DOLENTIUM HOMINUM No. 87 – year XXX – No. 1, 2015

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

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

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

Editorial and Business Offices: Pontifical Council for Health Care Workers (for Health Pastoral Care) 00120 Vatican City; Tel. 06.698.83138, 06.698.84720, 06.698.84799 - Fax: 06.698.83139 e-mail: [email protected] www.holyseeforhealth.net

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

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Contents

3 study Day on the 39 the Service to Life of Health-care Workers Letter on the Twentieth Anniversary 39 1. The Service of Health-care Workers of its Pubblication to Unborn Life. The Diagnosis 25 March 2015 and Treatment of Sterility in Couples as a Service to Life 5 Message of H.E. Msgr. Zimowski Prof. Riccardo Marana H.E. Msgr. Zygmunt Zimowski Dr. D. Milardi Dr. G. Grande 6 Paper of Msgr. Mupendawatu Dr. D. Ricciardi Msgr. Jean-Marie Mupendawatu Dr. A.L. Astorri Dr. E. Fruscella 7 The Challenge to Life Dr. G. Pompa and the Role of the Family Msgr. Carlos Simón Vázquez 43 2. The Service to Life of Health-care Workers: the End of Life 13 The Socio-cultural Context Dr. Giovanni Zaninetta of the Encyclical Evangelium Vitae Msgr. Mauro Cozzoli 46 Conclusions and Recommendations Don Maurizio Funazzi 16 The Contemporary Relevance of Evangelium Vitae from a Bio-juridical Point of View Topics Prof. Jean-Marie Le Méné 52 Catholic Nurses and Midwives: 19 The Contribution of the Ministers of Life Encyclical Letter Evangelium Vitae Msgr. Jean-Marie Mupendawatu to the Theology of Pastoral Care in Health 59 Francis’ Theology of Prof. Massimo Petrini Accompaniment H.E. Msgr. Zygmunt Zimowski 25 The Reception of the Encyclical Letter ‘Evangelium Vitae’ in the Moral, Spiritual and Apostolic Formation of Health-care Workers

25 1. Nurses Don Francesco Coluccia

28 2. Medical Doctors Msgr. Jacques Suaudeau

35 3. Pharmacists Fr. Pierre Jean Welsch

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Study Day on the Encyclical Letter Evangelium Vitae on the Twentieth Anniversary of its Pubblication

25 March 2015 S. Pio X Hall Vatican City

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The Most Reverend Jean-Marie Mupendawatu, Secretary of the Pontifical Council for Health Care Workers Via della Conciliazione, 3 Rome, 00193

On the occasion of the study day organised by this dicastery on the encyclical Evangelium Vitae on the twentieth anniversary of its publication, the Holy Father sends his cordial greetings to those taking part and hopes that this initiative will foster the deepening of scientific, anthropological and ethical contributions and bring about a renewed and generous commitment to the spread of the culture of life so that this incommensurable gift will be increasingly welcomed in all its mysterious and fascinating riches. With these wishes, His Holiness expresses his appreciation of all those who every day, albeit amidst so many difficulties, bear witness to their faithfulness to the Gospel of Life, and willingly sends to all those present his apostolic blessing, Cardinal Pietro Parolin, Secretary of State of His Holiness

From the Vatican, 18 March 2015

Original text in italian

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Message of H.E. Msgr. Zimowski

H.E. Msgr. expectant mother. In opposite fash- Letter to the Elderly in which St. Zygmunt Zimowski ion, the ‘right to have a child’ is John Paul II expressed his love for the President of the invoked, with resort to techniques life as a gift of God and exhorted us Pontifical Council of assisted procreation, which, to appreciate it in every situation. for Health Care Workers, amongst other things, lead to the Despite the limitations that arrived the destruction of innumerable embry- with his advancing age, the Holy os. In addition, it is ever more the Father observed: ‘I continue to en- case that countries in the industrial- joy life. For this I thank the Lord. warmly greet all those taking part ised world have increasingly legal- It is wonderful to be able to give Iin this Study Day. I am very sor- ised euthanasia, even for children. oneself to the very end for the sake ry that I am not present with you. I ‘The culture of death’ – this is the of the Kingdom of God’ (n. 17). would like to take this opportunity sad observation that must be made Grateful for this gift he ended with to thank you all for your nearness – has not surrendered and has not the prayer: ‘Grant, O Lord of life, and solidarity but above all else I laid down its lethal weapons! that we may be ever vividly aware would like to thank you for your Through this Study Day organ- of this and that we may savor every prayers. ised by the Pontifical Council for season of our lives as a gift filled Exactly twenty years ago, on Health Care Workers we wish to with promise for the future. Grant 25 March 1995, St. John Paul II stress the contemporary relevance that we may lovingly accept Your signed the much awaited encycli- of the teaching of St. John Paul II will and place ourselves each day cal Evangelium vitae, one of the as regards the dignity and the invi- in Your merciful hands’ (n. 18). most authoritative documents of olability of human life. This teach- his magisterium. In it he expressed ing was recently restated by Pope the truth of the value and invio- Francis in his address of 5 March Serve Life! lability of human life, especially 2015 to those taking part in the when it is weak, frail and defence- plenary assembly of the Pontifical With these words I address first less, in the face of the very many Academy for Life: ‘I repeat the ap- and foremost all health-care work- imminent threats to it: ‘In addition peal of St. John Paul II: ‘respect, ers who are, and always should be, to the ancient scourges of poverty, protect, love and serve life, every servants of life. The Charter for hunger, endemic diseases, violence human life! Only in this direction Health Care Workers, which was and war’, he wrote, ‘new threats will you find justice, development, published immediately after the en- are emerging on an alarmingly vast true freedom, peace and happi- cyclical Evangelium vitae, defines scale… any type of murder, geno- ness!’ (Evangelium vitae, n. 5)’. them as ‘servants of life’. In partic- cide, abortion, euthanasia, or wilful ular in n. 4, this Charter stated: ‘To self-destruction, whatever violates serve life is to serve God in the per- the integrity of the human person, Respect and Defend Life! son: it is to become “a collaborator such as mutilation, torments inflict- with God in restoring health to the ed on body or mind, attempts to co- In order to perform in a more ef- sick body” and to give praise and erce the will itself…all these things fective and incisive way the task of glory to God in the loving welcome and others like them’, emphasised respecting and defending life from to life, especially if it be weak and the Pope, ‘are infamies indeed… conception until natural death, on ill’. they are a supreme dishonour to the 11 February 1985 St. John Paul Following the example of St. Creator’ (EV, n. 3). II instituted the PontificalC om- John Paul II, the founder of our Over the last twenty years since mission for Pastoral Assistance Pontifical Council, we as well, to- the publication of Evangelium vi- to Health Care Workers and three gether with all those who are in- tae we can see that these attacks years later he elevated it to the rank volved in the field of health and have not diminished but have, rath- of a Pontifical Council. Subse- health care, must be courageous er, increased, taking on increasing- quently, thinking of providing a sci- defenders of human life. Only in ly new and subtle forms. Today, in- entific support for this evangelising this way, uniting our forces, will deed, in the wake of scientific and mission, on 11 February 1994 the we be able to counter the advance technological progress, human life Pope instituted the PontificalA cad- of the ‘culture of death’. May the is manipulated in the name of pur- emy for Life which is organically Lord , who said in the Gospel ported ‘rights’. Reference is thus connected to the Pontifical Council according to St. John ‘I have come made to the ‘right to abortion’ and for Health Care Workers. in order that you might have life – women are pushed towards the use life in all its fullness’ (Jn 10:10), of the ‘morning after pill’, with- support us! out any concern about the damage Love Life! With all my heart I wish you a caused to unborn life and without most fruitful meeting! May God any concern about the health of the I would like to refer here to the bless you!

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Paper of Msgr. Mupendawatu

Msgr. Jean-Marie hood stand at the very beginning lated in a unanimous way by the Mupendawatu of the mystery of life which Christ Cardinals at the extraordinary Secretary of the came to bestow on humanity (cf. consistory of April 1991, and in Pontifical Council for Jn 10:10). Through her acceptance the face of the numerous attacks Health Care Workers, and loving care for the life of the on life perpetuated in the world, the Holy See Incarnate Word, human life has the bishops asked the Pope to re- been rescued from condemnation affirm with his authority the val- to final and eternal death’ (EV, n. ue and the inviolability of human ost Distinguished Chairmen, 102). Mary is the Mother of the life: Pope John Paul II then pub- MSpeakers and Participants, living God, the Mother of the Son lished his encyclical Evangelium Dear Brothers and Sisters, of God, Jesus Christ the Way, the vitae in which we find a precise Dear Friends, Truth and the Life. We are truly and firm reaffirmation of the value sons in the Son and sons of Mary; of human life. Today, 25 March 2015, the Pon- from Mary we have received the An inescapable point of depar- tifical Council for Health Care gift of the Author of life. ture for our study day is this en- Workers is celebrating with joy The celebration of a twentieth cyclical which represents a sum- the twentieth anniversary of the anniversary is also an anamnes- mary of the constant and perennial publication of the encyclical letter tic operation. To turn one’s gaze teaching of the Church on respect Evangelium Vitae,1 and I extend to to the roots is a part, indeed, of for human life. you my most cordial greetings and memory. The magisterium of the Pope Francis in his apostolic I express to you my warm grati- has sought to promote the exhortation Evangelii gaudium tude for your participation. defence of human life from its be- says ‘no’ to the destruction of life: My welcome in particular goes ginning to its final moment. This ‘Our world is being torn apart by to the distinguished speakers and teaching became increasingly em- wars and violence, and wounded all the very important guests who phasised above all starting with by a widespread individualism have come here. For me it is an Humanae vitae of Paul VI (1968), which divides human beings, set- honour to chair this study day on which was followed in 1981 by ting them against one another as the encyclical letter Evangelium the Famil- they pursue their own well-being. vitae on the twentieth anniversary iaris consortio. In various countries, conflicts and of its publication. In 1983 the Synod of Bishops old divisions from the past are re- Indeed, four decades have denounced with fear the enor- emerging. I especially ask Chris- passed since John Paul II pub- mous struggle in the contemporary tians in communities throughout lished on 25 March 1995 the en- world between the culture of life the world to offer a radiant and at- cyclical letter Evangelium vitae, and the culture of death. This last, tractive witness of fraternal com- which has rightly been called a today, is unfortunately more root- munion’. 3 milestone of the pontificate of ed and more expressed: ‘In our The encyclical letter Evangeli- John Paul II. days the tension between the light um Vitae is a document of extraor- Today the Catholic Church cel- and the shadows (cf. 1Jn 2:8-11) is dinary contemporary relevance ebrates the solemnity of the An- an immense and enormous strug- which strongly emphasises that nunciation of the Lord, a joint gle between the culture of life and man constitutes the first and fun- feast day of Christ and the Vir- the culture of death… Culture of damental way of the Church. This gin: of the Word that became the death are ‘warlike aggression, vio- is why this study day does not Son of Mary (Mk 6:3) and of the lence and terrorism’, as well as the want to be a simple celebratory Virgin who became the Mother of terrifying ‘accumulation of weap- commemoration of the twentieth God. With her generous fiat (cf. ons’, especially atomic ones, and anniversary of its publication but Lk 1:38), she became, through the the scandalous traffic in weapons also intends to ask questions about work of the Spirit, the Mother of of war of every kind’.2 the culture of life in a cultural and God, but also the true Mother of In 1987 the Congregation for social context where the promo- the living by welcoming in her the Doctrine of the Faith published tion of ‘a culture of life’ that be- womb the author of life, the only the Instruction Donum vitae. In comes an existential heritage for Mediator (cf. 1Tim 2:5). 1993 John Paul II himself, in his the whole of humanity is urgently ‘The one who accepted “Life” encyclical , of- needed. in the name of all and for the fered the foundations of Catholic Distinguished speakers, all of sake of all was Mary, the Virgin morality, and, as a confirmation to us are responsible for the promo- Mother; she is thus most closely the commitment to defending life, tion of the culture life. John Paul and personally associated with the in 1994 he instituted the Pontifical II in his encyclical Evangelium Gospel of life. Mary’s consent at Academy for Life. Lastly, in 1995, Vitae highlighted how ‘only the the Annunciation and her mother- as a tribute to the request formu- concerted efforts of all those who

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believe in the value of life can she will support us in this activity Notes prevent a setback of unforeseea- and make us constantly ready to ble consequences for civilization’ give reasons for living, and hope, 1 Giovanni Paolo II, Lettera enciclica, Evangelium vitae, sul valore e l’inviolabilità (EV, n. 91). to our brothers and sisters. della vita umana (25 marzo 1995): AAS 87 In wishing you all a happy and Let us now stand to listen to the (1995), pp. 401-522. lasting outcome for your delibera- words and the apostolic blessing 2 VI Sinodo dei vescovi, ‘Messag- gio al mondo’, in L’Osservatore Romano, tions, let us implore the interces- of the Holy Father Francis which 28.10.1983, 1. sion of the Mother of life, the Vir- I have the honour and the pleasure 3 Pope Francis, Apostolic Exhortation gin of the Annunciation, so that to communicate to you! Evangelii gaudium , n. 99.

The Challenge to Life and the Role of the Family

Msgr. Carlos forms: above all else it is the cul- role or the response of the fami- Simón Vázquez ture which is behind the intention ly to the challenges to life, my in- The Under-Secretary to perpetrate these attacks that is tention is not to engage in a de- of the Pontifical Council more powerful and refined.A n at- tailed exposition of the contents for the Family, tempt is made to present crimes of this Magisterium, that is to say the Holy See against life as democratic rights the task which according to the which the state should author- teachings of the Church the fam- ise, protect and even carry out ily should perform. I will confine through the free action of health- myself in this paper to pointing care institutions, reaching the par- out only some of the most funda- Caring for and Defending life: adox that it is health-care profes- mental aspects or directions that the Response of the Family to sionals themselves who should should structure the work of the the Challenges to human Life attack life! Pope Francis recently family in this field. stated this when meeting Italian With this aim, my paper is di- Caring for and defending life Catholic doctors.2 vided into three parts. In the first is a task that today has a spe- Nobody, whatever may be – in line with the texts of the Mag- cial urgency. This was recently their level of participation in so- isterium – I will offer a survey, emphasised both by the Instru- cial life, can be exempt from pro- by way of a list, of the threats to mentum Laboris and the Relatio claiming and defending the value which human life is exposed to- Synodi of the last Extraordinary and the inviolability of human day. In the second, I will engage Assembly of the Synod of Bish- life. This is a right and a duty. But in a short analysis of the real ops.1 The challenge to life and the it escapes nobody that in this mat- question that underlies or is be- challenge to the family in a cer- ter the family has, and must have, hind the subject of human life. tain sense coincide. We may refer an important place. It is, indeed, Lastly, in the third part, I will ad- to the component features of this the natural setting for the birth, dress the question of the function challenge in the abundant indi- the development and the matu- of the family in the response to vidual challenges at various lev- rity of human life. This is one of these threats or challenges, in oth- els but in essential terms the great the reasons why the Magisterium er terms what role the family has challenge that threatens both life of the Church, aware of the sin- in the construction of a culture of and the family is the anthropolog- gularity of this mission, has as- life. ical challenge. Challenges have a siduously addressed families with positive dimension but they also the intention of helping them in have a negative dimension, that is the carrying out of this work. In 1. The Threats Today to say they are attempted threats. recent decades the to Human Life Today the threats to life have Humanae vitae and Evangelium characteristics of such a kind as vitae, the Instructions Donum vi- Human life today has to deal to make it increasingly evident tae and Dignitas personae of the with numerous and various threats how much human life is defence- Congregation for the Doctrine of and challenges. They come from less. The forms in which today’s the Faith, and the ‘Letter to Fami- different fields and concern both technologies allow attacks on life lies’ Gratissimam sane of St. John the origins of life and its develop- – especially at its beginning and Paul II, have been of special rel- ment and terminal stage. Albeit during its terminal stage – are evance in this sense. in different forms, they have al- not new or more sophisticated However, in addressing the ways existed, in one way or an-

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other, down the whole of history. each other, but it seems to me that man means to love God. Both of Now, however, they have charac- the right solution to the challenges these are achieved to the extent to teristics of such a character that that exist must always start from which the life of Christ is ‘repro- it does not appear exaggerated to a suitable answer to the question duced’). describe a part of our culture as a about the meaning and the foun- ‘culture of death’. dations of human life. What is the a. To what does Revelation The first chapter of Evangeli- meaning of life? Why must it be refer when it speaks about um Vitae, which echoes the strong looked after? These are the ques- respecting human life?5 denunciation of Gaudium et Spes tions that I will now examine. of crimes and threats relating to The life that the Lord came to life (cf. GS, n. 27), observes how give to men is ‘“new” and “eter- the ‘alarming spectacle’ of those 2. Care for Human Life, nal” life which consists in com- years far from growing smaller Care for the Person munion with the Father, to which had in fact been spreading. It al- every person is freely called in the so observes that those threats are The question of the value and Son by the power of the Sancti- planned in a scientific and system- the meaning of human life is not fying Spirit’ (EV, n. 1). ‘Eternal atic way (cf. EV, n. 17), at times only ethical – it is also, and first life is therefore the life of God upheld as ‘rights’, as signs of ma- of all, anthropological, as is also himself and at the same time the turity or as advances of medicine the case with the family.4 It pre- life of the children of God’ (EV, (cf. EV, n. 4, 11, 68); ‘with the supposes another prior and more n. 38). This life – to which the new prospects opened up by sci- radical question: who am I? What Lord refers when he says that he entific and technological progress is the meaning of my life? Only a is ‘the life’ (cf. Jn 6:33; 8:12) – re- there arise new forms of attacks wider picture of truth and the val- veals in the final analysis the ‘the on the dignity of the human be- ue of the person will enable me to greatness and the inestimable val- ing. At the same time a new cul- penetrate in the right way the im- ue of human life even in its tem- tural climate is developing and portance of the forms of care for poral phase’ (EV, n. 2); in it ‘all taking hold, which gives crimes human life, whatever the stage of the aspects and stages of human against life a new and-if possible- life in which it finds itself. life achieve their full significance’ even more sinister character, giv- This approach – the value of the (EV, n. 1). The life that the Lord ing rise to further grave concern: person and the meaning of his or speaks about is not only the life 3 broad sectors of public opinion her life – is the approach of Rev- that goes beyond time but also justify certain crimes against life elation when it speaks about the that life ‘which even now is open in the name of the rights of indi- love that is due to human life. to eternal life because it shares in vidual freedom, and on this basis Along these lines, Evangelium vi- the life of God’ (EV, n. 37; cf. nn. they claim not only exemption tae, which devotes its third chap- 1-2, 31; Jn 17:3). from punishment but even author- ter to describing the doctrine of Life in time is certainly the ba- ization by the State, so that these the faith on the respect due to hu- sic condition but it is above all things can be done with total free- man life, is above all an expres- its initial moment and the inte- dom and indeed with the free as- sion of the respect and love that gral part of the fullness of life to sistance of health-care systems’ are due to man. It does not confine which the human being is called. (EV, n. 4). The Instruction Dig- itself to being an invitation to pro- ‘The life which God bestows upon nitas personae of the Congrega- tecting life and pointing to actions man’, observes Evangelium vitae, tion for the Doctrine of the Faith that go against this. ‘is much more than mere exist- of 2008 corroborated the fact that We can say that the recurring ence in time. It is a drive towards the situation described by the en- principle of the teaching of Rev- fullness of life; it is the seed of an cyclical has continued to be com- elation as regards the life of a hu- existence which transcends the pletely present. man being is always admiration very limits of time’ (EV, nn. 34; Amongst the causes that led to for the dignity of the human per- 37). ‘God’s eternal life is in fact the spread of this culture against son: (‘What is man that thou are the end to which our living in this life, Evangelium vitae points to mindful of him?’, Psalm 8:5). world is directed and called’ (EV, those that ‘come from nature it- And given that the full truth about n. 30). self’ (EV, n. 10), ‘the result of man can only be known in Christ This is the reason why the val- situations of violence, hatred and (cf. GS, n. 22), the conclusion is ue of human life – in its earthly conflicting interests’ (EV, n. 11), that only in Christ does one find dimension as well – is perceived of moral relativism (cf. EV, nn. the right answer to what the value fully only starting with Revela- 11, 21), of the spread of a culture and the meaning of human life is. tion and, in more concrete terms, of the loss of the sense of man (cf. If ethics leads back to anthropol- ‘through the words, the action EV, nn. 11, 21), of a perverse idea ogy, anthropology, in order to be and the person himself of Christ’ of autonomy and freedom (cf. EV, adequate, leads back in its turn to (EV, nn 28, 29). Christ is he who nn. 18, 21), of the eclipse of the Christology (after a certain fash- reveals the whole truth about sense of God (cf. EV, n. 21) and ion we can say that the stages man. It is the Lord who, through of practical materialism (cf. EV, of the thinking of the encyclical his life, death and resurrection, n. 23). These are all clearly unit- are the following: to love human makes known and realises to the ed and intertwining, and explain life means to love man; to love full the design of salvation for

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man which had been hidden in trinsic connection with the full- – each human person – comes in- God since the beginning of time ness to which it tends, but it does to existence as the result of a di- (cf. Eph 1:9). ‘Truly great must be not have in itself the explanation rect and particular intervention the value of human life if the Son of its own being, its intelligibility, by God (the soul of each human of God has taken it up and made its goodness or its value.6 being is created immediately by it the instrument of the salvation The consequences that derive God). Secondly, this special rela- of all humanity!’ (EV, n. 33). The from this concern the stance to be tionship with his or her Creator is life of Christ and in particular his adopted towards physical or cor- due to his or her destiny: amongst death on the cross ‘while it re- poreal life are clear, as Christian the creatures of the visible crea- veals the grandeur of the Father’s thought has always emphasised. I tions, only the human person was love, shows how precious man is will point to only some of these created for ‘fellowship with God in God’s eyes and how priceless is consequences. in knowledge and love of him’ the value of his life’ (EV, n. 25). – An adequate valuing of the (EV, n. 38). The Incarnation of the Son of God various dimensions of human And this is because he or she is the ultimate explanation for the life requires a taking into account is sacred and inviolable. ‘God dignity of human life which from of the organisation that they are therefore is the sole Lord of this its beginning until its end has ‘its called to objectively, as dimen- life: man cannot do with it as he foundation in God and his crea- sions of that ‘unified totality’ – wills’ (EV, n. 39). Human life is tive activity’ (EV, n. 39). the human person. the property of God the Creator In current language the term – Earthly existence is not an and Father (cf. EV, n. 40); ‘no one ‘life’ is habitually referred to ‘ultimate’ but a ‘penultimate’ re- can, in any circumstance, claim this way of existing which hu- ality of human life. If it is said that for himself the right to destroy di- man beings share with other liv- human life has an absolute value, rectly an innocent human being’ ing organisms, which are ‘ca- this must be understood only with (DVi, Intr, 5; cf. EV, nn 53, 43). pable of defending themselves, reference to the relationship that it ‘No one, however, can arbitrarily developing and multiplying on maintains with eternal life; physi- choose whether to live or die; the their own’. This is biological life cal or corporeal life is not in itself absolute master of such a decision (bios). According to this usage, an absolute good:7 one can and is the Creator alone’ (EV, n. 47). the word ‘life’ can, however, al- one must offer to protect and de- The inviolability of human life so mean ‘the set of experiences fend higher goods such as faith or is a sign of the inviolability of the that are lived (psychological life) freedom (cf. EV, nn. 2, 47). person, an echo of the creative or the entire existence of an indi- – Although the physical or cor- act of God which is heard in the vidual inasmuch as he or she is a poreal life is not an absolute val- very heart of man, as is attested project of humanity always in fi- ue, it is the most fundamental to by universal experience. In the eri (personal life)’. But in Holy good of the human person and has depths of his or her conscience, Scripture, as we have seen, in the a decisive moral transcendence. the person perceives that he or she New Testament, and in particu- The personal improvement of the is called to answer at any moment lar in the Gospel of St. John, the human being and the fullness of for his or her approach to life – word ‘life’ is employed to indi- life to which he or she is called the life of that person and the life cate supernatural life or the life of are connected with the existence of other people – as a reality that grace, ‘eternal life’. And the term of the body. Hence the right/duty does not belong to him or her and used is zoê in order to distinguish to care for and defend health, etc. which he she cannot dispose of it from bios. as he or she so wishes. This is a In the human person these three b. Why care for human life? perception that is imposed on the levels are so interrelated that the person and which he or she can- biological shares in the other two One of the clearest affirmations not escape. and vice versa. This is also, af- of Revelation as regards human Biblical texts emphasise the in- ter a certain fashion, the clear be- life is that it is ‘sacred’ and thus violable character of human life lief in universal consciousness. inviolable.8 ‘Human life is sacred in the most varied contexts and Man, indeed, perceives himself because from its beginning it in- also with the most varied ap- as a good that already exists but volves the creative action of God, proaches. ‘The covenant between at the same time he is not such in and it remains forever in a spe- God and mankind is interwoven a definitive way. He understands cial relationship with the Creator, with reminders of God’s gift of himself as a project or a task to be who is its sole end’ (DVi, Intr., human life… The Old Testament accomplished. He lives in a drive 5; cf. CCC, n. 2258; EV, n. 53). always considered blood a sacred towards a fullness that is still not This ‘particular and specific bond sign of life. This teaching remains possessed. From this point of view with the Creator’ (EV, n. 34) dur- necessary for all time’ (CCC, n. one also understands how the val- ing the course of his or her entire 2260). An essential element of ue of the ‘historical existence’ of existence the person owes, first of this teaching is the ‘command- man lies in being the pathway of all, to his or her origins: the hu- ment about the inviolability of his own personal fulfilment, the man being is the only one of the human life [which] reverberates way by which to achieve life to creatures of the visible world cre- at the heart of the “ten words” in the full. The preciousness of his- ated ‘in the image and likeness the covenant of Sinai’ (EV, n. 40, torical life is explained by its in- of God’. Only the human person cf. Ex 20:13).9

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The New Testament, confirm- a. The sovereignty of God and or she carry out the mission that ing and bringing to its fullness dominion or lordship over man has been entrusted to him or her, this message of the Old Testament when it was given to that person, ‘is a forceful appeal for respect The sovereignty or lordship of for other people, because respect for the inviolability of physical God over human life does not as- for life is the primary manifesta- life and the integrity of the per- sume any reduction in any way of tion of love of man. This duty is a son. It culminates in the positive man’s responsibility for his own requirement of the common good commandment which obliges us life, nor does it attack this respon- and is at the heart of the message to be responsible for our neigh- sibility. However, it does indi- of the Gospel. bour as for ourselves: “You shall cate the framework in which man With wisdom and love. The love your neighbour as yourself”’ must exercise dominion over life. right/duty to care for life must be (EV, n. 40). Its deepest dimension As the image of God, man has re- exercised with wisdom and love is summed up in the need for love ceived the task of dominating the because it is in this way that God and veneration of one’s own life earth, that is to say of completing takes care of man and human life. and the lives of other people. the creative work of God, and in Life is a gift that ‘asks to be wel- The absolutely inviolable char- a particular way his own fulfil- comed, preserved and esteemed, acter of innocent human life ‘is ment, that of his own life and that with a deep sense of responsibil- a moral truth clearly taught by of the lives of other people. ‘To ity. In giving life to man, God de- Sacred Scripture, constantly up- defend and promote life, to show mands that he love, respect and held in the Church’s Tradition reverence and love for it, is a task promote life’ (EV, n. 52). We find and consistently proposed by her which God entrusts to every man’ here another reason that justifies Magisterium’ (EV, n. 57). (EV, nn. 42, 52). the licit character of the use of ‘God is the only lord of this This is a task or charge which suitable means and the illicit char- life’. Only God can say ‘“It is I involves a real dominion: on man acter of disproportionate means in who bring both death and life” (Dt depends whether he lives or does caring for health, such as ‘exag- 32:39)’. But the lordship of God not live his own life and, with gerated treatment’. over man and human life is not ar- various nuances – according to ‘Thou shalt not kill’ (Ex 20:13) bitrary, He does not exercise it ‘in whether he is dealing with him- ‘is a forceful appeal for respect an arbitrary and threatening way’ self or other people – how he does for the inviolability of physical but ‘rather as part of his care and this. This dominion, however, is life and the integrity of the per- loving concern for his creatures’ at the same time relative, that is to son’ (EV, n. 40) and thus ‘prohib- (EV, n. 39). Every human being – say it must always be exercised in its all personal injury inflicted on every human life – is the result of the awareness that a person must another’ (EV, n. 40). the love of God, who takes care answer for how he or she lives But this commandment is first through His providence of all the is own life. This is a ministerial of all an invitation to love other beings and every being of the cre- lordship. This means that because people: ‘to be responsible for our ation, and who, as regards man, is the dominion of man over his life neighbour as for ourselves: “You in addition very special, as Rev- is, in essential terms, participation shall love your neighbour as your- elation demonstrates so profusely in the sovereignty of God (cf. EV, self”’ (EV, n. 40). Its deepest as- (cf. Lk 21:18). n 39), man’s just conduct in rela- pect is the ‘requirement to show tion to life involves reflecting and reverence and love for every per- making visible the dominion and son and the life of every person’ 3. How should Human Life lordship which are God’s alone. (EV, n. 39). And since the image be Cared for? The Answer For this reason, man’s caring for and the perfect expression of this of the Family life is a right and a duty that must love are, as I have previously ob- be engaged in with wisdom and served, the work and the person ‘God, the Lord of life, has con- love. of Christ, it is here that man must ferred on men the surpassing min- A right/duty. Life is a gift en- search, in the ultimate analysis, in istry of safeguarding life in a man- trusted to man. Each human being order to know and live the truth ner which is worthy of man’ (GS, is the first and direct custodian of and the good of human life. From n. 51). These words of the Second his or her own life, that is to say of this ‘source’ man receives not Vatican Council determine the na- its stewardship and fulfilment. He only ‘the possibility of “know- ture of the dominion or lordship or she truly can say that his or her ing” the complete truth concern- of man over human life and, spe- life is ‘his’ or hers’. It is a ‘belong- ing the value of human life., but cifically for this reason, of care ing’ or property which, because of in a special way the ‘capacity to for human life. Pope Francis re- its special features, gives rise to a “accomplish” this truth perfect- cently emphasised this strongly, primary and intangible right: it is ly (cf. Jn 3:21), that is, to accept offering an explanation of it by the most fundamental right, the and fulfil completely the respon- using another word ‘to honour’. basis of all the other rights of the sibility of loving and serving, of This is a task that the family is human person. Specifically for defending and promoting human called to share om fundamentally this reason, the protection and the life’ (EV, n. 29). Because it is in but which medical science is also defence of life is also a duty for Christ, ‘from the blood of Christ called explore.10 the individual himself or herself, that all draw the strength to com- because only in this way can he mit themselves to promoting life’

