result obeys simultaneously and its misunderstandings (due jective exhaustion (even if hu- two contradictory tendencies: it not to the impulse of the Coun- man action will never be able to is rendered more acute because cil but to the way in which it neutralise the effectiveness of the need for prediction increas- was received Ð too often selec- divine action at an objective es and it is at the same time de- tive, short-sighted, and futuris- level but only to disfigure it and motivated because the feeling is tic), demonstrates to the full the make it unrecognisable. This, widespread that people are not difficulties of this path. To sum- indeed, it can do, and also in a up to the tasks of prediction and marise, the principal failings very serious way). control. In other words, the which influence in a major way There remains present there- horizon of expectations be- the celebration of the sacra- fore a self-referential which pri- comes lower when the future ments within a context of ill- vatises the sacramental act Ð appears more as an indetermi- ness are as follows: this diminishes the valid need nate threat than as a promise Ð the persistence of formal for a celebration which is taken full of contents and when the and executive forms of engag- part in and felt, the personal ‘re- experience of it as a whole loses ing in ritual; lationality’ of the salvific rela- its characteristics of a meaning- Ð forms of language involv- tionship (tua agitur, ‘he loved ful and consistent continuity. ing gestures and words which me and gave himself for me’), The feeling of discomfort and have little meaning; and into a folding in of the individ- disorientation in a fragmented Ð arbitrary innovations and ual into himself which contra- world thereby spreads’.11 ceremonial ‘selections’. dicts in essential terms both the A sound concern with the theo-logical and the communi- b. Preaching faith of those who ask for the tarian dimension of the sacra- The relevance of convention- sacraments has at times led to a ment. al preaching, which transmits verbose form of liturgy with a the vision of faith in a simple strong didactic and/or paraenet- and effective way, deserves dis- ic or hortatory emphasis which Propaedeutics cussion. In a world in which makes it heavy and also de- perhaps most men have lost or forms it nature. 1. The Patient and Tenacious made uncertain a faith in the Work of Redefining ‘immortality of the soul’ and in c. The Risks of Ambivalence the Cultural Contexts a world beyond this one, it be- and Falsification comes more difficult to think Not in the sense Ð which a. Communication about, plan and implement should itself be rejected on the The health care ministry be- one’s own existence as a period grounds of ambiguity! Ð which gins in the subtle lattice-work of of time which prepares the way is indicated by Chauvet: ‘the communication where the con- for another life. For this reason, sacramental rituality thereby ceptual and symbolic infrastruc- preaching urgently needs a rich DH n.45 ing 69-144 2.8.2001 15:45 Pagina 120

theological rethinking, of a Christian vision itself of man in Ratio). This also implies a ca- wise and courageous character, the wholeness of his natural pacity which is not confined to which does not remove the constitution and historical con- the level of concepts and instru- pressing subjects of suffering dition. ments but which is open to the and death but knows how to Solemn international declara- sphere of meaning and rela- face up to them with illumina- tions bear witness to, and in a tions. tion and a capacity for direction certain sense codify, this shared This allows one to avoid the and meaning. The relationship and widespread sensitivity and double counterposed drift to- between theology and pastoral awareness.12 wards hieraticisation and/or ba- care in health is neither acci- The catechesis, which is the nalisation which threatens the dental nor intrinsic. Without school of faith in the concrete- celebration of the sacraments. theology, diaconia becomes ness of specific historical, per- Above all in a situation which levelled down and becomes re- sonal, cultural and social co-or- is as essentially relevant and duced to any kind of social ac- dinates, discovers in this ten- sensitive as illness, a dry as dust tion which is carried out by spe- dency of the contemporary celebration would empty the cialists and experts. No longer mind a trace and an effect Ð sacramental sign and betray the having clear roots and a secure even though it is only partly re- words of salvation. identity, it falls victim to the an- alised Ð of the Gospel words. It As has been seen, because of thropological ideas of the mo- rediscovers them, indeed, in the worrying decrease in the ment. Without diaconia, for its their value as an overall mes- numbers of presbyters as well, part, theology becomes separat- sage of salvation for man and there is an increase in the risk ed from experienced witness, it for the world. that salvation will be reduced to becomes abstracted from, and Called to be a non-evanescent something which exists within 120 no longer dialogues with, the hermeneutic place of the strong a reductive parameter of an om- community and with the world. moments of existence, the cate- nivore theology of the Word. chesis thus presents itself as an The effectiveness of the Word, c. The Pastoral Vision educational voyage during rightly illustrated by Dei Ver- The ecclesial commitment to which the sacraments progres- bum, cannot be separated from health extends the tasks of the sively also appear in their in- the sacraments, not can it in Christian presence in the planet structive value of welcoming anyway take their place. This is of suffering and medical care and accompanying, an interior a critical element which is also and treatment beyond the tradi- force of renewal and/or coapta- advanced in the world of tional celebration of the sacra- tion, and words of concrete Protestantism, as Pannenberg ments and the other liturgical help. This requires a catechesis well observes: ‘there remains rites. which is able to present in a only to ask ourselves if baptism Today the health care min- clear and convincing way the and the Eucharist are really on- istry involves cultural initia- Christian propensity towards ly illustrations of this verbal tives, the activation of specific perceiving life in positive terms process, which would already training courses for hospital and seeing the gift of life as the contain in itself the salvific staff and personnel, and care centre of the work of creation presence!’13 From the reduction for, and an increase in, profes- and redemption (the tree of life of the theology of the word to sional and voluntary work asso- Ð Jn 10:10). As something pastoral care of the word as the ciations. The figure and the role which is able to educate people sole human consolation, the of the hospital chaplain are also as to the meaning of mystery step is very brief! approached anew in relation (sacramentum!) as a dwelling In their narrative-symbolic both to the action of the health place of meaning and not as the dynamic, rites appear as a pro- care structures and to the local concealing of, or escape from, found experience in which sub- Christian community so that he reality. Pain raises questions for, jectivisation does not come can feel and act as the first and shakes, human intelligence, about through the self-affirma- agent of the health care min- but it cannot be reduced to a tion of the individual but rather istry. mere intellectual question. Only through his conversion. In rites communion with the Cross un- there operates an original and 2. The Difficult and veils the abyss of evil but also irreplaceable pedagogy of the Inescapable Involvement the summit of redemption Ð the faith which marks out life of the Christian Catechesis mystery of darkness becomes paths: ‘rites are workers of ex- the mystery of redemption. istence, operators of images, From ‘Resignation’ to Taking A culture immersed in hedo- matrices which generate experi- Care of Health nism, during the rush for suc- ences, and places of permanent A surprising change in cul- cess, and acting within the maieutics’.14 tural approach Ð health as a pro- myth of eternal youth, places an The sacramental rite reminds ject of society and of life. opaque veil over the under- man of his fact of being a crea- The anthropological inflec- standing of suffering. ture through the radical un- tion of contemporary culture Education in symbols, to availability of language: ‘man leads directly to an emphasis on which reference is often made does not possess language be- the subject of health, and with in the catechesis, must develop cause he does not pre-exist it Ð the risks and the deformations within the person the ability to instead he elaborates it within to which reference has already go beyond the plane of the phe- himself; indeed, he is possessed been made in this paper. But al- nomenon to draw upon (albeit by it’.15 so with the gain of a more com- per speculum in aenigmate) the One should not, however, plete sensitivity towards the plane of foundation (Fides et forget that whereas capacity for DH n.45 ing 69-144 2.8.2001 15:45 Pagina 121

symbols is natural, symbolic Ð I live, I feel, I perceive, I oc- ‘With regard to man, God activity is cultural. It thus in- cupy a space, I am inserted into created him with his hands, tak- volves the catechesis in its a field of interactions which ask ing very fine and pure earth and work of training at the level of questions at every level. Each mixing in the right measure his knowledge (in a total sense) of symbol has its roots in reality, force to the earth. To this end the faith. When this task is well which indeed is accessible to He impressed his likeness on understood and carried out, cor- the human senses, and for this His creature so that he ex- poreality enters as a natural di- reason we must exercise our pressed the image of God in his mension into spirituality, as a senses if we want to understand exterior appearance as well’.20 constituent component to be the language of symbols’.16 ‘Therefore man means above celebrated. Not as a mere cov- all modelled matter followed by ering, an accessory which is the whole man. I would like to cumbersome, but as a suitable References suggest this thought to you so form according to the law of the that you realise that everything ‘In his approach to the sick which was provided for and and to the mystery of suffering’, promised to man is not due only we are told, ‘an individual is to his soul but also to his flesh, guided by a precise conception if not on the basis of shared ori- of the human person and of his gins at least because of the priv- destiny in the design of God’.17 ilege implied in the term’.21 ‘Awake, man, and recognise The Christian Conception the dignity of your nature. Re- of Corporeality member that you are made in the image of God: wounded by 121 A rapid reference to the theo- Adam this was reshaped in logical-practical dimension of Christ’.22 the question is sufficient here. ‘The point of arrival of this However, this is something path, in fact, is the end of hu- which is necessary because a man wishes. Now man desires correct Christian perspective is two things in the main: firstly far from being prevalent in the that knowledge of truth which conception which is most wide- is proper to his nature. Second- ly spread in today’s society. I ly, permanence in being, a will begin with the splendid pa- property which is shared by all tristic forms of witness which I things. In Christ both are to be incarnation. The Christian faith will confine myself to quoting found... If therefore you are and its rites do not produce es- in a direct way: looking for where you should trangement from reality, an es- – ‘Represent God entirely oc- go, welcome Christ because he cape into an imaginary world, cupied with the image of clay; is the way: ‘This is the road, but an ability to immerse one- to it He consecrates hands, travel down it!’ (Is 30:21). St. self in life in forms and expres- thought, action, reflection, wis- Augustine says: ‘Walk through sions which are always authen- dom, foresight, and above all man and you will reach God’. It tic, that is to say salvific. that love which inspired this is better to limp on the way than Things themselves then be- project of His. Because every- walk along off the path. The come transparent and reveal the thing was expressed in that man who limps on the way, mystery of God. All this be- clay, it was conceived with ref- even if he goes only a little dis- longs to the task of initiation of erence to Christ, who would be- tance, nonetheless draws near the catechesis because modern come man, that is to say clay as to the end. The person, howev- man is short-sighted, when that well, and to the Word that er, who walks along off the path is to say he is not actually blind, would become flesh’.18 finds that the faster he runs the when faced with symbols, be- – ‘Indeed, through the Son more he distances himself from cause one dimensional (materi- and the Spirit Ð because they his goal’.23 alist) thought blocks him at the signify those ‘hands’ of God Ð We are still prisoners of the most superficial level of reality. man, and not a part of man, be- metaphysical dualism of ‘Access to the world of sym- comes in the image and like- Descartes if we affirm with him bols is made possible only by a ness of God... The perfect man (or remain in the pre-compre- developed capacity for percep- is a mixture and union of the hensive horizon) that matter is tion Ð to know how to look, lis- soul, which has received the inert extension and spirit is un- ten, touch, and reopen the gates Spirit from the Father, and of extended activity. through which our body places flesh, in which he is joined and We therefore need to over- itself within the environment, shaped in the image of God’. come, in preaching and in pas- that is to say to restore to the Here shaped refers to both the toral practice, an anthropology senses their genuine function, is soul and the flesh! ‘When, in- which is too narrow and which the first and indispensable step stead, this spirit, fused with the ‘despises or at the least neglects by which to draw near to sym- soul, is united to the shaped this essential aspect in man, his bols. The appeal to symbols is, body, through the effusion of relationship with the world’.24 therefore, at the same time an the Spirit there arises a spiritual In this respect I can but direct invitation to rediscover one’s and perfect man: the man who the reader’s attention to the own body, its modes and forms is made in the image and like- splendid vision of the anthropo- of experience and communion ness of God’.19 logical, Christological, histori- DH n.45 ing 69-144 2.8.2001 15:45 Pagina 122