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(EV, n. 25). One understands from This involves, on the part of the supernatural fullness. For this rea- this the importance of the incor- family, the promotion, amongst son, education in the true mean- poration of Christ (through grace other things, of a culture of the ing of freedom is an inescapable and the sacraments) into the task truth and the meaning of sexuali- element of education which must of defending and caring for life, ty, of conjugal love, of fatherhood be carried out in the family. since it will be possible ‘to repro- and motherhood and so forth (cf. Education in freedom must be duce’ his approach to, and his care EV, n. 97). The response of the directed not only to ensuring that for, human life to the extent that family to the challenges to life and children are capable of deciding his Life itself is lived. in the building of a culture of life on themselves but also and above The death of Christ on the cross is of particular importance in the all else to ensuring that these de- is significant not only because it area of education. One of the fun- cisions are taken and put into reveals the love of God and the damental steps must, therefore, practice in the domain and the di- value of man but also because consist in ‘forming consciences rection of what must be, that is man fulfils his own life to the ex- with regard to the incomparable to say respecting the ethical val- tent to which he gives it: ‘his vo- and inviolable worth of every hu- ues of upright moral behaviour. It cation consists in the sincere gift man life’. Thus, Evangelium vi- follows from this that education of self’ (EV, n. 25). tae specifies, ‘It is of the great- in freedom must be education in est importance to re-establish the the virtues. The virtues, indeed, b. The family: a sanctuary of life essential connection between life have as their purpose helping and freedom’ and ‘the recovery of man to use, and to relate to, creat- Evangelium vitae, which dedi- the necessary link between free- ed goods with freedom, that is to cates its fourth part to the promo- dom and truth’ (cf. EV, n. 96). In say in the world that corresponds tion of a ‘new culture of human the ultimate analysis, only with to the nature of these goods and life’ (nn. 78-101), dwells in a spe- an adequate formation will peo- to the nature of man, according to cial way on addressing the ‘re- ple be able to proceed in the right what they are and how they serve sponsibility of the family’ which way in caring for and protecting the good of man. it defines as ‘decisive’ in this pro- human life. Education in the meaning of motion (nn. 92-95). This teaching, The ultimate goal of education justice and love. ‘The home is the which is an extension of what was is to ensure that the person devel- natural environment for initiat- affirmed by ops in such a way as to find his ing a human being into solidari- and was carried on in other docu- or her identity and act in accord ty and communal responsibilities. ments such as the ‘Letter to Fam- with what he or she is called to Parents should teach children to ilies’ Gratissiman sane, is of in- be by vocation. Integral and com- avoid the compromising and de- terest for the subject of this paper plete education requires that all grading influences which threaten inasmuch as it points to the foun- aspects are cared for: the mate- human societies’ (CCC, n. 2224). dation of how the family must re- rial, the spiritual, the natural, the For this reason as well, the family spond to the challenges to human supernatural etc. Hence the per- is the primordial cell of society; it life and even the way in which this son must always be at the cen- is the first school for the humani- should be done: ‘Within the family tre of education. For this reason, sation of man and society. each member is accepted, respect- without engaging in a detailed list Given the human social condi- ed and honoured precisely because of the values and the aspects that tion, children cannot achieve the he or she is a person; and if any must integrate this education, we development of their personalities family member is in greater need, can well say that education must and exercise their talents without the care which he or she receives always bear in mind two funda- relating to other people (cf. GS, is all the more intense and atten- mental dimensions of the person: n. 12). To perform this task, there tive’ (EV, n. 92). For this reason, his or her personal dignity and so- should only be relationships that ‘the role of the family in building ciality, and, in the case of Chris- are sincere and based upon truth, a culture of life is decisive and ir- tians, the supernatural dimension that its to say relationships that replaceable’ (EV, n. 92). that is specific to the children of correspond to ‘a sense of true jus- The text of Evangelium vitae God – divine filiation – ‘the true tice, which alone leads to respect also speaks about the spheres and and integral dimension of his hu- for the personal dignity of each dimensions in which the family manity’ (GrS 16). The Magisteri- individual’ (FC, n. 37). ‘The hu- is called to respond to the con- um of the Church refers to this di- man person needs to live in so- temporary challenges to life. It mension when it speaks about the ciety. Society is not for him an expressly refers to those that are family as a school of humanity, a extraneous addition but a require- produced in the transmission of sanctuary of life, the foundation ment of his nature. Through the life and its education’ (EV, n. of society, etc. exchange with others, mutual ser- 92). As regards the transmission Educating in freedom. Freedom vice and dialogue with his breth- of life, we must include all those – the most eminent sign of the im- ren, man develops his potential; challenges against life in the field age of God in man (cf. GS, n. 17) he thus responds to his vocation of procreation, a ‘unique event – is one of the fundamental values (cf. GS, n. 25)’ (CCC, n. 1879). which clearly reveals that human in education. Only through the For this reason, education in the life is a gift received in order then upright exercise of freedom can a true meaning of justice is another to be given as a gift’ (EV, n. 92). person reach his or her human and of the essential values that parents

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must necessarily attend to in the The setting for the education ciety to perform its fundamental education of their children. On- of children. In the family, parents duty of respecting and promoting ly in this way will the family be must be aware of the very deci- the family itself. In this area, the a school of humanity. It is clear, sive role that the family plays in responsibility of the family and however, that the right relation- this education. The thousands of society is complementary. ‘But ship with other people (affirming details of family life are decisive society – more specifically the the ‘other’ and treating him or her milestones in the formation of State – must recognize that “the in line with the respect that is due the personality of children. ‘They family is a society in its own orig- to him or her) is achieved, in the bear witness to this responsibili- inal right” and so society is un- ultimate analysis, in love. This is ty first by creating a home where der a grave obligation in its rela- the right way of relating to other tenderness, forgiveness, respect, tions with the family to adhere to creatures when they are people. fidelity and disinterested service the principle of subsidiarity’ (FC, For this reason, education in the are the rule. The home is well n. 45); ‘families should grow in real meaning of justice cannot suited for education in the virtues’ awareness of being “protago- depart from education in the real (CCC, n. 2223). nists” of what is known as “fam- meaning of love. But the role of the family in ily politics” and assume respon- Education in chastity. For the the response to the challenges to sibility for transforming society’ same reason, an important part of life does not end here, that is to (FC, n. 44). This is the permanent this education in love is education say within the family, within the and current challenge posed to a in chastity. We cannot forget that home. It is no less important out- Christian family: to be a resource, education in love is an overall re- side the family. And one of the an agency and a patrimony of hu- ality and that education in charity concrete forms possessed by the manity. Only in this way will it is inseparable from education in family to perform this function is be possible for the Kingdom of the other virtues. Sexuality con- taking part in politics. There are God to become that tree which is stitutes riches of the person in his two fundamental ways of carry- so great that it can shelter all the or her totality and is directed to- ing this out: the witness of fam- birds of the sky in its shade (cf. wards ‘leading the person to the ily life and active participation Mk 4:32). There is no life with- gift of self in love’ (FC, n. 37). in the configuration of society so out the family, or better it is only The way in which sexuality is that the laws and institutions of within the boundaries of the fam- lived is inseparable from the way the State do not offend but, rath- ily, as wanted and revealed by justice and love with other people er, support and positively defend God, that human life shines forth are lived. It follows from this that the rights and duties of the fam- in all its beauty and dignity; but education in sexuality is a part of ily. This is because the family is, it is also true that the family does education in the real meaning of and must be, the first and princi- not exist without life. The family love. And it also follows from this pal protagonist of the politics of becomes what it is in welcoming, that authentic education in sexual- the family. in taking care of, and in the inte- ity must be education for charity. If within a specific society laws gral development of, human life. Chastity is the virtue which in exist which are against the fam- Such is the always new challenge seeking ‘to permeate the passions ily, a family should be aware of to the family: to integrate in a cor- and appetites of the senses with the fact that its witness to faith- rect way the vertical dimension reason’, ensures that man can in- fulness to those values that these with the horizontal dimension, tegrate his sexuality in an upright laws do not protect or contravene the social with the religious, and way in his relationships with other can transform society at a deep the human with the divine. This people. In sexual education, there- level. At the same time every is why the development of peo- fore, formation in values and mor- family in particular and, even bet- ples and the new evangelisation al rules cannot be departed from. ter, in association with other fami- have in the family not only an al- Indeed, conforming one’s own be- lies, should, with the means that ly but also an element that cannot haviour to these values and rules are available to it, work to ensure be departed from in building, ‘hic is the road that is required to inte- that ‘the laws and institutions of et nunc’, new heavens and a new grate sexuality into the unity of the the State not only do not offend earth. person. Only then can one achieve but support and positively defend freedom and self-control, in or- the rights and duties of the fami- der to relate to others, as persons, ly’ (FC, n. 44). As a consequence, Notes through the giving of self, given one should create associations, one’s own condition and that of take part in political parties, pro- 1 Instrumentum Laboris, Synod of Bish- ops: III Part, ‘l’apertura alla vita e la respon- other people: parents, spouses, mote currents of opinion etc. that sabilità educativa’ (nn. 121-134). Relatio children, brothers and sisters, etc. foster engagement in activities Synodi, ‘La trasmissione della vita e la sfida There appears here another rea- that benefit the family as such. della natalità’, nn. 57, 58, 59. 2 The predominant school of thought son why in sexual education vir- Respect of the State for the so- sometimes leads to “false compassion” ginity in a special way should be cial and political participation of which holds that it is a benefit to women to valued, given that virginity is ‘the the family in the configuration of promote abortion; an act of dignity to per- form euthanasia; a scientific breakthrough supreme form of that self-giving society derives from the nature of to “produce” a child, considered as a right that constitutes the very meaning the bond that unites society with rather than a gift to be welcomed; or to using of human sexuality’ (FC, n. 37). the family and which requires so- human lives as laboratory animals, alleged-

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ly in order to save others. Instead, the com- treats them as items of consumption to be 7 We can say that it posseses an absolute passion of the Gospel is what accompanies exploited, with the result that – as is so tragi- value in the sense that it is a good that can- us in times of need, that compassion of the cally apparent – whenever a human life no not be disposed of as a means for the benefit Good Samaritan, who “sees”, “has compas- longer proves useful for that machine, it is of other people. sion”, draws near and provides concrete help discarded with few qualms, as in the case 8 Some authors prefer to use the phrase (cf. Lk 10:33). Your mission as doctors plac- of the sick, of the terminally ill, the elder- ‘dignity of human life’ and not ‘sacredness’ es you in daily contact with so many forms ly who are abandoned and uncared for, and or ‘holiness’ of human life. They do this to of suffering. I encourage you to take them children who are killed in the womb. This avoid a comparison between ‘sacredness’ on as “Good Samaritans”, caring in a spe- is the great mistake made “when technol- and ‘quality’ of life.. cial way for the elderly, the infirm and the ogy is allowed to take over”; the result is 9 Holy Scripture itself makes clear that disabled. Faithfulness to the Gospel of life a confusion between ends and means. It is what the commandment (‘thou shalt not and respect for life as a gift from God some- the inevitable consequence of a “throwaway kill’) prohibits is bringing about the death of times require brave choices that go against culture” and an uncontrolled consumerism’. the innocent: ‘do not slay the innocent and the current, which in particular circum- Pope Francis, Address to the European Par- righteous’ (Ex 23:7). stances may become points of conscientious liament in Strasbourg, 15 November 2014. 10 Today “to honour” could also be trans- objection. This faithfulness brings with it 4 Pope Francis, ‘Address to the Inter- lated as the duty to have the utmost respect many social consequences. We are living national Colloquium on the Complementa- and to take care of those who, due to their in a time of experimentation with life. But riness of Men and Women’, 17 November physical or social condition, may be left to it is harmful experimentation. Making chil- 2014. die or “made to die”. All of medicine has a dren, rather than accepting them as a gift, as 5 The terms ‘love’, ‘care’ and ‘respect’ special role within society as a witness to I said. Playing with life. Be careful, because in relation to human life, although they are the honour that we owe to the elderly person this is a sin against the Creator: against God closely connected and related to each other, and to each human being. Evidence and ef- the Creator, who created things this way’: are not, as is well known, equivalent. Here, fectiveness cannot be the only criteria that Pope Francis, ‘Address to the Association however, they are used in this way. govern physicians’ actions, nor can health of Italian Catholic Doctors’, 15 Novermber 6 This is the difference between Christian system regulations and economic profits. A 2014. ethics and individualist ethics which argues state cannot think about earning with medi- 3 ‘To our dismay we see technical and for the primacy of the autonomy of the in- cine. On the contrary, there is no duty more economic questions dominating political dividual. The question is addressed in M. important for a society than that of safe- debate, to the detriment of genuine concern Faggioni, ‘Bioetica secolare e Bioetica cat- guarding the human person’: Pope Francis, for human beings. Men and women risk be- tolica’, Studia Moralia, 52/2, 275-296, espe- Address to the Pontifical Academy for Life, ing reduced to mere cogs in a machine that cially, 285-289 5 March 2015.

The Socio-cultural Context of the Encyclical Evangelium Vitae

Msgr. Mauro Cozzoli the social doctrine of the Church the access password and the her- Full Professor when a good is called into ques- meneutical key to the mystery and of Moral Theology, tion this does not only concern the good of life, culture constitutes the Pontifical Lateran University, the individual choices and acts the river-bed of the unfolding – Italy; of people, the ethically debatable and the terrain of focus and the Consultor of the problematic decisions and actions target – of the encyclical. Here we Pontifical Council for of individual entities. A good that have the tension between the ‘cul- Health Care Workers becomes a question is a socio-cul- ture of death’ and the ‘culture of tural emergency that has an impact life’: the first threatens the second on social, mass-media and politi- with its multiple challenges; the he socio-cultural context of the cal structures and institutions. In second is the antidote of the Gos- Tencyclical Evangelium vitae is his Evangelium vitae John Paul II pel to the impact of the first. outlined by this encyclical itself. addressed a social question, that is When addressing the roots of And it is to that context that it re- to say a socio-cultural emergency the ethical question today, John fers and tries to respond. John Paul brought about and marked by a se- Paul II in his encyclical Verita- II – today St. John Paul II – was ries of challenges for the Church tis splendor centred the whole of amply aware of the socio-cultural to which she had to respond. Not morality around the truth, around background to the question of life, in the way in which a moral case the light of the meaning and mo- a question that he sought to influ- is addressed but in a way in which tivation of truth:1 ‘morality [is] ence. a broad-ranging emergency is ad- founded upon truth and [is] open dressed. We are dealing here with to truth in authentic freedom’.2 In a spectrum which in a globalised the encyclical Evangelium vitae 1. The Question of Life world has the same boundaries as this truth is life: the truth of life. the world itself. The interlocutor of truth is free- Life in the eyes of John Paul II Where for John Paul II – Evan- dom. Authentic freedom lies in an was – and this remains the case to- gelium vitae – the Gospel is the active adherence to truth: ‘free- day – was called into question. In central key, we could indeed say dom negates and destroys itself…

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when it no longer recognizes and are perpetrated against life, which motivate strong values: it confines respects its essential link with the are seen as such and deplored, but itself to portraying and organising truth. When freedom… shuts out also of a mentality that becomes a the existing. Thus there are no rea- even the most obvious evidence of custom, of a loss of the sense and sons to recognise and defend hu- an objective and universal truth, the value of life in the collective man life in its meta-physical, me- which is the foundation of per- consciousness which, in turn, gen- ta-empirical and meta-functional sonal and social life, then the per- erates indifference, the postpo- dignity and it is seen and addressed son ends up by no longer taking sition of values and the approval in a physical, empirical and func- as the sole and indisputable point of illicit practices: ‘Choices once tional way. Life is not appreciated of reference for his own choices unanimously considered criminal for what it is – with reference to its the truth about good and evil, but and rejected by the common moral value – but for the factual way in only his subjective and changea- sense are gradually becoming so- which it is understood: its defence ble opinion or, indeed, his selfish cially acceptable’.6 does not obey criteria of truth but interest and whim’.3 This detach- In this sense the Pope speaks ones of interests, preference or ment of freedom from truth and its about a ‘culture of death’ and consensus.16 Thought that does not folding in on itself is the origin of ‘structures of sin’ which take have metaphysical roots, which is moral disorder – sin. The objectiv- shape and acquire depth.7 With- reduced to descriptive observa- ity of truth is replaced by a self- out doubt sin is a personal act. The tion, does not manage to make dis- centred subjectivity which is with- real responsibility lies with peo- tinctions between living creatures, out references to truth.4 ple: only individuals are agents to see the essential difference (of The good of life is one of the of moral acts.8 But it is also true being) between human life and an- goods that is today most exposed that many sins take the form of imal life. to this sliding from the objectiv- current ideas, habits, systems and The perverse idea of freedom is ity of truth into the subjectivity practices which bring about a cul- ‘in a notion of freedom which ex- of opinion, and to such an extent tural ethos that is not favourable alts the isolated individual in an that very often and in various ways to the perception and the perfor- absolute way, and gives no place its value is not recognised and its mance of good. In this way au- to solidarity, to openness to oth- dignity is violated. In large meas- thentic ‘structures of sin’ are pro- ers and service of them’.17 Free- ure, the wish is to limit the field duced and strengthened which dom is perverted into detachment of life, which is a field of assess- have a negative impact on the for- and deviation from the truth: from ment and decision, to the opinions mation of the moral conscience.9 moral freedom – freedom for good and preferences of the individuals. This last, ‘darkened as it were by – it retreats to freedom of choice, Today in circumscribing ethics to such widespread conditioning, is to the possibility of deciding ac- the public domain, that is to say to finding it increasingly difficult to cording to what is opportune and the system of associative life, eve- distinguish between good and evil convenient. In this way, a ‘self- rything that is outside the relation- in what concerns the basic value of ish notion of freedom’ is estab- ships and exchanges of social life human life’.10 lished which exasperates and de- comes to be seen as private and forms the notion of subjectivity:18 thus ethically indifferent and left the self becomes the yardstick of to the freedom of the judgements 2. The Roots of the Culture judging about good. In this way and choices of individuals. This of Death we can explain the subjectivisa- is what takes place in relation to tion of good, as well as the formal the good of life, as well as to the The manifestations and the and rhetorical affirmation of law.19 goods of sexuality, marriage and symptoms of the ‘culture of death’ The law does not create moral and the family. are the many sins (offences, at- juridical obligations because of This ethical subjectivisation and tacks and crimes) committed eve- its value for its own sake but be- marginalisation is concomitant ry day against life: these are at one cause of what is attributed to it. with the loss of the dignity of the and the same time the effect and The good of life and the right to individual and the value, as an end the cause of other sins. This cul- life are emptied of objective value in itself, of human life and its re- ture belongs to this perverse spiral. and are related to subjective feel- duction to being an object which The encyclical engages in a de- ings and wishes: this is the ‘emo- has a use value. A life is not val- tailed survey of it.11 At its roots we tionalisation’ of good and law, de- uable because it is but because of find an obscuring of the value of termined (not by the ontos and the its way of being. The value of life life,12 a perverse idea of freedom,13 logos of life) by the feelings and is subjected to parameters of its and the eclipse of the sense of God wishes (pathos) of individuals. ability to be enjoyed, its attractive- and of man.14 These become absolutes to be sat- ness, its efficiency, its visibility, its The obscuring of the value of isfied ‘at any cost’, bending truth strength, its rewards, its pleasant- life is a consequence of the weak- and law to its claims. This is the ness, its prosperity and its health.5 ness of thought ‘which generates case with unborn life which, if it This illuminates the socio-cul- scepticism in relation to the very is not wanted, we must be able to tural aspects and character that foundations of knowledge and eth- rid ourselves of; or which we must have been acquired today by sin ics’.15 This thought, reduced to a be able to obtain through any tech- against life. We are not in the pres- descriptive view of data and facts, nically possible instruments if it is ence simply of criminal acts that does not manage to find and to wanted. From being an expression

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and defence of objective value, er), is now reduced to being “mat- behaviour contrary to life, but also good and law become a subjective ter”, and is subjected to every kind because it encourages the “culture wish. Life is thus exposed to the of manipulation’.25 To sum up, the of death”’, the outcome of many arbitrary will of an individual who eclipse of the sense of God is an wrongs perpetrated against life, becomes free to opt in a deformed eclipse of logos and telos, that is which take a cultural form and way against good, with the rather to say of profound and ultimate depth. In relation to this socio-cul- frequent complicity and fostering meanings, and this is translated tural solidification, a ‘structure of of the law. In this way ‘a hedon- into a fall of ethos, of ethical mo- sin’ is formed which constitutes, istic mentality unwilling to accept tivations and responsibilities, that so to speak, a materialisation in responsibility in matters of sexu- is to say: sufficient reasons for re- opinions, institutions, structures, ality’ becomes widespread which spect and commitment no longer fashions and customs of the ‘mor- inhibits the perception of, and re- exist. The field of life is the field al conscience of society’, creating spect for, what cannot be subject- that is most exposed to the per- and consolidating actual “struc- ed to prior conditions: life is not verse effects of this noethical and tures of sin” which go against life’ understood and loved in its truth- ethical regression. ‘Where God is and which are expressed by the value but in consonance with the denied and people live as though matrix of negative influences ex- preferential feelings of individuals he did not exist…the dignity of the ercised by the socio-cultural ethos and the prevalent opinion of soci- human person and the inviolabil- on consciences. ety. In this way ‘the ground is laid ity of human life also end up be- Awareness of this socio-cultur- for society to be at the mercy of ing rejected or compromised’.26 al outcome and expansion fosters the unrestrained will of individu- At the same time, and as a conse- a less narrow and individual con- als or the oppressive totalitarian- quence, the denial of the dignity sciousness, and one that is more ism of public authority’.20 of the person and the violation of extensive and inclusive of sins and In looking for the ‘deepest roots’ life produce ‘a kind of progressive crimes against life. In its insistent of the culture of death we encoun- darkening of the capacity to dis- opposition to, and strong denunci- ter ‘the eclipse of the sense of God cern God’s living and saving pres- ation of, the ‘culture of death’, the and of man, typical of a social and ence’.27 Forgetting about God and encyclical does not hesitate and cultural climate dominated by sec- the insignificance of life are joint- does not give way to pessimism or ularism’.21 When man loses the ly involved in the same sin and the to diffidence. First of all because it sense of God, he understands less, cultural ethos which springs from is open to an explicit recognition or no longer understands, himself, it and nurtures it. of all the signs of concern, love the mystery of his being and the and commitment of today towards singular dignity of human life.22 life, which are an expression and The obscuring of the Supreme 3. Towards a ‘Culture of Life’ index of a real and alternative Good darkens its refraction in eve- that Overcomes ‘culture of life’. And then because ry specific good: each good shines the ‘Culture of Death’ love full of hope – generated by less in its human and moral good- the Gospel of life, that is to say the ness and more in its physical and The intertwining of these fac- paschal faith that good is strong- functional goodness. Everything tors brings about that cultural hu- er than evil, that life that defeats in this way tends to be levelled mus which is not favourable to the death – does not give space to any and melt as in a game of shad- perception of the integral good of lack of confidence, surrender or ows. ‘Man is no longer able to see life and the responsibilities that disengagement in the presence of himself as “mysteriously differ- it involves. Within it the many evil. John Paul II aims, in opposite ent” from other earthly creatures; sins against life proliferate. These fashion, at awakening that glob- he regards himself merely as one should be deplored because they al responsibility, in total terms, more living being, as an organism are acts of individuals who deny which the gospel of life generates which, at most, has reached a very and offend good. One cannot but and supports. high stage of perfection’.23 In los- render naked the ‘terrain’ of the This goes beyond strictly inter- ing his salvific relationship as a emergence and proliferation of subjective and ecclesial individual creature with God, man does not sin. This encyclical does this with domains and opens up to society, understand the transcendent value recurrent references to the ‘cul- politics and culture. This is not a and destiny of his being. From this ture of death’ which, indeed, trav- matter simply of sensitising and derives ‘a practical materialism, erses and marks our society. For forming personal consciences. It which breeds individualism, utili- Evangelium vitae, ‘It is a question, is necessary to have an impact on tarianism and hedonism’;24 ‘qual- above all, of the individual con- the processes of formation of the ity of life’ is understood and pur- science, as it stands before God ethos: of that ‘social’ conscience sued as a ‘life of quality’, suffering in its singleness and uniqueness’: which as a habitat pervades and and death no longer have sense, the in relation to the individual, to his influences the consciences of in- body is reduced to matter, sexual- self-determination, ‘sin’ is defined dividuals. This leads to the ac- ity is depersonalised and exposed as a choice for evil. ‘But it is also quisition of those social, political, to being made banal, unwanted a question, in a certain sense, of mass-media and cultural respon- procreation becomes a danger that the “moral conscience” of society: sibilities which authentic love for must be defended against. ‘Nature in a way it too is responsible, not life involves. This means that ethi- itself, from being “mater” (moth- only because it tolerates or fosters cal responsibilities as regards the

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defence and promotion of life – rected towards ‘achieving a cultur- and become the source of other sins, and so influence people’s behaviour’ (n.36). which for a Christian are evange- al turning point’: a global commit- 10 EV, n. 4. Cf. n. 24. lising responsibilities – embrace ment to a ‘new culture of life, the 11 ‘murder, suicide, genocide, war, mas- ‘public life’: to act effectively for fruit of the culture of truth and of sacres, abortion, euthanasia’. But not only these: ‘whatever violates the integrity of the life is to act for a ‘culture of life’ love’. human person, such as mutilation, torments which opposes and overcomes the inflicted on body or mind, attempts to coerce ‘culture of death’. the will itself; whatever insults human dig- nity, such as subhuman living conditions, ar- Notes bitrary imprisonment, deportation, slavery, prostitution, the selling of women and chil- Conclusion 1 Cf. M. Cozzoli, ‘La verità principio dren; as well as disgraceful working condi- normativo della morale nella Veritatis splen- tions, where people are treated as mere in- dor’, in Lateranum 60 (1994) pp. 67-97. struments of gain rather than as free and Evangelium vitae provides a 2 John Paul II, Veritatis splendor (here- responsible persons’. His denunciation al- strong and authoritative impetus to after VS), 6 August 1993, n. 101. so includes the malnutrition and hunger to 3 EV, n. 19; cf. n.96. which millions of people are subjected, the becoming aware of the socio-cul- 4 ‘any reference to common values and scandalous arms trade, the criminal spread tural ‘range’ of the ethical question to a truth absolutely binding on everyone is of drugs, the promotion of certain kinds of in general and the bioethical ques- lost, and social life ventures on to the shifting sexual activity which are morally unaccepta- sands of complete relativism. At that point, ble and also involve grave risks to life, every tion in particular. Morality hither- everything is negotiable, everything is open form, that is to say, of open or subtle threats to has accredited a notion of duty, to bargaining: even the first of the funda- to human life’. Contraception, sterilisation, of sin and of conversion which for mental rights, the right to life’ (EV, n. 20). techniques of artificial reproduction which 5 Cf. EV, nn. 68-69. are incompatible with the dignity of human the most part has been confined to 6 EV, n.4. generation, pre-natal diagnoses directed to- the intimacy of consciences and ‘broad sectors of public opinion justify wards eugenic abortion, experiments involv- the individuality of actions. This is certain crimes against life in the name of the ing unacceptable risks, exaggerated treat- rights of individual freedom, and on this ba- ment. basic and it cannot be abandoned. sis they claim not only exemption from pun- 12 Cf. EV, nn. 10-17. But it is not sufficient.W e have to ishment but even authorization by the State, 13 Cf. EV, nn. 18-20. cultivate awareness of the socio- so that these things can be done with total 14 Cf. EV, nn. 21-24. freedom and indeed with the free assistance 15 EV, n. 11. Cf. n. 24. At the basis of the cultural factor: its impact on the of health-care systems’ (EV n.4). question of life (the moral question), there is decisions and actions of individu- 7 Cf. EV, nn. 12, 24. question of man (the anthropological ques- als and the role, in turn, of these 8 Cf. John Paul II, apostolic Exhortation tion), at whose beginning there is the ques- Reconciliatio et paenitentia, 2 December tion of truth (the epistemological question). in the strengthening and character 1984, n. 16. 16 Cf. EV, n. 20. of the socio-cultural factor. It is for 9 The first document to use the category of 17 EV, n. 19. this reason that the task required ‘structure of sin’ was the encyclical Sollici- 18 Cf. EV, nn. 13, 19. tudo rei socialis (30 December 1987), which, 19 Cf. EV, n. 18. – and this is the case today more in the wake of the apostolic exhortation Rec- 20 Cf. EV, n. 96. than ever before – by the truth of onciliatio et paenitentia, which itself spoke 21 Cf. EV, n. 21. life, which this prophetic encycli- about ‘social sin’ (cf. n.16), observed ‘struc- 22 Cf. EV, nn. 21-22, 48, 96. tures of sin…are rooted to personal sin and 23 EV, n. 22. cal gives voice to, is not confined are thus always linked to the concrete acts of 24 EV, n. 23. to individual duties and the ethical individuals who introduce these structures, 25 EV, n. 22. Cf. n. 23. formation of people. This is a task, consolidate them and make them difficult to 26 EV, n. 99. Cf. n. 22. we are told by St. John Paul II, di- remove. And thus they grow stronger, spread 27 Cf. EV, n. 21.