cal, essential and social that is the seventh World Day of the torally suitable (and profession- to be found in the encyclical Sick in Beirut involved dwelling ally excellent) when health is Redemptor Hominis of John upon the subject ‘Request for taken care of in the name and Paul II.25 This leads to a vision Health, Nostalgia for Salvation’. the perspective of overall salva- which perfectly integrates the In the sacraments, health (and tion. deep personal aspect and the its denial) are the tent of the en- apostolic dimension of the counter, in line with a deep The Sacraments: commitment to fraternal soli- nexus, attested to by the whole A New Creation darity: ‘only in coming out of of the practice of Jesus: ‘Christ himself, in creative service to teaches us salvation in healing Within the context of the re- the world, does the individual us. He does this fundamentally newed interest of religion in experience his meaning and in through actions and signs (Mk 1 psycho-physical well-being, one it his salvation’.26 Corporeality 14ss). His, therefore, was a sal- can effect an enlightening tends to communion, it goes to- vation offered sacramentally, re-reading of the subject of the wards the other (the Other). Sin that is to say it manifests and effectiveness of the sacraments inflicts suffering on the corpo- veils at the same time, a propos- of faith. However, it is essential reality of man because it frac- al to faith and to welcoming, not to give way to facile fash- tures communion. Redemption freely effective and entrusted to ions but to carefully verify the reconstructs the unity of the the responsibility of man...’28 opportunities and the inevitable person and of persons because risks. One can certainly affirm it knocks down the wall of sep- The Narrow Way that ‘sacramental life produces aration and reopens access to the overall healing of the per- the Father in a single Spirit. Afflicted health brings out the son’ and share the critical ap- 122 The full positive appreciation ‘precariousness’ of the human proach towards a foreseen of corporeality, in which the cel- condition: the path then either aphaxia of the celebration of the ebration of the sacraments falls into the depths of despera- sacraments, even after the re- writes itself at the summit (cf. tion (or its ataraxic sublimation) form of Vatican Council II.29 Rom 12:1-2) does not put to one or it scrambles on the impene- However, one cannot reduce side the transience of the terres- trable path of the mystery of salvation to the therapeutic trial body and its aspiration to sphere and one cannot indulge salvific transformation, some- in forms of magical-supersti- thing which in the case of illness tious evocations. The fact that becomes especially dramatic many people allow themselves and evident. ‘For this perishable to be attracted by oriental nature must put on the unperish- philosophies and practices, and able, and this mortal nature must forms of religion of the New put on immortality’ (1 Cor Age kind, or even by so-called 15:53). In the work of the Holy alternative forms of medicine, Spirit the continuity between the must not lead to forms of adap- creational act and the sacramen- tation which are equally suspect. tal act is to be found. ‘If he But at the same time this cannot should take back his spirit to be underestimated as being a himself, and gather to himself phenomenon which demon- this breath, all flesh would per- strates a lack of satisfaction in ish together, and man would re- relation to depersonalised medi- turn to dust’ (Job 34:14). cine, on the one hand, and to a The Christian vision of spirituality and a liturgy on the health as a value (see e.g., Jn other which do not respond to 1:1ss; Sir 30:14ss; Jn 10:10, the depths of meaning. without forgetting Gen 6:12: pain on which with great diffi- What should be the relation- ‘And God saw the earth and be- culty the person’s gaze opens up ship between religious faith and hold it was corrupt; for all flesh and expands to the horizon on the physiology of the body and had corrupted their way upon which wishes and expectations health? Some recent research the earth’) does not for this rea- progressively abandon the un- brings out a greater capacity for son fall into a facile and illuso- certain outlines of dreams or a reaction on the part of religious ry optimism in which the cor- utopia to encounter the question people. The Christian concep- rect vision of health as the over- Ð and then the gift Ð of salvation of the person provides all well-being of the person in tion. guidelines as to how to face up his environment forgets the fact The wish for health is a wish to illness and suffering, and that suffering cannot be sup- for the infinite and an invoca- turning to God in situations of pressed and thereby becomes tion of salvation. It is necessary difficulty is not a symptom of impeded in assessing it in a to combat, with a strong and weakness but the perception of suitable way. ‘Suffering seems multiform cultural action, the an ultimate reference point, of to belong to the transcendence falsifications of the surrogates the origins and ends of our life. of man. It is one of the points which mislead or the mystifica- The wish for care and treatment where man in a certain sense tions which reduce health to which takes the whole of the comes to be ‘destined’ to rise physical performance, to beau- person into consideration is above himself, and is called to ty, and to sporting and competi- alive and strong, that is to say this in a mysterious way’.27 tive energy. an approach to health and heal- The principal celebration of Therapeutic capacity is pas- ing in which the spiritual di- DH n.45 ing 69-144 2.8.2001 15:45 Pagina 123

mension is recognised as hav- everything is created, it also, of man within the universe has ing a primary role in the facts of however, is not in a state of per- a profound theological (salvif- the case. fection but of movement to- ic) meaning. wards perfection. Because of One can therefore positively In the Background a Theology the invasion of sin it was sub- affirm that man is to be found and a Mysticism of Creation jected to the risk of disfigure- in a meaningful relationship ment, transience, annihilation: with the world. The advance of ‘Accende lumen sensibus/in- the ‘grimace of being...’ science, although in an increas- funde amore cordibus/infirma We have to retrieve this dy- ingly deep way it discovers the nostri corporis/virute firmans namic and spiritual relationship laws which regulate the uni- perpeti’. with the created, but without verse with admirable perfec- This is what Bulgakov calls falling into those forms of new tion, and although it perceives the ‘natural grace of the cre- superstition (modern gnoses) with greater awareness (and ation’. The world is not extra- which lead to a liquefying of less mechanics) its intrinsic neous to God or hostile to Him: the relationship with nature into logicality and correlation, finds it is the work of His hands. At a pantheistic and psychologis- itself increasingly powerless to times a very poor interpretation ing identification which is very understand its meaning. As the of Christian faith has produced far from the Christian approach Nobel prize winner S.Weinberg a marked lack of sensitivity to- Ð the Spirit pushes us towards a puts it: ‘the more the universe wards the world and nature, or relationship of responsible and appears to be understandable, even a devaluation of every- creative commitment, which is, the more it appears to have no thing that is material or corpo- that is to say, cultural and not purpose’.32 It is only in its rela- real. However, it is not possible falsely mystifying. tionship with man (and thus here to discuss the bases or the This allows us to refer again with God) that the universe can 123 limitations of this critical ap- to the stimulating work by Bul- pass from the cold and impene- proach. gakov: ‘the creation possesses trable perfection of the scientif- But it should be restated with its own depth and its own ic vision to the meanings of the great force that every devalua- strength. One could even say vision held by faith: ‘This is tion (like every exaggerated that the world has a created what we read in the first words evaluation) of terrestrial reali- soul... The Spirit of God which of the Book of Genesis: “In the ties is to be located outside an hovers over the creation mani- beginning God created the sky authentic Christian perspective. fests through its force the forms and the earth... and the spirit of The God of Israel, the God of of being hidden in Him... The- God (ruah Elohim) descended Jesus, is the God of the creation ology thus meets natural sci- on the waters”(Gen 1:1ss). This and of history. The traces of the ence, which hopes to become biblical concept of the creation love and of the goodness which the theology of nature’.(p. 323) involves not only the call to ex- led God to the creation are to be The creation is dynamism istence of the very being of the found in terrestrial realities. against nothing. In this way the universe, that is to say the giv- Even medieval (Scholastic) the- world can take on that eschato- ing of existence, but also the ology stated this without hesita- logical dynamism which con- presence of the Spirit of God in tion: ‘This action of the natural stitutes its meaning and destiny. the creation, that is to say the grace of the creation, breathed The creation is not only ex nihi- beginning of the Salvific com- by the Holy Spirit into the crea- lo, it is also contra nihilium. municating of God with the ture, this soaring of the Holy Because of this liberating and things that he creates. This is Spirit which dwells and always promoting value, the creativity true first of all of man, who was continues over the waters of the of man is linked in the biblical created in the image and like- creation, is the positive force of vision to divine blessing (Gen ness of God’.33 being’.30 It is also the authorita- 1:28). This refers to the con- Two testimonies of special tive teaching of John Paul II: stant action of God in relation incisiveness from worlds which ‘In this way the Church also re- to man to achieve his salvation: are different in terms of epoch sponds to certain deep elements His blessing, therefore, inserts and sensitivity, but which come (ecology, New Age) which be- from the moment of the cre- from the same source-spring of lieve that they can read the ation of man (and correlatively faith, should here be presented hearts of the men of today: a of the world) a dynamism and to the reader: new discovery of God in his orientation which find in His – ‘I, the most sublime and transcendent reality of infinite word (‘and God said...’) the in- burning power, have lit every Spirit, as presented by Jesus to dication of His project and in spark of life... I, the burning life the Samaritan woman; the need His action (‘and God blessed of divine essence run shining to worship Him “in truth and in them...’) the propulsive force of through the beauties of the spirit” (cf. Jn 4:24); the hope of realisation. In this way, the ac- meadows. I shine in the waters finding in Him the secret of tion of man within the universe and burn in the sun, in the love and the force of a “new is creative because it is origi- moon, and in the stars. I with creation” (cf. Rom 8:12; Gal nally, dynamically, and consti- every breath of wind, which 6:15): yes, precisely He who tutively connected with the cre- like invisible life maintains gives life’.31 ative action of God, and everything, awaken the whole The beauty of nature has its through the close link of this of life. The air lives in the com- strengths and its limitations. A with the history of salvation it ing forth of green and of flow- sign of the work of the Spirit, a receives from it vocation and ers. The waters flow as though reflection of the perfect image salvific strength. they were alive... And thus do I of the Father, Christ, in whom For this reason, the activity lie, hidden in all reality, like a DH n.45 ing 69-144 2.8.2001 15:45 Pagina 124

burning force. Everything The sacraments tell the truth which in the constitutive image bursts into flame through Me about life. They are the begin- and likeness establishes his just as the breathing of man is ning of (real) life because eter- bond and creative projection in always in movement, similar to nity lies in being with Christ time. a flame shaken by the wind... with the Lord (Lk 23:42ss; 2 Modern society favours the To all things I give the breath of Cor 5:6-8; Phil 1:23; 1 Theos future (traditional society life... because I am life’.34 4:17). In this way, in the per- favours the past). But the falling – ‘Today, for the first time, I spective of faith, there is healed curve of modernity is charac- have understood what is meant that yearning, which would oth- terised by the fact that man no by the statement that all things erwise be only utopian, for longer finds himself in front of speak of God. He created every- completion,37 and the redemp- a clear vision and a future thing and every single thing, He tion Ð at the level of meaning which is seen as being progres- is behind every smallest reality. now and fullness later Ð of the sive and certain. Instead, he ‘is Everything, constantly, is recre- intolerable in-significance of once again in front of chaos’.40 ated through Him. The person pain and death.38 On the one hand, this appears who experiences this, experi- as a very open and uncondi- ences God in everything. Al- The End of Time, the Time tioned possibility. ‘With the en- ways different, as this leaf is. of the End. Hope and Pledge try of the future into the imagin- And it is always Him. This was able the secularisation of history experienced by the Greeks ‘The path towards the Ju- comes to a conclusion. The un- when they saw each and every bilee, while it refers to the first known of the future, without a thing as being divine’.35 historical coming of Christ, al- face and without a name, but so invites us to look forward in which compels nothing, towards 124 the expectation of his second which no hidden determinism Approaches and Practice coming at the end of times. This hurries, is the pure future, liber- eschatological perspective, ated from the theological tangle Pastoral Action which which indicates the fundamen- which continued to partly hide it Proclaims the Uniqueness tal tendency of the Christian ex- for two centuries... This is its of the Salvation of Christ istence towards ultimate reali- greatest paradox: it becomes ties, is a continuous appeal to more secular the more it is seen In the pastoral vision and pas- hope and at the same time to as belonging even more to the toral practice the understanding commitment in the Church and order of the invisible’.41 of the sacraments as events of the world. We must not forget On the other hand, this in- overall salvation finds response that the éschaton, that is to say volves an evident loss of recog- and almost reinforcement in the the final event, understood in nisable perspectives on the fu- idea that the sick person is a Christian terms is not only a ture; the post-modern returns to sacrament of suffering Christ. goal placed in the future but al- myth. But it does not abandon The proclamation of the so a reality which has already mobility, the real fact of the salvific effectiveness of the begun within the historic com- modern. One time, our own, is sacraments does not give rise to ing of Christ. His passion, his defined perhaps more by escape any simple illusion. The sacra- death, and his resurrection con- from reality rather than by the ments open up hope, through stitute the supreme event of the dominance of reality, at least death, not by by-passing it but history of humanity. This has from an anthropological point by enduring its apparent victory by now entered its final stage, of view. Contemporary culture in order to proclaim the real engaging thereby, so to speak, displays a situation of stall and victory of Christ. in a leap of quality. There is almost of the irrelevance of his- Furthermore, the removal of opened up within time the hori- torical time. The fleeting mo- death (by the various ways zon of a new relationship with ment is not only the title of a which not only an instinctive God, characterised by the great successful film of a few years mechanism of defence but to- offer of salvation in Christ’.39 ago, it also reflects a rather day a more threatening and sub- History is the place of Reve- widespread perception (even tle cultural mystification con- lation and the space for its ful- though this perception is rarely stantly formulates and propos- filment. In the creation of man worked out or rendered explic- es) is an emptying of being and God impresses a dynamism ac- it). The faith itself of Christians a dulling of knowledge. ‘From cording to which reference to has questions posed to it by the death, from the fear of death, nature does not indicate Ð as is fleeting moment and suffers begins and is raised all knowl- the case with the animal king- difficulty because of it. A fun- edge about Everything’.36 This dom Ð repetition (evolution, damental and leading category is the overturning of the ‘timor correctly understood by the is at stake: ‘In Christianity time fecit deos’ of ancient memory various scientific theories does has a fundamental importance. and modern (Freudian) redis- not markedly alter this picture, Within its dimension the world covery. Without the thought of which is substantially static). was created, within it there death, life would fold in on it- Rather, it involves a norm of takes place the history of salva- self in a present foolishness creativity. In other terms, man tion, which has its culminating which is drawn between ag- was created to live in and to point in the ‘fullness of time’ of gression and dismay. The cultivate the garden, to grow, to the Incarnation and its end in Christian vision locates the multiply and to dominate the the glorious return of the Son of horizon of life and celebrates it, earth. Neither arbitrarily nor in- God at the end of time. In Jesus giving it a real beginning and dependently, certainly, but ac- Christ, the Word made Flesh, visibility, in the sacraments. cording to the norm of nature, time becomes a dimension of DH n.45 ing 69-144 2.8.2001 15:45 Pagina 125