The Contemporary Relevance of Evangelium Vitae from a Bio-juridical Point of View

Prof. Jean-Marie Le Méné wenty years after the publi- consider their effectiveness in the President of the Tcation of Evangelium Vitae, contemporary context. ‘Jérôme Lejeune’ Foundation, which took place on 25 March Consultor of the 1995, it is still not certain that the Pontifical Council for world has really become aware 1. What Evangelium Vitae Tells Health Care Workers, of its deep meaning and its great us at a Bio-juridical Level Member of the Pontifical relevance. Responding to a re- Academy for Life quest of the Pontifical Council for To begin, let us remember in Health Care Workers, I would like summarising fashion the organi- to examine some bio-juridical as- sation of this encyclical. In the pects that were presented by this first part the text refers to the new document of the Magisterium and threats to human life (the war of

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the powerful against the weak, ethics. Secondly, it observes the and against which we fought, the fact that these attacks lose the existential and relational difficul- seems to have given way at the character of crimes and acquire ties that undermine society. The end of the twentieth century to a that of rights, and the confusion text observes, however, that the philosophical anti-humanism that of good and evil). human conscience does not cease has been imposing itself. In the second part it presents the to describe the value of life which Christian message about life that is sacred and inviolable. New discoveries and enriches the value of life which is Lastly, the encyclical describes transgressions already known by reason (man is the consequences of this situation placed at the summit of the cre- and uses a new concept: ‘a verita- We must bear two dates in mind: ative action of God, the redemp- ble structure of sin. This reality is 1997 and 2006. Two years after tion restored the divine image to characterized by the emergence of Evangelium Vitae, in 1997, the man, and the dignity of man is to a culture which denies solidarity possibility of cloning mammals share in divine life for ever). and in many cases takes the form was discovered. The question was The third part remembers that of a veritable “culture of death”’. raised of the cloning of humans, commandment which is immuta- From this comes the concept of that is to say asexual reproduction. ble by its nature: ‘thou shalt not a ‘conspiracy against life’ which Beyond cloning, a controversy kill’ (a solemn reaffirmation of reaches the point of ‘damaging was begun about the complemen- the inviolability of innocent hu- and distorting, at the international tariness of the sexes, influenced man life, a reminder of the ex- level, relations between peoples by gender studies, which would communication latae sententiae and States’. lead to homosexual marriage. The and of the fact that civil law must One reaches – affirms the text question of procreation and sur- conform to moral law). – a surprising contradiction be- rogate motherhood for the benefit To end the encyclical, the tween the innumerable declara- of homosexuals was raised, while fourth part describes the question tions of rights and, at the same awaiting the artificial womb. The of a new culture of human life time, the paradoxical calling into possibility of cloning also opened (‘you did it to me’, Mt 25:1-46, question of this culture of human up the road to that of the produc- an appeal to general mobilisation rights. The roots of this contra- tion and use of embryos as an infi- as in Rerum Novarum, an evoca- diction are in be found in the ex- nite reserve for stem cells for ther- tion of the Apocalypse with Mary acerbating and denaturing of the apeutic purposes. near to the birth of her child with concept of what is an individual The Japanese scientist Yamana- the dragon in front of her). which sees the autonomous being ka published in 2006 (on animals) This structure, on a number of as the only bearer of rights. and in 2007 (on humans) the re- occasions, has references to law, We also find these same roots in sults he had achieved with the re- above all in the first part. where a conception of freedom that ex- programming of somatic cells in- the weakness of human law which alts the individual in an absolute to stem cells which countered the is unable to oppose the attacks on way, without any connection with interest in human cloning because life and even encourages them is charity or freedom. Everything this technique of rejuvenation perceived, and the third part in seems to have become a matter does not resort to the production which the immutable prohibition of contracts and everything is ne- and destruction of embryos. on killing is restated. gotiable, the right to life as well, Despite this, the total availa- Indeed, in the first part the within the domain of a practical bility of human embryos and the text demonstrates that the threats materialism that propagates indi- techniques derived from cloning to human life have novelties of vidualism, utilitarianism and he- have increasingly led researchers three kinds. These acts hostile to donism. The mortal danger, last- to venture into the production of life lose their character of being a ly, is the confusion between good human beings starting with more crime and take on the character of and evil. Evangelium Vitae stig- genomes, as the recent British ex- a right with the involvement of the matises abortion above all else, perience has demonstrated, at a state. They attack life where it is then the techniques of artificial concrete level with the production extremely weak, when it is with- reproduction and prenatal diagno- of man/animal hybrids. out any capacity for defence. Para- sis, and, lastly, euthanasia. Today, This development character- doxically, these attacks take place after Evangelium Vitae, we can ises a further step that goes be- within the family and through its see that the discoveries have ac- yond the transgressions described action. The characteristics of these celerated, in the same way as the by Evangelium Vitae. Whereas deeds distinguish them from those transgressions, and the philoso- the encyclical describes the con- attacks on life which have never phy that supports them has expe- tradiction between the culture of ceased to traverse history. rienced a new turning point. human rights and its being called The text then explains how we into question, contemporary de- have arrived at this situation of velopments tend to do without the eclipse of the value of life. On 2. What Changed after references to man, his rights, and, the one hand, it points to the deep Evangelium Vitae lastly, to humanism. The end of crisis of our culture which gen- man leads to two consequences: erates scepticism about the very The political anti-humanism the creation of the sub-human and foundations of knowledge and that sprung from two world wars, the creation of the superman.

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The end of humanism who constitutes a global threat to 1980s and it brings together phi- the environment. losophers, scientists, mathemat- We are the first in the history of We have transgressed by go- ics and experts in UCT technol- the world to live the end of man. ing beyond, towards being super- ogy. The starting idea is that man I am referring to the title of an es- men, with the temptation to limit is in constant evolution, that we say by C.S. Lewis of 1943. For the patent of humanity only to in- moved from animals to men and years apocalyptic books by pres- dividuals with specific qualities. that we will pass from men to ma- tigious authors have followed one Today techno-science is fashion- chines. This evolution is possible another. The Abolition of Man by able. In this way we have the right thanks to nanotechnology, to biol- Lewis, The Obsolescence of Man to make man, to unmake him, to ogy, to information and commu- by Günther Anders, and The End perfect him, to want him at any nications technology, and to the of History and the Last Man by price or not to want him at all, not cognitive sciences – four tech- Francis Fukuyama. More recent- to provide any explanation if we niques that converge and become ly Prof. Remi Brague, Prof. Jean- destroy him or, if we do destroy very powerful in remedying the François Mattei and Prof. Xavier him, not to provide explanations humiliation (in front of machines) Martin have published books on which are worse than silence. In of illness, of old age and of death. the end of humanism, devastated this way we are moving from the Transgumanism passes through man or deconstructed man. From man/animal to the man/machine three stages: ‘repaired man’, first now on, the question ‘how can of all, who benefits from trans- we protect human beings?’ is no Sub-humans: anti-speciesism plants, artificial limbs or suchlike; longer posed, that is to say how ‘augmented man’, whose physical to defend them against all the in- Lastly, when we are reduced to and mental performances are de- human attacks of which they have cells, to the genome, to molecules, coupled; and ‘transformed man’, become the subject, but ‘why pro- nothing separates us from the oth- who is a machine-man who will tect man?’. What is the use of hu- er living species. Darwin placed live longer, or will not die, if one manism? man in the process of animal evo- can believe the prophecies of the After the Enlightenment, man lution without allowing man to transhumanists. became his own limit, his own distinguish himself from the oth- Transhumanism is not a hu- yardstick, his own foundation of er species. Montaigne had blurred manism. On the contrary: it is a truth, of the beginning and the end. this line when arguing that ‘dif- non-humanism inasmuch as it No longer being a gift, no longer ferences are no longer to be found tends to deprive man of mortal- being created, he defines himself between one man and another and ity which is, to employ the words and defines his own status. In the between an animal and a man’. used by Hannah Arendt, the mark history of philosophy there are Man is no longer differentiated of the human species. In seeking two kinds of morality: those that from an animal by nature – it is to escape mortality, transhuman- are based on a foundation outside only a matter of degree (‘we have ism closes itself to birth, inas- man, which is higher than him and learnt to speak about chimpan- much as a mankind that grows old which give him legitimacy (nature, zees, providing a parallel between no longer takes into consideration God) – heteronomy, and those that the way human societies work its own renewal. Let us remember are based on an autonomous foun- and their behaviour and 95% of here that today births tend at times dation, on man himself, a term that our DNA is shared by monkeys’, to be adjudged a prejudice (in the refers to his capacity to give him- Rémi Brague observed). This is processes of wrongful life): in this self his own laws – auto nomos. what is called anti-speciesism, As we have already reached transhu- We have passed from values that a consequence, there is no reason manism. Transhumanism replaces derive their legitimacy from an ex- to deny a parity of treatment and the question ‘why are we mortal?’ ternal reference to an autonomous of rights to animals who are, as with the question ‘why are we not reference. We have rejected our ti- we are, rings in this great chain of immortal?’ The answer must not tle of nobility, which is so strong, life. Ecology has taken the place be, as is the case with the great that is to say that of being the chil- of biology in order to deny that religions of the world, that death dren of God. But this autonomous man has the right to affirm his su- is a trial that has to be overcome humanism, still marked by the val- periority over other living beings. before a final revelation, but that ues of Christianity, has been an il- Thus, for example, for Peter Sing- death is only an error that has to lusion for about 250 years, like the er of Princeton it is more grave be corrected. But to what end if moon provokes an illusion when to kill a monkey who belongs to not the creation of a cyborg, a it is still illuminated by the sun. a protected species than to kill a man-organism hybrid, arising in Now that it has finished, we dis- disabled child. Singularity, a historical moment cover that uprooted humanism is a when artificial intelligence will cold star. Supermen: transhumanism go beyond human intelligence? On the one hand, we have re- In essential terms, transhuman- gressed to the level of sub-hu- Transhumanism is a philosophy ism is a mixture of evolutionism mans: man no longer has the right that seeks to transform human na- (the great chain of life according to subordinate other living beings; ture basing itself on technology. to which man is the outcome of a link in the great chain of life ex- The beginnings of the transhu- natural selection), of materialism ists and he is, rather, a parasite manist movement go back to the (man is the sum of his particles

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and of his functions), and of lib- The light of the Apocalypse, cares for humanity). As an ‘order- eralism which led to the hunting cited at the end of Evangelium ing of reason’, law rests upon the of inferior beings and the promo- Vitae, helps us be aware that life truth of being: the truth of God, tion of superior beings, according is always at the centre of a great the truth of man, the truth of cre- to the dogma of the maximisation battle: the dragon wants to devour ated reality itself as a whole. And of profits. But this desire to go be- the child that has just been born, in Evangelium Vitae he adds: yond of man is marred by a grave the figure of Christ that Mary ‘”But when a law is contrary to defect: it always proceeds from brings into the light in the fullness reason, it is called an unjust law; the human which is expressed in of time. but in this case it ceases to be a the place of virtual transhuman- It is this light that we also find law and becomes instead an act ism which does not exist. in the last book of St. John Paul, of violence”. And again: “Every What is lacking in transhuman- , when the law made by man can be called a ism above all else, folding in on a Pope asks: ‘why does all of this law insofar as it derives from the man who is emptied of his being, happen?’ What is the root of these natural law. But if it is somehow is to acknowledge what man spe- post-Enlightenment ideologies? opposed to the natural law, then it cifically is: he has not been pro- The answer, in definitive terms, is not really a law but rather a cor- duced but comes from origins, a is simple: this takes place because ruption of the law”’. gift, a body, a sex, a relationship God as Creator has been reject- We must therefore complete the and a birth that gives him ac- ed, and thus as a source of decid- definition of law with the tradi- cess to the only true immortality, ing what is good and what is evil. tional definition of justice which which cannot be resisted. The notion of human nature as a is’ suum cuique tribuere, give to real fact has been rejected and in each his own’. its place has been placed a prod- What should be given to man 3. The Contemporary uct of thought freely formed and if not the Gospel of life, the good Relevance of freely mutable according to cir- news of having been created in Evangelium Vitae cumstance. And subsequently, the image and likeness of God, as in Evangelium Vitae, we read of having been redeemed through In Confessions, St. Augustine that ‘St. Thomas offers the well- the sacrifice ofH is son Jesus said that we love the light when it known definition of law: “Lex Christ and of having been called shines but that we detest it when est quaedam rationis ordinatio to an eternal relationship of love it rebukes: amant eam lucentem, ad bonum commune,ab eo qui in them? oderunt redarguentem. Today this curam communitatis habet prom- What is man, so that you might light is perceived by many of our ulgata”’ (Law is an ordering of remember what he is? The answer contemporaries as violence on the reason promulgated with a vuew of Evangelium Vitae is the answer part of those who project it. to the common good by he who of eternity.

The Contribution of the Encyclical Letter Evangelium Vitae to the Theology of Pastoral Care in Health

Prof. Massimo Petrini n 25 March 1995 St. Pope vitae of the question of the Lord Dean of the International OJohn Paul II signed his elev- to Cain, ‘What have you done? Institute for the Theology enth encyclical, Evangelium vi- The blood of your brother cries to of Pastoral Care in Health, tae, which as he himself observed me from the ground’ (Gen 4:10), the ‘Camillianum’, Italy; was ‘meant to be a precise and which opens the first chapter, Consultor of the Pontifical vigorous reaffirmation of the val- this question is now addressed to Council for Health Care ue of human life’ which is worthy contemporary man to make him Workers of respect and inviolable because aware of the breadth and gravity of what it is and not because of its of the attacks on life, by which, utility, and in all situations of life indeed, the history of humanity (cf. EV, n. 5). continues to be marked. When we think in Evangelium We are dealing with special

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kinds of attacks that concern un- it acts. This action is seen in the life. It takes into account the evo- born life and the terminal stage encyclical as taking place in two lution of this doctrine, reading the of life on earth, attacks that have stages: one stage is more doctri- whole of the Biblical message in new characteristics compared to nal in character, the other is more the light of Christ who is Life for the past and ones that raise prob- pastoral.1 the world.5 In the use that Pope St. lems that require critical reflec- One may affirm that the true John Paul II makes of Holy Scrip- tion in the field of the world of unity of Evangelium vitae lies in ture to strengthen the doctrine that medicine. its positive and constructive ap- is offered in the encyclical, one This encyclical, in fact, consti- proach. The condemnation of can perceive that specifically Bib- tutes a denunciation of these at- contraception, of abortion, of ar- lical intention that is present in all tacks. First of all of the contra- tificial fertilisation, of genetic the pastoral practices of the Lord diction of the human approach to manipulation and of euthanasia Jesus.6 medicine: on the one hand, med- takes up the traditional doctrine One can therefore state that the icine is required to produce con- and teaching of the Magisterium encyclical Evangelium vitae calls stant advances in therapy in or- of the Church and takes them up on pastoral care to perform to the der to achieve an ideal of physical with special breadth, accompany- full the redemptive role indicated health and the cure of all patholo- ing this condemnation with a de- by the Second Vatican Council gies; on the other, in some cases, scription of recommendations and and which can be defined as being it is asked to bring death. But it directives of human and pastoral that of the Good Samaritan who is also a denunciation of medicine value, at the same time specifying bandages the wounds of man who itself because it is often not heard all those instruments which are is left half dead by a culture that generating a general defence of suitable to promoting a new cul- increasingly threatens the person.7 life, a defence which is, indeed, a ture of life that is able to ward off Because of what has been said component part of the reason for and defeat the ‘culture of death’.2 hitherto, one can read Evangeli- its existence. The encyclical thus To the present culture which is um vitae as the manifesto of the emphasises that medicine, which defined in these terms the encyc- theology of pastoral care in health by its vocation is ordered to the lical opposes a culture of life that because it portrays a society that defence and care of human life, is is founded upon the theological is sick, men and women that are increasingly lending itself to per- horizon of hope. What the Church sick, and discerns in the back- petrating acts against the person wants to save is not the life of ground the presence of so much and in this way it deforms its face, every person but, rather, the very human suffering. contradicts itself, and humiliates concept of the person: a culture The theology of pastoral care in the dignity of those who practise of life that in its anthropology has health in large measures revolves it (cf. EV, n. 4). the concept of the dignity of man around an irreplaceable trilogy: The description of these contra- who is seen in his spiritualised the ‘fundamental events of hu- dictions is accompanied by a re- corporeal self, in his concrete de- man existence’ (birth, life, health, alistic reading of the difficulties velopment and in his supernatu- illness, suffering, death); the so- encountered in defending life be- ral development. This approach is cio-cultural and health-care con- cause this has to take place in a specific to the pastoral Constitu- text in which these take place; and world that has a culture defined as tion on the Church in the world, health-care workers (a very broad a ‘culture of life’, which has spe- Gaudium spes, which observed term which includes the family, cific characteristics, in an epoch that man is at the centre of eve- schools, professionals, pastors, that is marked by a cultural crisis ry analysis, man in the unity of the Christian community, etc.) whose dominant notes are materi- his body and soul, heart and con- who implement in that context the alism and individualism. science, intellect and will.3 salvific and health-inducing plan The encyclical is organised ac- In this encyclical, as is known, of God. The ‘fundamental events cording to the known stages of the declarations of the Magiste- of human existence’ are deeply human behaviour and evangeli- rium on the biological aspects of rooted in the person and the com- cal discernment: seeing, judging, unborn life and the grave immo- munity, they are at the centre of acting. rality of abortion and euthanasia the history of salvation, the sub- To see is specifically to know are also read in the light of what ject of the plan of salvation, and reality as it is and to see this real- Holy Scripture says on the sub- thus are essential to our under- ity when the panorama of threats ject. On the other hand, life is standing of the mystery of Christ to life presents itself. To judge: to the problem of man, from the be- and the Church. They are also the discern is not only to know – it is ginning of his existence until his subject of pastoral and ethical also interpreting reality and un- death, and the Bible is an illustra- practice and a ‘setting’ for evan- derstanding it. This is possible up tion of the problems of man which gelisation.8 to a certain point with the light of are seen in the light of God.4 The Given that pastoral theology is reason but one can succeed in this encyclical, therefore, is from systematic reflection on the con- to the full only with the light of its beginning until its end a dis- ditions for the performance of the Word of God which illumines course on life, and it lays a great this task by the Church, here and the reason of man. To act: true deal of emphasis on the harmony now, within historical process- discernment is not confined to re- that exists between the two Tes- es, in the concrete experience of maining with ideas: it decides and taments as regards the doctrine of people, in their interactions and

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in response to their problems and on which her dignity is founded: which the Fathers of the Church, their questions, the theology of making people know about God and especially the Cappadocians, pastoral care in health means try- and proclaiming His Kingdom. always emphasised, that is to say ing to bring the Word of healing Specifically in this way, and only the existence in man of a certain of God to suffering man but also in this way, is that spiritual space natural aspiration to know God, to a social/health-care world and created in which the moral mo- which is a belief with a philo- humans who can also be the vic- ment can existentially go back to sophical foundation (the analogy tims of this world, and it can do flourishing well beyond the world of being) and which has a theo- this through pastoral care for life, of believers alone.11 logical foundation (created in the health and suffering. On the other hand, ethics can image and likeness of God). In this context one of its first el- not be limited to describing a sit- It is only in faith that certain ements is therefore overall pasto- uation – it is characterised by its values can be discovered or rec- ral care for life. Pastoral care for proposing of normative and bind- ognised in their total worth, even life must take upon itself the sub- ing values. In other terms, the task though they are rationally know- ject of welcome for, and respect, of ethics is not to say what people able, and also when faith is not at- defence and promotion of, human ‘do’: customs that are practised tentive to scientific analysis. In- life, specifically because of all the or those values that are felt and deed, the Second Vatican Council observations made by Evange- lived as such. Its task, rather, is to observed that ‘if methodical in- lium vitae. This kind of pastoral say what people ‘should do’, even vestigation within every branch care must be arranged within the though they do not do it or may of learning is carried out in a gen- dialogue of faith and reason and not do it. This assumes that one uinely scientific manner and in seek the redemption of frail hu- accepts the existence of objective, accord with moral norms, it nev- man life in the unity and totality universal and immutable values, er truly conflicts with faith, for of the person.9 that is to say values founded on earthly matters and the concerns The Gospel of life, in fact, is reality as such (in our case on the of faith derive from the same not a simple reflection on human person as such) and thus extended God’.14 life: the Gospel of life is a con- in space and time exactly as real- It is for this reason that in the crete and personal reality because ity as such is extended. And the formulation of its definition it is it is the message of the very per- believer has the opportunity and possible to affirm that ‘bioethics son of Jesus. This does not mean the responsibility to interpret real- should be rational ethics which, that in the encyclical the whole of ity, referring to a reason illumined starting with the description of the theology of life is reduced to, by faith; listening, therefore, to the scientific, biological and med- or deduced starting with, Chris- the relevant Word of God.12 ical facts, rationally examines the tology. Reference is also made This is done starting with the legitimacy of intervention upon to God the Creator and the Lord statements that ‘The God of the man. This ethical analysis has its of life, but from a Christological Covenant has entrusted the life of immediate pole of reference in the point of view, and this is because every individual to his or her fel- human person and his transcend- ‘Through the words, the actions low human beings, brothers and ent value, and his ultimate refer- and the very person of Jesus, man sisters, according to the law of ence in God who is the absolute is given the possibility of “know- reciprocity in giving and receiv- Value. In this approach, interac- ing” the complete truth concern- ing, of self-giving and of the ac- tion with Christian Revelation is ing the value of human life’ (EV, ceptance of others’ (EV, n. 76) incumbent and spontaneous and n. 29). and ‘The Gospel of God’s love for interaction with current philo- Indeed, the answers to the man, the Gospel of the dignity of sophical conceptions is also fruit- bioethical problems raised by the person and the Gospel of life ful’.15 Evangelium vitae can present are a single and indivisible Gos- If, then, moral theology un- some ambiguities. An attempt pel…We need then to “show care” derstood as a determining of the at partial answers can make the for all life and for the life of eve- person-value and the norm-value Church run the risk of allowing ryone. Indeed, at an even deeper with reference to the Absolute can herself to be degraded to being a level, we need to go to the very be beneficial inasmuch as it calls mere instrument for the moralisa- roots of life and love (EV, nn. 2, bioethics to the very foundations tion of society, as the liberal State 87). In other words, this encycli- of ethics, pastoral care, for its would wish, and, at an even low- cal constitutes ‘the expression of part, is preparatory to it because er level, of wanting to legitimate the meaning of man and his life it fosters and allows personal ad- herself in virtue of the utility of seen with the eyes of God’.13 herence. This is because pastoral her initiatives of a social charac- This is a matter of highlighting care increases capacity in judg- ter. The more the Church concen- the points of contact and the deep ing, responsibility in choosing, trates her attention only on what relationship that exist between and power in deciding and act- in this area should be, so to speak, the lives of each man in order to ing in order to make possible the her ‘specific contribution’, the achieve a pastoral care of life that triune-Christological faith in the more she will fail.10 The Church enters a daily culture in which a ‘heart of man so as to build up the must first and foremost, and in ‘personal’ faith also exists with Church, and to give meaning and a resolute way, do what is spe- ‘personal’ choices and assess- visibility to human existence’.16 cific to her and perform the task ments that refer to that situation In this context, pastoral care

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must ask scientists and health-care of the salvation has its roots in towards the complete fulfilment workers first of all to contribute to the very mystery of Christ and in of man. It is salvific health and that reawakening of conscienc- a particular way in his therapeu- health-inducing salvation.19 es that leads to an awareness, as tic activity for sick people and the It is affirmed that a person is was the case with Israel, that life so-called ‘healthy’ of his time.17 In healthy when he or she is able to ‘is not at the mercy of a Pharaoh the history of salvation, above all live using all the energies that he who can exploit it at his despotic in the New Testament, the thera- or she possesses, and which are whim. On the contrary, Israel’s peutic action of God does not so really available, for the carry- life is the object of God’s gentle much emphasise illness as health. ing out of his or her mission, in and intense love’ (EV, n. 31) that The world of health, of illness any situation that may arise, even asks to be welcomed as a gift and and of suffering thus appears as when that situation is difficult and celebrated at every moment with a ‘privileged setting’ of the salv- painful, or, in other words, in or- a veneration that is tenaciously ific pedagogy of God. Health is der to develop at every moment borne witness to. always connected to salvation (of the highest disinterested love of A culture of life imposes itself which it is a sign, manifestation Christ, of which he or she is con- on medical doctors and health- and anticipation) and becomes a cretely capable, at any moment of care workers more than on other true ‘theological setting’ for an his or her life. 20 social workers because they have understanding of the history of All of this belongs to the broad known ever since antiquity and salvation. framework of reference of pas- the experience of the Asclepiads In Christ – in addition to ex- toral care in health, namely ‘the that man must be cared for in his pressing in an exemplary way presence and the action of the lost psycho-bio-spiritual integri- the notes that identify the sub- Church directed towards the ty, and that the most sophisticated ject of health – was revealed the evangelisation of the health-care forms of treatment of the illness itinerary that human health, be- world through the actualisation of alone sit unevenly with that pro- held from the perspective of its the liberating, healing and saving cess of healing of the person that subject, is called to tread. Start- presence of Christ, in the power of is expressed in a renewed and re- ing with the Incarnation, Christ the Holy Spirit. It is implemented discovered physical and spiritual becomes a great symbol of the by making available to sick peo- equilibrium. Medical doctors and health-inducing pathway of be- ple, and those who take care of health-care professionals must be ing in this world. In the light of them, the support of a warm hu- called to educate in the value of this mystery one can state that the manity and the instruments of the person as a unique and un- first act of health lies in welcom- grace, promoting and defending repeatable gift for other people, ing life which is thus received as life and health, sensitising people thereby educating in health in an a gift and as a mission. Welcom- to the problems and the needs of overall vision of the soul and the ing life means making the verb ‘to those who suffer, and accompany- body. be born’, which is initially only ing men in the search for answers The encyclical then insists that passive, active – a task that is as to the great questions posed by the ‘Gospel of life’ must become long-lasting as existence itself.18 living, suffering and dying’.21 history, it must express itself and In giving life to man, God gives The Church, which was born be realised in the mentalities and him at the same time the com- from the mystery of the redemp- the customs of the Christian com- mandment to live; God the crea- tion of Christ, is called upon to munity and human society. This tor orders man to honour life – his look for encounter with man in a requires pastoral care to be imple- own life and the lives of others particular way on the way of suf- mented in a specific and charac- – as a possession that He lends. fering. In this encounter man ‘be- terised way, with a pastoral pro- There is, therefore, an obedience comes the way of the Church’ and gramme that is expressed in the to God which is inherent in hu- this is one of the most important three directions of evangelisation: man existence as such. ways.22 proclaiming (the munus propheti- In the light of faith, health is seen Whereas it was stated before- cum), celebration (the munus sac- as belonging to man’s vocation hand that the Evangelium vitae is erdotale), and service to life (the as a creature and as a Christian, the Good Samaritan who band- munus regale). where the cause-effect schema ages the wounds of the man left The theology of pastoral care can never be the ultimate expla- wounded by the culture of death, in health must motivate pastoral nation of the relationship between now pastoral care in health is care in health starting with inter- the Gospel and health. Here, in- the Good Samaritan who band- national organisations and nation- deed, we find ourselves inside an- ages the wounds of the man left al governments so that attempts other logic: that of Grace, which wounded on the road of life. are made to eliminate the causes can also make illness and suffer- However we may ask them- that obstruct human health, foe ing health-inducing, and can even selves if there is such a thing as example a shortage of food, low render physical health less impor- a man who does not suffer. The levels of instruction, bad living tant. Human health in the design God of the Bible is portrayed with conditions, and inhuman working of God and in its actuation in the the features and characteristics of conditions. mystery of Christ (and now by the a physician. The physician of all This interpretation that takes Church) always exists on a jour- infirmities. Indeed, He ‘heals the health as its key to the message ney towards fullness, that is to say broken-hearted and bandages their

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wounds’ (Ps 147:3) and addresses minal stage of an illness that lies What is needed, therefore, is man with the following words: behind that request? a broad programme of action in- ‘Your wounds are incurable, your In the encyclical we then have volving pastoral care in health, injuries cannot be healed…no discussion about the suffering starting with the formation of remedy for your sores, no hope that takes place after an abortion, consciences which begins with of healing for you…I will make a wound that has still not healed theology faculties, seminaries and you well again, I will heal your and which, perhaps one may add, various Catholic institutions (EV, wounds’ (Jer 30:12-13. 17). Next will never heal, but which in a n. 82). to Him, in glory, there is Christ renewed relationship with God Hence, once again, the need whose hands are often laid on sick and in solidarity with people who to promote the moral and ethi- bodies.23 are friends and competent can cal training of social/health-care Patristic literature attributed to become a new way by which to workers because it is specifical- Christ the title of ‘Christus medi- look at the life of man (EV, n. 99). ly to health-care workers that the cus’, the physician of the body When in the encyclical a cultural Pope entrusts the special respon- and the spirit, almost to confirm turning point is called for in this sibility of animating with gener- the idea that every man suffers. field, the contribution of women osity, readiness to help and pro- The Second Vatican Council took is called for, giving to them in this found awareness, ‘Agencies and up this title in the Constitution cultural turning point in favour of centres of service to life, and all on Sacred Liturgy, Sacrosanctum life a space of thought and action other initiatives of support and concilium (n. 5), drawing upon a which is singular and perhaps de- solidarity which circumstances quotation from Ignatius of Anti- termining: they are to become the may from time to time suggest… och (Eph 7:2). It stated that Christ promoters of a new ‘feminism’ Their profession calls for them to was sent to evangelise the poor which knows how to recognise be guardians and servants of hu- and to heal the contrite of heart and express the true female ge- man life’ (EV, n. 89). (cf. Is 61:1; Lk 4,18) as a corpo- nius in all of its expressions in In the Christian outlook, an en- real and spiritual physician. civil life, working to overcome all counter with a health-care worker This suffering should also be an forms of discrimination, violence has a special structure. It is an ex- element of human solidarity, or, and exploitation. plicit moment of love for neigh- in other words, of that compas- Even though one cannot jus- bour which exactly describes the sion that acts as a force that arises tify at an ethical level the threats professional duty as an opportuni- from an awareness that weakness to life pointed to in the encycli- ty to respond to the invitation ‘go is something held in common and cal Evangelium vitae, they none- then, and do likewise’ (Lk 10:37). from consciousness of reciproc- theless express a human reality And just as love, horizontally, is ity. and highlight how ‘The field of a part of faith, so prayer is such Naturally, in this area of anal- human suffering is much wider, vertically.25 ysis the word ‘suffering’ must be more varied, and multi-dimen- Pastoral care for families and read within a context of a vast sional. Man suffers in different young people is irreplaceable meaning because it is present in ways, ways not always consid- and they can find great help in very many forms in the human ered by medicine, not even in its the social and health-care agen- world, both at an individual and a most advanced specializations’.24 cies and institutions that provide social level. This reference to broader hu- care. Hence the new view of the The threats to human life which man suffering can lead us to think role of hospitals, clinics and nurs- are denounced by the encyclical of the need for a pastoral care in ing homes, geriatric institutions can also be read in terms of the health that is not confined to plac- and hospices, whose true identity personal perspective of individu- es of care and treatment alone be- is not only that of being institu- al men and women and thus they cause it has its foundations in a tions where sick and dying peo- refer to the world of human suf- shared human condition. Reading ple are taken care of but also and fering, just as the apostolic letter the apostolic letter Salvifici dolo- above all that of being contexts in Salvifici dolorishas a role in pas- ris should inspire a form of pas- which suffering, pain and death toral care in health. toral care in health that seeks to are recognised and interpreted in Do not the techniques of artifi- meet the difficulties and the suf- their human meaning and spe- cial reproduction express, albeit fering which men and women may cifically their Christian meaning. in an ethically not correct form, encounter on their life journeys. These agencies and institutions at the suffering of a father and of From an awareness that we are the service of life need to be ani- a mother in their wish to have a after a certain fashion ‘all sick’, mated by people who are gener- child? Does not abortion itself en- should be born a culture of soli- ously ready to help and who are visage the further suffering, even darity that supports life and this is profoundly aware of how decisive though sometimes not immediate- the real answer to the culture of the Word of God is for the good of ly after the act, of individual men death. This would be a solidarity the individual and society and for and women who will never forget naturally illumined by the Word spiritual healing. that they were parents? Can not of God, which alone bring healing In the field of pastoral care in the euthanasia requested by a per- to a human wound, even though health, the Christian idea of heal- son be motivated by the despera- on a journey of faith which can be ing always looks to the wish to tion of that person during the ter- long, painful and tiring. weaken physical illnesses and

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moral suffering, and in this way we, the pilgrim people, the peo- Rodriguez J. (eds.), Per una cultura della vita Atti del Congresso Internazionale nel 1 an- it does nothing else but confer a ple of life and for life, make our niversario della pubblicazione dell’enciclica concrete form on the healing in- way in confidence towards “a new “Evangelium vitae” Roma 22-24 aprile 1996 tention of God who is ‘the friend heaven and a new earth” (Rev (LEV, Vatican City, 1997), p. 32. 7 Cf.. Anderson C.A., ‘Evangelium vi- of life’ (cf. Wis 11:26). But over- 21:1), we look to her who is for tae e cultura post-moderna’, in Pontificia Ac- coming illness forms only a part us “a sign of sure hope and sol- cademia Pro Vita, Evangelium vitae di Sua of Christian healing activity. If ace”’ (EV, n. 105). Santità Giovanni Paolo II, Enciclica e Com- menti (LEV, Vatican City, 1995), p. 215. we stopped here, with this kind This is the certainty with which 8 Alvarez Rodriguez F., Teologia della of interpretation of healing which St. John Paul II ends his encycli- salute (Camilliane, Turin, 2014), p. 31. recognises only dealing with ill- cal Evangelium vitae. 9 Cf., Sgreccia E., Per una pastorale della vita umana Riferimenti fondativi e ness, one could almost state that contenuti dottrinali (Cantagalli, Sienna, God only accepts healthy people. 2011), pp. 45-56. However a healing pastoral care 10 Ratzinger J., Svolta per l’Europa? Notes Chiesa e modernità nell’Europa dei rivol- means, in a much more complete gimenti (Paoline, Cinisello Balsamo ,1992), way, being with the sick and the 1 Lucas Lucas R., ‘Struttura logica e for- p. 142 ‘so-called healthy’ so that they za dell’argomentazione della “Evangelium 11 Ibdem, pp. 142-144. vitae” e del commento interdisciplinare’, in 12 Ibdem, pp. 142-144. learn to accept, in the light of di- Sgreccia E. and Lucas Lucas R. (eds.), Com- 13 Basso D., ‘Pastorale e servizio alla vi- vine grace, that they are limited mento interdisciplinare alla “Evangelium ta’, in Pontificia Accademia Pro Vita, Evan- beings who have defects that may vitae” (LEV, Vatican City, 1997), p. XXII gelium vitae di Sua Santità Giovanni Pao- 2 Angelini F., ‘L’Enciclica Evangelium lo II, Enciclica e Commenti (LEV, Vatican even be incurable as well as very vitae’, Dolentium Hominum 29 (1995), pp. city, 19959, p. 257. many dark sides. 4-6. 14 Gaudium et spes, 36 Even though there is no longer 3 Cf. Sgreccia E., ‘The commemora- 15 Sgreccia E., Manuale di bioetica. I tive day of the 5° anniversary of the En- fondamenti ed etica biomedica (Vita e Pen- the prospect that a body will go cyclical Evangelium vitae’, in Vial Correa siero, Milan, 1994), p. 56. back to being better, one can hope J. and Greccia E. (eds. )Evangelium vitae, 16 Pacomio L., Teologia pastorale e azi- in healing. Indeed, by healing one Five Years of Confrontation with the So- one pastorale (Piemme, Casale Monferrato, ciety. Proceedings of the Sixth Assembly 1992), pp. 117-118. should not only understand physi- of the Pontifical Academy for Life Vatican 17 Cf. Alvarez Rodriguez F., Teologia cal recovery: one should also un- City 11-14 February 2000 (LEV, Vatican della salute (Camilliane, Turin, 2014), p. 22. derstand that achievement of psy- City, 2001), p. 402 . 18 Cf. Alvarez F., ‘Vita e vita in abbon- 4 The word ‘life’ and its derivatives ap- danza” nel Vangelo di Giovanni’, Camilli- chological peace, that courage and pear about 1,500 times in Holy Scripture anum 14(2005), pp. 219-248. that moral strength, that the Word and this in itself constitutes an element that 19 Cf. Alvarez Rodriguez F., Teologia of God can bring and which en- helps us to understand how important this della salute (Camilliane, Turin, 2014), p. subject is (Medina Estévez J., La fede e il 121. able us not to move in the wrong Magistero al servizio della vita, in Pontificia 20 Haering B, Etica medica (Paoline, direction even though the body is Accademia della Vita, Evangelium vitae di Cinisello Ballsamo (MI), 1970), pp. 252- falling apart. Sua Santità Giovanni Paolo II. Enciclica e 255. commenti (LEV, Vatican City, 1995), p. 198. 21 Brusco A., Pintor S., Sulle orme di This is a partial healing in the 5 Monsengwo Pasinya L., ‘Presenza Cristo medico (EDB, Bologna, 1999), p. 37. outlook of a certain hope that ‘In ed uso delle Sacre Scritture nell’enciclica 22 Salvifici doloris, n. 3. the “new Jerusalem”, that new “Evangelium Vitae”’, in Rodriguez F. and 23 Specifically in order to emphasise the Rodriguez J. (eds.), Per una cultura della vita action of raking care of somebody, Pope world towards which human his- Atti del Congresso Internazionale nel 1 an- Francis in his homily of 22 October 2013 tory is travelling, “death shall be niversario della pubblicazione dell’enciclica given at Santa Marta offered the image of no more, neither shall there be “Evangelium vitae” Roma 22-24 aprile 1996 God the nurse. mourning nor crying nor pain any (LEV, Vatican City, 1997). p. 33. 24 Cf. Salvifici doloris, n. 5. 6 Monsengwo Pasinya L., ‘Presenza 25 Sittler J., The Structure of Christian more, for the former things have ed uso delle Sacre Scritture nell’enciclica Ethics (Lousiana State University Press, Ba- passed away” (Rev 21:4). And as “Evangelium Vitae”’, in Rodriguez F.,and ton Rouge, 1958).

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The Reception of the Encyclical Letter ‘Evangelium Vitae’ in the Moral, Spiritual and Apostolic Formation of Health-care Workers

1. Nurses

Don Francesco Coluccia lights points of strength and cur- other, or to put it better an Alter National Ecclesiastic Consultant rent critical points. Indeed, it is Cristus. This imposes an immer- of the Catholic Association of like that absent-minded profes- sion in the life of Christ in order to Health-Care Workers - A.C.O.S., sor who, while he is travelling cease to be what one has been, re- Director of pastoral care in a train, is preparing to give a moving one’s old form, like a silk- in health of the diocese talk and spreads all his books and worm that is transformed and be- of Otranto, papers inside the compartment. comes a butterfly, in order to bring Italy While he is immersed in his read- to life another self which is per- ing, the inspector arrives who meated by that humanism that is asks for his ticket. The professor specific to Christ: ‘Man is called begins to look for his ticket inside to a fullness of life which far ex- his bags and pockets but does not ceeds the dimensions of his earth- Introduction manage to find it. He looks again ly existence, because it consists through his papers and books but in sharing the very life of God’.3 ‘Live what you are! In a pru- all of his efforts lead to nothing. Looking at the spiritual formation dent, just and strong way, and Faced with his desperation, the of nurses means to perceive the with temperance’. This quotation inspector looks at him with com- free initiative of God who irrupts from the Greek philosopher Pin- passion and says: ‘Don’t worry. into their lives through Christ-the dar (522-445 BC) refers to the es- I’ll take your word for it. You have Word. This is a living and per- sence of the identity of nurses who lost your ticket. It doesn’t matter’. sonal experience of he who fas- are called, as the people of life, to But the professor goes on looking cinates, calls upon us and is wel- qualified and human service at the but finds no peace. The inspec- comed and cultivated above all side of those who suffer. ‘We are tor reassures him again. ‘Don’t in sacramental life. Over the last the people of life because God, in worry, I believe you! I know that twenty years listening to the Word his unconditional love, has given that you are not travelling with- of God at a personal level, in spir- us the Gospel of life and by this out a ticket!’ Near to desperation itual retreats, during days of spir- same Gospel we have been trans- the professor replies, overcome ituality, in courses of spiritual ex- formed and saved. We have been with desperation: ‘Certainly, but ercises and in sacramental life has ransomed by the “Author of life” I don’t need the ticket for you: I directed Catholic nurses. The gift (Acts 3:15) at the price of his pre- have to know where I have come of faith, in its turn, is as of one cious blood (cf. 1 Cor 6:20; 7:23; from and where I am going!’ This with charity, which for a nurse 1 Pet 1:19). Through the waters of anecdote well reflects the current is a capacity to love sick people; Baptism we have been made a part status of nurses who hold dear it is faith which according to the of him (cf. Rom 6:4-5; Col 2:12), the Gospel of life which loving- phrase used by John: ‘If you do as branches which draw nourish- ly received day after day by the not love your brother whom you ment and fruitfulness from the Church is to be preached to the see how can you love God whom one tree (cf. Jn 15:5). Interiorly people of every age and culture.2 you do not see?’(1 Jn 4:20), be- renewed by the grace of the Spir- comes a programme for life. The it, “who is the Lord and giver of spirituality of a nurse is based up- life”, we have become a people 1. The Spiritual formation on, and finds its deepest roots in, for life and we are called to act ac- of Nurses in the Light of the relationship with the patient cordingly’.1 In pursuing the truth Evangelium Vitae in whom is seen the very person about the nursing profession from of Jesus Christ. We could say that the publication of Evangelium Vi- In our modern liquid world, here he or she can engage in ad- tae on 25 March 1995 until today practising the art of life means oration of the Eucharist, medi- (25 March 2015), we encounter, transforming one’s life into a tation, contemplation, and most over the span of two decades, a work of art, permanently redefin- authentic prayer, knowing that sort of similitude which high- ing oneself in order to become an- ‘Whenever you did this for one of

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the least important of these mem- b. Lovingness: a synonym for such activity as human experi- bers of my family, you did for to cordiality, benevolence, under- ence, moreover in an area of spe- me’ (Mt 25:40). The spiritual for- standing, sweetness, not of form cial delicacy, where personal and mation that Evangelium Vitae has but spontaneous in character, for social responsibilities, relation- given to nurses is thus Christo- the habit of seeing people posi- ships with other people, research centric. This encyclical has ena- tively, without reservations or and respect for the dignity of man bled nurses to develop knowl- prejudices and because of the sin- are involved. For that matter, a re- edge about, and consciousness of, gle fact that people are being seen. ductive vision both of ethics and themselves. Indeed, the nursing c. Meekness: which we also of medicine or their separation profession is governed by legis- translate with meekness, goodness. would lead in itself to the risk lative elements and directed by a d. Modesty: that is to say re- of not seeing the sick person as deontology; by cultural assump- spect for the sensitivity of a sick the subject of all therapeutic acts tions that shape it and influence it; person, his or her right to his or and seeing medicine as a divinity and by social requests that justi- her intimacy; correctness and re- which yokes man to its power and fy it. But if a nurse was not aware serve in care and treatment. an economy that is not at the ser- of the essence of his or her call to e. Pleasantness: or joviality, or vice of man but if its own profit, life, he or she would not be able good grace, the opposite of rude- with a consequent advantage for a to be a true servant to life – this ness or discourtesy. It is not only few and not of society as whole. is what Evangelium Vitae states medicine that treats but also the Professionalism belongs to mor- when providing a complete vi- way in which one approaches a al responsibility; it should nev- sion of what a nurse is. To be hon- patient. er be technical-scientific knowl- est in our analysis, however, we f. Respect: for a person, his or edge for its own sake but, rather, should, as this encyclical says, ‘go her needs, his or her dignity, his it should always be illumined by to the heart of the tragedy being or her illness, and his or her bad a humanising relationship. The experienced by modern man: the character. In the person of a sick criterion of the common good eclipse of the sense of God and of person a nurse recognises a broth- reminds us that there are shared man, typical of a social and cul- er, takes part in his or her human goals to be followed in a comple- tural climate dominated by secu- story. These twp groups are un- mentary and co-responsible way, larism… when the sense of God doubtedly differentiated but they according to the roles and the ca- is lost, there is also a tendency to are also substantially equal. pacities of each party. The world lose the sense of man, of his dig- g. Honour: at a human level we of health and of health care can nity and his life’.4 We have before may invoke a tradition that comes only have at its centre man, a sub- us weak thought which absorbs from Africa. When a man ill- ject who on his own and for his and destroys everything, leaving treats another man, the Africans own sake is valuable and who has behind it – nothing. The twenty cry out: ‘Stop it, don’t ill-treat written in his DNA all of his fu- years that have passed since the us’ (they do not say: don’t ill- ture; what we have before us, in publication of this encyclical tell treat him): in ill-treating him, we fact, is knowing how to read that us that although, on the one hand, are ill-treated, that human nature future. The criterion of action in the process of renewal of nurses that we have in communion is ill- this field must always be propor- has witnessed the rediscovery of a treated, our brothers and sisters tionate to the situation of that indi- necessary and advisable spiritual are ill-treated! And when they see vidual in particular. That is to say formation, on the other it has seen vultures swoop down on the body one must assess from one situation a reductionism based upon a phi- they say: ‘Leave us alone!, not to another what can be the great- losophy of exaggerated efficiency leave him alone. ‘In hitting him, est good of that person and what dictated by disenchanted new sci- you hit us, you hit a brother to- most is of benefit to his or her gen- ence and by an exaggerated phi- wards whom we feel supportive’. eral wellbeing. Almost the whole losophy of technology based on The spiritual formation as ad- of the population passes through the idea of immanence and bear- vocated by Evangelium Vitae a hospital which is the truest mir- ing an utilitarian impress which is what helps us to think anew ror of society, the most important has subjected the promoters of life about, and renew, our objectives, place there is for an understanding themselves. Evangelium Vitae in structures, styles and methods of of human reality in its totality. A this field, therefore, has not been professional health-care activity patient is responsible for his or her completely taken on board, but it that is addressed to a sick man in health and as such has the right to is of contemporary relevance and order to help him to live even in be informed by the health-care innovative. A Christocentric ap- his frailty! team about the diagnostic-ther- proach allows a nurse to acquire apeutic pathway to which he or those human-spiritual characteris- she is subjected, with simple and tics which make him or her a per- 2. The Moral Formation sufficient explanations that will son who proclaims life in Christ: of Nurses in the Light of help him or her to give his or her a. Maternal affection: modern Evangelium Vitae consent, in order to decide upon psychology has proposed anew special forms of treatment or ex- the value of tenderness in estab- Ethics is within all activity that aminations. Medicine is constant- lishing a relationship involving takes place in health care and in ly exposed to two ‘kinds’ of dis- help. medicine because it calls upon pute – a social and legal dispute

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with a citizen and a professional ways justifies the means, for the ation, experimentation on embry- one with the managers of compa- company it is the available means os, direct or indirect euthanasia, nies. Evangelium Vitae well pho- that justify the ends that can be passive euthanasia or euthanasia tographed this reality when it said: pursued and the rules that are de- through omission, are present in ‘Even certain sectors of the medi- signed to limit them. Well, this is many States of the world, with a cal profession, which by its call- not only a conflict which is far connected involvement of health- ing is directed to the defence and from negligible but it is also at care workers. These are facts that care of human life, are increasing- the specific basis of that part of create disturbing prospects about ly willing to carry out these acts the ethical emergency that seeks which Evangelium Vitae declares, against the person. In this way the to make compatible the needs of in a clear fashion: ‘All this ex- very nature of the medical profes- the patient with the resources that plains, at least in part, how the sion is distorted and contradicted, are available, thereby condition- value of life can today undergo and the dignity of those who prac- ing the autonomy of health-care a kind of “eclipse”, even though tise it is degraded’.5 workers. ‘The only goal which conscience does not cease to point A window through which one counts’, declares Evangelium Vi- to it as a sacred and inviolable val- can see the problematic relations tae, ‘is the pursuit of one’s own ue, as is evident in the tendency that exist between professions, material well-being. The so- to disguise certain crimes against companies and patients is cer- called “quality of life” is inter- life in its early or final stages by tainly deontology. Deontological preted primarily or exclusively as using innocuous medical terms codes are evolving in the search economic efficiency, inordinate which distract attention from the for new values, in an attempt to consumerism, physical beauty fact that what is involved is the reaffirm the old, in a strange al- and pleasure, to the neglect of the right to life of an actual human most subtle competition between more profound dimensions-inter- person’.9 This takes place because economic contexts that call upon personal, spiritual and religious- the moral formation of nurses, ex- the professions to have moral flex- of existence. In such a context cept in Catholic contexts, does not ibility and the professions, on the suffering, an inescapable burden contemplate in the study plans the other hand, which fear that their of human existence but also a fac- teaching of personalist bioethics. nature will be deformed through tor of possible personal growth, Those who over the last twenty the flexibility that is called for. is “censored”, rejected as useless, years have acted with courage and Today almost all the codes of indeed opposed as an evil, always determination in promoting man, professional practice of the vari- and in every way to be avoided. and the whole man, have always ous professions have shared char- When it cannot be avoided and fallen prey to anachronistic and acteristics: they are directed to- the prospect of even some future sectarian judgements, although wards a strong pluralism (in these well-being vanishes, then life ap- they have demonstrated in a sci- codes, in reality, there are very pears to have lost all meaning entific way the truth of life. Evan- many different sets of deontologi- and the temptation grows in man gelium Vitae, therefore, although cal ethics: law, good, the person, to claim the right to suppress it. it has formed and directed genera- what is right, what is fair, what is Within this same cultural climate, tions of nurses in respect for hu- good, etc.). The values that pre- the body is no longer perceived as man life and its inviolability, wit- dominate are certainly those of a properly personal reality, a sign nessed a vast gamut of threats to autonomy and responsibility; they and place of relations with oth- human life with their legal recog- are all codes to come in the sense ers, with God and with the world. nition by the state, passing from that the changes to which they try It is reduced to pure materiality: what was considered a crime to to respond make them, in fact, on- it is simply a complex of organs, being a right, with a subsequent ly provisional and revisable. It ap- functions and energies to be used implementation of them through pears that the only path that can be according to the sole criteria of gratuitous action by health-care followed is conscientious objec- pleasure and efficiency’.7 workers themselves.10. In this cli- tion. ‘Those who have recourse to Thus the moral formation of mate of widespread moral uncer- conscientious objection’, declares nurses in the light of Evangelium tainty, one should, therefore, re- the encyclical, ‘must be protected Vitae can only be anthropocentric. turn in university lecture halls and not only from legal penalties but The recommendations and the ac- courses of professional training to also from any negative effects on tivity of a nurse will be founded offering an anthropocentric moral the legal, disciplinary, financial on the ontologically based con- formation. and professional plane’.6 Has this cept of the person. However, the kind of guarantee covered how laws and the operational choic- people work? The sentences in- es of the last twenty years have 3. The Pastoral Formation flicted on nurses and health-care made us have to deal with a sys- of Nurses in the Light of workers who have been conscien- tematic violation of the moral law Evangelium Vitae tious objectors makes us answer especially in the grave area of ‘no’ to this question. Today the respect for human life and its dig- ‘The crowds of the sick and management procedures do noth- nity.8 Abortion, the morning after the outcasts who follow him and ing else but administer a system pill, the five days after pill, RU seek him out (cf. Mt 4:23-25) find of rules in a rigid way. Whereas 486, abortion-inducing methods, in his words and actions a reve- for the worker it is the end that al- FIVET, medically assisted procre- lation of the great value of their

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lives and of how their hope of concerted and generous action by self first of all asking people to salvation is well-founded. The all the members and by all sec- collect wood and preparing the same thing has taken place in the tors of the Christian communi- tools; do not distribute tasks, do Church’s mission from the begin- ty. This community commitment not organise the work. But, in- ning. When the Church proclaims does not however eliminate or stead, first awake in men a nos- Christ as the one who “went lessen the responsibility of each talgia for the distant and limit- about doing good and healing all individual, called by the Lord to less sea. As soon as this thirst is that were oppressed by the dev- “become the neighbour” of eve- awakened in them they will im- il, for God was with him” (Acts ryone: “Go and do likewise” (Lk mediately set themselves to work 10:38), she is conscious of being 10:37)’.13 Indeed, a mission in the to build the ship’. Evangelium Vi- the bearer of a message of salva- world of health and health care as tae helps nurses and health-care tion which resounds in all its new- Catholic health-care workers that teams in general to dig into the ness precisely amid the hardships is not of the Church and in the depths of their being in order to and poverty of human life’.11 The Church is not thinkable. Vocation free their most authentic wishes, pastoral formation of nurses starts is born and develops in the ma- those towards which the yearn- from the awareness that they are ternal womb of the Church. Each ing for complete fulfilment vi- called by Jesus who entrusts a one of us constitutes a fundamen- brates. The formation of nurses, task to them and gives them indi- tal part of this body that always defined in these terms, refers us cations, the means and the powers acts together and in unity. It can to the Most Holy Trinity, the uni- needed to carry it out, and sends never be a solitary action accord- fying principle of charity and the them out as a Church, a healing ing to one’s own vision – it must full achievement of life. This is a community. ‘Heal the sick! The always be synergic and synod- demanding undertaking that re- Church has received this charge al and proclaim the Kingdom of quires a purification of desires, from the Lord and strives to car- God, that is to say an extension of those interior gymnastics sug- ry it out by taking care of the sick the Church itself. Ecclesiocentric gested by St. Augustine to those as well as by accompanying them pastoral formation means that who want the ship of their lives with her prayer of intercession. a nurse never feels alone but al- to speed towards the safe port of She believes in the life-giving ways feels sent out and supported true happiness. presence of Christ, the physician by the prayers of the Church. It is of souls and bodies’.12 For nurses, certainly the case that if this is the being sent out by Christ means, character of the call of nurses to Notes therefore, sharing his same mis- mission, then a strong becoming sion. Thus where the spiritual for- aware of it which opens up com- 1 John Paul II, Evangelium Vitae, n. 79. 2 Ibid., n. 1. mation of nurses is Christicentric munity pathways above all in par- 3 Ibid., 2. and their moral formation is an- ishes and associations is needed. 4 Ibid., 21. thropocentric, their pastoral for- 5 Ibid., n. 4. 6 Ibid., n. 74. mation can only be imparted as 7 Ibid., n. 23. ecclesiocentric: ‘We have been Conclusions 8 Ibid., n. 21. sent as a people. Everyone has an 9 Ibid., n. 11. 10 Ibid., n. 11. obligation to be at the service of Antoine de Saint-Exupéry 11 Ibid., n. 32. life. This is a properly “ecclesi- wrote: ‘If you want to build a 12 CCC, n. 1509. al” responsibility, which requires ship you should not trouble your- 13 Ibid., n. 79.

2. Medical Doctors

Msgr. Jacques Suaudeau he encyclical Evangelium Vi- relates to the safeguarding of life. Ecclesiastical Assistant of Ttae has a special character for At the same time, they are also in the International Federation professionals who work in the the front line as protagonists or of Associations of Catholic health-care world: medical doc- co-workers in relation to every- Medical Doctors - F.I.A.M.C., tors and nurses, employees of thing connected with the attacks France; various kinds, and the heads of to which human life is exposed Consultor of the Pontifical institutions connected with sick today in the biomedical field, For Council for Health Care people or elderly people. Indeed, health-care professionals, this en- Workers they are in the front line as serv- cyclical constitutes a useful syn- ants in relation to everything that thesis of the documents of the

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Magisterium of the Church in re- of the health-care professions, al- are, roots that demonstrate its ad- lation to human life and a very though they are directed towards vance in the consciousness of our strong appeal to the practical im- the defence of life, can today co- contemporaries. plications of the commandment operate, without great resistance, ‘thou shalt not kill’ in the health- with the works of this culture. a. A Perverse Idea of Freedom care field.A bove all, however, it Legitimated by parliaments and offers these professionals a perti- promoted by numerous national a.1 the contradiction individual nent analysis of the roots of that and international institutions, the rights/human rights ‘culture of death’ in which they culture of death has penetrated To explain the spread of the cul- are immersed and which influ- consciences. If Pope John Paul II ture of death and its increasing ac- ences them, without them always made increasing reference to it in ceptance within society, a different realising in a clear way the role bis writings and his speeches,1 this element to the influence of utili- they play in this process. At the took place not only following a tarianism or the mass media or the same time, this document pro- deeper realisation of the gravity of role of parliamentary majorities vides them with guidelines on the the problem but also because of a must be recognised. That element conduct they should have as re- real escalation of the phenomenon is the absolutisation that is made of gards legislation that tolerates or in contemporary society. In his en- the individual freedom of a person approves a right to bestow death cyclical Evangelium vitae, John and the perverse idea of that free- on other people or on oneself, and Paul II observes that the ‘culture dom – called ‘autonomy’ – that is which leads them both to cooper- of death’ is by now supported by advanced by liberal culture. ate in evil and to refuse this co- ‘broad sectors of public opinion’. For John Paul II, the ‘most sub- operation through conscientious It has achieved sedimentation as an versive’ aspect of the decisions of objection. For health-care profes- element which by now is a part of contemporary culture is the in- sionals, one should emphasise in our Western world. We have before terpretation that it has of crimes particular these last two aspects of us an anti-life mentality, which by against life as ‘legitimate expres- this encyclical, namely the roots now is strongly inserted into the sions of individual freedom’ (EV, n. of the culture of death and these cultural landscape as well as be- 18). Society, as a consequence, ful- guidelines. ing supported by unjust laws and a ly contradicts itself. On the one had, high level of ignorance and confu- it profoundly affirms its attachment sion. ‘Choices once unanimously to human rights but, on the other, it 1. The Culture of Death considered criminal and rejected contradicts the fundamental right to by the common moral sense are life by privileging individual and In the introduction to Evange- gradually becoming socially ac- subjective rights (EV, n. 18). lium Vitae, Pope John Paul II pro- ceptable’ (EV, n. 4b). vides a rapid but striking descrip- This culture of death has two as- a.2 A totally individualistic and tion of the attacks on human life pects. On the one hand, there is its not supportive freedom which since the Second World War individual aspect which is charac- This contradiction, which is in- have greatly increased in number, terised by an increasing sensitisa- herent in the approach now to be in an unprecedented way and on a tion of public opinion in the face found in our societies, refers to the scale never seen before, in partic- of the gravity of certain attacks on liberal idea of freedom as an indi- ular in the industrialised and rich human life in the name of a right vidualistic freedom which exalts world of technology and mate- of individuals that goes against the the individual and thus is extrane- rial prosperity. It is this tendency, weakest and favours the strong- ous to solidarity (EV, n. 19). Free- which pays very little attention to est. On the other there is its col- dom thus becomes the ‘freedom of human life, in particular when it is lective, ‘democratic’, aspect which the strongest’. Force becomes the weak, vulnerable and defenceless, involves an absolutisation of the criterion for choices and action in and which leads to the special in- consensus decisions at the level interpersonal relationships. The terests of the strongest prevailing of parliamentary assemblies in the ‘force of reason’ is replaced by the over human life, which John Paul name of the principle of democra- ‘the reasons of force’ (EV, n. 19). II denounces when he applies to cy carried to the level of an end in this phenomenon the appellation itself. This means that institutions a.3 A freedom that is emancipated ‘culture of death’. pass immoral anti-life laws with- from truth: ‘autonomy’; What characterises this cul- out respecting morality and con- positive law against ture of death is its institutionalisa- sciences (EV, nn. 69,70). natural law tion and the fact that it is founded This exaltation of the individual on what John Paul II calls ‘social in our liberal societies has another structures of sin’, ‘a network of 2. The Roots of the ‘Culture feature: natural morality is reject- complicity’ that acts at a national of Death’ (EV, nn. 18-24) ed, that is to say the recognition of and international level. As regards values common to all humanity ex- health-care workers, the culture of Faced with such realities, we pressed in human rights, and there death appears first and foremost as have the right to ask ourselves is a move towards ‘easier’ moral- a certain perversion of conscienc- where this culture comes from, a ities, ones that are subjective and es. It is with reference to it that one culture which until a few years ago which exalt the individual and his can explain how some members was unknown, and what its roots ‘conscience’ as the source of truth.