God... From this relationship of qualification of culture because and free other people’.46 God with time is born the duty faith in Christ is not a pure and But not only as a predisposi- to sanctify it’.42 simple value amongst the values tion. More deeply as a histori- If time, instead, is confined which the various cultures put at cal-existential truth of the to the present, if one does not their centre. For the Christian it sacraments. Their effectiveness give any overall meaning or is the last judgement which achieved ex opere, indeed, does meaning in terms of design to judges them all, albeit in full re- not render what constitutes events, which take place with- spect for their own coherence’.44 their human component super- out pausing without ever ‘oc- This does not involve any fluous or marginal. Indeed, it is curring’; if the only philosophy prevarication, nor any mixing. precisely the sacraments which of history remains the disap- The Church does not invade the fully appreciate and require, by pointed ‘carpe diem’ of Horace, sphere of state powers, nor does their internal logic, the highest there is no place for the very she merge with them.45 consistency between the visible idea of creation and redemp- sign and action, albeit always tion, there is no place for Christ Motivations sovereignly freely given by as the alpha and omega of his- grace. The ecclesial agent who ad- To the necessary psychologi- ministers the sacraments does cal maturity and interior clarity not enter merely at a functional other requirements are thus level so as to constitute the added which take form from sacramental sign. the very practice of Jesus: One is certainly dealing with Ð He shows that he is always psychological maturity and up- interested in the inner man, right intention, as J.Moltmann even though there is a clear pri- 125 explains very well: ‘The person ority of the eternal over the who commits himself to social temporal. or diaconal action because he Ð For this reason he keeps a has not solved his own personal visible critical distance: a space problems does nothing else but of encounter in order to open impose his own burden on oth- the necessity of faith and a con- ers. Social action and the diaco- fident entrusting. nia are not remedies for the Ð Jesus does not confine him- weakness of the self. We have self to fighting symptoms or often seen in recent years stu- syndromes: he wants to en- dents who sought to compensate counter the sick person, defeat for their internal emptiness with his estrangement (and at times good works done for other peo- social ostracism) through con- tory. Everything comes to be ple. In this way they have made tact, nearness, and the saving swallowed up by a present those in need even weaker. The encounter. which is suspended in the void. person who wants to help and to Ð Healing is a gift: no com- For the Christian faith a reli- do something for others or the pulsory tie (even if gratitude is gious dimension is not given world, without having deepened expected): open freedom even which is not Ð contemporane- his own knowledge about him- after the healing. ously and substantially Ð an self, his own freedom and ca- Ð The relevance of biography ethical dimension, involvement pacity for love, will not find for the pastoral care of the ill- of existence in the construction anything that he can give to oth- ness (of the sick person) and for of a new society of which the ers. Granted his good will and a fruitful celebration of the Church is the sign and the first his good faith, he will do noth- sacraments. A fact which the fruit.’43 ing else but communicate his communicating tradition of the When the Christian involves own selfishness to other people, past has always considered (al- himself, as a Christian and in re- his fear, his aggression, his self- though certainly favoured by a sponse to the impulse of his own ish ambitions, and his ideologi- much more homogeneous Christian faith, in the au- cal prejudices. The person who socio-cultural situation). tonomous structures of the wants to fill this emptiness Ð You will never allow me to world of politics, of the econo- through helping others will only die alone in the anonymous my, of science, and of culture, spread this emptiness. Why? death of a hospital... The escha- he does this in the knowledge Because every person acts on tological dimension is real if it that these structures remain au- others not so much with his own is not confined to sublimating tonomous and of this world. action as with his existence, and the Christian action but really And yet the Christian is well more than we activists would connotes it making it capable of aware that even the dignity of like to admit. Only the person criticism and suitable planning. the creature, which is positive who has found himself can give and ‘autonomous’, wounded as of himself. Only he who has Specific Questions. it is by sin, inexorably runs the recognised the reason for his The Specific Ways of risk of destroying itself when it own life can act in a rational Celebrating the Sacraments is not made true by grace. The way. Only the person who has in Situations of Illness Christian belief is courageous become internally free from and Infirmity and respectful: ‘There exists, selfishness, from the weakness and one should not be afraid to of the ego and of anxiety, can According to the (theological) affirm the point, a Christian share and welcome suffering law of incarnation, the nature of DH n.45 ing 69-144 2.8.2001 15:45 Pagina 126

the sacraments Ð in its symbolic datur’): the viaticum summaris- gence and criticism which char- linguistic nature Ð writes the ac- es the sacramental journey to acterise our culture of suspi- tion of God into the reality of salvation in the dimension of a cion, without however yielding the human in the real dimension company which is already a to the intellectualist movement of corporeality and the internal new beginning. which falls back into itself. dynamics of the human person, who in a certain way is connot- The Personal and Community Pastoral Subjectivity: The Sick ed and conditioned (kenosis) by Dimension: Balance Person Teaches the Healthy it. This confers (and requires) a and Reciprocity different resonance of words To frequent the world of the and a different impact of ges- Diaconia is worthy of the sick is an authentic school of tures. As has been repeatedly name ‘Christian’ only if it is life, an apprenticeship which de- observed in recent studies, in the based upon the agape of Christ. velops a capacity for discern- celebration of the sacraments It expresses itself in and from ment in relation to the funda- the illocutionary dimension pre- the community, it addresses it- mental questions of existence in vails over the elocutionary. In self to everybody, without any an insuperable way. The sick this way, the form is a funda- form of discrimination (Gal person also shakes the most mental question. The commu- 3:28; 1 Cor 12:1). The Eu- sluggish sensibility and reminds nicative encounter is that in charistic assembly is the point it of the most simple and pro- which a/the person/people re- of departure, the narrative place found values which in a situa- veal himself/themselves, that in where the word is a memorial tion of good health are often rel- which something takes place (an and an announcement (event egated, paradoxically enough, to event). And the place of celebra- and practice) of salvation. This a secondary level. It is a school 126 tion is a symbolic space in does not mean that the truth of for relationships. Even those re- which the architectonic struc- faith depends on the verifiabili- lationships which are nearest ture, sound and music, the ty of socially perceivable ef- and most intimate are under- arrangement of objects, and the fects. It does not make them ir- stood afresh and aspects of them movements and actions of the relevant; indeed, quite the con- emerge which daily routine had various actors all constitute not trary. left in the shade. There are thus only the con-text, or the enjoyed, albeit in the dramatic pre-text, but the text itself of the Welcome and Availability nature of the situation of illness, sacramental event in the exer- Above All discoveries of humanity which cise itself of the functions for would otherwise have remained which they are respectively re- Pastoral dialogue requires latent. Conversely, we are put to sponsible. evangelical questions to be the test because the patient asks In this symbolic practice one raised (the encounter between for care and attention, reacts is dealing not with the transfor- the Gospel and the faith of the with acute sensitivity, and at mation of the world but of itself Church cannot be omitted or times also puts the person who in relationship with God. watered down in an attempt to takes care of him with a gener- Everything thus converges on achieve peace). But it also asks, ous spirit to the test as well. that nucleus which is the sacra- on the other hand, that these The bed of the sick person is mental formula in a narrow questions are raised in the style a teaching chair of spirituality sense, a formula incorporated of the Gospel. This means the and faith. in the gesture itself, in which welcoming of people as they the expression of faith reaches are, in their concrete humanity, its full truth (for example the with their imperfect motivations Conclusion baptismal rituals of the ancient (but who, one might say, can Church where the liturgical say that they are perfect?). The The training of those who are practice was the profession of ethical approach does not gen- called to work in the world of the faith which was underway). erate moralism but pastoral care health care is without doubt one The messianic ministry of and concern so that its fragile of the primary concerns of con- healing is completely the oppo- flame can release full light. temporary society, which is so site of the removal of suffering. Welcome also involves cele- interested Ð even if not always It does not remove it, nor does brations which can be under- in a positive or correct way Ð in it sublimate it. It faces up to it stood and which are accessible. the quality of life. The great and fights it; it understands and This does not mean a broaden- transformations which charac- accepts the mystery of suffering of the didactic part, some- terise the modern age, above all ing. On the contrary, the lack of thing which leads to a deforma- during these recent decades soteriological (existential) rele- tion of the liturgy and the bore- which have opened up towards vance provokes the evanes- dom of the community, but, the third millennium, have cence of the Christological rather, making the rite alive and deeply affected the identity and proclamation, and the eschato- meaningful. This is a by no role of health care workers. logical reference appears as an means easy task. Here, indeed, These, no less than other pro- escape route in the face of a we have two apparently contra- fessional figures (indeed, per- powerlessness to heal. dictory points Ð respect for the haps more acutely), feel the Suffering as daily baptism language specific to the liturgy impact and difficulties of these marks out a way of conversion in its symbolic and pragmatic transformations. This is ob- in which the Eucharist brings inflection on the one hand; and served in a strong way at the its own promise to fullness (‘fu- on the other, taking into full ac- level of points of reference in turae gloriae nobis pugnus count the upholding of intelli- terms of values and at the level DH n.45 ing 69-144 2.8.2001 15:45 Pagina 127

of new knowledge and techno- the observations of the Magis- ple, between the faith that they logical and scientific approach- terium, produces not only profess and their daily lives, is es. These give rise to problems strengthened personal beliefs to be listed among the most se- and difficulties which are by no but precise formative paths. A rious errors of our times. For means small; at times, indeed, salient feature of these is the this reason there should not be they lead to regressions and constant search for the deep, opposition, without good rea- backward steps which are and I would like to say inner, son, between professional and deeply damaging. However, quality of the medical profes- social activity on the one hand these reasons for worry and sion, in the heart itself of the and religious life on the other’ concern should not lead us to Gospel of life. And in a way (Gaudium et Spes, 43). forget that during our epoch that Christian faith does not ap- The Christian faith therefore new prospects and horizons are pear only as an additional mo- proposes an overall vision, being opened up of a very great ment or an ethical border but as which is unitary but not static, and positive nature. an original and special factor of the world and life. For this First of all, reference should of the harmonic and positive reason, in addition to the nec- be made to the cultural widen- expression of the capacity that essary knowledge of the ing of the concept of health, the work of God the creator Catholic faith at the level of its something which is no longer doctrinal and moral implica- confined to an absence of ill- tions, it would be highly op- ness and the clinical structures portune for faculties of medi- which are dedicated to the cine to give space and impor- treatment of such illness. This tance to the study of the social has taken place with undoubt- doctrine of the Church, above ed advances but also with all else through research and 127 equivocal extensions which, by exchanges of an interdiscipli- identifying the value reference nary character between the var- points in a social practice ious faculties. In this way, in which is subject to alteration, addition to framing formative bring about approaches, forms paths which are more harmo- of behaviour, and legislative nious and understandable, one codifications which are con- can set in motion an overcom- trary to the fundamental rights ing of that accentuated frag- of the person. Based upon a mentary character of knowl- markedly subjectivistic cultur- edge which characterises the al platform, the expansion of present-day configurations of the concept of well-being Ð university teaching in a sepa- which is in itself positive Ð rateness which damages the thus runs the risk of rebound- overall training of the person. ing against man, while the de- places from the outset in the The identification of relation- sire for life, which is anchored hands of man and the salvific ships which are established to- only in a self-referential way, gift of the passion of the Re- day between social praxis and declines into a culture of death. demptor which redeems evil the concept of health thus All of this calls Christians to a and raises up to an always new demonstrate themselves to be, commitment which is more expansion of life. In this way, when understood in the light of convinced and stronger, as the incarnating itself in a compe- faith, a suitable and appropriate Pope reminded us in the en- tent and wise professionalism, path for a relaunching of the cyclical Evengelium Vitae: ‘the the word of the Gospel pro- profiles of professional ethics task of accepting and serving claims the opening up of the which are now so necessary, es- life involves everyone; and this horizons of life onto eternity Ð pecially in the medical field. task must be fulfilled above all not tearing it in the least but This is an appeal which has a towards life when it is at its rather increasingly positively value which is completely spe- weakest. It is Christ himself and involvingly immersing it cial: ‘What is urgently called who reminds us of this when in time and history. for is a general mobilisation of he asks to be loved and served There is thus achieved at a consciences and a united ethical in his brothers and sisters who deep level the unity of faith and effort to activate a great cam- are suffering in any way: the of life to which Vatican Council paign in favour of life. All to- hungry, the thirsty, the foreign- II called our attention: ‘The gether we must build a new cul- er, the naked, the sick, the im- Council exhorts Christians, who ture of life; new because it will prisoned... Whatever is done to are citizens of different cities, to be able to confront and solve each of them is done to Christ strive to carry out their earthly today’s unprecedented prob- himself (cf. Mt 25:31-46).’47 duties faithfully, making them- lems affecting human life; new, A specific and special task, selves be guided by the spirit of because it will adopted with in this framework, falls to aca- the Gospel. Those are in error deeper and more dynamic con- demic institutions Ð a role of who, knowing that we do not viction by all Christians; new, increasing relevance from a have here a stable citizenship because it will be capable of scientific and cultural point of but instead search for that of the bringing about a serious and view. In such institutions, future (Heb 13:14), think that courageous cultural dialogue thought imbued with faith, ma- they can neglect their earthly between all parties’.48 tured in the cultivation of a ro- duties... The detachment, which Enjoyed and/or refound bust spirituality enlightened by is to be observed in many peo- health manifests the mystery of DH n.45 ing 69-144 2.8.2001 15:45 Pagina 128

the human condition and re- 19 IRENAEUS, Adversus Haereses, 5, 6, is there still a horizon of expectation 1. when there is no longer utopia, when veals ‘in the flesh’ the mystery 20 IRENAEUS, Espositio Praedicationis what E.Bloch has called the of the compassion of God, cre- Apostolicae, 11. ‘Principle-Hope’ has gone?’ ator and redeemer. It is an intro- 21 TERTULLIAN, De Resurrectione 38 Ibid., p. 31: ‘Thus I ask myself the duction to the immense mys- Mortuorum, 7. question which I will leave this evening 22 LEO THE GREAT, Sermo, 27, 6. without an answer: in the same way in tery of death and foreshadows 23 THOMAS AQUINAS, Esposizioni su which the idea of progress has been for the blessed resurrection. Giovanni, chap. 14, lectio 2 (comment the modern period the secularised equiv- on ‘Io sono la via’, Jn 14:6). alent of a secularising Heilsgeschichte, 24 CTI, ‘Alcune Questioni Riguardanti does there not take form today, in the Prof. MONS. SERGIO LANZA la Cristologia’, Civ. Catt. 131 (1980), epoch which some call post-modern, a Director of the Pastoral Institute 4/278. new face to face between the preaching ‘Redemptor Hominis’. 25 In particular nn. 11-15. of the madness of the cross and the 26 H.U.VON BALTHASAR, Verità del kènosi of Christ and the decayed forms Mondo (Teologica II, Milan, 1987), p. of the Hegelian philosophy of history? 66. And if one asks what Christians still 27 SD, 2. have to say on the matter, I answer: the hope that in a way which is unknown to us the histories of victims, defeated and Notes scattered histories, will collaborate with the Kingdom of God which will come. A 1 CCC, 1421. hope which, without doubt, is itself 2 Cf D.MARTIN, A General Theory of mad...’ Secularization (Oxford, 1978). 39 JOHN PAUL II, Catechesis of 3 P. BOURDIEU, La Distintion (Paris, Wednesday, 22 April 1998. 1979), La Distinzione (Il Mulino, 1976). 40 R.GUARDINI, La Fine dell’Epoca 4 P.L.BERGER, Una Gloria Remota..., Moderna (Brescia, 1993(8); Basel, p. 73. 1950), p. 74. 5 D. HERVIEU-LEGER, Verso a Nuovo 41 M.GAUCHET, Le Dèsenchantement Cristianesimo? (Brescia, 1989), p. 59. du Monde (Paris, 1985), p. 267. 128 6 H. SCHELSKY, Die Skeptische Gener- 42 TMA, 10. ation (1963), 2, p. 297. 43 C.RUINI, Il Vangelo nella Nostra 7 J.MOLTMANN, Teologia della Sper- Salute. Chiesa, Cutlura e Società in anza (Brescia, 1966), pp. 316ff. Italia (Rome, 1989), p. 76: ‘The insepa- 8 F.X.KAUFMANN, in F.X.KAUFMANN rability of the religious dimension from AND J.B.METZ (ed.), Capacità di Futuro the ethical dimension constitutes the fun- (Brescia, 1988), p. 68. damental structure of the Old Testament, 9 J.MOLTMANN, Diaconia. Il Servizio from the covenant of Sinai to prophetic Cristiano nella Prospettiva del Regno di preaching. In the New Testament love Dio (Turin, 1986), p. 22. for God and love for one’s neighbour 10 L-M.CHAUVET, Linguaggio e Sim- make up an indivisible unity in which we bolo..., p. 150. address ourselves to everybody, includ- 11 R.BODEI, ‘La Salvezza Laica. Miti e ing our enemies, up to the point of ‘turn- Utopie della Rivoluzione Francese’, in ing the other cheek’. In Holy Scripture G.FERRETTI (ed.), La Ragione e i Simboli there is no dualism between intention della Salvezza Oggi (Genoa, 1990), p. and action (just as there is no dualism be- 80. 28 F.ALVAREZ, ‘El Evangelio, Fuente tween ‘soul’ and ‘body’, but rather at the 12 For example: the Universal Decla- de Vidaen el Mundo de la Salud y de la same time the most radical penetration ration of Human Rights (10.2.1948), art. Enfermedad’, in Camillianum, 11, into the centre of the person (the ‘heart’), 25,1: ‘every individual has the right to a (1995), p. 46. against the exteriority of legalism, and standard of living sufficient to guarantee 29 A.LANGELLA, ‘La Funzione Ter- the most rigorous concreteness of the his own health and well-being and that of apeutica della Salvezza nell’Esperienza ‘works of love’. Not only solidarity to- his family’. The Constitution of the della Chiesa: Sguardo Diacronico e Rif- wards the poor man, but also justice are World Health Organisation (1946), art. lessione Sistematica’, in N.Terrin (ed.), fully included: Christian love is not a 1: ‘the objective of the Organisation will Liturgia e Terapia. La Sacramentalità a surrogate for justice, and not even sim- be to obtain for all peoples the highest Servizio dell’Uomo nella sua Interezza ply a development which goes beyond it, level of health’ (see also the ‘Preamble’: (Padua, 1994), p. 126: ‘Sacramental the- as is often thought in opposing quarters. responsible governments: health as a ology and liturgy, even after the reform On the contrary, love involves justice as subject of international policy; the Dec- of Vatican Council II, have only implic- an essential part of itself... It is true laration of the Rights of the Child itly restored the therapeutic role of the rather that justice can be fully achieved (20.11.1959): ‘the child must benefit sacraments’. only through love, that is to say by open- from social security. He must be able to 30 S.BULGAKOV, Il Paraclito ing ourselves to the other, giving our- grow and develop in a healthy way. To (Bologna, 1971; Paris, 1935), p. 321. selves to him, and accepting him in his this end medical care and treatment and 31 Dominum et Vivificantem, 2. quality as a man. Here a very solid suitable social protection must be guar- 32 S.WEINBERG, I Primi Tre Minuti thread links the preaching of the anteed to him and his mother, especially (Milan, 1977), p. 170. prophets with the words of Jesus, the in the period before and after birth. The 33 Dominum et Vivificantem, 12. Gospel, and the First Letter of John and child has the right to nourishment, a 34 H. VON BINGEN, Welt und Mensch the First Letter of James, to cite only a home, entertainment, and suitable med- (Da Operatione Dei) (Salzburg, 1965), few meaningful examples’. ical care and treatment’. The Italian Con- p. 25. 44 JOHN PAUL II, Homily 8 February stitution, art. 32: ‘The Republic defends 35 R.GUARDINI, Wahrheit des Denkans 1984. health as a fundamental right of the indi- und Wahrheit des Tuns (Padeborn, 45 Vatican Council II, Gaudium et vidual and interest of society as a whole 1985(4)), diary 24 August 1953. Spes, 76: ‘The Church, because of her and guarantees free care and treatment to 36 F.ROSENZWEIG, La Stella della Re- office and her role, in no way can blend the sick’. denzione (Casale Monferrato, 1985), p. with the political community and is not 13 W.PANNENBERG, Teologia Sistemat- 3. linked to any political system. She is at ica, 3, (Brescia, 1996; Gottingen, 1993), 37 P.RICOEUR, ‘Miti della Salvezza e one and the same time the sign and the p. 374. Ragione Contemporanea’, in Ferretti safeguard of the transcendent character 14 G.SOVERIGNO, Rito e Persona. Sim- (ed.), La Ragione e i Simboli della of the human person... In preaching the bolismo e Celebrazione Liturgica: As- Salvezza (Genoa, 1990), p. 30: ‘The evangelical truth and throwing light on perri Psicologici (Padua, 1988), p. 62. question which should be raised is that of all the sectors of human activity with her 15 M.L.CHAUVET, Du Symbolique au knowing whether a society can live with- doctrine and with the witness borne by Symbole. Essais sur les Sacrements out a collective project, without a direc- Christians, she also respects and pro- (Paris, 1979), p. 20. tive utopia. This is the question posed by motes political freedom and the respon- 16 O.BETZ, I Simboli per Comunicare R.Kosellec in Vergangene Zukunft. Is the sibility of citizens’. l’Esperienza a la Fede (Frascati, 1990), structure of historical time, which is not 46 J.MOLTMANN, Diaconia. Il Servizio p. 6. represented but lives and put to work, Cristiano nella Prospettiva del Regno di 17 DH, 2. made up of the polarity between horizon Dio (Turin, 1986), p. 37. 18 TERTULLIAN, De Resurrectione of expectation and space of experience, 47 EV, 43. Mortuorum, 6, 3-4. something which can be overcome? And 48 EV, 95. DH n.45 ing 69-144 2.8.2001 15:45 Pagina 129

Conclusions of the Work Groups of the Study-Seminar on ‘the Sacraments in Pastoral Care in Health’

The Pontifical Council for situation of weakness with re- thentic journey of healing the Health Pastoral Care promot- gard to the preaching of the soul. Only after this has taken ed and organised a Good News. Hospitals also place can one think of special study-seminar on ‘the sacra- experience a situation of in- celebrations with special ments in pastoral care in complete evangelisation Ð the spaces for the sick person. health’ which was held on 2-3 present is crystallised without In this context a specific June 2000. This was organ- an eschatological hope being space is opened up for the in- ised and promoted together provided. volvement of members of the with the Pastoral Institute 2. It is necessary to share laity who can draw near to the ‘Redemptor Hominis’ of the the pain of the sick person be- sick person with a more direct Pontifical Lateran University ginning with the illness. The perception of his family and and was addressed to theolo- attitude of the worker of pas- social condition. gians, experts and workers toral care in health involves The relationship with the 129 who are active in various ca- compassion (in the etymolog- sick person must be experi- pacities in the world of health ical sense of ‘with’ passion), enced as a mutual exchange Ð and suffering. of drawing near to the situa- the sick person, too, catechis- Certain observations and tion of precariousness and es. Too often in hospitals the proposals emerged from the concern, but it also involves figure of the psychologist is work groups over these two openness to the great ques- more present than the figure days: tions of the meaning of life of the chaplain. In this way 1. Contemporary society which are provoked by the the marginalisation of the presents itself as an entity state of illness. sacraments is accentuated: the which is divided into speciali- At times the very celebra- relatives themselves, rarely sations. Pastoral care also re- tion of the sacraments runs helped to understand the ther- quires specialisation. However, the risk of falling into forms apeutic value of the sacra- this is not free from risks, and of a miracle-working kind. mental event, impede its cele- in particular those which are Too often the person who is bration and maintain that it is run when separating contexts suffering in his body searches a dark harbinger of death. At which are strictly connected in for a ‘magic potion’ to the root of everything there is pastoral terms and which can achieve recovery from his ill- a lack of a catechesis on death only produce positive out- ness, and in this way he con- Ð death as a fundamental comes if taken together. fuses the sacraments with stage of life. The sick person During the debate, despite miracles. The celebration of is fundamentally alone, aban- being based on concrete situa- the sacraments is the end doned by a society which runs tions, a certain difficulty in in- point of what has been careful and cannot stop to spend time tegrating the different basic preparation, a real and au- with the sick person. But even perspectives to which each more serious is the abandon- person referred became evi- ment of the sick person by the dent. Two different kinds of ecclesial community. The pastoral approaches emerged: hospital is becoming a com- one which followed a sub- pany, a machine where the stantially applied way of do- chaplain is a man of urgency ing things, and another which and not of serene steps, and it moved in the direction of the is too often the case that semi- method of evangelical initia- narists who are not prepared tive. theologically or materially are The situation of contempo- chaplains in contact with suf- rary pastoral care reveals from fering, pain, and death. different angles what are by A careful training of semi- no means marginal failings. narists is also required where The training of extraordinary the formative path towards ministers for the Eucharist is being a presbyter achieves an often inadequate, and this is authentic human and spiritual something which compromis- maturity which is capable of es the understanding of the understanding and sharing sit- meaning of the sacrament and uations of suffering. Pastoral its full reception Ð we live in a care in health is an education DH n.45 ing 69-144 2.8.2001 15:45 Pagina 130

to be faced up to as early as tionship between suffering the pre-school and school age. and sin. A real preparation for the Some proposals worthy of workers of the sector is of pri- note emerged at the end of the mary importance – ‘put your meeting: heart in those hands!’ (St. 1. That the whole of pas- Camillo). Through care for toral action should be directed the body passes care for the towards permanent education soul. Care for the sick and in relation to the sacraments care for the elderly should be as a meeting with Christ and approached in different ways. an experience of the love of In the dioceses pastoral God towards us. care in health must be organ- 2. That pastoral workers ised and arranged in a better should be trained in accompa- way and there should be a nying, understood as a specific delegate. Time reawakening to the truth of should be dedicated to think- God. ing about, and motivating, the 3. That in the future there sacrament of the anointing of should be hospital pastoral the sick. Its need and value services which are institution- should be pointed out; the alised, professionalised, and sick person’s fear of this subject and not only as the organised. sacrament, which is seen ex- object of care and treatment. In order to produce pastoral 130 clusively as a preamble to In illness feeling that one is a care in health which is more death, should be uprooted subject is of fundamental im- qualified and qualifying the from his mind. A fundamental portance. At a moment in whole of the pastoral care of step is to recreate and re-es- which the capacity to act the local Church is of impor- tablish the overall vision of physically is reduced or di- tance. Furthermore, it is nec- pastoral care and its health minishes, it is important for essary to proceed to a new care dimension Ð how do we the sacraments to be rediscov- look at the ‘New Rite of the behave towards illness and ered as action and not as pas- Sacrament of the Anointing of death? sivity. In rediscovering the the Sick’ where the rite is en- The alienation of death is value of baptism one can also riched with celebrations and important. Everybody dies reach an acceptance of suffer- prayers on the part of the alone, in a hospital bed, in a ing and death Ð baptism as the Christian community with nursing home. The death of a way of the faith and as under- and for the sick. relative is no longer experi- standing of the faith. It is im- It is also necessary to face enced within the family as a portant to proceed systemati- up to thinking about death natural event but as some- cally in the preparing of peo- with courage by reproposing thing which has nothing to do ple who work in the medical the Viaticum as a celebration with any of us because when sector in line with their differ- of the last communion. it arrives the person who un- ent vocations and profession- The discussion dwelt upon dergoes it has already been al responsibilities. They the need to bring out the fol- expelled from the family, should be offered a differenti- lowing requirements: from the community. ated, adequate and person- 1. An elaboration of the Listening is fundamental in alised preparation. The chap- concept of health in a spiritu- suffering. Desperation cannot lain, for his part, must effect a al-transcendent perspective. listen if it is not listened to. strong action of raising of 2. A reaffirmation of the Only after listening can one awareness and sensitivity in centrality of Christ in the install a dialogue. During ill- relation to the sick person. Church and for the Church in ness the very capacity to feel 3. To summarise, the meet- her pastoral action. oneself in communion with ing centred around the fol- 3. The figure and the mode God sometimes vacillates. lowing question: how can we of action of the ordained min- The place of encounter is ac- foster in believers an adher- ister is of decisive importance ceptance of illness Ð this is ence to Christ which is intelli- Ð he must direct himself to- the propitious moment for gent and affective, a context wards spiritual care for the drawing near to the sacra- within which it is possible to person and not confine him- ments and living them in their celebrate and receive the self to being a mere adminis- totality. The Eucharist is then sacraments as real events of trator. For this reason, it is seen as sharing offered during grace for life? necessary to study forms and the celebration which be- Some theologically rele- working models which foster comes in a certain way partic- vant elements should be em- and promote an approach of a ipation in the suffering of phasised: the centrality of therapeutic character. God and men. And this to be Christ in the sacramental cel- new and alive people in ill- ebration; the need for the Prof. Mons. SERGIO LANZA ness as well. faithful to be directed towards Dean of the Pastoral Institite The Magisterium presents the mystery of Christ through ‘Redemptor Hominis’ the sick person as a pastoral that celebration; and the rela- of the Pontifical Lateran University. DH n.45 ing 69-144 2.8.2001 15:45 Pagina 131

Ninth European Congress of the FEAMC

Twentieth World Congress of the FIAMC

Tewnty-second National Congress of the AMCI

Medicine and Human Rights

Rome, 3-7 July 2000 DH n.45 ing 69-144 2.8.2001 15:45 Pagina 132

Prayer Written by the Holy Father for the Congress of Catholic Medical Doctors

Lord Jesus,

Divine Physician, who in your earthly life showed special concern for those who suffer and entrusted to your disciples the ministry of healing, make us ever ready to alleviate the trials of our brethren. Make each one of us, aware of the great mission that is entrusted to us, strive always to be, in the performance of daily service, an instrument of your merciful love. Enlighten our minds, guide our hands, make our hearts diligent and compassionate. Ensure that in every patient we know how to dis- 132 cern the features of your divine Face. You who are the Way, provide us with the gift of knowing how to imitate you every day as medical doctors not only of the body but of the whole person, helping those who are sick to tread with trust their own earthly path until the moment of their encounter with you.