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The link between freedom and rights of individual freedom, and ing truth from falsehood has as truth is broken. It is the individ- on this basis they claim not only its grave consequence a crisis ual himself or herself, feed from exemption from punishment but of truth. Contemporary man no any reference to moral law, who even authorization by the State, so longer knows in a good way to becomes the source of truth. ‘The that these things can be done with discern where the truth lies. His person ends up by no longer taking total freedom and indeed with the conscience is darkened. For him, as the sole and indisputable point free assistance of health-care sys- all policies are the same. of reference for his own choices tems’ (EV, n. 4a). This phenomenon has been the truth about good and evil, but even more accentuated by chang- only his subjective and changeable b. The Eclipse of the Sense es that have taken place in legisla- opinion or, indeed, his selfish inter- of God – the Eclipse tion. Rather than guiding citizens est and whim’ (EV, n. 19). of the Sense of Man towards an attitude that is more The fact that man thinks that he consonant with natural morality, is the criterion and the norm of his We cannot stop here at this per- this new permissive legislation actions means that he believes that verse idea of freedom alone. We distances them from it, thereby he has the right to ask society to must, rather, go deeper, to where aggravating the confusion of con- guarantee him the possibility of, we find the eclipse of the sense sciences. and the ways of deciding about, of God which leads to the eclipse ‘The fact that legislation in his own life ‘in full and total au- of the sense of man (EV, n. 21). many countries, perhaps even tonomy’ (EV, n. 64). This is ex- Indeed, the ‘culture of death’ is departing from basic principles pressed, for example, in the form the ultimate sub-product of the of their Constitutions, has deter- of so-called ‘prior’ ‘wishes’ or in ‘death of God’ in consciences. It mined not to punish these practic- requests for assisted suicide be- is specifically the phenomenon es against life, and even to make cause of ‘tiredness as regards life’. of secularisation and the aban- them altogether legal, is both a As a consequence of such an in- donment of the roots of faith that disturbing symptom and a sig- dividualistic vision of freedom, have led to contemporary uncer- nificant cause of grave moral de- which eliminates all reference to tainties (EV, n. 21). cline. Choices once unanimously shared moral norms, new legisla- The eclipse of the sense of God considered criminal and rejected tive proposals are based only on leads to the lose of a moral sense by the common moral sense are the role of parliamentary majorities and thus respect for human life gradually becoming socially ac- without any relationship to morality as well. This is a vicious circle ceptable’ (EV, n. 4). (EV, n. 20). Law no longer depends because in freeing himself from ‘Even certain sectors of the on justice or human rights but, rath- moral law, man falls into a deeper medical profession, which by its er, on the force of a majority. darkening of his own conscience calling is directed to the defence We are faced with a caricature which distances him even further and care of human life, are increas- of legality and ‘the democratic from God (EV, n. 21). ingly willing to carry out these acts ideal…is betrayed in its very foun- What is lost is a sense of the against the person. In this way the dations. How is it still possible to transcendence of man, of his vo- very nature of the medical profes- speak of the dignity of every hu- cation, of his value and of his dig- sion is distorted and contradicted, man person when the killing of the nity. ‘Human rights’ continue to and the dignity of those who prac- weakest and most innocent is per- be talked about but their founda- tise it is degraded’ (EV, n. 4). mitted?’ (EV, n. 20). tions are no longer understood. Dignity is reduced to the exercise d. The Loss of the Sense a.4 the recognition of a right of autonomy and in the end man of the Social and Intangible to death or to lead someone is placed at the same level as an- Character of Human Life to death imals, and rights are claimed for In this approach of the absoluti- animals rights that are denied to d.1 the erosion of the value sation of individual freedom, death man (EV, n. 22). given to human life – whether one is dealing with abor- The loss of the sense of God and tion, suicide, euthanasia or infanti- c. The Confusion of Consciences. the transcendence of man naturally cide – becomes a real ‘object of Medicine Disfigures leads to the loss of the transcend- law: the right to choose death in all its own Face ent, sacred and intangible charac- freedom, for oneself or for other ter of human life. A man who has people’ (EV, n. 18b). The eclipse of the sense of God lost the sense of God can no longer The consequence of this attitude and of the sense of man involves grasp the sense of life as a ‘mag- is the increasingly sustained sup- the confusion of consciences – nificent gift of God. Life becomes port for the abolition by the state that mental infirmity which char- simply ‘a thing’ which he can of all legal obstacles that limit the acterises the crisis of thought of dominate, manipulate and whose free option of death. The unprec- contemporary society, as was an- owner he is (cf. EV, n. 22). edented thing, in this new cultur- alysed by John Paul II in his en- After losing the sense of his al situation, is that, as John Paul II cyclical Veritatis Splendor (6 Au- transcendence, man can no longer observed, ‘broad sectors of pub- gust 1993). ‘pose questions to himself’ about lic opinion justify certain crimes The current difficulty endured the sense of his life and the sense of against life in the name of the by consciences in distinguish- his death. Suddenly his attitude to-

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wards death changes and he passes communities expressions of self- it nonetheless developed more from ‘being’ to ‘doing’, from ques- ishness and violence amongst hu- than any other document of the tions to programmes (EV, n. 22). man beings. But here one is not Magisterium two questions relat- Another consequence of the loss only dealing with forms of indi- ing to health-care workers: that of the sense of transcendence is that vidual selfishness but also with a of cooperation in evil and that of contemporary society no longer ac- social conscience which, not be- conscientious objection. cepts suffering which appears to it lieving in the inviolable value of as ‘an unbearable setback, some- human life, makes itself its ab- a. Cooperation in Evil thing from which one must be freed solute master and arbiter without at all costs. Death is considered any possibility of appeal’.3 The John Paul II devoted an entire “senseless” if it suddenly interrupts loss of conscience in relation to sub-section in his encyclical to the a life still open to a future of new human life as such leads to a loss question of cooperation in evil. and interesting experiences. But of love and respect for every hu- it becomes a “rightful liberation” man being.4 Choices begin to be a.1 Definition of cooperation once life is held to be no longer made, with some people loved in evil meaningful because it is filled with and respected and others seen as When a moral agent realises pain and inexorably doomed to ‘unworthy’ of life, or it is even be- the existence of a connection be- even greater suffering’ (EV, n. 64). lieved that it would be ‘better for tween his or her own actions and them’ not to live. behaviour and a bad action com- d.2 the values of being mitted by another person or party, are replaced by the values d.4 Attitudes involving this agent enters the moral prob- of having the rejection of certain lives lem which has been classical- The loss of the transcendent This undervaluing of the dig- ly addressed as ‘cooperation in sense of human life means that nity of every human being gener- evil’,5 with his or her participation ‘The values of being are replaced ates ‘feelings or attitudes of indif- in the moral guilt of a sin commit- by those of having. The only goal ference, contempt or rejection in ted by another person or party. which counts is the pursuit of relation to life’ (EV, n. 98d). Cooperation in evil is a mental one’s own material well-being’ ‘A life which would require and/or moral contribution made (EV, n. 23). greater acceptance, love and care by a person to a bad act of anoth- The result of this is that the oth- is considered useless, or held to er person who is described as the er person is no longer appreciated be an intolerable burden, and is principal actor. for what he or she is but for what therefore rejected in one way or Traditional has analysed in a he or she is worth; it is the criteri- another. A person who, because of precise way the various possibil- on of efficacy that dominates, as a illness, handicap or, more simply, ities of this cooperation in evil, result of which the strong prevail just by existing, compromises the making clear what the conditions over the weak. The elderly and well-being or life-style of those are where cooperation in a bad act vulnerable person is ‘separated’ who are more favoured tends to be cannot be justified. Of fundamen- (EV, n. 23). looked upon as an enemy to be re- tal importance in this analysis is The concept of ‘quality of life’ sisted or eliminated’ (EV, n. 12b). the distinction between formal is typical of this mentality where Commencing with the mo- cooperation and material cooper- the former is interpreted, as John ment when man sees human life ation.6 Paul II observes, ‘primarily or ex- as something that can be disposed Cooperation can be active when clusively as economic efficiency, of, no ethical limit can be applied it helps to prepare for, or to carry inordinate consumerism, physical anymore – only what is useful out, a bad act both physically and beauty and pleasure, to the neglect counts. This is the logic of eugen- morally (advising it, encouraging of the more profound dimensions ic prenatal diagnosis. And from it, ordering it…). It can be passive – interpersonal, spiritual and reli- there one easily reaches the in- both physically (by omission) and gious – of existence’ (EV, n. 23b). terruption of the alimentation-hy- morally (abstaining from warning We thus allow ourselves to dration of handicapped children beforehand, not opposing it while measure, using pseudo-mathe- in order to end their lives. After it is being carried out and not de- matical formulas,2 the value of the legitimating abortion, one easily nouncing it afterwards). life of a person on the basis of his comes to legitimate infanticide. Moralists make a distinction or her age and state of health. This is the return of barbarism, a between two kinds of cooperation barbarism that we thought we had – the formal and the material. In d.3 Eugenics ‘left behind for ever’ (EV, n. 14). formal cooperation the individual What characterises this new at- adopts the bad action of the prin- titude towards human life is its cipal agent, thereby sharing in its utilitarianism, which is pervaded 3. For Medical Doctors. bad intention. This kind of coop- by a strong does of eugenics. This Cooperation in Evil, eration in which the will of the leads it to discriminate against Conscientious Objection person who cooperates is intrin- certain human lives which are sically bad is always gravely im- held to be useless or even injuri- Although the encyclical Evan- moral and thus always illicit. ous. It is certainly the case that gelium Vitae is not addressed spe- Material cooperation is coop- there have always been in human cifically to health-care personnel, eration with a bad act but with-

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out adhering to the intention that motherhood, which leads to abor- To refuse this direct formal or presides over that act. The indi- tion (EV, n. 59). material cooperation is an elemen- vidual cooperates in the material The fifth circle is passive coop- tary human duty inasmuch as such act but does not agree with the in- eration through omission. This re- cooperation would be contrary to tention of the principal actor. If it lates to all those who should have the dignity of the person and con- is voluntary, material cooperation opposed abortion by implementing trary to his or her freedom (EV, n. is totally imputable. If it is invol- effective family and social policies 74). And it is from this statement untary, the blameworthiness de- to support families, and in particu- that John Paul II then leads us on pends on the varying degrees of lar numerous families (EV, n. 59). to conscientious objection. direct cooperation. It can be im- And finally there is the wide cir- mediate or mediated. cle of the ‘network of complicity’ b. Conscientious Objection with abortion which includes inter- a.2 An example of cooperation in national institutions, foundations The negative precept ‘do not evil: abortion; EV, n. 59 and associations which systemati- kill’ which leads to the positive The encyclical Evangelium Vi- cally campaign for the legaliza- precept of absolute respect for eve- tae provides us in section 59 with a tion and spread of abortion in the ry human life can require an act of clear illustration of this cooperation world’ (EV, n. 59). conscientious objection in the case in evil and makes us touch with our of the crimes of abortion and eu- own hands its scope in the form of a.3 Evangelium Vitae and thanasia. circles of complicity, or complicity cooperation in evil ‘“Causing death” can never be in cooperation, which are increas- In this encyclical John Paul II considered a form of medical treat- ingly broad and extensive as one calls attention to the teaching of ment, even when the intention is draws away from the illicit act that the Church about cooperation in solely to comply with the patient’s is at their centre. Here we are talk- evil. He brings together in the same request. Rather, it runs completely ing about cooperation in abortion. condemnation formal cooperation counter to the health- care profes- In abortion not only the mother and immediate material coopera- sion, which is meant to be an im- is guilty. In reality, this is an act tion (direct participation in the act): passioned and unflinching affirma- that involves the responsibility of ‘Such cooperation occurs when an tion of life’ (EV, n. 89). a large number of actors who co- action, either by its very nature or Evangelium Vitae addresses con- operate directly to a varying extent by the form it takes in a concrete scientious objection starting with a in the act. situation, can be defined as a direct question raised by unjust laws that First of all there is the father who participation in an act against in- allow abortion or euthanasia. abandons the woman as regards nocent human life or a sharing in facing up to the problems raised by the immoral intention of the person b.1 When a law goes against the pregnancy (EV, n. 59). committing it’ (EV n. 74). moral order, it ceases to be a Then in this circle of responsi- Duty of conscience calls on law and is no longer binding bility we find the wider family and Christians not to enter into coop- The imperfection of civil laws friends, all of those people, that is eration of this kind : ‘Christians, raises the question of the relation- to say, who apply moral pressure like all people of good will, are ship between civil law and mor- to the woman to make her have an called upon under grave obligation al law. This is a subject on which abortion – they, too, are responsible of conscience not to cooperate for- the Church has always reflected a for the abortion on a level which is mally in practices which, even if great deal. John Paul II pays es- the same as that of the woman. permitted by civil legislation, are pecial attention to it in section 72 The third circle of responsibil- contrary to God’s law’ (EV, n. 74). of’Evangelium Vitae where he em- ity is made up of medical doctors This kind of cooperation in phasises the following points. 1. and health-care personnel who co- which the will of the person coop- ‘Certainly the purpose of civil law operate in the abortion, very often erating is intrinsically bad is always is different and more limited in at a formal level (encouraging the gravely immoral and thus always scope than that of the moral law’ woman to have an abortion, giving illicit: ‘from the moral standpoint, (n. 71). ‘The real purpose of civ- her their assent), at times at a direct it is never licit to cooperate formal- il law is to guarantee an ordered or indirect material level. ‘Doctors ly in such evil’ (EV, n. 74). There social coexistence in true justice’ and nurses are also responsible, is never any excuse for this kind of (n. 71). 2. The task of civil law when they place at the service of cooperation: ‘This cooperation can ‘is that of ensuring the common death skills which were acquired never be justified either by invok- good of people through the recog- for promoting life’ (EV, n. 59). ing respect for the freedom of oth- nition and defence of their funda- In the fourth circle there are ers or by appealing to the fact that mental rights, and the promotion those legislators who have pro- civil law permits it or requires it. of peace and of public morality’ moted and passed laws that allow Each individual in fact has moral (n. 71). 3. As a consequence, civil abortion; the administrators of care responsibility for the acts which he law must assure to all members of institutions that are used to carry personally performs; no one can society respect for certain funda- out abortion; and lastly all those be exempted from this responsibil- mental rights, the first of which ‘is who are responsible for the spread ity, and on the basis of it everyone the inviolable right to life of eve- of the current mentality of sexual will be judged by God himself (cf. ry innocent human being’ (n. 71). permissiveness and contempt for Rom 2:6; 14:12)’ (EV, n. 74). 4. ‘The legal toleration of abor-

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tion or of euthanasia can in no way 73). They thus require conscien- cism, the loss of one’s job, notable claim to be based on respect for tious objection: ‘There is no obli- fines or prison sentences or, lastly, the conscience of others, precisely gation in conscience to obey such the loss of one’s own life: ‘The because society has the right and laws; instead there is a grave and passing of unjust laws often rais- the duty to protect itself against clear obligation to oppose them by es difficult problems of conscience the abuses which can occur in the conscientious objection’ (EV, n.73). for morally upright people with name of conscience and under the regard to the issue of coopera- pretext of freedom’ (n. 71). 5. Giv- b.3 this is an essential right tion, since they have a right to de- en that civil law has a more lim- The ‘duty of conscientious ob- mand not to be forced to take part ited scope than moral law, ‘in no jection’ can lead the person who in morally evil actions. Sometimes sphere of life can the civil law take engages in it to then have grave the choices which have to be made the place of conscience or dictate professional problems. Although are difficult; they may require the norms concerning things which are recognised at a theoretical level, sacrifice of prestigious profession- outside its competence’ (n. 71). 6. as a part of the rights of the per- al positions or the relinquishing If, ‘for the good of public order’, son, conscientious objection does of reasonable hopes of career ad- civil law at times has to be toler- not have, in general, its own leg- vancement’ (EV, n. 74). ated to avoid ‘a graver injury de- islation which assures its exer- For this reason Evangelium Vi- riving from it (Donum Vitae III), it cise. It is not expressed in human tae affirms that in the face of an cannot, however, go against moral rights (which cite only ‘freedom obligation to cooperate in an act law. ‘The doctrine on the neces- of conscience’ and not freedom of against life, conscientious objec- sary conformity of civil law with conscientious objection). It is not tion should be recognised as a right. the moral law is in continuity with written into the Constitutions of ‘To refuse to take part in commit- the whole tradition of the Church’ the world’s nations or is present in ting an injustice is not only a moral (n. 72). 7. Consequently, laws and their laws. What we find are only duty; it is also a basic human right. decrees enacted in contravention special regulations which deal, for Were this not so, the human per- of the moral order, and hence of example, with conscientious ob- son would be forced to perform the divine will, can have no bind- jection at a military level or which an action intrinsically incompat- ing force in conscience’ (n. 72). 8. define its limits as regards health- ible with human dignity, and in ‘Indeed, the passing of such laws care personnel. this way human freedom itself, the undermines the very nature of au- From the point of view of state authentic meaning and purpose of thority and results in shameful authorities, the recognition of the which are found in its orientation abuse’ (n. 72). When a law is con- right to conscientious objection to the true and the good, would be trary to the moral order, it ceases is not seen as an obligation of the radically compromised. What is at to be law and no longer commands state because it is considered a fun- stake therefore is an essential right obedience: this is the teaching of damental right of the person but, which, precisely as such, should the whole of the tradition of the rather, it is seen as a concession to be acknowledged and protected by Church, a tradition that was devel- citizens, without a morally obliga- civil law’ (EV, n. 74). oped in particular by St. Augustine tory character, because the enacted This means that health-care pro- and taken up by St. Thomas Aqui- law that constitutes the problem is fessionals – medical doctors, nurs- nas. Civil laws that legitimate the legal and thus must be obeyed ac- es, paramedical staff and the heads direct killing of human beings, as cording to the principle of demo- of hospitals and health centres – in the case of laws that allow abor- cratic government. Conscientious should be able to benefit from this tion or euthanasia, are ‘in complete objection, indeed, tends to be seen right. opposition to the inviolable right as an act of individual rebellion, a ‘In this sense, the opportunity to to life proper to each individual’ break with what forms the basis of refuse to take part in the phases of (n.72). Such laws are ‘opposed not solidarity in a country, a negation consultation, preparation and ex- only to the good of the individu- of consensus, which runs the risk ecution of these acts against life al but also to the common good; of injuring consensus itself. It is not should be guaranteed to physi- as such they are completely lack- seen in a very positive light. Thus a cians, health-care personnel, and ing in authentic juridical validity’ recognition on the part of state au- directors of hospitals, clinics and (n.72). ‘Consequently, a civil law thorities of the possibility of engag- convalescent facilities. Those who authorizing abortion or euthanasia ing in conscientious objection is not have recourse to conscientious ob- ceases by that very fact to be a true, in the least automatic: as an act of jection must be protected not only morally binding civil law’ (n. 72). good will, a government concedes from legal penalties but also from only the right to objection, placing any negative effects on the legal, b.2 Laws that legitimate the it within the same context of con- disciplinary, financial and profes- killing of human lives make ceding to an individual the right not sional plane’ (EV, n. 74). an appeal to conscientious to bear arms. This is a concession objection and not an obligation. Because they go against mor- For this reason, to exercise the Conclusion al law, laws that eliminate human right to conscientious objection is lives are not laws. They are ‘intrin- never easy and for those who en- Pope John Paul II, when he ad- sically unjust’ and illegitimate: ‘’it gage in it the price to be paid is al- dresses in the fourth chapter of is never licit to obey’ them (EV, n. ways social and professional ostra- Evangelium Vitae those who are

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especially involved in the defence can involve medical doctors be- ble against those who wish for their of life or, in opposite fashion, are coming ‘manipulators of life, or disappearance as soon as possible. exposed to taking part in attacks on even agents of death’ (EV, n. 89). We need new Professor Lejeunes life, refers to health-care person- In the face of this temptation, to proclaim the value and the digni- nel, to whom, indeed, he dedicates the responsibility of medical doc- ty of the human person whether in a special section of his work. tors is greater. John Paul II pointed the womb of his or her mother or in Indeed, health-care personnel to the pathway that should be fol- a geriatric institute, whether the re- have in relation to human life a lowed – to return to the ‘the intrin- ceiver of the Nobel Prize for medi- special role of being at its service, sic and undeniable ethical dimen- cine or in a school for children with as a part of their vocation, but they sion of the health-care profession’ Down’s syndrome. We have to re- also, in opposite fashion, can be in- and rediscover the ‘Hippocratic discover the great tradition of med- volved, that is to say take part in Oath, which requires every doc- ical doctors who are the servants of a more or less active way, in the tor to commit himself to absolute life. As John Paul II says in his en- manipulation of human life and respect for human life and its sa- cyclical Evangelium Vitae, ‘we are even in its death. This ambiguity credness’ (EV, n. 89). all involved and we all share in it, did not appear in the past because In the fight between the culture with the inescapable responsibility the medical profession was faithful of death and the culture of life, of choosing to be unconditionally to the Hippocratic oath, and it was medical doctors cannot play the pro-life’ (EV, n. 28). unthinkable that a medical doctor part of observers, waking up on- could bestow death or make him- ly to defend their own interests, self or herself an accomplice of which, indeed, are often distant Notes murder. Things have now changed. from those of their patients. They 1 G. Miranda, ‘“Cultura della morte”: John Paul II brings us back to the must rediscover their fundamental analisi di un concetto e di un drama’, in”Commentario interdisciplinare alla essential: the profession of people vocation of being ‘servants of life’. “Evangelium Vitae”, S. Sgreccia and R. Lu- who work in the world of health Pope John Paul II emphasised their cas Lucas (eds.) (Libreria Editrice Vaticana, and health care makes them ‘serv- responsibility in the relativising of Rome, 1997), pp. 225-243. 2 P. Singer, J. McKie, H. Kuhse, J. Rich- ants of human life’. ‘A unique re- the value of human life and the ba- ardson, ‘Double jeopardy and the use of sponsibility belongs to health-care nalising of the voluntary, active or QALYs in health care allocation’, Journal personnel: doctors, pharmacists, passive, elimination of that life at of Medical Ethics, June 1995, vol. 21, n. 1, pp.144-150. nurses, chaplains, men and women the two poles of the life cycle. It is 3 ‘Ai partecipanti al congresso sulla vita religious, administrators and vol- they who know, above all else, the promosso dalla CEI. Roma 16 aprile 1989’, unteers. Their profession calls for value of human life, this wonderful in Insegnamenti XI,1,1989, p. 836. 4 ‘Discorso ai leader dei Movimenti In- them to be guardians and servants and free gift that the Evangelium ternazionali Pro-Vita, Roma, 15 novembre of human life’ (EV, n. 89). Vitae so forcefully calls attention 1991’, in Insegnamenti XIV, 2, 1991, p. 1159. But John Paul II immediately to. Despite this knowledge, medi- 5 A. Fisher, ‘Cooperation in Evil’, Cath- olic Medical Quarterly, 1994, pp.15-22; adds that in the contemporary con- cal doctors have given too much L.Melina, ‘La cooperazione con azioni text, which is one of the applica- room to the culture of death, for moralmente cattive contro la vita umana, in tion of technology to medicine, reasons of convenience, out of a Commentario Interdisciplinare alla “Evan- which is now more expert but also fear of adopting a stance, and even gelium Vitae”’, E. Sgreccia and Ramòn Lu- ca Lucas (eds.), (Libreria Editrice Vaticana, less close to people and less sen- because they have lost the sense of 1997), pp. 467-490; E. Sgreccia, Manuale di sitive to the accompanying of pa- the transcendental character of hu- Bioetica, vol. I, reprint of third edition (Vi- tients, medical doctors can ‘lose man life. Utilitarianism has pen- ta e Pensiero, Milan, 1999), pp. 362-363; D. Tettamanzi, ‘Cooperazione’, in Dizionario di sight of their inherent ethical di- etrated medicine, measuring men Bioetica, S. Leone and S. Privitera (eds.), (Is- mension’ (EV, n. 89). more by what they do than by what tituto Siciliano di Bioetica, EDB-ISB, 1994), This loss of the ethical dimen- they are. Today we need Profes- pp. 194-198. 6 Jean-Pascal Perrenx, Théologie mo- sion of medicine runs the risk of sor Lejeunes to defend the handi- rale fondamentale. Les actes humains (tome having grave consequences which capped, the elderly and the vulnera- 2) (Pierre Tequi editeur, 2008), pp. 450-461.

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3. Pharmacists

Fr. Pierre Jean Welsch providing information, as is right cent facilities. Those who have Ecclesiastical Assistant during the stage that involves the recourse to conscientious objec- of the International Federation creation of a product and its reg- tion must be protected not only of Catholic Pharmacists - istration, whereas a pharmacist from legal penalties but also from F.I.P.C., particularly feels – and is obliged any negative effects on the legal, Belgium to be such – responsible for its disciplinary, financial and profes- good use, its side effects, its inju- sional plane’. As one can seen, rious interactions with other prod- the encyclical does not have am- ucts…and is concerned whether it biguities and the use of the verb has a beneficial effect in the long ‘should’ indicates the situation of First Part term on the patient. difficulty of the pharmacist who Let us continue with our reading is not always acknowledged as Without any fear of being in er- of this number of the encyclical: having this right, in contrary fash- ror, we can affirm that the publi- ‘scientific research itself seems ion to medical doctors and nurs- cation in 1995 of the encyclical to be almost exclusively preoc- ing staff. Twenty years later, we Evangelium Vitae was received cupied with developing products have not achieved any steps ahead by pharmacists as a great encour- which are ever more simple and in this sense, at least at the level agement. Not only did the encyc- effective in suppressing life and of national legislation. lical cite them (at n. 89) but it also which at the same time are ca- However, there has been no ab- dwelt upon the various challenges pable of removing abortion from sence of appeals. Twice, follow- that had been posed to the profes- any kind of control or social re- ing on from the encyclical, two sion for a large numbers of year, sponsibility’. John Paul II had al- direct statements by Pope Bene- challenges which hitherto – this ready had an opportunity in the dict XVI explicitly requested con- should be acknowledged despite year 1990 when talking to the In- scientious objection: in his speech everything – have not, unfortu- ternational Federation of Catho- of 29 October 2007 in Rome and nately, obtained really satisfacto- lic Pharmacists to highlight this in the message of 14 September ry solutions. role of a pharmacist in being a 2009 in Poznan (Poland) which Number 13 of the encyclical ‘careful adviser for all those who had been entrusted to our Presi- is concerned with the fact that purchase remedies, without men- dent, Msgr. Zimowski: ‘In the ‘enormous sums of money have tioning the moral help that he can moral field your Federation is been invested and continue to give to all those who, after com- called to address the question of be invested in the production of ing to purchase a product, expect conscientious objection, which is pharmaceutical products which from him also advice, a reason a right that your profession must make it possible to kill the foe- for hope, a path to follow’ (3 No- be recognised as having, allowing tus in the mother’s womb without vember 1990, n. 3) and he encour- you not to collaborate, directly or recourse to medical assistance’. aged the federation to have a clear indirectly, in the supply of prod- It has to be recognised that the awareness of its specific duties. ucts whose purpose is choices that intermediate position of a phar- Our federation is increasingly are clearly immoral, like, for ex- macist between a medical doc- concerned to ensure that favour- ample, abortion or euthanasia’. tor and a patient, that is to say able conditions exist so that this The only point of light, which is the sick person, has always made role can be effective. still not a dawn, is resolution n. him or her vulnerable. As far back The second challenge is resort 1763 of the Council of Europe as 1986, in an address to Italian to conscientious objection. Three which was passed at its sitting of pharmacists, Pope John Paul II numbers of the encyclical refer to 7 October 2010 and which grant- recognised the delicate situation it – 73, 74 and 90 – and apply it ed this right to every person with- of pharmacists as regards abor- to all health-care professionals. in the framework of legal medical tion not carried out surgically but Number 74 is the most explicit: treatment. States should draw up through chemical and mechani- ‘What is at stake therefore is an regulations that are complete and cal products which were ‘surrep- essential right which, precisely precise and thus ones that include titiously’ abortion-inducing. Here as such, should be acknowledged pharmacists. there comes into play a difficulty and protected by civil law. In this Various national associations that has been increasingly grow- sense, the opportunity to refuse to of our federation have drawn up ing in size: with time, pharmacists take part in the phases of consul- a specific programme, in particu- in their pharmacies or in hospitals tation, preparation and execution lar in Spain. This has not discour- have increasingly less produced of these acts against life should be aged Christian pharmacists from their own products and have been guaranteed to physicians, health- adopting very clear individual obliged to trust the great laborato- care personnel, and directors of stances and enduring the possible ries which are miserly as regards hospitals, clinics and convales- consequences of them, like that

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couple of pharmacists of Alicante This is a story, the encyclical goes a mixed international commission who in the end had to close their on, that each Christian communi- for theological dialogue between pharmacy, or that French phar- ty must continue to write through the two Churches. In addressing macist who was fined because he multiple pastoral care and social this other important concern of did not supply the morning after activity with a renewed sense of the pontificate of John Paul II, I pill… For the moment, at least in responsibility. In order to respond do not neglect the suggestions of Europe, it is Italy that appears to to this appeal, I perceive that we the encyclical itself: service to the perform best, thanks to article 9 of must place ourselves on a horizon Gospel of Life finds ‘a valuable law n. 194 on abortion which ap- of thought and hope that is broad- and fruitful area for positive co- plies the conscience clause. Our er in order to engage in new and operation with our brothers and President has had an opportunity bolder initiatives. For that matter, sisters of other Churches and ec- to implement it before the judicial n. 88 of the encyclical invites us clesial communities’ (n. 91). system of the country. to do this rapidly. ‘In particular, I now propose to turn to the There is another challenge the role of hospitals, clinics and thinking of an Orthodox bishop which worries our federation and convalescent homes needs to be and theologian of the same time this is pointed to at n. 26 of the reconsidered… Above all they as the encyclical on the mystery encyclical: the complete imple- should be places where suffering, of the human person (these ob- mentation of true international pain and death are acknowledged servations are from 1996 and take justice in the distribution of med- and understood in their human up certain ideas of 1986). This is ical resources. Real access (at an and specifically Christian mean- an analysis that corresponds to- affordable price) to primary med- ing’. We remember here the pre- tally to the intentions of Pope ical products, defined in relation vious encyclical, Salvifici doloris, John Paul II and his Christocen- to the specific needs of a region, of 11 February 1984 and its strong tric approach, which sees clear- worries our Federation with- concern to understand the human ly that human life is fulfilled to in the increasingly broad hori- and complete meaning of suffer- the utmost in total self-giving zon of emergency treatment. The ing in the life of man, and this is (cf. n. 86) and which enables us problems of patents, which the at a time when Pope John Paul II to refine the distinction individ- Federation accepts without any was in convalescence following ual-person thanks to its illumi- problems in principle, is directly the attack on his life. nation by the Trinity. ‘Each man connected to this. In this area the I would like to return to the con- is an individual’, declares Msgr. recent publication in 2012 by an text that witnessed the birth of this Kallistos Ware, ‘but not an au- important director of a large phar- encyclical, namely the years 1994 thentic person. It is our relation- maceutical group, Mohand Sidi and 1995, in order to understand ships that make us personal’.2 Let Saïd, is one of the most stimulat- its potentialities, which, howev- is summarise the point: one can ing texts there is.1 er, have remained overly hidden be a person only when the possi- The encyclical thus comforts from view. The encyclical is dat- bility of being exists for that per- the profession in the challeng- ed 25 March, the feast day of the son; only when a shared world ex- es that it has to address. Could a Annunciation during which our ists. He directs us towards seeing reading anew of it today not help gaze turns to Mary whose ‘yes’ a human being as a person open to us to take up again some of its made her an incomparable mod- communion and to being like the suggestions? In particular, ‘em- el for the welcoming of life and Trinity. The Mystery of the Trin- phasizing the anthropological solicitude for life itself. She wel- ity opens us not only to the mutu- reasons upon which respect for comed life within her and not any al love of the Father and the Son. every human life is based’ in or- life but the life of the Word made This mutual love is also shared by der to achieve ‘the establishment flesh. This was the first new thing a third party – the Holy Spirit. In of a new culture of life’ (n. 82). for a culture that bestows value this man is truly Trinitarian. And only on what begins on its own. as man is created in the image of To begin this period of two years, this Trinity, he is fulfilled only in Second Part in 1994 the international confer- this way. One is dealing with our ence on population and develop- lives for each other and lives that In order to answer this ques- ment in Cairo was held. This year share. Refusing to love other peo- tion, I would like to follow two in- was also the year of the creation ple, in the end, leads to the loss sights: one which is to be found in- of the Academy for Life. But there of all joy and all meaning, de- side the encyclical and one which was also, at the end of these two clares Msgr. Kallistos (p. 55). In is to be found outside it, with at- years, on 25 May 1995, the issu- living in this way, a human being tention being paid to its environ- ing of the encyclical truly becomes the living heart of ment. I will begin this pathway in to relaunch ecumenism, and on this world. We are faced with an order to respond to the appeal of 29 June 1995 the Supreme Pon- authentic choice: either we love n. 87 of the encyclical concerning tiff welcomed to St. Peter’s Basil- other people (we would then need the ‘service of charity’, that is to ica the Patriarch of Constantino- to establish the bases of why all say making oneself a neighbour ple, Bartholomew I, who wanted other people, without exceptions) to every man, with a marked pref- to recite with Pope John Paul II in the image of God-the Trinity, erence for the man who is poor- the creed in its Constantinople or we condemn ourselves to the est, most alone and most in need. form. From this meeting was born void. Here Msgr. Kallistos agrees