You who are the Truth, provide us with the gift of wisdom and science in order to penetrate the mystery of the human person and their transcendent destiny as we draw near to them in order to discover the causes of their maladies and find suitable remedies.

You who are the Life, provide us with the gift of preaching and bearing witness to the ‘Gospel of life’ in our profession, committing ourselves to defending it always, from conception to its natural end, and to respecting the dignity of every human being, and especially the dignity of the weakest and the most in need.

Make us, O Lord, Good Samaritans, ready to welcome, treat, and console those we encounter in our work. Following the example of the holy medical doctors who have preceded us, help us to offer our generous contribution to the constant renewal of health care structures.

Bless our studies and our profession, enlighten our research and our teaching. Lastly, grant to us, having constantly loved and served you in our suffering brethren, that at the end of our earthly pilgrimage we may contemplate your glorious countenance and experience the joy of the encounter with you in your Kingdom of joy and everlasting peace.

Amen.

The Vatican, 29 June 2000 DH n.45 ing 69-144 2.8.2001 15:45 Pagina 133

The Medical Doctor should Respond as a Conscientious Objector to Legislation in Favour of the Crimes of Abortion and Euthanasia THE SPEECH OF THE POPE TO THE PARTICIPANTS AT THE INTERNATIONAL CONGRESS ON THE SUBJECT “MEDICINE AND HUMAN RIGHTS”

1. I extend a cordial welcome to you all, fundamental right to life, on which every dear Catholic doctors who have come to other personal right is based. Rome with your family members to attend Every day in your professional work you the international congress organized by the render a noble service to life. Your mission Italian Catholic Medical Association, the as doctors puts you in daily contact with the European Catholic Medical Association and mysterious and wonderful reality of human the International Federation of Catholic life, prompting you to be concerned for the Medical Associations. The principal aim of sufferings and hopes of our many brothers 133 your meeting in the Eternal City is to cele- and sisters. Persevere in your generous ded- brate your Jubilee. I fervently hope that, re- ication, showing particular attention to the freshed by this timely spiritual break, you elderly, the sick and the disabled. will able to give fresh, courageous vitality You have first-hand experience that in to your Gospel witness in the important area your profession medical care and technical of medicine and health care. services are not enough, even if provided I greet you all affectionately, beginning with exemplary professionalism. You must with Cardinal Dionigi Tettamanzi, Arch- also be able to offer the sick that special bishop of Genoa, and Professors Domenico spiritual medicine which is the warmth of Di Virgilio, Paul Deschepper and Gian Luigi genuine human contact. This can restore the Gigli, Presidents respectively of the above- love of life of your patients, inspiring them mentioned associations. And I greet Fr Fey- tor Pinto and Fr Valentini Pozaic, along with the ecclesiastical advisers present. I also extend my greetings to Archbishop Javier Lozano Barragán, President of the Pontifical Council for Health Pastoral Care, an institution which I entrusted with the task of encouraging and promoting the work of formation, study and action carried out by the International Federation of Catholic Medical Associations, especially in the context of the Jubilee Year. I lastly offer my particular thanks to prof. Domenico Di Virgilio, who has well expressed the sentiments you share and your loyal fidelity to the Chair of Peter.

Offer the sick the warmth of genuine human contact

2. The theme chosen for your congress Ð medicine and human rights Ð is very important, not only for the cultural effort it expresses of combining medical progress with the ethical and juridical requirements of the human person, but also for its timeliness because of actual or potential violations of the DH n.45 ing 69-144 2.8.2001 15:45 Pagina 134

conscientious objection. The great progess made in recent years in the palliative treatment of pain make it possible to provide suitable care for the difficult situations of the terminally ill. The many disturbing ways in which health and life are attacked should be courageously addressed by every person who truly respects human rights. I am thinking of the destruction, suffering and death that afflict entire populations because of conflicts and fratricidal wars. I am thinking of the epidemics and diseases that occur among populations forced to abandon their lands and flee into the unknown. How could we remain indifferent to the agonizing scenes of children and the elderly living in intolerable situations of hardship and suffering, especially when they are denied even the basic right to health care! 134 A vast field of action lies before you, dear Catholic doctors, and I express my heartfelt appreciation to those of you who courageously decide to dedicate some of their time to people in situations of such dire emergency. Missionary cooperation in the health-care field has always been open- hearted, and I fervently hope that this generous service to suffering humanity will con- to struggle for it with an inner determination tinue to grow. that is sometimes decisive for their recovery. The sick must be helped to regain not only their physical health, but also their psy- Health-care personnel need chologial and moral well being. This pre- moral and religious preparation supposes that the doctor, in addition to his professional skill, also has an attitude of 4. As we enter the third millennium, men loving concern inspired by the Gospel im- and women, especially in the poorest coun- age of the Good Samaritan. With every suf- tries, are unfortunately still deprived of ac- fering person, the Catholic doctor is called cess to health services and the essential to bear witness to those higher values which medicines for their treatment. Many of our have their firmest foundation in faith. brothers and sisters die each day of malaria, leprosy and AIDS, sometimes in the midst 3. Dear Catholic doctors, you know so of the general indifference of those who well that it is your indispensable mission to could or should offert them support. May defend, promote and love the life of every your hearts be attentive to these silent human being from its beginning until its please! It is your task, dear members of natural end. Today, unfortunately, we live in Catholic medical associations, to work so a society dominated both by an abortionist that every person, regardless of his social or culture, leading to the violation of the fun- economic status, can exercise his primary damental right to life of the unborn, and by right to what is necessary for restoring his a concept of human autonomy expressed in health and thus to adequate medical care. the demand for euthanasia as self-liberation Some of you are researchers in the bio- from a situation which for some reason has medical sciences, which by nature aim at become distressing. advancing, developing and improving the You know that it is never licit for a conditions of human health and life. I ur- Catholic to be party to an alleged right to gently appeal to them to make a generous abortion or euthanasia. Since legislation al- contribution to providing humanity with lowing such crimes is intrinsically immoral, better health conditions, while always re- it cannot represent a moral imperative for specting the dignity and sacredness of life. the doctor, who will rightly have recourse to Everything that is scientifically possible is DH n.45 ing 69-144 2.8.2001 15:45 Pagina 135

not always morally acceptable. sion to Christ and for opening your hearts to When you return to your respective na- those in need. May the fruit of your Jubilee tions, take with you a desire to continue celebration be a deeper concern for your with new zeal in your work of formation neighbour, a generous sharing of knowl- and updating, not only in the disciplines as- edge and experience and an authentic spirit sociated with your professions, but also in of solidarity and Christian charity. theology and bioethics. It is very important, May our Blessed Lady, Salus infirmorum, particularly in the nations with young assist you in your complex and necessary Churches, to see to the professional and eth- mission! May St. Giuseppe Moscati be your ical-spiritual formation of doctors and example, so that you will never lack the health-care personnel, who often have to strength to bear witness with consistency, confront serious emergencies calling for complete honesty and absolute integrity to professional skill and suitable preparation in the “Gospel of life”! the moral and religious field. Thanking you again for your visit, I im- plore the Lord’s constant benevolence for 5. Dear Catholic doctors, you congress is you, for your families and for everyone en- providentially occurring during the Jubilee, trusted to your care, as I whole-heartedly a favourable moment for personal conver- impart to all a special Apostolic Blessing.

135

Greeting to the the Medical Congress on ‘Medicine and Human Rights’

A cordial greeting to the or- pacity means the always open achieve harmony at every ganisers of the ninth Euro- possibility of a hope towards stage of life. It is to open one- pean, twentieth world, and perfect future realisation self to a tendency which twenty-second national con- which in the field of medicine searches for the unity of the gress of Catholic doctors, on involves constant advance to human being structured in the the subject of ‘medicine and economic, social, political and human rights’. cultural dimensions. Human rights are a need in May this congress investi- the realisation of the human gate these rights in the light of person; the human person is the Gospel so that Catholic always a realisation and a ca- doctors give the world at the pacity; as a capacity he is a beginning of this millennium project to be fulfilled; as a re- safe ways by which to embody alisation he is fulfilled history. the doctrine of Christ in rela- And the right of the person is tion to medicine and thus con- the right to affirm himself in tribute to the good of the history and actualise himself whole of mankind! through his capacity. The human right of the per- H.E. Mons. JAVIER son as history in the field of LOZANO BARRAGÁN, medicine means the right to Archbishop-Bishop Emeritus use all the advances which of Zacatecas, President of the Pontifical Council man has achieved hitherto in for Health Pastoral Care, the field of medicine. The hu- the Holy See. man right of the person as ca- DH n.45 ing 69-144 2.8.2001 15:45 Pagina 136

Greeting of the President of the IFCMA

Dear Friends, tion in the life of the Church, we will not have anything It is a great honour for me special to say to our patients to welcome you to Rome in or our colleagues. the name of the International The Jubilee offers us a Federation of Catholic Med- unique opportunity to engage ical Associations. In the mid- in this personal inner renewal. dle of the year of the Great It calls upon us to profess our Jubilee you have come to faith and at the same time to Rome to discuss ‘medicine change our lives. It invites us and the rights of man’, the to rediscover Christ, living in very meaningful subject cho- the Church, and to be com- sen for the twentieth world mitted in the temporal reality congress of the IFCMA. Our of our profession, in cultural meeting here in Rome, how- transformations, in the free- ever, this year has a special giving of works of charity, value and significance which and in social and political ac- 136 goes beyond the actual sub- tion. ject of this congress, however In the name of the interna- important that subject may be. with those who accompany tional federation which on the You, indeed, have come to Christ on the cross from a po- basis of a specific mandate Rome seeing it not only as a sition of proximity, the mean- given to us by the Church place for the congress but also ing of death, which is not a co-ordinates the work of the as the destination of your pil- window which opens up onto individual associations, I grimage. It is a city which the void but the real goal of would like to thank the takes us back to the Apostles man the pilgrim on this earth, friends of the Italian associa- and it is the home of the Pope the goal which opens us to the tion for the great and gener- Ð the visible sign of the unity beatific vision of the counte- ous work that they have car- of the Church and the First nance of God. ried out in organising this Defender of the Rights of Profoundly inspired by congress. I would also like to Man in the whole of the these beliefs, we will be more thank those who work in the world. able to understand the dilem- associations throughout the Like many brothers and sis- mas and the contradictions re- world and help Catholic med- ters of past centuries, you lating to respect for the rights ical doctors to live out their have come to the tombs of the of man in the practical appli- faith and bear witness to the Apostles Peter and Paul to re- cation of medicine. In many rights of man and duties to- discover the origins of your regions of the world Catholic wards God amongst patients, faith, to carry out a journey of medical doctors are certainly medical colleagues and the inner purification, to open only a minority which at other professionals of the yourselves to greater solidari- times is oppressed. We are world of health and health ty and fraternity. The man however aware that we are an care. I would like, if it is pos- who lives at the beginning of important minority Ð a fact of sible, to encourage you to do the third millennium of the which we are proud Ð which even more and to invent new Christian era, perhaps even is able to express a prophetic and more effective ways of more than the pilgrims of the presence, especially on the being present in the medical medieval age, needs to travel basis of all the other rights of profession, in teaching, in re- along the roads of the search man: the right to life. search, in a spirit of commu- for what is true and good, The struggle for a medicine nion and of service, especially leading to the rediscovery of which respects the rights of towards those people whose the deepest meaning of his man touches upon the very rights are most trampled up- humanity, that humanity heart of our Christian witness on. May God help and bless which only Jesus Christ can because as lay members of our efforts! In doing this we reveal to us. The pilgrimage the Church we are called to be can hope with trust and confi- to the tombs of the Apostles present at the centre of pro- dence that our earthly pil- thus becomes an image of the fessional life and to try to grimage will never become a other pilgrimage, that pil- change its structures and journey which is lacking in grimage which lasts for the forms of behaviour, so that meaning. whole of our lives. they can become a more The pilgrimage of the Ju- transparent image of the heal- GIAN LUIGI GIGLI, bilee can help us to rediscover ing love of Christ. However, President of the IFCMA, respect for life, the meaning without a renewal of our faith the International Federation of of human suffering, solidarity and a more intimate participa- Catholic Medical Associations. DH n.45 ing 69-144 2.8.2001 15:45 Pagina 137