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with the well known observations tally protects the State. ‘We are number of the encyclical dem- of sociologists (see Lipovetsky not exchangeable tokens or com- onstrates the unity of the two di- in 19833). The star that guides puter programmes: in each one of mensions of Christ as a sacrificed the thinking of Msgr. Kallistos is us there an inestimable treasure Lamb who lives bearing the signs the intention of Isaac the Syrian that cannot be found in anybody of the Passion in the splendour of in his ascetic discourses: ‘When else. Ever since before our birth the Resurrection. In fact, a medi- we have reached love, we have – in reality since eternity – God cal product, of which the pharma- reached God and our journey is the creator has known each one us cist is the producer, acts with all over. We have crossed to that is- is in our uniqueness; He has for of its force when it is received at land that is beyond the world, each one of us a special love and the point of junction in which the where we find the Father, the Son a different project. In each one of physical resources of the earthly and the Holy Spirit’. Is this not us, He discerns possibilities that body and trust in the providence perhaps what John Paul II hoped cannot be achieved by anybody of the Father encounter each oth- in n. 81 of his encyclical: ‘Life… else in the world. Each person has er Thus a pharmacist, who is of- should be protected with loving a vocation to create something ten forgotten as the intermediate concern’? ‘Being human means that is beautiful in his or her own agent in the world of health and sharing. Because we believe that way, which is inimitable’.5 health care, finds himself or her- God is not simply one but one- Let us come to the second in- self more than another person at in-three, we are, as Zosima says, sight. Man is the only creature to the point of encounter between ‘responsible for everyone before take part in two domains at one the physical and the spiritual, and everyone’. We offer ‘in everyone and the same time: the material this pushes him or her to explore and for everyone’ not only during and the spiritual. We can trans- the mystery of the human person the Eucharist but throughout the figure the environment with our who is created in the image and whole of the liturgy of human life. acts of moral choice or we can likeness of God the Trinity. ‘Am I my brother’s keeper?’ The do exactly the opposite: pollute it To end this reading anew of answer to Cain’s question lies in or imprison it. And Msgr. Kallis- the encyclical and to give some the dogma of the Trinity’. ‘Seeing tos goes on. This work of cosmic future of this dynamic of mutual human nature as being in the im- mediation was inaugurated by Je- exchange, of solidarity, of self- age of the Trinity, we can make a sus Christ, and it has been carried offering, of abandonment to the distinction between an individual on and extended by each member will of God, of the transfigura- and a person. Even though these of the Body of Christ. For that tion of suffering, and of prophetic words are often used indifferently matter, man is called ‘anthropos’ contesting of worldly wisdom, I as synonyms, in reality a vital dif- ‘because he looks upwards’. The would like to return to the obser- ference exists between these two greatness of man is to be found vations repeated on a number of terms. When we speak about an in the image of the nature of the times in the encyclical on the neg- individual (in ancient Greek ato- Creator. Our vocation is specifi- ative trends of a culture that is op- mon), we are speaking about an cally to keep together the mate- posed to solidarity; on the selfish isolated human being who is sep- rial dimension and the spiritual conception of freedom which ex- arate and in competition. When dimension, to unite ourselves and alts the individual in an absolute we speak about a person (in an- to unite the world to God. ‘We way; and, lastly, on the fact that cient Greek prosôpon), we are must find within ourselves the the State is not longer the ‘shared speaking about a human being place of encounter between the home’ in which everyone can live. with relationships, who is in com- human and the divine, the centre Have human beings become more munion, and of a human being as of me in which our person opens selfish than in the past? Is it really a co-worker. Separated from oth- to the person created by God’.6 enough to impute this loss of au- ers, centred on himself, not con- This insight is pointed to towards thentic human conviviality solely nected, each person is an individ- the end of the encyclical when to the eclipse of the meaning of ual, a registered unit, but not an the words of the Second Vatican God and the meaning of man? authentic person’.4 Council are remembered: ‘by This would mean not recognising Before going on to the second His Incarnation the Son of God the crisis that is underway of the insight to be found inside the en- has united himself in some way providence-state which is a max- cyclical but one which is also re- with every person’ (n. 104, citing imisation of the protector-State vealed by the thought of Msgr. Gaudium et Spes, n. 22) and ‘It whose development into a prov- Kallistos, I would like to clarify is precisely in the “flesh” of eve- idence-state was possible thanks the foundation of the obligation to ry person that Christ continues to to the economic growth of the pe- respect unconditionally every hu- reveal himself and to enter into riod after the First World War, the man life from its very conception. fellowship with us, so that rejec- ‘glorious twenties’ which were We are truly unique! Two iden- tion of human life, in whatever an ‘accident’ in economic history tical human beings do not exist. form that rejection takes, is real- (see the works by Daniel Cohen).7 There is, therefore, no legitimate ly a rejection of Christ’ (n. 104). Indeed, we are witnessing a reason why I should contribute in It is admitted that this statement withdrawal of the role of the one way or another to making the is incomprehensible for a non- state, not its disappearance, and smallest of these unique beings believer but it is often unknown a sort of stasis of the social im- disappear. It is this that fundamen- to a believer. However, the last agination, according to the diag-

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nosis that had already been for- encyclical we also find an auda- to assure our life on earth; may mulated in the 1980s by Pierre cious suggestion – that of open- they equally become the remedy Rosanvallon8 who is today a pro- ing to women who have had re- that will heal us and will make us fessor at the Collège de France. It course to abortion so that with live for ever!’ (Prayer for Offer- is certainly the case that the ex- the advice of help and the near- ings of Thursday 17 May). traordinary power of this search ness of friendly and competent Perhaps our Pope Francis could for autonomy and independence, people they can become the most speak some words to us about free which we notice at every latitude eloquent defenders of the right of time as authentic and disinterest- of the world and which is extend- everyone to life. In this way, the ed self-giving? ed most easily to urban areas (cit- road is opened up to a pluralism ies makes people free), would of forms of social life. In order to gain by being utilised to extend find the foundation of this near- Notes a basic solidarity assured by the ness to the other, which creates state ‘through the establishment a tie between the generations, I 1 Mohand Sidi Saïd, L’esprit et la molécule. Une radioscopie de l’industrie of more decentralised systems or willingly refer to the observations pharmaceutique (Genèse Edition, 2012). short-term interventions directly of Catherine Chalier on fraternity, 2 Kallistos Ware, L’île au-delà du supported by concrete social re- hope in chiaroscuro.10 monde (coll. Spiritualité) (Paris, Le Cerf et 9 Pully, Le sel de la terre, 2012), p. 51. lationships’ (Rosanvallon). This Thus we are invited to live the 3 Gilles Lipovetsky, L’ère du vide. Ess- positive approach would allow a incarnation in all of its force, at- ais sur l’individualisme contemporain (Par- better guaranteeing of the cov- tentive to the most urgent needs is, Gallimard, 1983). 4 Kallistos Ware, L’île au-delà du erage of emerging social needs that a human being can experi- monde, p. 50. in new condition of social life in ence (without the risk of dis-in- 5 Kallistos Ware, p. 9. which one observes in numerous carnation). But where can we 6 Kallistos Ware, p. 69. 7 See for example Daniel Cohen, Les places an increase in free time, draw strength to imagine and infortunés de la prospérité (Paris, Julliard, and this in people who work as achieve all of this despite the ob- 1994). well. I observed this appeal in stacles? The Holy Spirit dwells 8 Pierre Rosanvallon, La crise de l’Etat-providence (Paris, Seuil, 1981, 1984 number 90 of the encyclical: peo- in our hearts. We therefore need and 1992). ple involved in voluntary work deeper spirituality. 9 Pierre Rosanvallon, p. 124. are called to play a specific role, ‘Lord, we offer you the goods 10 Catherine Chalier, La Fraternité, un espoir en clair-obscur (Paris, Buchet/ conjoining professional skills and that you yourself have given us: Chastel, 2003). See also Joseph Ratzinger, expertise with generous and gra- they express our gratitude to you Frères dans le Christ. L’esprit de la frater- tuitous love. At number 99 of the for all that your creation offers us nité chrétienne (Paris, Cerf, 2005).

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The Service to Life of Health-care Workers

1. The Service of Health-care Workers to Unborn Life. The Diagnosis and Treatment of Sterility in Couples as a Service to Life

Prof. Riccardo Marana, rived from the man and the egg cell this period without its own energy Dr. D. Milardi, derived from the woman, both en- sources: it uses energy provided Dr. G. Grande, counter a series of modifications in by the tube fluid that surrounds the Dr. D. Ricciardi, order to reduce the number of chro- embryo cells. Dr. A.L. Astorri, mosomes to a half of that of the so- Dr. E. Fruscella, matic cell, that is to say a decrease Dr. G. Pompa from 46 to 23 chromosomes. This Sterility in Couples The Paul VI International process has the name ‘meiosis’. Scientific Institute The reduction of the patrimony of When conception does not take for Research into Human chromosomes is necessary to avoid place within a year that has been Fertility and Infertility, the fusion of the male cell with the made up of free relations, one re- the Catholic University female cell having as its result an fers to sterility in a couple. Steril- of the Sacred Heart, individual with an excess number ity is a condition that affects one Rome, Italy of chromosomes. in every seven couples and it is an The potential of the genetic vari- emerging health-care problem of ability of the gametes that derives great public interest. It concerns from meiosis is astonishing. Con- not only the private dimension of sidering that in a human individual the couple but also, more in gen- Fertility and the Biological the genetic information is contained eral, the health-care system and Status of the Human Embryo in the form of pairs of homologous society as a whole. In the World chromosomes, one being maternal- Report on Disability of 2013 steril- Human fertility is defined as a ly derived and the other paternally ity is defined as a ‘disability’ from ‘state of fertility or reproductive ca- derived, at the moment of the fer- many points of view: the physical, pacity’ in the context of the couple. tilisation 70,000 milliard possible the cognitive, the mental, the sen- It is the result of the ‘synergy’ of genetic combinations can be ob- sorial, the emotional and the devel- the couple and thus does not refer tained, to which should be added opmental, as well as a combination to the capacity of a man or a woman the effect of crossing-over which of these. It is possible to recognise in isolation. consists of the exchange of genet- a male cause of sterility in 25-40% This synergy, when it takes place, ic material between the maternally of cases; a female cause in 40-55% leads to the fertilisation of the ovo- derived homologous chromosome of cases, with the presence of fac- cyte by the spermatozoon, that is to and the paternally derived one. The tors of sterility in both the conjugal say the conception of a new indi- result of this is a practically un- partners in 10% of cases, whereas vidual. limited variability which consti- in 10% of cases it is not possible to Biology, embryology and genet- tutes the biological mechanisms on identify a cause of sterility and ref- ics have agreed for over forty year which is based the uniqueness and erence is here made to unexplained in stating a human individual be- the unrepeatable character of each sterility. gins to exist from the moment of human individual. As regards sterility with a female fertilisation. It is through the act of The genetic identity of the new cause, a dysfunction of the ovules fertilisation, that is to say at the mo- human being is defined at concep- is detected in 30-40% of cases, ment of the union between the male tion: from that moment onwards whereas a factor relating to the per- germinal cell and the female cell development takes place in a con- itoneal tube is found in 25-35% of at the level of the tubal ampoule, tinuous and coordinated way. Dur- cases. that a human being is constituted ing the first three days of life the Amongst the risk factors relat- – a carrier of a genetic patrimony embryo journeys down the tube in ing to sterility, the ‘age’ factor to- that is individual and unrepeat- the direction of the uterus where day has an important relevance. able. The embryo, therefore, is a it is implanted on the seventh day. The search for a first pregnancy has human person from fertilisation This is a journey where the human in fact been extended and in Italy it onwards. In preparation for fertili- embryo demonstrates from the out- has reached the age of 32, accord- sation, two highly specialised cells, set its own biological autonomy. In- ing to the data of ISTAT 2011. To the gametes, the spermatozoon de- deed, a human embryo lives during this delay in the search for a preg-

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nancy is associated a greater inci- leads to an increased risk, of the or- ity of cases the couple. This means dence of pregnancies at risk at a der of 7-10, of a subsequent tubal that in the clinical management of more advanced age of women, in pregnancy. sterility both of the marriage part- addition to a more frequent condi- Early diagnosis and speedy and ners must necessarily be assessed. tion of sterility derived from bio- suitable therapeutic action consti- And yet of the about 7 million of logical factors correlated with the tute the best way of preventing the American couples directed towards ageing of the ovocytes and a long- consequences of PID for fertility. the use of artificial fertilisation in er exposure to those environmen- In particular, non-treated PID can the United States of America, over tal and infective factors which are cause the formation of situations 2 million men did not engage in any harmful to fertility. A consequence of proximal tubal occlusion (PTO), andrological assessment. It is there- of this is a reduction in the repro- periadnexal adhesions or distal tu- fore important to install for men, as ductive capacity of women, with a bal occlusion. Proximal tubal oc- well, a correct diagnostic and thera- gradual reduction of the possibility clusion is present in 10-25% of peutic pathway as regards the pos- of a pregnancy for every ovulation women who have a tubal pathology. sible causes of their sterility. with the advance of the woman’s A falsely positive diagnosis of PTO Amongst the aetiological factors age. This reduction is not limit- is reported in 42-95% of cases. Tu- of male sterility, those that are most ed only to the natural search for a bal occlusion can be real or linked frequently encountered are infec- pregnancy but is also highlighted in to artefacts, spasms, endometrial tious diseases that affect the genital causes where resort is made to ar- thickening or the presence of patch- apparatus, endocrinal pathologies tificial fertilisation. This is due, on es of amorphous material. In real- (such as male hypogonadism, hy- the one hand, to a progressive re- ity it has been demonstrated that in perprolactinemia, and thyroid pa- duction in the number of ovocytes patients with two previous exami- thologies) and varicocele, that is to in women after the age of 35, and, nations using hysterosalpingograhy say a dilation of the vases of the tes- on the other, to anomalies in the that document bilateral tubal occlu- ticular vein plexus. chromosome segregation during sion, the selective catheterisation of the meiotic division which make the tubes has confirmed this occlu- the ovocytes less easy to fertilise sion in only 4% of cases and with Artificial Fertilisation and in addition susceptible to ge- time the reproductive capacity of netic damage, with a consequent in- patients has been demonstrated to In order to overcome situations crease in early miscarriages and in be normal. These patients are para- of sterility in couples, various dif- chromosome anomalies in the con- doxically those who in our experi- fering techniques of artificial fer- ceived child. ence are more frequently directed tilisation are offered and they are As regards female sterility caused towards artificial fertilisation be- divided into intra-corporeal tech- by dysfunctions of the ovules, use cause of a false diagnosis of tubal niques, where the fertilisation takes is made of appropriate pharmaco- occlusion. place in the genital pathways of logical therapies according to the Another pathology that is fre- the woman (intrauterine insemina- aetiology of the dysfunction. quently associated with female ste- tion and GIFT), and extra-corporeal The treatment of female sterility rility caused by the tubal-peritoneal techniques, where the fertilisation caused by a tubal-peritoneal fac- factor is endometriosis which ap- takes place in a test-tube (FIVET, tor where the principal causes are pears as a consequence of the pres- ICSI). Techniques of artificial ferti- a pelvic inflammatory pathology ence of the endometrial tissue, that lisation that take place in a homolo- (PID) and endometriosis is more is to say of the mucous that lines the gous way, with the gametes of the complex and more debated. uterine cavity, in other places than couple, or in a heterologous way, The principal cause of the tubal- their natural location. This pathol- through the use of one, or both, the peritoneal factor leading to sterility ogy is present in 7-10% of women gametes of a donor who is extrane- is the damage caused by previous of a reproductive age. 30-50% of ous to the couple. 25 July 1978 is episodes of pelvic inflammatory ill- women with endometriosis have a date that has passed into history ness consequent upon the rise into problems of sterility. 20-50% of because of the birth in Great Brit- the reproductive tract of infective sterile women are affected by endo- ain of Louise Brown, the first baby agents that are sexually transmit- metriosis. In the absence of therapy, ‘produced’ in a test-tube (a ‘test- ted. When the germs reach the del- in the case of endometriosis cysts tube baby’) using the technique of icate tubal epithelium, an inflam- of the ovaries, the percentages of in vitro fertilisation created by the matory reaction is set in motion pregnancies are 21% in the case physiologist Robert Edwards. Fer- in response to the infection which of monolateral cysts and 0% in the tilisation in vitro (FIV) followed by then leads to the destruction of the case of bilateral cysts. In our stud- embryo transfer (ET), indeed, rep- epithelium itself. The post-inflam- ies we have demonstrated that after resented the first technique of ex- matory scar retraction that follows laparoscopic surgery the percent- tra-corporeal artificial fertilisation this alters the tubal architecture and age of pregnancies which lead on to and was initially recommended in provokes definitive sequels that go a birth rises to 55%. cases of sterility of tubal origins. from the formation of adhesions to A male factor of sterility, wheth- A variant of in vitro fertilisation is tubal occlusions. After a single epi- er isolated or in association with the micro-injection of spermatozoa sode of PID the risk of sterility is the female factor, has been report- directly into the cytoplasm of the 12% but in the case of repeated epi- ed in up to 50% of cases of steril- egg cell (ICSI = intracytoplasmic sodes it can reach the level of 50%. ity in couples. Sterility is therefore sperm injection) which was origi- Pelvic inflammatory pathology also a situation that affects in the major- nally recommended in the presence

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of severe reductions of the seminal the cytoplasm level of the ovocyte which passes by way of the policy parameters. which can be subsequently trans- of a complete diagnostic pathway As regards the results of tech- mitted to the embryo. The authors that involves authentic forms of niques of in vitro fertilisation, the of this article published in the Brit- therapy and aims at removing the Italian data published in the report ish Medical Journal thus end their causes themselves of sterility, and of the Ministry of Health of 2014, text by stressing the importance of which, through scientific research, and connected with the activities of a correct assessment, before acced- is directed towards understanding the centres of artificial fertilisation ing to techniques of fertilisation in the molecular mechanisms that pre- in 2012, document a percentage of vitro, of those couples who have a side over the physiology of human cumulative pregnancy for FIVET possibility of spontaneous concep- fertility and the physio-pathologi- and ICSI equal to 22.1% and of tion after medical-surgical therapy. cal mechanisms that are connected pregnancies leading to a birth of One is dealing here with the same with sterility. 16.5% through ovocyte removal. criterion contained in Italian law n. On 9 November 2000, the rector From the same report by the Minis- 40/2004 where the criterion is pro- of the Catholic University gave to try of Health one learns that of the posed of gradualness in access to His Holiness John Paul II a Foun- 114,276 embryos that were formed, techniques of assisted procreation dation dedicated specifically to 91,720 embryos were transferred which are allowed only when the the sector of human procreation. and 9,814 babies were born. It fol- impossibility of solving the causes This initiative was presented as a lows that 91% of the embryos that that impede procreation by other response to the calls made by the were formed were ‘lost’. In the light ways have been ascertained. The Holy Father himself. The Paul VI of such observations, the statement subsequent guidelines, however, International Scientific Institute that St. John Paul II left behind us hitherto have never codified the di- Foundation for Research into Hu- in Evangelium Vitae, whose twen- agnostic-therapeutic itinerary that a man Fertility and Infertility was tieth anniversary we are now cele- couple must engage in prior to ac- created on 22 June 2001 and in brating, encounters scientific valid- ceding to medically assisted pro- March 2003 clinical activity was ity: ‘these techniques have a high creation techniques, in fact leaving commenced with the opening of the rate of failure…[which] in fact re- ample discretional margin to access ISI clinic for the treatment of steril- duces human life to the level of to these techniques, at times in the ity in couples which came to flank simple “biological material” to be absence of any diagnostic-thera- the research activity of the institute. freely disposed of’. peutic framework. The protection of life in the expe- For these reasons, the scientific The techniques of artificial fer- rience of the ISI coincides with the and cultural world has recently en- tilisation are therefore injurious to defence of life at its origins. This is gaged in a careful analysis of the the dignity of procreation and the a priority and delicate task because problems connected with the tech- conceived child; they are associat- it is the applied to the very moment niques of artificial fertilisation. Is- ed with a high level of embryo loss; that life begins. The activity of the sues in this sense have been ad- and they are associated with risks International Scientific Institute dressed not only in the press but for the health of the mother and the takes place in three sectors. also in the most important inter- unborn child. Lastly, one should re- The clinical sector connected national scientific journals. In the member the possible further aberra- with the ISI clinic where diagnosis prestigious British Medical Jour- tions, from an ethical point of view, and treatment of causes of sterility nal, researchers of three groups of that are present in resort to heterol- are carried out in order to obtain a centres in Amsterdam (Holland), ogous fertilisation, to diagnosis, to natural conception. Aberdeen (UK) and Adelaide (Aus- pre-implantation screening, and to The different specialist compe- tralia), who were the pioneers of the selection of embryos. tences are concentrated on the pro- FIVET, published an article entitled It should further be remembered cess which is at the origin of life in ‘Are we Overusing IVF?’ that the techniques of artificial ferti- order to obtain a natural conception The authors engaged in a careful lisation do not constitute an authen- and foster the normal development review of the literature in the field tic therapy inasmuch as far from of a pregnancy. Our work is direct- on the increased risks for the health eliminating the causes of sterility ed towards protecting life, follow- of a child conceived using IVF and they by-pass it. Indeed, they leave ing directly the stages that lead to related a greater risk of premature unchanged the pathological condi- its expression and intervening pro- birth, a low birth weight, perinatal tions in which the couple finds it- fessionally upon what can alter the mortality, and congenital malfor- self at the moment of access to such normal development of such a pro- mations. techniques. cess. In the same buildings there The explanation for this phenom- is in addition a clinic dedicated to enon could lie, on the one hand, in miscarriage for patients who en- a by-passing of natural selection, An Alternative that Respects counter difficulties in bringing their given that during natural fertilisa- Life: the Experience pregnancy to a happy conclusion. tion there is a selection engaged in of the ‘Paul VI’ International Then there is the sector of re- of spermatozoa with DNA defects Scientific Institute search into fertility and infertil- which is absent with in vitro tech- ity which is fundamental for the niques, and, on the other, in the What has been described hither- advancement of knowledge about technique itself, given that it is pos- to in this paper confirms the need the physiology of reproduction, the sible that there is damage to the mei- to promote a different approach to study of causes that have hitherto otic fusion and anyway damage to the problem of sterility in couples been unknown about sterility, and

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progress in the diagnostic process seminal parameters, which in oth- (Blackwell Scientific Publications, Oxford, 1976), vol.1, pp. 19.1-19.50, p.19.1. and in therapeutic solutions. er centres is the principal condition Carrasco M.A. and Ventura-Juncà P, Lastly, there is the operational that leads to a recommendation to ‘¿Cómo identificar un ser humano unicelular? sector connected with the Centre employ ICSI, the analysis carried Teología y Vida’, Urgencia de la Bioética an- out by Milardi et al. and published te la Biotecnología 2010, LI 179-231. for the Natural Regulation of Fertil- Ventura-Juncá P. and Santos M. J., ity which deals with families who, in the International Journal of En- ‘The beginning of life of a new human being in making a responsible choice, docrinology demonstrated that on- from the scientific biological perspective and decide to open themselves or oth- ly 35% of conceptions obtained at its bioethical implications’, Biol. Res. 2011, 44, 201-207. erwise to welcoming a new life by the ISI clinic took place in the pres- Savada D., Craig Heller H., Orians taking advantage of natural meth- ence of normal seminal parameters G. H., Purves W.K., and Hills D.M., Bio- ods for the regulation of fertility. whereas in 65% of pregnancies the logia. La scienza della vita (Zanichelli Edi- tore, 2010). The treatment of sterility in cou- male spouse had alterations in at Cain M.L., Discover Biology, Third Edi- ples takes place through a diag- least one seminal parameter. This tion (W. W. Norton & Co. , 2006). nostic-therapeutic protocol that in- statistic highlighted that the reduc- Klug W. S. , Cummings M.R., and Spen- cer C. A. , Concetti di genetica (Pearson volves, contemporaneously, both tion in seminal parameters does not Prentice Hall, eighth edition, Paravia Bruno the marriage partners, implement- exclude the possibility of a spon- Mondadori Editori, 2007, p. 28. ing a multi-specialist approach taneous conception. Every patient Sapere.it Variabilità genetica (De Agosti- ni Editore, 2012). which envisages the contribution of should thus be able to have access Stanford J.B., ‘What is the true preva- a team made up of a gynaecologist, to an in-depth diagnostic and ther- lence of infertility?’, Fertil. Steril. 2013 Jan 8. an andrologist, a reproduction sur- apeutic assessment even when the p. ii: S0015-0282(12)02498-3. [Epub ahead geon and an endocrinologist. These prospects of obtaining seminal pa- of print]. WHO Infertility: a tabulation of available specialists are flanked by other pro- rameters characterised by ‘normal- data on prevalence of primary and second- fessional figures of the polyclinic ity’ appear to be reduced. ary infertility. Programme on Maternal and such as a urologist and a psycholo- As regards the surgical treatment Child Health and Family Planning, Division of Family Health (World Health Organiza- gist who are drawn upon in cases of patients with sterility caused by tion, Geneva, 1991). where such figures are needed. a tubal-peritoneal pathology, of Hardee K., Gay J., and Blanc A.K., Over 5,700 couples were as- the 152 patients who underwent ‘Maternal morbidity: neglected dimension of safe motherhood in the developing world’, sessed for sterility from April 2003 an operation, 325 obtained a ‘child Glob. Public Health 2012;7(6): 603-17. to December 2014 and about 500 in their arms’ and 27 patients had WHO & The World Bank, Summary new couples adhere to the ISI clin- pregnancies after the operation. World Record on Disability (Geneva, 2011). Dunson D.B., Colombo B., and Baird ic every year, of whom about 25% One should, to end this paper, D.D., ‘Changes with age in the level and dura- live outside the region of Lazio. remember the words that St. John tion of fertility in the menstrual cycle’, Hum. This demonstrates that our clinic Paul II left us in his encyclical Reprod. 2002 May; 17(5): 1399-403. may be defined as a centre of refer- Evangelium Vitae: ‘The “people of Rodgers A.K., Budrys N.M., Gong S., Wang J., Holden A., Schenken R.S., and ence at a national level. 850 preg- life” rejoices in being able to share Zhong G., ‘Genome-wide identification of nancies have been obtained (about its commitment with so many oth- Chlamydia trachomatis antigens associated 15%). This statistic is comparable ers. Thus may the “people for life” with tubal factor infertility’, Fertil. Steril. 2011; 96(3): 715-21. to the success rate in percentages of constantly grow in number and Centers for Disease Control: ‘Sexually FIVET-ICSI in Italy and yet it has may a new culture of love and soli- transmitted diseases: treatment guidelines, been obtained without the use of darity develop for the true good of 1982’, MMWR 1982; 31(Suppl. 2)730-746. Marana R., Muzii L., Paielli F.V., Luc- techniques which injure the dignity the whole of human society. ci F.M., Dell’Acqua S., and Mancuso S., of procreation and manipulate life. The commitment that our centre ‘Proximal tubal obstruction: are we over-di- We have also highlighted that if has engaged in over recent years is agnosing and over-treating?’ Gynecol. En- dosc. 1992; 1:99-101. those 500 couples who come every witness to a possible alternative to Tanahatoe S., Lambalk C., McDon- year to the ISI had had access, in- in vitro fertilisation which respects nell J., Dekker J., Mijatovic V., and stead, to techniques of artificial fer- human life. This is witness that the Hompes P., ‘Diagnostic laparoscopy is need- ed after abnormal hysterosalpingography to tilisation, each year over a thousand International Scientific Institute prevent over-treatment with IVF’, Reprod. embryos would have been ‘pro- offers to the Church, to the ‘peo- Biomed. Online 2008; 16(3): 410-5. duced and lost’. ple of God’, and at the same time it Marana R., Ferrari S., Merola A., As- In our experience we have seen is hoped that Catholics will see in torri A.L., Pompa G., Milardi D., Giampi- etro A., Lecca A., and Marana E., ‘Role how in many cases it is possible to the ISI a bulwark of the culture of of a mini-invasive approach in the diagnosis remove the causes of sterility and in life, which should be protected and and treatment of tubo-peritoneal infertility as particular to obtain a good level of stewarded, at the service of every an altenative to IVF’, Minerva Ginecol. 2011 Feb; 63(1): 1-10. success as well in situations where couple suffering from sterility, at Practice Committee of the American Soci- the general tendency is to propose the service of the Church and so- ety for Reproductive Medicine, ‘Endometrio- resort to techniques of artificial ciety. sis and infertility: a committee opinion’, Fer- til. Steril. 2012 Sep; 98(3): 591-8. fertilisation, such as, for example, Abrao M.S., Muzii L., and Marana for severe alterations in seminal R., ‘Anatomical causes of female infertil- parameters or for female sterility ity and their management’, Int. J .Gynaecol. Bibliography Obstet. 2013 Dec; 123 Suppl. 2: S18-24. doi: caused by a tubal-peritoneal pa- 10.1016/j.ijgo.2013.09.008. Epub 2013 Sep 11. thology, which, indeed, constitute Jeffcoate T.N.A., ‘Pregnancy and child- Review. the principal conditions respective- bir th’, Chamber’s Encyclopaedia 1969, vol. Marana R., Lecca A., Biscione A., and ly that lead to a recommendation to XI, 169-171, p. 169. Muzii L., ‘Endometriosis: the gynecologist’s Scothorne R.J, ‘Early development’, in opinion’, Urologia 2012 Jul; 79(3): 160-6. engage in ICSI and FIVET. R. Passmore and J.S. Robson (eds), A Com- doi: 10.5301/RU.2012.9391 As regards severe alterations in panion to Medical Studies, Second edition Jedrzejczak P., Taszarek-Hauke G.,

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Hauke J., Pawelczyk L., amd Duleba A.J., Steptoe P.C. and Edwards R.G., ‘Birth one artificiale’, Medicina e Morale 2006; ‘Prediction of spontaneous conception based after the reimplantation of a human embryo’, 4: 719-740. on semen parameters’, International Journal Lancet, 1978 Aug 12; 2(8085): 366. Davies M.J., Moore V.M., Willson K.J., of Andrology. 2008; 31(5): 499–507. Herrero L., Martínez M., and Gar- Van Essen P., Priest K., Scott H., Haan Kamel R.M., ‘Management of the infer- cia-Velasco J.A., ‘Current status of human E.A., and Chan A., ‘Reproductive technolo- tile couple: an evidence-based protocol’, Re- oocyte and embryo cryopreservation’, Curr. gies and the risk of birth defects’, N. Engl. J. productive Biology and Endocrinology 2010; Opin. Obstet. Gynecol. 2011 Aug; 23(4): Med. 2012 May 10; 366(19): 1803-13. 8, article no. 21. 245-50. Di Pietro M.L. and Sgreccia E., Pro- Rylander L., Wetterstrand B., Hau- Souza Setti A., Ferreira R.C., Paes creazione assistita e fecondazione artificiale gen T.B. et al., ‘Single semen analysis as a de Almeida Ferreira Braga D., de Cás- – Tra scienza, bioetica e diritto (La Scuola, predictor of semen quality: clinical and epi- sia Sávio Figueira R., Iaconelli A. Jr, Brescia, 1999). demiological implications’, Asian Journal of and Borges E. Jr., ‘Intracytoplasmic sperm Legge contenente norme in materia di Andrology 2009; 11(6): 723–730. injection outcome versus intracytoplasmic Procreazione Medicalmente Assistita (Leg- Steptoe P.C. and Edwards R.G., ‘Birth morphologically selected sperm injection ge 19 febbraio 2004, n.40, art.15) after the reimplantation of a human embryo’, outcome: a meta-analysis’, Reprod. Biomed Casini C., ‘IV Rapporto del Movimento Lancet 1978 Aug 12; 2(8085): 366. Online 2010 Oct; 21(4): 450-5. per la Vita Italiano sull’attuazione della Leg- Relazione del Ministro della Salute al Par- Kamphuis E.I., Bhattacharya S., van ge n. 40 del 19 febbraio 2004 per l’anno 2010 lamento sullo stato di attuazione della Legge der Veen F., Mol B.W., and Templeton A., Esame e commento della relazione del Min- contenente norme in materia di Procreazione ‘Evidence Based IVF Group, Are we overus- istro della Salute presentato al Parlamento Medicalmente Assistita (Legge 19 febbraio ing IVF?’, BMJ 2014 Jan. 28; 348: g252. italiano il 28 giugno 2012’, Medicina e Mo- 2004, n.40, art.15), Roma, 30 giugno 2014, Klemetti R., Sevón T., Gissler M., and rale 2012; 4: 523-552. relativa all’attività nell’anno 2012 dei centri Hemminki E., ‘Complications of IVF and Milardi D., Grande G., Sacchini D., di procreazione medicalmente assistita. ovulation induction’, Hum. Reprod. 2005; Astorri A.L., Pompa G., Giampietro A., Keck C., Gerber-Schäfer C., Wilhelm 20: 3293-300. De Marinis L., Pontecorvi A., Spagno- C., Vogelgesang D., and Breckwoldt M., Mancini A., Grande G., Festa R., Gi- lo A.G., and Marana R., ‘Male fertility ‘Intrauterine insemination for treatment of acchi E.T.C., De Marinis L., and Di Pi- and reduction in semen parameters: a single male infertility’, Int. J. Androl. 1997; 20 Sup- etro M.L., ‘Nuovi problemi derivanti tertiary-care center experience’, Int. J. Endo- pl. 3:55-64. dall’impiego delle tecniche di fecondazi- crinol 2012; 2012: 649149.