The Greeting of the AMCI

The Association of Italian Paul II who has not only cen- freedom of the individual! Catholic Doctors (AMCI) wel- tred his Magisterium on the de- Have the amazing and explo- comes with enthusiasm the fence and the promotion of hu- sive advances of technology friendship of doctors and man rights but has also linked and science in the biomedical friends from over forty nations such rights to certain bases field always been directed to- who have come to take part in which are to be found within wards fostering the develop- the Congress of the Jubilee the Christian approach. ment of the individual and en- Year 2000! And the perspective of love couraging respect for the digni- It cannot be denied that this is the direction in which the ac- ty of the person? Or at times appointment organised in tion of Christians in relation to have these not represented risks Rome by the three associations human rights is played out. for man, who now seems to be Ð the AMCI, FEAMC, and FI- Our ‘Great’ Pontiff has even threatened by what he produces AMC Ð has a meaning and a dedicated some encyclicals to to the point of fearing that his significance which rise above these questions, which indeed achievements will be turned what usually characterises this are very dear to his heart. Thus against him? Hence, as John congress-encounter of Catholic it is that in Centesimus An- Paul II reminds us (Redentor medical doctors. nus(1991) he points out a se- Hominis, 1979), there is a need Ours is first of all the Con- ries of human rights: ‘the right for this explosive development 137 gress of the Great Jubilee of the to life, an integral part of of technology to be matched by year 2000. Providence has be- which is the right of the child a corresponding development stowed upon us the moving to develop in the mother’s of the moral life and of ethics privilege of living out this ex- womb from the moment of so that man ‘really becomes alting cross-roads of various conception; the right to live in better, more spiritually mature, events Ð the move into the next a united family and in a moral more aware of the dignity and century, the beginning of the environment conducive to the his humanity’. We Catholic third millennium, the holding growth of the child’s personali- doctors who have gathered to- of the Jubilee of the year 2000, ty; the right to develop one’s gether here in Rome from all and the intertwining of three intelligence and freedom in over the world want to con- congresses. Will we know how seeking and knowing the truth; tribute to an overall positive re- to respond to these evocative the right to share in the work sponse to the appeals of the and compelling appeals? which makes wise use of the Pope. We want with force to Will we know how to be ‘ac- earth’s material resources, and bear witness to the fact that tors’ aware of these amazing to derive from that work the medicine and its advances will events? means to support oneself and always be directed towards ser- And in such circumstances one’s dependants; and the right vice to man, and that solidarity the subject which we proposed freely to establish a family, to and respect for love must ce- – ‘medicine and human rights’ have and rear children through ment relationships between all Ð seems even more central and the responsible exercise of men. For this reason, we de- to the point. Indeed, what other one’s sexuality. In a certain clare that we are against every century has witnessed such an sense, the source and synthesis assault on life, always, and in irruption of a series of events of of these rights is religious free- relation to every creature, and a most dramatic character dom, understood as the right to for this reason we declare that which have seen man at times live in the truth of one’s faith we are against every restriction exalted and at times undefend- and in conformity with one’s on individual freedoms and ed and subject to violence? transcendent dignity as a per- thus against every form of tor- In what other century has the son.’(n. 47) ture and against the death increasingly strong distressed In essential terms they are penalty. cry of respect for the rights of the same rights, even if less And hope, nourished by faith man rung out so clearly? But clearly laid out, as those which and matched by charity, makes what rights are we talking are to be found in the Universal us aware that we must place about? It is really true that this Declaration of Human Rights, ourselves every day at the ser- final part of the century has rights which are indeed often vice of the sick, of the weakest been a light-giving lighthouse remembered but which in and the least defended, and that on the amazing journey of the many circumstances are delib- we must listen, beginning with human community in the face erately forgotten about or not those, believers or otherwise, of the coming and going of the upheld. who recognise that they belong ‘builders and destroyers’ of hu- Many laws have in fact de- to a society based upon respect man rights? nied the right to live through and love! In this explosive and lumi- the enactment of permissive nous scenario Ð to the great measures in the realm of abor- Prof. DOMENICO DI VIRGILIO good fortune of all men Ð there tion, genetic manipulation, eu- President of the Association of Italian has arisen the figure of John thanasia, and restrictions on the Catholic Doctors (AMCI) DH n.45 ing 69-144 2.8.2001 15:45 Pagina 138

The Year 2000: The Activity of the Pontifical Council for Health Pastoral Care

Introduction year 2000, and that aim was: ‘to the participation at various confer- celebrate the incarnation of the ences, seminars and meetings by The work plan of the Pontifical Word according to the Bull of con- the Superiors and Officials of the Council for Health Pastoral Care, vocation of the Great Jubilee of the Ministry etc., were of great rele- which was established at the Ple- year 2000, Incarnationis Mysteri- vance. nary Assembly of 1998 and subse- um, to enlighten health care cul- With respect to the evangelisa- quently approved by the Holy Fa- tures with the Gospel, to sanctify tion of faculties of medicine, the ther, involves fifty programmes. the sick person and the environ- Pontifical Council sought to main- These programmes are organised ment of health in general, and to tain and develop contacts with the around the Ministries of the Word, bring about the communion of pas- most important Catholic faculties of Sanctification, and of Commu- toral care in health throughout the of medicine, of pharmacy or of law, nion, and are entrusted to eighteen Church’. with a view to promoting suitable members of the Pontifical Council: future courses. The other pro- its Superiors, Officials, and collab- b. The Action of the grammes which were implemented orators. Through this work plan the Pontifical Council by the Pontifical Council in the Pontifical Council, especially dur- area of the Word with intensely-felt ing the year of the celebration of At a practical and concrete level, commitment were connected with the Jubilee Year 2000, has sought in order to achieve the above-men- the following areas: publications, 138 to respond in a more effective way tioned goals in a way which was in the World Health Organisation, the to the mission entrusted to it by the line with its own specific objec- book on the pastoral care of Holy Father Ð to be of help to his tives, in relation to the ministry of drug-addicts, pastoral guidance in most valuable Peterine ministry the Word (which involved eleven health, conferences, the interna- within the specific field of pastoral programmes) our Pontifical Coun- tional conference, research, teach- care in health and health care. cil established that its aim was: ‘to ing centres, and dossiers. In the drawing up of the work celebrate the incarnation of the As has already been observed in plan our point of departure was the Word so as to enlighten health care this report, in relation to the min- Motu Proprio Dolentium Hominum cultures with the Gospel through istry of sanctification the Pontifi- which established our Ministry and the Jubilee signs of pilgrimage, the cal Council drew up seven pro- the Apostolic Constitution Pastor Porta Santa, and indulgence. grammes of notable importance: Bonus, and we based ourselves, In relation to the ministry of baptism, the anointing of the sick, with regard to the Christian mean- sanctification, which includes sev- other sacraments, the book of ing of suffering and life, on the en programmes, our Ministry de- prayer and the sacraments, the Apostolic Letter Salvifici Doloris cided that its aim was: ‘to celebrate World Day of the Sick, and the and the Encyclical Evangelium Vi- the incarnation of the Word so as to ‘Intention’ of the Apostolate of tae. In elaborating the practical sanctify the sick person and in gen- Prayer. guidelines of the general work plan eral the world of health and health In order to achieve its aims in much reliance was placed upon the care through the Jubilee signs of relation to the ministry of commu- suggestions and observations of the pilgrimage, the Porta Santa, and in- nion in 2000, our Pontifical council Apostolic Letter Tertio Millennio dulgence’. established thirty-two programmes Adveniente and the Charter for In relation to the ministry of designed to strengthen or achieve Health Care Workers. communion, with its twenty-nine this solidarity-inspired commu- On the basis of these above-men- programmes which have to be im- nion. These programmes revolved tioned doctrinal premises, our Pon- plemented, our Ministry estab- around the anointing of the sick, tifical Council drew up and struc- lished that its aim was ‘to celebrate Catholic medical doctors and nurs- tured its work plan around four as- the incarnation of the Word so as to es, and support for their associa- pects Ð aims, policies, forms of ac- bring about solidarity-inspired tions, especially at an international tion, and programmes. communion in relation to the sick level. In this project, which aims at The work plan of the Ministry and to health care workers through- the unification of pastoral care in had as its culminating point the Ju- out the Church through the Jubilee health throughout the world, the bilee year. However, during the Ju- signs of pilgrimage, the Porta San- creation of an international union bilee year certain changes had to be ta, and indulgence’. of Catholic hospital chaplains is al- made in order to deal with the spe- In order to achieve the goals so of importance, as indeed is the cial details connected with that which the Pontifical Council estab- union of Catholic hospitals, the event. The changes which were lished for the ministry of the Word union of those members of reli- made involved the goals; the pro- the following initiatives were en- gious orders who work in hospitals, grammes themselves, on the other gaged in and promoted: an attempt and the union of the bishops re- hand, remained unchanged in rela- was made to communicate the sponsible for pastoral care in health tion to what had been previously meaning of life and of suffering, within their respective bishops’ announced, although their form and the meaning of nature and its conferences. In addition, an attempt was altered. manipulation, by explaining such was made to intensify the pastoral meanings, spreading them, and action carried out in relation to a. General Aim making them reach everybody Ð Catholic health care voluntary and in particular the bishops who workers and to increase the number On the basis of what has just are responsible for pastoral care in of patients’ associations. Of the been outlined, the general aim of health within their bishops’ confer- various programmes belonging to the Pontifical Council was estab- ences. In this undertaking, the cele- the sector of sanctification special lished, which of course especially bration of the fifteenth international reference should be made to: the concerned the moment of the cele- conference, the publication of the centres of bioethics and attempts to bration of the Great Jubilee of the journal Dolentium Hominum, and achieve their unification; the organ- DH n.45 ing 69-144 2.8.2001 15:45 Pagina 139

isation and the celebration of the ter’s Square where it received the his homily the Holy Father pro- World Day of the Sick; the univer- blessing of the Holy Father; and the nounced the following most valu- sal right to health; the Christian pious act of the Via Crucis to the able words: ‘The Jubilee is an ex- communication of goods; emer- Coliseum. perience of a very special Visita- gency diseases (AIDS and lep- The most significant celebration tion. In making himself man, the rosy); drugs; inter-Ministerial rela- was without doubt the solemn cele- Son of God came to visit every per- tions; the bishops responsible for bration of the Eucharist held on Fri- son and made himself ‘the Door’ pastoral care in health; papal Nun- day 11 February in memory of the for everybody: the Door of life, the ciatures; ad limina visits; the par- Blessed Virgin of Lourdes. This Door of salvation. Man must enter ticipation and representation of the celebration was presided over by through this door if he wants to find Pontifical Council at conferences the Holy Father in St. Peter’s salvation. Each and every person is and meetings outside Rome and Square, a place which became for invited to cross this threshold... The abroad; pastoral visits and journeys the event almost a great and open Church enters the new millennium etc. In the work plan emphasis was air place of passage. clasping to her heart the Gospel of also placed on the internal adminis- Next to the altar there was the suffering, which is the good news trative programmes of the Ministry white statue of the Madonna of of redemption of salvation. Sick which form a part of the sector of Lourdes. There were also fifty con- brothers and sisters, you are the communion, that is to say: the sec- celebrants in white chasubles, special witnesses to this Gospel. retariat, the administration, the amongst whom His Eminence Car- The third millennium expects this archives room, the provision of witness from suffering Christians. printed material, and the catalogu- It also expects such witness from ing and archiving of documents you, workers of pastoral care in and publications. health, who, with different roles, at The above mentioned pro- the side of sick people carry out a grammes were implemented with mission which is both meaningful keenly-felt commitment on the part and appreciated, indeed very appre- of all the members of the Ministry. ciated’. 139 The results gave rise to great satis- The administration of the sacra- faction and confirmed that the work ment of the anointing of the sick plan was fully in harmony with the was also a very moving moment. goals established for 2000. The Holy Father personally admin- Given this, we would like here to istered this sacrament to ten sick list in a more detailed way a num- people. It was also administered to ber of salient aspects of the activity another ninety sick people by bish- of the Pontifical Council in the year ops and priests, among whom the 2000. President of the Pontifical Council, H.E. Mons. Lozano, H.E. Mons. Redrado O.H., and Rev. P. Felice 1. The Celebration Riffini M.I., respectively the Secre- of the Jubilee of the Sick tary and Under-Secretary of the and Health Care Workers dinal Etchegaray, President of the Pontifical Council. Committee for the Great Jubilee of The celebration of this special Within the framework of the the Year 2000, with the Secretary day terminated with the solemn ministry of sanctification we en- of the same Committee, Archbish- blessing of all the participants, and counter a very important pro- op Crescenzio Sepe; H.E. Mons. J. especially the sick and infirm. gramme of the activities of the Pon- Lozano Barragán, President of the 2. Study. On 9-10 February a tifical Council Ð the annual celebra- Pontifical Council for Health Pas- conference of bishops responsible tion of the World Day of the Sick. toral Care, accompanied by the for pastoral care in health in their During the Jubilee year this was Secretary of the same Ministry, respective bishops’ conferences, solemnly celebrated at Rome in the H.E. Mons. José Redrado, and its and the Catholic associations of form of the ‘Jubilee of the Sick and Under-Secretary, Rev. Felice health care workers, was held in the Health Care Workers’. Ruffini M.O.; and forty-seven arch- New Hall of the Synod in the Vati- Four salient elements marked bishops and bishops responsible for can. During these two days of the various celebratory events. pastoral care in health in their re- study, in different rooms, thought These were: prayer, study, festive spective bishops’ conferences. was addressed both in the teaching gatherings, and visits to a number Three hundred and fifty priests in- conferences and in the group fo- of places closely linked to the Ju- volved in the world of pastoral care rums to the identity of Catholic bilee event. in health throughout the world also health care workers given the chal- 1) Prayer. More than 20,000 pil- concelebrated in the presence of lenges with which they are faced by grims Ð infirm people and health civil and military authorities. the third millennium. Over two care workers Ð arrived from all The celebration of the Eucharist, hundred participants were present, over the world to take part in the in which over thirty thousand pil- and they represented all the conti- various events and celebrations grims took part (of whom 2,400 nents of the world. The President of which had been prepared with great were infirm people and had to sit in our Ministry, H.E. Mons. Javier care by the Pontifical Council for wheel-chairs), was solemn and in- Lozano, introduced the days of Health Pastoral Care. The moments tense. 1,700 disabled people unable study and provided two instructive of intense spirituality were the fol- to walk were seated in front of the papers. One was directed towards lowing: the celebration of the Holy statues of St. Peter and St. Paul in bishops responsible for pastoral Mass of welcome on 10 February the square. In addition, there were health in care and was on the sub- at the basilica of ‘St. Paul’s Outside the family relatives of sick or in- ject of ‘pastoral care in health’, and the Walls’, presided over by H.E. firm people, medical doctors, para- the other was addressed to Catholic Mons. Javier Lozano, the President medical staff, voluntary workers, medical doctors and was on ‘the of our Ministry; the Marian proces- those who accompany the sick and identity of the Catholic medical sion “Aux Flumbeaux” along the the infirm, and members of male doctor’. In addition to the President Via della Conciliazione, which was and female religious orders. of the Pontifical Council, the fol- led by the President of the Pontifi- In addressing the sick and dis- lowing gave papers: H.E. Mons. cal Council and finished in St. Pe- abled and health care workers, in Redrado O.H, Secretary of the DH n.45 ing 69-144 2.8.2001 15:45 Pagina 140