2. The Service to Life of Health-care Workers: the End of Life

Dr. Giovanni Zaninetta above all in the Western world, has same clarity is present in a large Medical head of the Unit interacted with two apparently con- number of declarations of believ- of Palliative Care, tradictory aspects: the possibility of ers and non-believers as regards the the Domus Salutis ‘governing’ death through an ap- concrete situations in which clini- Nursing Home, proach that is highly intensive, on cal and ethical decisions have to be the Teresa Camplani the one hand, and the wish to speed taken with respect to the end of life. Foundation, up its arrival when it appears to be The most relevant problem in Brescia, Italy close at hand, on the other. This ap- my view concerns the sharing of a parent contradiction involves in method by which to reconcile, on both cases the same intention to the one hand, the objective and de- od did not make death, and he transform an ineluctable fact into a tailed technical capacity of mod- ‘Gdoes not delight in the death horizon of absolute decisional au- ern medicine with individual clini- of the living’ (Wis 1:13). tonomy. cal situations, and, on the other, to ‘But through the devil’s envy I would like to immediately state adapt individual and social expec- death entered the world’ (Wis 2:24). that the question of euthanasia, tations as regards health to fears – which is full of troubling implica- which are not always confessed – In these Biblical passages, which tions and a subject that has been of being at the mercy of a science are placed at the beginning of the amply debated at a theoretical level that in its complexity one cannot be encyclical Evangelium vitae, we but, hitherto, fortunately with few understood. find the harsh pathways of those examples of support at a legislative I would like to emphasise that who accompany people during the level, is not the first and principal forgoing what is defined as exag- last stage of their lives in an attempt problem of those people who try gerated treatment cannot be an op- to reconcile the invincible wish for to take care of individuals who are tional choice either for patients or life that characterises man with his coming to the end of their lives. for health-care workers because the material finitude. In relation to euthanasia there is, duty exists to practise – following For many centuries, death was as is known, a Declaration of the science and conscience – only pro- characterised by a ineluctability Sacred Congregation for the Doc- portionate forms of treatment: in that was taken for granted and by trine of the Faith1 which defines other terms, exaggerated treatment, the evident impossibility of pro- in a clear way the position of the to which I would add the exag- crastinating it, and it has only been Catholic Church: we will see be- gerated carrying out of diagnoses, for a few decades that humanity, low that one cannot affirm that the should be avoided because here we

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are dealing with technical errors phrenic approach was generated as sufficient medical culture which which cannot, and must not, be tak- regards dying people where an at- still sees the use of painkillers, en into consideration. tempt was made to impede an inev- even when appropriate, as a way of Obviously enough, the question itable death with disproportionate bringing about death rather than a that is raised is discernment as to forms of treatment (let us also say technique by which to improve life, what is proportionate and what is clearly with exaggerated treatment) at its end as well. not proportionate according to a and people were, in fact, abandoned A good control of pain, which is criterion that takes into account, in to their process of dying because a result that can be obtained in al- a concrete way, personal values and they were no longer interesting (or most all sick people, allows a fo- clinical conditions. remunerative) clinical cases. cus on the complexity of the condi- The Declaration on Euthanasia Palliative care seeks, instead, to tion of those who are drawing near of 1980 that has already been cit- offer to all people who are drawing to the ends of their lives, from a ed offers a very clear summary: ‘In near to the end of their lives a form clinical point of view but also, and any case, it will be possible to make of care that takes responsibility for above all else, from an existential a correct judgement as to the means all the pain and all the suffering that perspective. In other words, treat- by studying the type of treatment to are involved, involving the whole ment of the pain of these people is be used, its degree of complexity or of the family group which, what- the point of departure of palliative risk, its cost and the possibilities of ever the case, is experiencing the care and not its point of arrival. using it, and comparing these ele- burden of providing care and suf- The freeing of people from pain ments with the result that can be fering caused by an imminent loss, allows them to draw near to the tru- expected, taking into account the and assuring a continuity that is in- est subject of their condition: the state of the sick person and his or dispensable in relieving the anxiety search for, or the confirmation of, her physical resources’. and the insecurity that are specific a meaning to their life experienc- The use of these criteria is one to this stage of life. es; the time that is still left to them; of the basic principles of pallia- Another fundamental aspect is a horizon that is growing smaller; tive care cited in Evangelium Vitae: connected with the place of care: having to abandon the people that ‘In modern medicine, increased at- continuity can be assured if the pal- they love; giving and receiving for- tention is being given to what are liative care is available at the home giveness; and preparing themselves called “methods of palliative care”, of the sick person but also in special for their meeting with their Creator. which seek to make suffering more institutions such as hospices which It is evident that all of this can be bearable in the final stages of ill- offer a suitable environment and a addressed not only from a health- ness and to ensure that the patient is specifically trained team, allowing care point of view and more gen- supported and accompanied in his the sick person and his or her fam- erally in terms of assistance. The or her ordeal’. ily a choice as regards which con- questions and answers that are in- Palliative care, which was ex- text they prefer. volved relate to the greatness of life plicitly referred to by Pope Francis In its development, palliative and not to the small practices of in a recent interview that he gave care has first of all been concerned care, which are certainly important to Il Corriere della Sera, can be the with pain, which is the symptom but are absolutely not up to the situ- response that allows us to recon- which afflicts many sick people, ation in hand. cile two apparently contradictory above all those suffering from can- Cicely Saunders, who is seen as needs: the protection of life and the cer, at the ends of their lives, trying one of the founders of modern pal- acceptance of death to control it as best as a possible, liative care, gave rise to the phrase The World Health Organisation comforted in this by the wise and ‘total pain’: this covers all the man- defines palliative care as ‘an ap- enlightened recommendation made ifestations which, under various proach that improves the quality by His Holiness Pius XII from 1957 headings, cause overall suffering, of life of patients and their families onwards,3 and utilising in an appro- anxiety, fear, frustration, physical facing the problem associated with priate way all the pharmacologi- pain, and a religious crisis. life-threatening illness, through cal and non-pharmacological in- Palliative care seeks to take the prevention and relief of suffer- struments that have been gradually care of sick people and their fami- ing by means of early identification made available. However, this goal lies from all these points of view, and impeccable assessment and has been reached only over the last involving, in addition to medical treatment of pain and other prob- few years and this because of a se- doctors and nurses, psychologists, lems, physical, psychosocial and ries of causes that are to be found physiotherapists, ministers of wor- spiritual’ and adds that it ‘provides in the technical and cultural short- ship, social workers and volunteers. relief from pain and other distress- comings of very many health-care All of this activity, however, runs ing symptoms; affirms life and re- workers rather than in prejudices the risk of being rendered vain by gards dying as a normal process; of a religious character which some an attitude that is also present in intended neither to hasten or post- people state to be the case in a ten- many Christians: dealing with a pone death’.2 dentious way. Phobia towards pain- chronic progressive illness at an ad- After many centuries when the killers, which is the cause of enor- vanced stage by denying that physi- pathway of dying was entrusted to mous and useless suffering, does cal death is a possibility. From this medical treatment that had a low not have its origins in religious be- comes the common denial of the level of availability and above all liefs, in particular Christian reli- truth to patients by health-care to spiritual care, an almost schizo- gious beliefs, but, rather, in an in- workers and their families – not so

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much, and not only, a lack of cor- that also assures good treatment at not licit to deprive a dying person rect information about the diagno- home and in a hospice, which is an of self-consciousness without grave sis, in particular one that indicates institution, as is known, that is spe- reason’.4 It is the ethical duty of eve- cancer, but above all else only a cifically organised for the taking ry Christian health-care worker to vague communication of the prog- care of people who are near to the ascertain this ‘grave reason’ which nosis, with a levelling of the hori- ends of their lives. in my view can be a norm identi- zon of the patient to illusory hopes It is no accident that many of fied in untreatable symptoms such which have nothing at all to do with these residential institutions were as a grave shortage of breath, deliri- eschatological Hope but a great created by religious Congregations um or uncontrollable pain. Whereas deal to do with lies that are not even or by people very near to the same one has to assess with discernment marked by pity. kind of sensibility. – sharing them when possible with I believe that by now the moment The creation of hospices, which the patient and his or her family – has come for the Christian commu- by now are widespread through- situations where a correct taking of nity, which is more motivated and out the world, with aspects which, responsibility of the patient in line more cohesive that civil society, to naturally, are shaped by the various with the ‘overall’ criteria of pallia- address with maturity the problem cultures in which they operate, is tive care in order to accompany him of relationships and communica- in line with the assumption that the or her to the end of his or her life tions in the case of a fatal illness, end of life, before being a clinical without depriving that person of his using great respect for the sensitiv- problem, is an existential event that or her consciousness, for his or her ity of the individual but also great is connected with factors which are sake or that of those who love him respect for personal dignity, re- markedly more complex than path- or her, can be sufficient. spect that cannot see sick people ological phenomena which lead to In definitive terms what are the suddenly as lesser bearers of right, death alone. Those who take care characteristics of a health-care less people than healthy people, be- of these people must, therefore, worker who has to address people cause of a condition of illness and contextualise their behaviour as re- who are coming to the end of their the presence of the ending of life. gards the life event they are dealing lives? I would like to state first of The justifications for silence, lies with, neglecting neither the psycho- all (and I hope that St. Paul will for- or at least reticence that family rel- logical dimension nor the spiritual give me) that charity is not enough atives offer to health-care workers dimension, giving space to comfort if by this term we understand a are often very fragile and dictated in relation to these aspects as well. generic kindness of spirit which much more by reasons relating to In this breadth of horizons of care draws us near to dying people. Tak- self-defence as regards a fatal ill- and treatment a question is emerg- ing care of the dying means associ- ness than by a purported emotional ing that is closely connected with ating with Charity those virtues that defence of the sick person himself palliative care, specifically because all Christians must aspire to; a spe- or herself. of its expansion and the knowledge cific technical competence in the It is specifically this discreet about it that is beginning to spread. control of symptoms, in communi- and respectful care in accompa- This is a question that we could de- cation, and in a capacity to interact nying the sick person in a dimen- fine as the ‘anaesthesia of death’. with various professional roles, rec- sion of truth that is the indispensa- We are not talking about euthana- ognising in the most frail and de- ble pre-condition to engaging with sia but, rather, of an attitude which, fenceless person as well the image him or her, in a way that is not hid- seeing death as unbearable a priori, of the suffering Christ who asks not den from that person, in the crucial theorises the need for sedation to only for nearness but also appropri- moments of the last months of his accompany the last days of a sick ate health-care practices; respect or her life: thinking about giving a person’s life. Recently the French for life but also respect for its fini- meaning to his or her last time on Senate has approved for the first tude; and helping the dying to re- earth; choosing whether to aban- time a law, adding to the Leonetti fer such a dramatic experience to don forms of treatment which are law of 2005, which refers explicitly the project of God, in the difficul- by now ineffective or trying a final to the slogan ‘sleeping before dying ty but also the joy of being able to treatment that can slow down the so as not to suffer’. This is a con- say, in the end, with Simeon. ‘Lord illness; awaiting death in the inti- cept which in the context of pallia- now lettest thou thy servant depart macy of his or her own home with tive care has a meaning in the case in peace, according to thy word (Lk people who are loved or in a hos- of untreatable symptoms, whereas, 2:29). pice or running uselessly towards a out of that context, it becomes, as useless emergency department of a I have already said in this paper, a Notes hospital, perhaps with that person’s theorisation of the anaesthesia of life ending in the paradoxical lone- death. 1 Sacred Congregation for the Doctrine liness of a crowded corridor. On this subject we are helped of the Faith, Declaration on Euthanasia, 5 May 1980. As I have already pointed out in once again by words of Pius XII 2 http://www.who.int/cancer/palliative/ this paper, this sharing is possible which stated, albeit referring to definition/en/ above else when a good control of painkilling therapy but certain- 3 Pio XII, ‘Allocutio, die 24 febr. 1957’: AAS 49 [1957] 147. symptoms has been achieved, when ly applicable to sedation with the 4 Pio XII, ‘Allocutio, die 24 febr. 1957’: one can also address in a calm way other pharmacological instruments AAS 49 [1957] 145; cf. Pio XII, ‘Allocutio, the daily routine of specific care that are now available to us, ‘it is die 9 sept. 1958’: AAS 50 [1958] 694).

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Conclusions and Recommendations

Don Maurizio Funazzi encyclical: signs of its embodied timate analysis we have to observe President of the Diocesan truth, of its enlightened realism.1 that the first permissive legislation Consulta and I do not want to seem rhetori- as a regards abortion goes back to Director of the Diocesan Office cal to you: it is not my intention 1920 and the USSR. In Pope Wo- for Pastoral Care in Health, to deny the problems that we are jtyla’s Poland abortion was legal- Brescia, Italy. still faced with today or to conceal ised in 1956. In the United States of from myself the difficulties that ex- America the Supreme Court legal- ist or to propose a sugary vision ised it in 1973. would like to extend my heartfelt of the world today, as though EV This encyclical was published Ithanks to H.E. Msgr. Zygmunt could have been the panacea for all in 1985. But there was no absence Zimowski and Msgr. Jean-Marie wrongs. I believe, however, that it of previous stances adopted by the Mupendawatu for offering me the is right to allow ourselves to give Catholic Magisterium in relation possibility of speaking at the end of room to feelings such as these, that to attempts to transform a crime this day. I would also like to thank it is right to praise God and to thank against human life into a purported all of you who have taken part for those who gave us this enlightened right. As regards threats to unborn listening to me after such intense teaching. life, for example, we find positions hours of study and analysis. Thank you Holy Father John Paul taken, and here I to cite only a few, II. Thanks to the Cardinals of the in the encyclical Casti Conubii of extraordinary consistory of April Pope Pius IX of 1930.3 In 1965 the 1. Comfort and Gratitude 1991 who asked ‘unanimously for Second Vatican Council made a sol- the Supreme Pontiff to reaffirm ‘the emn proclamation on the ‘abomina- Allow me to share with you first value of human life and its inviola- ble crime’ of abortion.4 We may al- of all the deep feelings of comfort bility’, with reference to the current so think of Humanae vitae of 1968, that I experience because of the gift circumstances and the attacks that of the Declaration on Abortion of to us of Evangelium Vitae (EV). threaten it today’. Thanks to the the Congregation for the Doctrine We are moving towards the end bishops of the world2 who respond- of the Faith of 1974, of the troubled of this day of study on the twenti- ed to the appeal of the Pope to offer appeal of Blessed Pope Paul VI of eth anniversary of the publication their contribution to building this 1978 shortly before the passing in of this encyclical, a sublime gift monumental document of the Mag- Italy of Law n. 1945, and of Famil- by which the successor of St. Pe- isterium – hitherto the most overall iaris Consortio of 1981... ter, together with the bishops of the and exhaustive doctrinal teaching In what sense, therefore, can whole world, confirmed the Faith of on the fundamental human right to such threats be said to be ‘new’ and the disciples of Christ in the Gospel life, understood in the light of Rev- in need of a new declaration by the of life in an epoch that was marked elation and reason. This is a Magis- Magisterium of the Church? by ‘new threats to [human] life’. terium in which in the light of the It is certainly true that an element After listening to thoughtful and value of human life, fundamental of newness has been caused, then wise analyses and papers, it seems structures of civil society such as as now, by the very rapid advance to me important to address our at- freedom, democracy, law, legal- of scientific and medical knowl- tention for an instant to these feel- ity, the meaning and duties of the edge – in a cultural context that has ings: to the feelings that EV pro- family, of States and of the inter- often been closed to transcendence voked at that time but which I still national community are re-exam- – and by the enormous capacities feel when reading it, as though ined. Thanks to the Spirit of Christ acquired by technology to inter- these thirty years had not gone by. who continues to spread within vene directly upon human physical And it does not provoke these feel- the Church his riches through our life at its various stages. ings anew in me alone – of this I am forms of poverty. Thanks you for These advances – which in them- convinced. these twenty years. selves should be welcomed posi- These are feelings of joy and tively – also involve risks. As Don pride because of the interior illu- Francesco Coluccia has observed mination that comes from it; of re- 2. Unprecedented Threats before me, Evangelium Vitae pro- newed resolution and fortitude in vided warnings about them: ‘Even the commitment to the defence and And I would like to ask with you: certain sectors of the medical pro- the protection of human life; and why twenty years ago? In what fession, which by its calling is di- before everything else: feelings of sense could one say that the threats rected to the defence and care of gratitude. placed at the roots of the tree of hu- human life, are increasingly willing This ‘newness’ that Evangelium man right were in that epoch ‘new’ to carry out these acts against the Vitae conserves, this freshness, this (EV, nn. 3-4)? person. In this way the very nature capacity to involve, to move, to mo- If one looks, for example, at the of the medical profession is distort- bilise the reader, are themselves al- threats to unborn life, which is one ed and contradicted, and the dignity so eloquent signs of the very great of the problems that finds important of those who practise it is degraded’ contemporary relevance of this long space in this encyclical, in the ul- (EV, n. 4).

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In addition, this encyclical goes 3. The Intertwining with Gender dent, for example, in the shift from beyond abortion and dwells upon a Feminism the idea of ‘government’ – that is to multitude of attacks on frail human say government entrusted to elect- life from conception until its natu- What are the factors that have in- ed representatives, an idea con- ral sunset, attacks which have been fluenced this ‘unprecedented’ situ- nected with the concept of ‘repre- made increasingly broad and more ation? Obviously enough, they are sentative democracy’ – to that of easily accessible by modern pro- many in number. I have already re- ‘governance’, an idea connected gress. We are dealing here, as we ferred, just to cite one of them, to with the new concept of ‘partici- have heard observed in the papers the important impetus that was born patory democracy’ where govern- that have preceded mine, of an ex- (and is born) from the fear of ‘over ment was now entrusted to a num- tensive document that contains not population’ derived from a eugenic ber of agents, not all of which were only theoretical summaries but also and neo-Malthusian mentality.7 But legitimated by democratic repre- thoughtful operational guidelines at I also want here to refer to another sentation, and where, however, a pastoral, social and political level. significant factor which during the participation was not possible for It expresses an attempt to offer an middle of the 1990s experienced a everyone but only for certain inter- overall picture. strong impetus. est groups which are sufficiently What made these threats ‘unprec- Those were years when ‘gender powerful to have lobbyists working edented’ in the view of the Church, studies’ moved out of the elite cir- at the centres of institutions .10 however, seems to be the fact that cles of radical feminism and the Thus it was that, in particular after the fall of the Berlin Wall and drawing rooms of famous universi- with supranational institutions, the Soviet regimes of Eastern Eu- ties and became transformed from there was a shift from the political rope these threats engaged in a cul- being ‘mere’ social and anthropo- practice that governments related to tural and political leap: they then logical theories into being an au- intermediary social formations (for appeared as a global cultural chal- thentic international political pro- example non-governmental organi- lenge6 which no longer remained gramme, and to such an extent as sations) that enjoyed a position of confined to the domains of theoreti- to determine in 1994 – the year be- pre-eminence and were strength- cal elaboration and philosophical fore the publication of Evangelium ened by the role of representation and sociological justification but, Vitae – the orientations of the UN that they received from citizens, to rather, inaugurated a new political international conference on popula- a new practice of partnership which practice which aimed at the estab- tion and development in Cairo. In envisaged various actors interact- lishment of a ‘new world order’ 1995 they had an even greater influ- ing in situations of parity, indepen- (EV, n. 5) centred around neo-Mal- ence on the conclusions of the UN dently of whether they had behind thusian policies to limit populations international conference on women them democratic legitimation or (EV, n. 16); an idea of happiness that was held in Peking. At these represented, instead, the interests of that tends to identify happiness international assemblies were to be powerful minorities.11 This ‘parity’ with material wellbeing alone (EV, found for the first time in official soon revealed its real face: NGOs n. 23); a relativistic philosophical documents terms such as ‘gender’,8 ended up by dictating the interna- approach (EV, n. 20); and an idea which would subsequently enjoy tional political agenda. of freedom that is detached, there- great success and which involves In this way, the democratic pro- fore, from any criterion of objectiv- the deconstruction of responsible cesses were weakened and small ity and based only on the wishes of sexuality; ‘reproductive rights’ and and powerful elites were able to the individual (EV, n.19). ‘reproductive health’, which im- have a major influence on the deci- In this individualistic and secu- ply the astonishing idea that only sions of elected governments. And larised context, the Supreme Pon- wanted children have the right to where this new practice encoun- tiff observed, ‘conscience itself, be born; and other concepts of new tered difficulties in rooting itself darkened as it were by such wide- coinage which constitute keys by and some legislators were reluctant spread conditioning, is finding it which to open up the road to the in- to adopt the new ultra-free-market increasingly difficult to distinguish dividualisation of law (which car- Word, these powerful lobbies none- between good and evil in what con- ried to its extreme constitutes pre- theless retained an instrument of cerns the basic value of human life’ cisely the negation of law9 and the control over the judicial systems in (EV, n. 4). Indeed, ‘when he denies upholding of the will of the individ- order to coerce non-aligned legisla- or neglects his fundamental rela- ual – as long as he or she is strong tors with a burst of sentences. tionship to God, man thinks he is – over the principle of the ‘common These groups, thanks to the his own rule and measure, with the good’). United Nations (and other supra- right to demand that society should These aggressive cultural minor- national institutions) being porous guarantee him the ways and means ities, that is to say, helped to change when it came to their demands, of deciding what to do with his life the political context by introducing thus sought to re-read the treaties in full and complete autonomy’ new paradigms and correlated new on human rights along gender lines (EV, n. 64). languages and new political prac- and to modify in a strong way the For these reasons, this document tices, and this to the point of pro- meaning of key passages, for ex- concentrates on the attacks on the posing a holistic and post-modern ample those relating to the family, fundamental right to life which are ‘new international ethics’ which to parenthood, to the upbringing of legalised – and this is their distinc- abandoned the heritage of person- children, to the concepts of equal- tive characteristic – if not, indeed, alism. ity and non-discrimination, and promoted by public authorities as Neologisms indicating this naturally to the right to life as well. new forms of rights. change in political practice are evi- And it was in perceiving this ‘un-

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precedented’ framework of refer- cause Pope John Paul II believed Christ that one can know the full ence that the Church felt the need that women could be the people truth about man (cf. GS, n. 22): this for a new teaching of the Magis- who would successfully counter was expressed very clearly by Prof. terium on these subjects (cf. EV, such distortions. And if perhaps Massimo Petrini in his paper. n. 4). It is not therefore of second- this wonderful day of study has had For that matter, John Paul II ary influence that Evangelium Vitae a limit, a limit which I know was himself had already clearly stated re-examined at a deep level, in the not intended but, rather, dictated in 1982: ‘The synthesis of culture light of the value of life, fundamen- by circumstances, it is that of not and faith is not only a requirement tal structures of civil society such having had amongst the speakers of culture but also one of faith… A as freedom, democracy, law, legal- any woman who could analyse the faith that does not become culture ity, and of the role of States and the twentieth years since this encycli- is a faith that is not fully accepted, international community. cal from the perspective of the ‘oth- not entirely thought, not faithfully er half’. lived’.17 In the thinking of the Pope, what- The new culture that he wanted 4. Women as a Determining ever the case, ‘In transforming cul- to foster is called ‘culture of life’, Resource ture so that it supports life, women that culture, that is to say, that sees occupy a place, in thought and ac- in human life the dignity that comes One can find a lively documen- tion, which is unique and decisive. from the fact of the incarnation of tation on the derailing then expe- It depends on them to promote a Christ (see EV, nn. 35 and 39). rienced by the UN as regards its “new feminism” which rejects the This confirms that Evangelium goals12 in the acute writings of cer- temptation of imitating models of Vitae seeks to meet an authentic tain direct witnesses of the inter- “male domination”, in order to ac- anthropological challenge, as was national conferences of 1994 and knowledge and affirm the true ge- well emphasised in his paper by 1995. It is no accident that these nius of women in every aspect of Msgr. Carlos Simón Vázquez. were women: for example, Dale the life of society, and overcome The recognition that human life O’Leary and her incomparable all discrimination, violence and ex- has such a high dignity is then, but Maschi o femmine? La guerra del ploitation’ (EV, n. 99). only then, gravid with ethical con- genere (Rubettino, 2006)13 but also Women, therefore, have a very sequences which are expressed in the works of Marguerite A. Peeters special role and importance in em- the same approach of the life of – I remember in particular her La bodying these teachings both in the Christ, that of oblative love (EV, nuova etica globale: sfide per la thought and in the implementation n. 25), love that takes on respon- Chiesa (2006).14 And the views of of the vision that they offer. Evan- sibility for the other, for every hu- the German sociologist Gabriele gelium Vitae entrusts itself with man life. Let us allow the encycli- Kuby that she expressed in her La confidence to women; a trust that cal itself to speak on this point: ‘It rivoluzione sessuale globale. Dis- a great many people have not dis- is therefore a service of love which truzione della libertà in nome della appointed, as I have been able to we are all committed to ensure to libertà.15 see with my own eyes in my per- our neighbour, that his or her life The titles of their publications sonal experience of pastoral care in may be always defended and pro- highlight how questions relating to health and pastoral care for life: at moted, especially when it is weak our way of understanding mother- times, indeed, to the point of attain- or threatened. It is not only a per- hood, the family, health care and ing heroism. sonal but a social concern which we the value and inviolability of hu- must all foster: a concern to make man life have been intertwined unconditional respect for human ever since then with an authentic 5. Towards an Evangelisation of life the foundation of a renewed transformation of the very idea of the Culture of Human Life society. We are asked to love and a ‘man’ and a ‘woman’ (cf. EV, nn. honour the life of every man and 11, 21) and their reciprocal rela- In the quotation from number woman and to work with persever- tionships, as emerged in particular 99 of the encyclical that we have ance and courage so that our time, in the so-termed ‘gender theories’ just heard, the central offering of marked by all too many signs of or theories of ‘transhumanism/post- this broad fresco on the value and death, may at last witness the es- humanism’, as was clearly pointed the dignity of human life is evi- tablishment of a new culture of life, out in the paper given at this meet- dent: it does not simply intend to the fruit of the culture of truth and ing by Prof. Jean-Marie Le Méné. offer a more complete instrument of love’ (EV, n. 77). As I said, it is no accident that for the ethical assessment of med- Yes: faced with a culture that ex- these authors were women. The ex- ical practices or social or individ- alts fundamental rights to the point ponents of the various radical fem- ual decisions. This is specifically of running the risk of transform- inist movements16 were one of the because the question is not simply ing all relationships into contrac- fundamental engines behind the ethical – it is also anthropological tual and legalistic (I have the right/ sexual revolution and then of the in character. The encyclical seeks you owe me) relationships and re- campaigns for ‘new rights’ such in a consistent fashion to foster a moving space for love, service to as those of so-called ‘reproductive new pastoral role of the Church in the other and forgoing something health’, of artificial fertilisation and order to obtain a ‘transformation for oneself for someone else, EV of surrogate motherhood. Evange- of culture’, an evangelisation of affirms that the human is achieved lium Vitae addresses women in par- culture (see EV, nn. 78-101); a re- only where love is lived. ticular, as is evident, for example, newed proclaiming and incarnation This love, however, is authentic in number 99 of the encyclical be- of the Gospel because it is only in love, that love which can be seen in

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the life of Jesus Christ; not a sweet- last twenty years within the Church tween fullness and limitation, and ened parody of love, not a love that – and though her in the world – to give a priority to time…This cri- thinks that it does good by closing thanks, as well, to the fertile terrain terion also applies to evangeliza- its eyes to uncomfortable truth; not that was prepared by Evangelium tion, which calls for attention to the a love that is reduced to an encoun- vitae. bigger picture, openness to suitable ter of egoisms to obtain the satis- We may think of what she has processes and concern for the long faction of the each person’s desires. generated in the world of pastoral run. The Lord himself, during his care in health, for example, and we earthly life, often warned his dis- have listened to evident testimonies ciples that there were things they 6. Evangelium Vitae: Witness to this today. I am thinking of the could not yet understand and that to an Outgoing Church awareness and motivation that she they would have to await the Holy has offered to people marked by ill- Spirit (cf. Jn 16:12-13). The para- Evangelium vitae, and I here ness or disability and to very many ble of the weeds among the wheat come to the end of my paper, con- care professionals who are believ- (cf. Mt 13:24-30) graphically illus- stitutes one of the manifestations ers. trates an important aspect of evan- within the Church of the 1990s of We may think of what influences gelization: the enemy can intrude the vivacity of her missionary spirit. she has had in the field of pastoral upon the kingdom and sow harm, It manifests an ‘outgoing Church’18 care for families, and of the very but ultimately he is defeated by the that is not folded in on herself but, many ministries that have arisen or goodness of the wheat’ (Evangeli- rather, listens to the great cultural have been developed during these um Gaudium, nn. 223, 225). transformations that were under- years to offer formation and sup- Yes: we have many reasons to way at a global level. port to families and couples, for ex- thank the Church of St. John Paul II It is witness to a Church that ample. and to give thanks to God. agreed to enter the forum of the in- We may think of what she has The gospel commitment pro- ternational cultural debate about meant in the social and politi- posed by Evangelium Vitae calls human rights and presented in a cal fields; of the variegated pro- on the Church still today to receive reasoned and respectful way her life world to which she has given the witness of those who have pre- own arguments, offering to those strength and at the same time to ceded us, adopting the pathways of who listened not condemnations19 which she has offered discernment conversion that EV proposed to its but, rather, a commitment to a ‘ser- so that the sinner is not condemned time. Amongst these reference may vice of love’. together with the sin and so that be made to: prayer and fasting; be- This is a commitment that has forms of extreme vitalism are not ing there – accepting getting one’s not ended and which we are also entered into which end up by de- hands dirty; a commitment to for- called to continue to adopt. This is nying the finitude of man and his mation; and the social and political a commitment that is not easy be- being which is destined to pass by engagement of believers. cause in recent years, as Pope Fran- way of the door of death towards a First and foremost it is prayer cis observes in his apostolic exhor- greater Future. and fasting that we must revital- tation Evangelii Gaudium (n. 213) We may think of the great en- ise in our personal and communi- when discussing unborn children: ergy of volunteers and profession- ty lives since the cultural conver- ‘Frequently, as a way of ridiculing als provided at the side of women sion which the encyclical aimed to the Church’s effort to defend their tempted to end the lives of their achieve is primarily in the hands of lives [or any other pastoral care for own babies in their wombs or at the God of life who touches men’s life], attempts are made to present the side of family relatives who are hearts. He is the protagonist of the her position as ideological, obscu- very worried about the conditions Work of Salvation and we are only rantist and conservative’. of life of their own sick or disabled secondary actors. We can at certain moments per- loved ones. Secondly, we, the Church of the ceive a sense of disappointment We may think, lastly, of the nu- twenty-first century, are asked to and demoralisation in the face of merous Catholic institutions and conquer resignation; not to forgo the development of globalised cul- movements which have been ferti- being there in these fundamental ture during our epoch because of lised by her ideas; of the renewed areas of the production of culture: the grave character, and the board commitment of Catholics to scien- overcoming the temptation to run range, of the attacks on human life. tific research that respects every life away and to turn our gaze only to Despite the unceasing commit- or to offering care and treatment cultural points and subjects where ment engaged in by thousands of that is worthy of the human person. it is easier to obtain consensus. Our Christian men and women and by I am convinced that you share this Church is still asked to ‘get her men and women of good will in the vision with me, a vision that is able hands dirty’ – as can easily happen defence and the promotion of hu- to recognise the good that exists in a ‘field hospital’ – in the domains man life, the weeds seem to con- and to recognise how, as Pope Fran- of caring for life. For example by tinue to grow in a luxuriant way cis teaches, ‘time is greater than offering high quality care and treat- amidst the good wheat. space’: ‘This principle enables us ment that are attentive to the process Such observations are certainly to work slowly but surely, without of ethical assessment. For example, understandable and arise from con- being obsessed with immediate re- moreover, by exerting ourselves to cern about, and love for, the Gos- sults. It helps us patiently to endure support lines of scientific research pel but they run the risk of losing difficult and adverse situations, or that are ethically directed… from sight the very abundant fruits inevitable changes in our plans. It Thirdly, the encyclical calls on that have been generated over the invites us to accept the tension be- us to continue with the very fertile