Ministry, who spoke on ‘the pro- in a number of inter-Ministerial called that martyrs are a perennial gramme of the Ministry: the work meetings: sign of the truth of Christian love. plan’; Dr. Gian Luigi Gigli, Presi- – at the Pontifical Council ‘Jus- Ð On 23 February, in Rome, the dent of the International Federation tice and Peace’. Rev. Don Antonio Official of the Pontifical Council, of Catholic Medical Associations Soto, an Official of the Ministry, Rev. Mons. Jean Marie Mpen- (FIAMC), whose subject was ‘the took part on 8 April in the dawatu, took part in the meeting or- challenges of Catholic medical inter-Ministerial meeting dedicated ganised by the ‘Child Jesus’ hospi- doctors and the third millennium’; to the preparations for the World tal on the question of international Rev. Joseph Joblin, the Ecclesiasti- Day of Peace (2001); action to help children afflicted cal Assistant to the International Ð at the Pontifical Council for with AIDS in Romania. Committee of Nurses and Culture. On 8 June, Rev. Don Ð On 25-27 February, in the Vat- Medical-Social Assistants (CICI- Krzysztof Nykiel, an Official of the ican, H.E. Mons. Lozano and H.E. AMS), who gave a paper on ‘the Ministry, took part in the Mons. Redrado took part in the in- identity of the Catholic nurse’; inter-Ministerial meeting on the ternational conference on ‘the im- Miss An Verlinde, General Secre- subject ‘the science-faith dialogue: plementation of the Ecumenical tary of the CICIAMS, who ad- new perspectives’. Vatican Council II’ which had been dressed the assembly on ‘chal- organised by the Historical Theo- lenges for the third millennium’; logical Commission of the Jubilee. Rev. Felice Ruffini, Under-Secre- 3. Participation and tary of the Pontifical Council, who Representation at Congresses MARCH spoke about ‘the identity of the and Conferences Ð On 3 March, in Frosinone, in Catholic pharmacist’; and Prof. response to an invitation extended Alain Lejeune, President of the In- Another programme of the min- to him by by H.E. Mons. Salvatore ternational Federation of Catholic istry of the Word was the participa- Boccacio, the Bishop of Frosinone, Pharmacists (FIUPC), who gave a tion and representation of the Pon- the President of the Pontifical paper on ‘the challenges of the tifical Council at various congress- Council took part in a seminar or- 140 third millennium’. es and conferences. Throughout the ganised around the subject of ‘the 3. Festive events. Two splendid year 2000 Superiors and Officials tragedy of illness and hope of re- festive events with a strong spiritu- of the Pontifical Council took part lief. From the loneliness of the sick al meaning also took place. On the in such meetings. person to participation in his pain’. evening of 11 February, in St. Pe- The President of the Pontifical ter’s Square, at the end of the torch- Council gave a paper entitled ‘hope light procession, an ‘evening of and the sick person: theological light and sounds’ was enjoyed, and perspectives’. on 12 February a ‘day of joy and Ð On 28 March, in the basilica of hope’ was held in the Paul VI Hall St. Peter’s, the President of the of the Vatican, made up of the wit- Ministry, H.E. Mons. Lozano, ness of a number of people, presided over a concelebration of amongst whom artists and repre- the Eucharist at the opening of the sentatives of the world of sport, seventh national congress of the who through their suffering had en- ‘College of Teachers of Dentistry’. countered Christ Ð their joy and For those taking part this was also hope. The infirm people were the an opportunity to observe the re- real protagonists of this festive quirements of the Jubilee. event. 4. Visits. On 12 February in the APRIL morning visits organised for groups Ð On 4-6 March, in Mexico City, based on the respective languages accompanied by the Official of the spoken took place at the basilicas Ministry, Rev. Don Krzysztof of the Jubilee Ð Santa Maria Mag- Nykiel, H.E. Mons. Javier Lozano giore, San Giovanni in Laterano, was a participant at the fourth na- and Santa Croce in Gerusalemme. JANUARY tional congress and the third inter- In addition, the national Churches Ð On 24-29 January, at Geneva, national congress of religious insti- arranged a number of visits for Rev. Mons. Jean-Marie Mpen- tutions at the service of health. This their own pilgrims. dawatu was a member of the dele- congress had been organised by the The various festive events and gation of the Holy See to the meet- Archdiocesan Commission for Pas- celebrations were broadcast by ing of the executive committee of toral Care in Health of the Archdio- television throughout the world by the World Health Organisation. cese of Mexico and the Congrega- satellite. Especial emphasis should tion of the Franciscan Religious of be placed on the link with the Mari- FEBRUARY the Immaculate Conception, A.R., an sanctuaries where the World Ð On 14 February, in the Vati- on the subject: ‘curing the body; Day of the Sick has been held in the can, H.E. Mons. Javier Lozano was healing the soul. Towards the third past or where it will be celebrated a participant at the Day dedicated millennium’. The President gave a in the near future. to commemorating the Encyclical paper on the subject: ‘curing the The celebration of the World Evangelium Vitae, an event pro- body and healing the soul’. Day of the Sick terminated on 13 moted by the Pontifical Academy Ð On 6-7 April, in Mexico City, February with the holding of Holy for Life. the President of the Ministry took Masses in the places of welcome. Ð On 17 February, in Rome, the part in the ‘Second Annual Pan- President of the Ministry, H.E. American Catholic Health Care Di- Mons. Lozano Barragán, presided alogue’, which had been organised 2. Inter-Ministerial Meetings over the celebration of the Eu- by the Pontifical Council for Health charist which was held at the end of Pastoral Care and the Archdiocese Within the framework of the the symposium on Mexican of New York on the subject: ‘A Ju- ministry of Communion, the Pon- Catholic martyrs. He emphasised bilee celebration for the whole of tifical Council maintained strong that the symposium was to be locat- humanity’, and gave a paper on the contacts with the other Ministries ed within the context of the Jubilee subject: ‘the celebration of the Ju- of the Roman Curia, and took part celebrations. The President also re- bilee and the sick person’. Rev. DH n.45 ing 69-144 2.8.2001 15:45 Pagina 141

Don Krzysztof Nykiel, an Official desafios para a igraja do Brasil’. spiritual needs of the sick child and of the Pontifical Council, also took The President gave a paper on his pastoral care’. part in the deliberations of this con- ‘AIDS, ecclesial reality and pontifi- ference. cal perspectives’. OCTOBER Ð On 7 April, in Rome, the Sec- Ð On 5-8 October, in Pittsburgh, retary of the Ministry, H.E. Mons. JULY the President of the Pontifical Redrado, presided over the concel- Ð On 12-15, in Kuala Lumpur Council, H.E. Mons. Lozano, took ebration of the Eucharist at the time (Malaysia), H.E. Mons Lozano and part in the annual meeting of the of the national conference on ‘an- H.E. Mons. Redrado took part in Association of Catholic Medical swers of Italian religious life to dis- the twelfth Congress of the Asian Doctors of Pittsburgh, and gave a abled people’, and gave a homily Federation of Catholic Medical As- paper which bore the title: ‘the on the subject matter of the confer- sociations, organised by the Asso- medical doctor and his vocation in ence. ciations of Malaysian Catholic relation to the mission of the Ð On 27 April, in Rome, Rev. Doctors, on the subject: ‘health Church’. In addition, the President Don Krzystof Nykiel, an Official of challenges in Asia in the new mil- presided over a solemn celebration the Ministry, took part as a repre- lennium’. The President gave a pa- of the Eucharist with the rite of the sentative of the Pontifical Council per on ‘healing in the Gospels’. entrusting of the Catholic medical in the conference organised by the doctors of the United States of Faculty of Theology and the Pas- AUGUST America to the Immaculate Heart toral Pontifical Institute ‘Redemp- Ð On 20 August, in Zamorra of the Virgin Mary. tor Hominis’ of the Pontifical Lat- (Mexico), H.E. Mons. Lozano, in Ð On 10 September, in Rome, eran University, together with the the presence of two hundred med- H.E. Mons. Redrado presided over local committee for the XLVII In- ical doctors and other health care a prayer meeting organised by the ternational Eucharistic Congress of workers, held a conference on the Pontifical University ‘Regina the Diocese of Rome, on the sub- subject of ‘the identity of the Apostolorum’, and gave a paper on ject: ‘Jesus Christ. The only sav- Catholic medical doctor’. the subject: ‘witnesses and servants iour of the world; bread for a new to hope’. 141 life’. SEPTEMBER Ð On 11-13 September, in the Ð On 5 September, in Chieti, the Vatican, the Official of the Min- MAY Secretary of the Ministry, H.E. istry, Rev. Don Krzysztof Nykiel, Ð On 10 May, in Genzano near Mons. Redrado, presided over the represented the Ministry at the In- Rome, the Official of the Pontifical deliberations of the international ternational Pastoral Theological Council, Rev. Don. Krzysztof congress on ‘the ethical questions Congress on ‘children: the spring Nykiel, took part in the first Inter- and issues of clinical experiments’ of the family and of society’, or- national Workshop on the Humani- which had been organised by the ganised by the Pontifical Council tarian Initiatives and the Experi- archdiocese of Chieti-Vasto within for the Family. ence of Co-operation of Non-Gov- the framework of the Jubilee of ernmental Organisations (NGOs) university teachers. In addition, he NOVEMBER and Non-Profit Organisations gave a paper on ‘research and re- On 7 November, in Rome, in re- (NPOs), and gave a paper on ‘the spect for human life’. sponse to an invitation extended to activity of the Pontifical Council Ð On 6 September, in Rome, the him by Dr. Agostino Falconi, the for Health Pastoral Care’. Secretary of the Ministry, H.E. President of the Organ Transplant Ð On 15-20 May, in Geneva, the Mons. Redrado, was a participant Association of the Marches, H.E. President of the Ministry, H.E. J. at the Jubilee of university teachers Mons. Lozano presided over a cele- Lozano, took part, as head of the and gave a paper which introduced bration of the Eucharist on the oc- delegation of the Holy See, in the the deliberations on the subject. casion of the Jubilee of that associ- fifty-third session of the World The paper was entitled: ‘the path of ation, and gave a homily during the Health Assembly, and gave a paper the terminally ill and death’. ceremony. on the concept of health in the Ð On 15 September, in Rome, Ð On 7-9 November, in Quito, Magisterium of the Church. Rev. H.E. Mons. Redrado presided over the Official of the Ministry, Rev. Mons. Jean-Marie Mpendawatu, an a celebration of the Eucharist on Mons. Jean-Marie Mpendawatu, Official of the Pontifical Council, the occasion of the course of per- took part as an observer of the Holy was also a member of this delega- manent training organised by the See in the Seventh Session of the tion. Congregation of the Children of the International Committee on Ð On 22 May, in Rome, H.E. Immaculate Conception, and gave Bioethics of UNESCO. Mons. Lozano inaugurated the a homily during the religious ser- Ð On 9 November, in Rome, meeting of the governing council of vice. H.E. Mons. Redrado took part in the Pontifical Academy for Life, Ð On 25-29 September, in Cal- the ceremony of the inauguration of and extended greetings to all the tanisetta (Sicily), accompanied by the academic year of the Catholic participants at this meeting. Rev. Antonio Soto, an Official of University of the Sacred Heart ‘A the Ministry, H.E. Mons. Lozano Gemelli’. JUNE was a participant at the Third Ð On 9-11 November, in Svit, Ð On 1 June, in Naples, in re- World Congress on Drug Preven- accompanied by Rev. Don sponse to an invitation extended to tion, organised by the ‘Casa Krzysztof Nykiel, an Official of the him by H.E. Mons. Antonio Ribol- Famiglia Rosetta’ Association, on Ministry, H.E. Mons, J. Lozano di, the Bishop Emeritus of Acerra, the subject: ‘new frontiers for the was a participant at the Ninth Inter- the President of the Ministry took prevention of drugs and criminality national Symposium organised by part in an international conference for young people and the commu- the Faculty of Theology of the Uni- on the subject of ‘the right of the nity’. The President gave a paper versity of Tirnava on the subject: child to health’ and gave a paper on on: ‘the ethical and moral position ‘the new evangelisation’, and gave ‘the right of the child to the defence of the Holy See in relation to a paper on ‘the identity of the of his health’. drugs’. Catholic medical doctor’. On 11 Ð On 12-15 May, in Itaici, Ð On 25-27 September, in November the President of the Brazil, H.E. Mons. Lozano took Madrid, H.E. Mons. Redrado took Pontifical Council, H.E. Mons. part in a conference organised by part in the Twenty-fifth National Lozano, also took part in the meet- the National Bishops’ Conference Day of Pastoral Care in Health, and ing of the European Federation of of Brazil on the subject: ‘AIDS e gave a paper on the subject: ‘the Catholic Medical Doctors at DH n.45 ing 69-144 2.8.2001 15:46 Pagina 142

Bratislava, and the next day witnessed the participation of about and sisters who are afflicted by lep- presided over a celebration of the a thousand people who had come rosy and would also provoke in the Eucharist for them and gave a from all the continents of the spirit of Christians a generous homily of relevance to their inter- world, and also witnessed the pres- readiness to help all of our brothers ests. ence of ecclesiastical and civil au- and sisters who are in need. On this Ð On 25 November, in Padua, the thorities. At the inauguration were theme, the Holy Father recalled President of the Pontifical Council, present His Eminence Cardinal An- that ‘Hansen’s disease, in fact, is H.E. Mons. Lozano, was a partici- gelo Sodano, the Secretary of State curable with medicines and drugs pant at the international conference of the Holy See, H.E. Mons. J. which are relatively cheap but organised by the University College Lozano, President of the Pontifical which are often not available to of Missionary Doctors on the occa- Council for Health Pastoral Care, those who are afflicted by this dis- sion of the fiftieth anniversary of its H.E. Mons. Redrado, the Secretary ease because of the state of great foundation, and gave a paper on the poverty in which they find them- subject of ‘Africa in the year 2000: selves. In essential terms, the most health for everybody’. dangerous ‘leprosy’ is acute pover- Ð On 28 November, in Fatima, ty which should be fought at an Rev. Don Antonio Soto, an Official economic level, and even prior to of the Ministry, took part in the de- that with a deep conversion from liberations of Fifteenth National the logic of selfishness to the logic Congress on Pastoral Care in of solidarity.’ Health of Portugal, and gave a paper on: ‘health and solidarity in the Jubilee year 2000’. 6. The Joint Meeting of Delegates of the Continents of the World DECEMBER and the Group of Experts Ð On 6-8 December, in El Alto, of the IACHCI 142 the President of the Ministry, H.E. Mons. Lozano, was one of the par- Within the context of program- ticipants at the National Meeting of ming the unification of pastoral Pastoral Care in Health in Bolivia, care in health throughout the world, and gave two papers Ð one on the Pontifical Council promoted ‘bioethics’ and one on ‘pastoral and organised, following the inter- care in health in Bolivia’. national symposium of the Interna- tional Association of Catholic of our Ministry, Rosy Bindi, Health Care Institutions (IACHCI) 4. Pastoral Visits and Journeys ex-Minister of Health of Italy, and which was held in the Vatican (at Prof. Henry Kiniffo, the President the Nova Domus Sanctae Marthe) Through pastoral visits and jour- of the Raoul Follereau Association on 1-3 July 1999 on the subject ‘the neys the Pontifical Council sought of Benin. Catholic health care institutions as to be present in a concrete way in The President of the AIFO, Dr. witness of the Church’, a joint the world of health and suffering so Enzo Zecchini, made an opening meeting of delegates from the con- as to help in the sanctification of speech of greeting to the partici- tinents of the world and a group of the sick person and of the world of pants. experts. This took place in the Vati- health more generally. During the deliberations of the can on 26-28 May 2000. seminar day attention was dedicat- About twenty-five people took MARCH ed to such subjects as: ‘poverty, depart in the meeting which was di- Ð On 26 March, H.E. Mons. velopment and health’; ‘leprosy in vided into two days of study and re- Lozano, in response to an invitation the world: analysis of the situation flection. The President of the Min- extended to him by the Primate of and new scientific developments’; istry, H.E. Mons. Javier Lozano, Poland, His Eminence Cardinal ‘the role of the member associa- opened the deliberations of the Josef Glemp, took part in the con- tions of the International Federa- meeting with a message of greet- secration of the Church dedicated tion Ð historical development and ing, which was followed by a simi- to Our Lady of Guadalupe situated future prospects’; ‘the figure of lar speech by the Director of the in Laski (near Warsaw), and spoke Raoul Follereau Ð the Luxembourg IACHCI, Fra Pierluigi Marchesi on the anthropological significance Raoul Follereau Association’; ‘the O.H.. During these two days the of the painting of the Madonna of figure of Father Damian Ð the Bel- strategies to be adopted after the Guadalupe. In addition, he visited gian Damian Foundation’; ‘disabil- symposium of July 1999 were dis- the largest Catholic centre for the ity and leprosy’; ‘journalists and cussed. The representatives of the blind in the country. The President those afflicted by leprosy’; and continents of the planet described was accompanied by Rev. Antonio ‘leprosy – a word for marginalisa- all the activities which they had Soto, an Official of the Ministry. tion’. promoted, or which they planned, The seminar day was ended with for the growth and development of a prayer presided over by the Presi- the IACHCI in their respective con- 5. The Seminar Day dent of the Ministry, H.E. Mons. J. tinents. Unanimously, the impor- on Hansen’s Disease Lozano. tance of a body such as the IACH- At the Angelus of Sunday 16 CI within the Church was upheld. On the occasion of the ‘World January, the Holy Father gave a Amongst the goals which the par- Day of Leprosy 2000’, a ‘Seminar cordial greeting to those taking part ticipants set themselves was the or- Day on Hansen’s Disease’ was in the seminar day and expressed ganisation of a new symposium in held in the Vatican in the New Hall his appreciation of their work in the year 2000. of the Synod. This event was or- favour of people afflicted by lep- The President of the Pontifical ganised by the Pontifical Council rosy Ð who at the present time in Council, H.E. Mons. Javier for Health Pastoral Care and the the world number about fifteen mil- Lozano, speaking at the end of the Italian Association of the Friends lion Ð and expressed the wish and deliberations thanked everyone for of Raoul Follereau, and bore the ti- hope that the year 2000 would the work which had been carried tle: ‘Hansen’s disease: reality and mark a decisive step forward in the out and made a concluding summa- prospects’. This international day healing and saving of our brothers ry of what had been achieved. DH n.45 ing 69-144 2.8.2001 15:46 Pagina 143

7. The Study Seminar The year 2002 was proposed as a training of health care workers, on ‘the Sacraments date for the next seminar. chaplains, and voluntary workers. in Pastoral Care in Health’ The participants at the international conference were received by In the work plan of the Pontifi- 8. The Fifteenth the Holy Father at an audience giv- cal Council for the ministry of International Conference en in the New Hall of the Synod. In Sanctification there are three pro- his authoritative speech the Pope grammes which relate to the sacra- On 16-18 November, in the Vat- emphasised amongst other things ments within the context of pastoral ican (in the New Hall of the Syn- ‘that the role of health care workers care in health, and more specifical- od), the fifteenth international con- has the characteristics of a voca- ly: baptism, the anointing of the ference was held. Promoted and or- tion: to encounter the sick person sick, and the other sacraments. ganised by the Pontifical Council, means to encounter thereby the suf- These ‘programmes’ have as its subject was: ‘health and soci- fering person and not merely to their goal the sanctification of the ety’. The annual international con- treat a sick body’. infirm person and of the world of ference is very important for the The Holy Father also empha- health and health care more gener- life of the Ministry, not least be- sised the concept of health when he ally. cause it forms a part of the pro- stated that ‘health, far from some- Of the many initiatives taken in grammes of the ministry of the thing to be identified with the mere this sphere, the Pontifical Council Word whose goal during the Ju- absence of illness, is a tendency to- promoted and organised on 2-3 bilee year of 2000 was to celebrate wards greater harmony and healthy June 2000, together with the Pas- the Word made flesh in order to en- balance at the physical, spiritual toral Institute ‘Redemptor Homin- lighten health care cultures with the and social level. From this perspec- is’ of the Pontifical Lateran Univer- Gospel. tive, the person himself is called to sity, a study seminar on ‘the sacra- About six hundred participants mobilise all his available energies ments in pastoral care in health’ from sixty-six countries took part in order to realise his vocation and which was addressed to theolo- in this international conference, as the good of others’. gians, experts and health care well as fifteen ambassadors to the 143 workers. During this seminar an at- Holy See, a representative of the tempt was made to bring out and World Health Organisation 9. The Inter-Continental investigate the questions and issues (WHO), three Ministers of Health, Meeting on AIDS of the subject from their various an- and two hundred and fifty medical gles: whether socio-cultural, an- doctors who represented their re- Another significant and impor- thropological, or connected with spective Catholic health care feder- tant moment in the activities of the dogmatic theology or pastoral the- ations and associations. Those who Ministry towards the end of the ology. gave papers at the international year 2000 Ð and once again an The seminar dwelt upon two conference included two Cardinals, event which took place within the main areas of concern: two bishops, as well as authorita- framework of the ministry of Com- Ð the sacraments in relation to tive researchers, scientists, and munion Ð was the inter-continental health and illness; and scholars from the humanistic disci- meeting on AIDS which was held Ð health and illness as favourable plines, the social sciences, the bio- in the Vatican (at the Nuova Do- and meaningful sites for the cele- medical sciences, and the discipline mus Sanctae Marthae) from 30 No- bration of the sacraments. of pastoral theology. vember to 1 December. The two days of study gave rise The President of the Ministry, H.E. Javier Lozano, President of to observations and a number of S.E. Mons. Lozano, made an intro- the Pontifical Council, began the guidelines about the meaning and ductory speech, and His Eminence deliberations of the meeting with a importance of the sacraments and Cardinal Angelini, Emeritus Presi- speech of greeting and a few words their relevance in pastoral care in dent of the Ministry, made a speech of introduction in relation to the health. of greeting to the participants. World Day of AIDS. In particular, during the delibera- The general subject of ‘health On the first day of this meeting, tions of the seminar the participants and society’ was examined by a H.E. Mons. Redrado outlined and placed emphasis on the need to or- number of speakers in the light of described the work which had been ganise another study seminar, this the Word of God and theology in carried out during the period time on the subject of the anointing order to bring out and illuminate 1999-2000. The AIDS library and of the sick. present-day technological chal- archive were then referred to and For this reason, given the impor- lenges and moral aspects in order discussed. The press conference on tance and sensitivity of this subject, to achieve the humanisation of the World Day of AIDS, which the Pontifical Council approached medicine within a society which is was held in the Vatican press room, the Congregation for the Doctrine increasingly globalised. was also of marked importance, as of the Faith, requesting its authori- During the deliberations of the was the presentation of the project tative participation at such a study conference the following subjects for a vademecum on AIDS which seminar, with a paper to be given were discussed and analysed: the was made by the Secretary of the by a qualified representative of that new frontiers of medical technolo- Ministry, H.E. Mons. Redrado. Congregation, gy, the new places of care and Reference should also be made to The Congregation for the Doc- treatment, hospitals and the homes the papers on the realities, prob- trine of the Faith assured the Pon- of patients, the new health care lems and proposals of the local tifical Council of its co-operation, workers, the new services offered Churches in relation to AIDS in the not least in the form of a delegate to sick people, the new kinds of continents of Africa, America, Asia who would be present during the sick people and new emerging dis- and Europe. planning stage of the above men- eases such as Alzheimer’s, AIDS, The second day was entirely de- tioned seminar. The letter also and those brought about by drug voted to the visit to two institutions communicated the fact that the abuse, etc., medicine and cultural where the problem of AIDS is pre- Congregation for the Doctrine of changes, the contemporary ques- sent – the ‘Baby Jesus’ hospital and the Faith was presently examining tions of moral theology, the Rebbibia prison. In these two the question of the theological defi- prospects opened up by modern places round table conferences nition of doctrine in relation to the medicine for inter-religious dia- were held which also involved the ministry of the anointing of the logue with Judaism, Islam, Hin- participation of those in charge of sick. duism, and Buddhism, and the these institutions. DH n.45 ing 69-144 2.8.2001 15:46 Pagina 144

The deliberations ended with the panied them. This was also true of Colombia) have been published of wish and the hope that those afflict- the various organisations involved the book by the President of the ed by AIDS would be accompanied in helping and looking after the in- Pontifical Council, H.E. Mons. by the solidarity of the Church and firm, such as UNITALSI, the Don Lozano, entitled ‘Theology and by the fraternal generosity of men Guanella Institute, the Cottolengo, Medicine’. An edition in Italian is and women of good will, following and others. They thus met the pre- also being prepared. A book enti- the example of the Good Samari- cisely expressed wishes of His Ho- tled ‘Women and the Good Samar- tan, and that they would be helped liness the Pope. itan’, the outcome of the first meet- with suitable instruments and mea- ing, at the level of the Universal sures and would be taken care of Church, on the presence and activi- until their last moment. 11. Publications ty of consecrated women in the world of health and health care, has Publishing activity is a part of been published in Italian. This is 10. Monthly Prayer with the programmes of the ministry of the first and comprehensive sup- and for Sick People the Word. First of all the attention port for the initial training of fe- During the Jubilee Year of the reader should be directed to male candidates for religious life the journal of the Ministry, Dolen- who are being prepared for the At the beginning of the Jubilee tium Hominum. The Church and ministry of caring for those who year the Holy Father expressed the Health in the World, which has suffer. wish that there would be special been published regularly. It is of- moments of prayer said by sick fered to our readers in four edi- people and other visitors in the tions: Italian, Spanish, French, and 12. Conclusion basilica of Santa Maria Maggiore English. One of the issues always in Rome during the whole of the contains the acts of the internation- The above mentioned pro- year 2000 with a view to obtaining al conference organised by the Pon- grammes of the work plan of this the Jubilee indulgence. The last tifical Council. During the year Pontifical Council directly and in- 144 Tuesday of every month was cho- 2000 the complete acts of the meet- tensely involved the Superiors, the sen as the date of the prayer meeting on Aids, of the study seminar Officials, and the internal and ex- ings with and for sick people. In or- on the identity of the Catholic ternal staff of the Ministry. In the der to involve all the countries of chaplain in pastoral care in health Pontifical Council building itself the world special dates were chosen and health care, of the seminar day activity was very intense. Meetings for each geographical region and on Hansen’s disease, and the study were held in order to prepare the eminent religious authorities were seminar on the sacraments in pas- ground for the conferences and invited to preside over each prayer toral care in health, were all pub- congresses organised by the Pontif- meeting. lished in this journal. ical Council, the meetings between At each of these moments of The Charter for Health Care representatives of Ministries of the prayer a passage from the Gospels Workers, which was published un- Roman Curia and other experts which bore on the meeting was der the auspices of the Pontifical within the framework of various read out, and there then followed a Council in Italian in 1994, has study groups held to study the few thoughts on the subject which since been published in various questions of drugs, AIDS, leprosy, were expressed by the ministrant. countries in the following lan- the IACHCI, guidance for pastoral Subsequently, prayer took place in guages: Spanish, English, French, care in health, the book on prayer front of the displayed most holy German, Dutch, Polish, Por- and the sacraments, and the prayer sacrament and ended with the tuguese, Russian, Czech, and Ro- meetings for sick people at the blessing of those present and a manian. After receiving the nulla basilica of Santa Maria Maggiore, prayer to the Holy Virgin ‘Salus In- osta of the Pontifical Council, edi- etc. firmorum’ which had been espe- tions are also being prepared in Thanks to this shared commit- cially written by the Holy Father Hungarian and Lithuanian. Trans- ment, it was possible to carry out John Paul II for this occasion. lations of the work are also now be- many initiatives (as, indeed, has Each month, for each geographi- ing prepared for publication in been demonstrated above). Other cal area, there was an intense par- Madagascan, Albanian, and Thai. initiatives are still being promoted. ticipation on the part of sick people, Four editions in Spanish (two in In addition, one should not forget the disabled, and those who accom- Mexico, one in Peru, and one in that during the year 2000 the epis- tolary correspondence of the Pon- tifical Council with episcopates, representatives of the Pope (and especially with those of recent appointment), with archbishops and bishops who visited Rome for reasons connected with the Jubilee or other reasons, and with priests, the members of female and male religious orders, and with health care workers, was also sustained and continued.

Rev. Don KRZYSZTOF NYKIEL Official of the Pontifical Council for Health Pastoral Care, the Holy See