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commitment to formation, a for- Notes are all ‘social constructions’ (that is to say exclusively dependent on culture and not mation which, in our current con- on foundations established by the reality text, can no longer be addressed to 1 ‘Ideas disconnected from realities give itself of man/woman); these cultural con- health-care workers alone or to ex- rise to ineffectual forms of idealism and structions, according to gender theories, are perts in this sector but which must nominalism, capable at most of classifying opposed to the equality and freedom of cit- and defining, but certainly not calling to ac- izens and for this reason should be ‘decon- be addressed to all those people tion. What calls us to action are realities il- structed’. If people are born male or female, who are ready to listen to us, and in luminated by reason’: Pope Francis, apos- that is to say, being or living as a man or particular the new generations and tolic exhortation Evangelii gaudium, n. 232. a woman does not depend on an objective See also what St. John Paul II writes in the and biological reality but upon cultural con- parents. encyclical itself at n. 2 when he referred to ditionings or, in the best of hypotheses, on a There are very many fields of the ‘profound and persuasive echo in the free individual choice. formation. Amongst others, I would heart’ generated by the Gospel of life. 9 ‘In this case it is force which becomes like to highlight the importance of 2 And not only bishops because women the criterion for choice and action in inter- and men lay believers, men and women reli- personal relations and in social life. But this educating – and educating in par- gious, and priests were also involved. is the exact opposite of what a State ruled ticular the new generations – in a 3 Abortion is described in that encyclical by law, as a community in which the “rea- correct sexual identity, in affective as a ‘very grave crime’ and the ‘direct kill- sons of force” are replaced by the “force of ing of an innocent being’ and this document reason”, historically intended to affirm’ EV( , relationships, and in a balanced un- rejects one by one the purported justifica- n. 19). derstanding of the exercise of sexu- tions for it which are related to ‘medical, so- 10 S. E. Mons. Silvano Maria Tomasi, ality. In this sense, we must work to cial and eugenic recommendations’. La forza delle parole: verità e ideologia support parents and families, mak- 4 . Gaudium et negli organismi internazionali, http://www. spes, n. 51. See also n. 27, quoted in EV al tracce.it/detail.asp?c=1&p=0&id=1387, ing sure that their right to direct the n. 3 2011; Marguerite A. Peeters, Il gender. Una education of their children in these 5 ‘In this rapid but dramatic list of attacks questione politica e culturale (Ed. San Pao- fields is respected in the face of the on life we cannot keep quiet about those that lo, 2014) (Le gender, une norme politique et are perpetrated – alas – with the chrism of culturelle mondiale. Outil de discernement, increasingly widespread attempts legality. Our thought goes first and foremost Inst. for Intercultural Dialogue Dynamics, to introduce forms of affective- to abortion. Superfluous comments and 2012). sexual education determined by the comments limited by the unfolding political 11 In this new context one understands the state which go in the direction of an situation. But one’s spirit is horrified only at fact that the presidency of the UN Interna- the thought that such a crime should obtain, tional Conference on Population and Devel- early sexualisation of young peo- as unfortunately takes place in other coun- opment of 1994 was entrusted by the Unit- ple and education in sexual indif- tries, legalisation, indeed the protection of ed Nations to the Ghanaian Fred T. Sai, the ference, which, indeed, is typical of public services, and this with the pretext of co-founder of the national section of Gha- concern for unhappy women who then car- na of the powerful NGO the ‘International gender theory. ry in their hearts the implacable remorse of Planned Parenthood Federation’ (IPPF), the Lastly, in defeating the impulse having consented to offending what it is giv- NGO which, in effect, decided the direction to retreating into the private and an en to a woman to possess in the natural order of the deliberations of the conference. The that is most august and ineffable – mother- UN itself, for that matter, is a body that is allergy to social and political en- hood! Poor and innumerable unborn human subject to a low level of democratic control. gagement, the exhortation of the lives overwhelmed in your weakness, in 12 John Paul II spoke here even of a ‘be- encyclical to look for forms and your innocence! How can a civilised soci- trayal of the noblest ideals of the United languages by which to present at a ety, and even more a Christian society, au- Nations’ in his Letter to Mrs Nafis Sadik, thorise and remain impassive, without tears, Secretary General of the UN International secular and public level the argu- in the face of such a ‘massacre of the inno- Conference on Population and Develop- ments of the Gospel of Life also ap- cents?’: Paul VI, Catechesis of Wednesday, ment of 18 March 1994, n. 4. See on this plies to we believers at the begin- 26 April 1978. subject also his of 29 June 6 ‘with the new prospects opened up by 1995. ning of this millennium. scientific and technological progress there 13 Original edition: The Gender Agen- This is not only a matter of con- arise new forms of attacks on the dignity of da. Redefining Equality (Vital Issues Press, tinuing to demand and broaden the human being. At the same time a new 1997). spaces for conscientious objection cultural climate is developing and taking 14 Original edition: The New Global Eth- hold, which gives crimes against life a new ic: Challenges for the Church (Inst. for In- in relation to murderous and free- and – if possible – even more sinister char- tercultural Dialogue Dynamics, 2006); see dom-killing laws but also of help- acter, giving rise to further grave concern’ also: The Globalization of the Western Cul- ing to promote a widespread aware- (EV, n. 4). tural Revolution (I.I.D.D., 2007). 7 The lobby that acts on the basis of such 15 Original ediition: Die globale sexuelle ness of the oligarchic mechanisms geopolitical worries is certainly the most Revolution: Zerstörung der Freiheit im Na- in which we are immersed and important one as regards the genesis of the men der Freiheit (Fe-Medienverlag, 2010). which aim to achieve an ‘ideolog- process of cultural and political transforma- See also Gender Revolution. Il relativismo ical colonisation’, as Pope Francis tion that I am here referring to, given its fi- in azione (Die Gender-Revolution. Relativ- nancial capacities and its political influence ismus in Aktion, 2006). so well put it. A task of believers re- that started as early as the 1950s. Without its 16 For example Margaret Sanger (1879- mains today that of fostering the ac- support, the socio-cultural minorities that 1966), Marie C. Stopes (1880–1958), Adri- quisition of awareness and of push- then acquired a centrality would not have enne Rich (1929-2012), Kate Millett (1934), had the strength either to occupy the scene Anne Koedt (1941-), Juliet Mitchell (1940), ing believers and non-believers to of the social and political debate or to influ- Robin Morgan (1941-), Donna Haraway reacquire the democratic process. ence the decisions of the institutions of the (1944-), Shulamith Firestone (1945-2012), A final expression of gratitude I international community. Gayle Rubin (1949-), Judith Butler (1956-), extend to you, distinguished par- 8 Gender theories, as systems of thought, to cite only some. are difficult to define because they are a set 17 Giovanni Paolo II, ‘Discorso del 16 ticipants, for the patience that you of very extensive and varied cultural ele- gennaio 1982 ai partecipanti al Congresso have demonstrated towards me, as ments which as yet do not have an overall Nazionale del Movimento ecclesiale di im- well as to the President and the of- structure and vary (for example) accord- pegno culturale’: Insegnamenti, V, 1 [1982], ing to the feminist context; the context of p.131. ficials of the Pontifical Council for gay culture; and the context of queer and 18 Pope Francis, apostolic exhortation Health Care workers for proposing transhumanist culture. A fundamental and Evangelii gaudium, nn. 20-24. this valuable day, a source of re- shared idea of gender theories, however, is 19 We may think of EV, n. 9 on the pro- newed motivation and enlightened the view that male and female identities and tection that God gives to Cain; we may also their complementary character, the vocation think of EV, n .99 where the Supreme Pon- analysis. May God bless our apos- to marriage of the human person, paterni- tiff in a tender way addresses women in- tleship! ty, maternity and being sons or daughters, volved in abortion.

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Topics

Catholic Nurses and Midwives: Ministers of Life

Pope Francis’ Theology of Accompaniment

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Catholic Nurses and Midwives: Ministers of Life Keynote Address

CICIAMS XIX World Congress 23-26 September 2014 Dublin, Ireland

Msgr. Jean-Marie the Synod on the Pastoral Chal- volves the creative action of God Mupendawatu lenges of the Family in the Context (Gen. 1:26-27) and remains for- Secretary of the of Evangelisation, which is due ever in a special relationship with Pontifical Council next month in Rome. The work- the Creator, who is its sole end.5 for Health Care Workers ing document (Instrumentum La- The life of the human person, boris) rightly notes that: “in these created in the image and likeness times, a widespread cultural, so- of God, is sacred and inviolable ost Reverend Diarmuid Mar- cial and spiritual crisis is posing a (Gn. 9:5-6) and in it the inviola- Mtin, Archbishop of Dublin, challenge in the Church’s work of bility of the human person finds The International, Regional and evangelizing the family, the vital its primary and fundamental ex- National Presidents of CICIAMS, nucleus of society and the eccle- pressions. Dear Catholic Nurses and Mid- sial community.”1 The document Furthermore, “By his Incar- wives, identifies several challenges to nation the Son of God has unit- Distinguished Guests, Ladies the family among which the pas- ed himself in a certain way with and Gentlemen, toral challenge concerning open- every human being.”6 The fact ness to life. Without prejudice to that God assumed the human na- It is a great joy and honour for the other challenges, I wish to ad- ture reveals to us the incompara- me to represent the Pontifical dress the issue of openness to life, ble value of every human person Council for Health Care Work- for I do believe it is at the core of and human life.7 God even made ers at this nineteenth World Con- your mission as Catholic health- himself instrumental in Christ for gress of CICIAMS. I bring to you care workers, for the life generat- our sake, thus establishing our the greetings and blessings of the ed in the family must be protect- dignity as children of God. This President, Archbishop Zygmunt ed and promoted. The challenges divine intervention, raised man to Zimowski, who asked me to con- to life urge us to strengthen our a condition beyond compare, he vey his apologies for not being mission and resolve. Moreover, is called to a fullness of life that able to be with us today, however as Pope Francis affirms, “we al- consists in sharing the divine life, he promised his prayers for all of so evangelize when we attempt to a life that exceeds the earthly ex- you and wishes you fruitful delib- confront the various challenges istence. The earthly life therefore, erations. which can arise”2 in opposition to is both an initial stage and an in- I thank the organizers of this the gospel truth. tegral part of the entire process of Congress for the invitation ex- human existence. Life is a sacred tended to me to participate in reality entrusted to us, one that we these days of reflection, sharing 1. The Sanctity of Human Life have to preserve with a sense of and learning, so as to strengthen responsibility.8 your service and witness as Cath- The first right of a human per- St. John Paul II, who was an olic Nurses and Midwives. My son is his life. It is the – funda- indefatigable defender of hu- sincere gratitude to the Interna- mental – condition for all other man life, affirms in the Encyc- tional Executive of CICIAMS, rights.3 Hence it must be protect- lical Evengelium Vitae, that the especially the secretariat for the ed above all others.4 Now the re- Gospel of life is at the heart of organization and to our host coun- spect, protection, and care right- Jesus’ message… to be preached try Ireland, especially the Catho- fully due to human life derive with dauntless fidelity to the peo- lic Nurses Guild of Ireland for the from its singular dignity. In the ple of every age and culture.”9 He great hospitality and organization. whole of visible creation it has calls every Catholic to be faith- The theme chosen for this Con- a unique value. To see this more ful to the message of Jesus Christ gress “Protecting Family Life: clearly we make recourse both to on human life. He also reminds The Role and Responsibility of divine revelation and the redemp- us that we live in times in which Nurses and Midwives,” comes at tive mission of Christ. there is a great cultural war be- the right moment when the Uni- Divine revelation shows to tween a culture of death and a versal Church, upon the invitation us the sacredness of human life, culture of life. As Catholics we of Pope Francis, is preparing for which from its beginning in- must have the courage to pro-

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claim the culture of life for the This bioethical Magisterium is for and the diffusion of an individu- common good of society. This is the health-care worker, Catholic alistic anthropological model are our duty as Catholics, and more or otherwise, a source of princi- causing a sharp decline in popu- so as health-care workers.10 ples and norms of conduct which lation whose social and human enlighten his/her conscience and consequences are not being ade- direct him/her – especially in the quately taken into account. Poli- 2. Catholic Nurses and complexity of modern biotechni- cies leading to a decline in the Midwives as Guardians cal possibilities – in his/her choic- birth rate are having an effect on and Servants of Life es, always respecting life and its the quality of marital relation- dignity. ships and relationships between The Charter for Health Care I will now proceed to offer an generations.”17 There is diffi- Workers, refers to those engaged outline of some of the challenges culty in accepting the Church’s in healthcare as “ministers of to human life, in the various stag- teaching on the unbreakable link life”. The nature of the activity es of growth, which challenges between conjugal love and the of healthcare workers “is a very put to task the duty and mission transmission of life.18 Hence the valuable service to life.”11 Like of Catholic nurses and midwives recourse to artificial means of fer- all healthcare personnel, Catholic as guardians and servants of life. I tility control – contraceptives and nurses and midwives are called will only highlight some of these abortion – enhancing the prolif- “to be guardians and servants of challenges and leave it to the ex- eration of the anti-life mentality, life.”12 In their care and concern perts who will be speaking later, which is also supported by anti- for the lives of other people, nurs- and will certainly treat some of life legislation. It must be remem- es and midwives perform an ac- these issues in a profound way. bered that “openness to life is at tion that involves the prevention, I wish to divide human life into the centre of true development. cure and rehabilitation of human three main stages: the early stage, When a society moves towards health and the stewardship of life. the middle stage and the end of the denial or suppression of life, Taking care of human life and life stage. it ends up no longer finding the health is both a Christian and hu- necessary motivation and energy man duty. In the first place, life to strive for man’s true good. If and health are precious gifts from 3. Challenges to Human life personal and social sensitivity to- God and we are but custodians, at its Various Stages wards the acceptance of a new life with a duty to take reasonable is lost, then other forms of accept- care of them.13 This makes taking 3.1 The Early Stage (Procreation) ance that are valuable for society care of life and health a response also wither away. The acceptance to a God given duty. This is the stage that concerns of life strengthens moral fibre and Secondly, we know that life the generation of new human be- makes people capable of mutual is the fundamental and primary ings. If new life is to be born, then help.”19 good of the human person. Thus there is the need that families be Today scientific development taking care of life and health is open to life. Today we live in an offers the possibility of effect- a truly human activity. Health- ageing society, where less and less ing antenatal diagnosis, enabling care workers, especially Catho- children are born and old people medicine to detect certain ill- lic nurses and midwives dedicate live longer. While the latter is a nesses from the foetal stage of themselves to this activity. Thus positive development, the former human development, so as to ob- as the Charter for Health Care will have dramatic consequences tain a cure or more effective pre- Workers affirms: “the principal for society. Many societies, es- vention. Without going into the and symbolic expression of “tak- pecially in the more developed discussion of the techniques, I ing care” is your vigilant and car- regions, have already attained wish to point out the moral prob- ing presence at the sickbed. It is older population age structures lem that arises when this diagno- here that medical and nursing ac- than have ever been seen in the sis is directed toward eugenics tivity expresses its lofty human past. Moreover, many developing and abortion. When an illness is and Christian value.”14 countries in the midst of the de- discovered the parents would be The Charter also emphasises mographic transition are experi- required to take a decision as to that ‘service to life is such only encing rapid shifts in the relative whether they would like to have if it is faithful to the moral law, numbers of children. The result is the child. These are difficult mo- which expresses exigently its val- an increasing share of older per- ments for the couple, where the ue and tasks. Health-care workers sons and a declining share of chil- advice and support of the medi- “draw their behavioural directives dren. cal personnel can be very deter- from that field of normative eth- While the causes are varied, minant for the decision of the ics which nowadays is called bi- certainly one of them is the lack parents and the life of the un- oethics.”15 Thus the Magisterium of what the working document for born child. The question is what of the Church endeavours to offer the Synod on the Family refers to type of counselling do we offer to appropriate guidelines on vari- as “openness to life and parental these troubled parent? ous questions and disputes arising responsibility in upbringing.”16 It As nurses and especially as from the biomedical advances and is noted that “in some parts of the midwives you have the privilege from the changing cultural ethos. world, a contraceptive mentality of following expectant moth-

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ers before, during and immedi- productive health”, with recourse to life,28 and ought to be consid- ately after birth. You have a mis- to artificial techniques of procrea- ered in his profound unity, for sion to spread the gospel of life, tion that entail the destruction of “every intervention on the human to encourage a mentality which embryos, or with legalized eutha- body touches not only the tissues, is more open to life, helping cou- nasia.”25 the organs and their functions, ples to understand that “true mar- Already in some countries, but involves also at various lev- ried love and the whole structure nurses have had to leave their els the person himself”.29 Health of the family life which results places of work or are denied em- care must never lose sight of the from it is directed to disposing ployment and promotion, just be- “profound unity of the human be- the spouses to cooperate valiantly cause they made an objection of ing, in the obvious interaction of with the love of the Creator and conscience and refused to partici- all his corporal functions, but also Saviour, who through them will pate in abortion programmes. As in the unity of his corporal, affec- enrich their family from day to individual Catholic nurses hold tive, intellectual and spiritual di- day.”20 For those couples there- on to the Christian values in de- mensions. One cannot isolate “the fore who are open to life and fending the sanctity and digni- technical problems posed by the need help on responsible procre- ty of human life, they need to treatment of a particular illness ation, yours is the duty to equip be supported by Christian legis- from the care that should be given them with appropriate knowledge lators, the Christian community to the person of the patient in all and offer them proper guidance.21 at large and the associations of his dimensions. It is well to bear I find the words of Pope Francis Catholic nurses, so that their voic- this in mind, particularly at a time to the International Federation of es can be heard and their rights re- when medical science is tending Catholic Medical Associations spected. We therefore have to pro- towards specialisation in every and Catholic Gynaecologists very mote and strengthen the Catholic discipline.”30 relevant here: “in this context of Nurses Guild and start it where it Moreover this holistic view of contradiction, the Church makes does not exist, as well as encour- the patient is already called for an appeal to consciences, to the age student nurses to join it. by the WHO definition of health consciences of all healthcare pro- On the other hand there are as a state of complete physical, fessionals and volunteers, and es- those couples who are desper- mental and social well-being and pecially to you… who are called ately looking for a child, but for not merely the absence of dis- to assist in the birth of new hu- one reason or another their at- ease or infirmity. St. John Paul II man lives. Yours is a singular tempts have not been successful. moved a step further to propose vocation and mission, which re- It is your duty as Catholic medi- a more adequate vision of health quires study, conscientiousness cal personnel to offer them proper based on an anthropology which and humanity. There was a time guidance and assistance. “Health respects the person in his entire- when women who helped in the care workers lend their service ty. “This vision of health, based delivery were called “comadre” whenever they help parents to on an anthropology that respects [co-mothers, midwives]: like one procreate responsibly, supporting the whole person, far from being mother with another, with the the needed conditions, removing identified with the mere absence real mother. You, too, are “co- obstacles, and protecting them of illness, strives to achieve a full- mothers” and “co-fathers”, you from invasive techniques unwor- er harmony and healthy balance too...”22 thy of human procreation.”26 This on the physical, psychological, The exercise of your profession is a mission we can fulfil as indi- spiritual and social level.”31 as Christian nurses and midwives viduals, as a professional group at Taking into consideration the requires you to be also witness- our places of work or as an asso- various dimensions of health, es to your faith, with a generous ciation, as well as in communities and thus the needs of the patient, commitment in support of human by being involved in the family helps us to adopt a wholly hu- life. We need to recognize that the apostolate. man approach to the suffering pa- spreading of the culture of death tient, in order to offer a holistic through legislation and customs 3.2 The Second Stage care that will integrate the family often starts with the legalisation of the patient into the care. Most of abortion, which severely af- This is the stage that concerns of our patients have a family be- fects the beginning of human protecting and promoting the hu- hind them, which family needs life and immediately from there man life that has started. Here the appropriate assistance to be able it moves on to threaten the final Charter makes an important dec- to support their suffering mem- stage of life through euthanasia.23 laration when it says that “from ber. Often one gets the impres- As Benedict XVI observed, the time that the ovum is ferti- sion that the family of the patient “there is often a lack of ethical lised, a life is begun which is nei- risks being seen as an intruder, clarity at international meetings, ther that of the father nor of the or a disturbance to our busy and and specifically the use of con- mother; it is rather the life of a tight schedule of care; instead we fusing language conveying val- new human being with its own should find an appropriate way of ues at odds with Catholic moral growth.”27 We therefore have be- positively involving them in the teaching.”24 This is the case when fore us a human individual en- holistic care, and helping them to it comes to “issues such as those trusted to our care who demands offer appropriate care to their suf- connected with the so-called “re- respect for his dignity and right fering member.

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As we noted at the beginning This is a subject – that of assis- for those who, beside his/her bed, there is an increased life expectan- tance for the dying – that requires are working to alleviating its im- cy, which however entails a grow- renewed and constant attention: pact.”37 ing number of people affected by the contemporary cultural con- In particular, “Death… must be neurodegenerative diseases that text tends to reject death and the evangelized: the Gospel must be are often accompanied by a dete- dying because they pose to med- announced to the dying person... rioration of the cognitive capaci- icine and health-care workers The announcement of the Gos- ties. These people need appropri- questions which they – if they are pel to the dying finds especially ate care and assistance in proper only technicians of health – may expressive and effective forms facilities, as well as in families, not know how to answer. A dying in charity, prayer and the sacra- which remain the privileged place person is thus misled about his or ments.”38 of warmth and closeness. her condition, or marginalised, Charity means that giving and Pope Francis condemns the or an attempt is made to make receptive presence, in which one mentality of disregard for the frail death belong to events that are establishes with the dying a com- members of our society. He notes determined technically, produc- munion that involves attention, that “a widespread mentality of ing them: such is the case with comprehension, concern, pa- the useful, the “culture of waste” euthanasia or postponing death; tience, sharing and selflessness. that today enslaves the hearts and such is the case with exaggerated One sees in the dying person the minds of so many, comes at a very treatment; “For the doctors and face of Christ who is suffering high cost: it asks for the elimina- their assistants it is not a question and dying, calling out for love tion of human beings, especially of deciding the life or death of an (Mt 25: 31-40). if they are physically or socially individual. It is simply a ques- weaker. Our response to this men- tion of being a doctor or a nurse, tality is a decisive and unreserved that is, of posing the question and 4. Some Important “yes” to life.”32 He says the con- then deciding according to one’s Requirements cern for human life in its total- expertise and one’s conscience for their Mission ity must be our priority especial- regarding a respectful care of the ly for the most defenseless. “In a living and the dying of the patient In order to correspond to this frail human being, each one of us entrusted to one”.34 vocation and fulfil their mission is invited to recognize the face of You will have to deal with is- faithfully, nurses need to pay at- the Lord, who in his human flesh sues concerning the appropriate tention to certain tasks and as- experienced the indifference and care for the terminally ill, issues pects of their ministry. We shall solitude to which we so often of assisted nutrition and hydra- now briefly present the major condemn the poorest of the poor, tion,35 offering palliatives care ones. whether in developing countries and the use of pain-relievers,36 as or in wealthy societies. well as the choices of the patient 4.1 Interpersonal Relationship …Every child who, rather than and their families regarding treat- of Trust and Conscience being born, is condemned unjustly ment. to being aborted, bears the face of The crisis which the proxim- The activity of a nurse is not Jesus Christ, …And every elderly ity of death brings into the lives only of a technical character: it person, even if he is ill or at the of sick people and their families also involves devotion to, and end of his days, bears the face of prompts the Christian and the love for, one’s fellow man, one’s Christ. They cannot be discarded, Church to be bearers of the light neighbour. It implies an inter- as the “culture of waste” suggests! of truth, which faith alone can personal relationship of a spe- They cannot be thrown away!”33 cast on the mystery of death. Life cial kind. It is a meeting between has to be celebrated and exalted “trust” and “conscience.” It is a 3.3 The Third Stage even and above all in the proxim- relationship of trust on the part of or End of Life ity of death itself. It must be fully a person in need of treatment and respected, protected and assisted care because he or she is afflict- The Charter for Health Care in those who are experiencing its ed by illness and suffering, and Workers observes that “for the natural conclusion. A patient even of conscience on the part of the health care worker, serving life though declared incurable by sci- person who is able to respond to means assisting it right up to its ence can never be declared un- this need through a fusion of care, natural completion. Life is in worthy of care. treatment and healing.39 God’s hands: He is the Lord, He As St. John Paul II observed: It is therefore important to re- alone decides the final moment. “the attitude in front of the ter- member that in exercising your Every faithful servant guards this minally ill is often the test of the profession you are always dealing fulfilment of God’s will in the life sense of justice and charity, nobil- with a person who has entrust- of every person entrusted to his/ ity, responsibility and profession- ed their body and health to you, her care. One does not consid- al skills of a health workers. The confident of your competence, er himself/herself the arbiter of positive interpretation of suffer- as well as your care and concern. death, just as and because they ing is a positive support for those Thus for a health-care profession- does not consider themselves the experiencing its weight and be- al the sick person should never be arbiter of anyone’s life’ (n. 114). comes the highest lesson of life a simple clinical case to be exam-

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ined scientifically. He or she is al- Moreover, by taking care of the of each patient. To be compas- ways a person in special need, to sick and suffering, you take care sionate, generous and self-sacri- whom scientific and professional of Christ himself (Mt 25, 34-41). ficing in the name of Christ is to expertise alone are not enough. A St John Paul II, reminds us that be Christ for others. proper response to the patient’s “human suffering evokes com- needs also requires love. passion; it evokes respect”42. You 4.5 Advocacy are called to offer compassionate 4.2 Technical and Professional care to your patients. And as such, It is true that, practically, nurs- Competence you should live out your profes- es are closer to patients and more sion as a call, as a mission. aware than doctors of the wider Life is the primary and funda- Traditionally, nursing has been needs of the patient. These needs, mental good of the human person, known as an altruistic and car- which could be psychological, so- which demands absolute respect. ing-focused profession. Remain- cial or spiritual, may be of great- Caring for this life is therefore an ing true to this vision of nursing er significance to the patient than extremely important duty, which may prove an uphill struggle in his or her medical problem. Nurs- requires adequate preparation and the highly developed present-day es may be placed in a situation a proper disposition. In order to technology, which has often been where they have to act as an ad- be properly equipped and not to criticized as being heartless and vocate for the patient. They may betray the trust and confidence of inhuman. Hence, the urgent call then be faced with loyalties di- their patients, health-care work- for the humanization of modern vided between patient, doctor ers, and therefore nurses and mid- high-tech healthcare delivery. It and manager. Advocacy is a use- wives, ought to have the appro- is therefore very important to re- ful mechanism for power sharing priate technical and professional member that the human person, within the team, but all too often competence to respond to the the sick person, should always be it is perceived in a negative way – needs of their patients. at the centre of your care, of your as a threat, or an implied criticism The continuous development mission and service. To them you of medical care. Doctors need to and progress of medicine de- are called to give integral care, in listen to their nursing colleagues, mands of health-care workers a full respect of their dignity, tak- who often have a broader view of thorough preparation and appro- ing into consideration the various the patient’s concerns. priate updating or ongoing forma- dimensions of a person’s health: tion so as to acquire the necessary physical, psychological, social 4.6 Prayer competence and expertise.40 and spiritual. The technology, which brings with it a lot of possi- The importance of prayer in the 4.3 Ethico-religious bilities that facilitate your service, healing ministry cannot be over- Professional Training should remain but an instrument emphasized. Today in a secular- to help you improve your service ized society there is a pressing Given the current advances in to fellow human beings, to the need to rediscover the therapeu- biotechnology, clinical cases are suffering brothers and sisters. tic dimension of faith. The Chris- becoming ever more complicat- Pope Benedict XVI in his En- tian understanding of health is a ed and problematical. Thus the cyclical Spe salvi observes that holistic perception that includes profession, mission and voca- “the true measure of humanity everything of the human person, tion of a nurse and a midwife re- is essentially determined in re- in all his dimensions: physical, quires a solid training and a con- lationship to suffering and to the psychological, social and spiritu- stant ethical-religious formation sufferer. This holds true both for al. In fact the holistic approach to in moral questions in general and the individual and for society. A healthcare reflects Jesus’ minis- in questions relating to bioeth- society unable to accept its suf- try of healing, which was always ics in particular. This will enable fering members and incapable of concerned with the whole person the health-care professionals to helping to share their suffering and their transformation. appreciate human and Christian and to bear it inwardly through Many people approached Je- values and refine their moral con- “com-passion” is a cruel and in- sus during his public ministry, ei- science.41 human society.”43 Your profession ther directly or through relatives as nurses and midwives empow- and friends, asking for the resto- 4.4 Compassion ers you to offer that much needed ration of health. The Lord wel- compassion-based care to the sick comed these requests but always As Catholic nurses you have people entrusted to you. Feel with insisted on having faith. “If you the privilege of being at the bed- them, be one with them in their can?” replied Jesus. “Everything side of the sick and suffering, not sorrows and joy, in the sense of is possible to one who has faith” only to treat them as your profes- solidarity as members of the hu- (Mk 9: 23). For centuries, people sional preparation may empower man community. In other words, of faith have offered prayers for you to, but above all to take care they need your “availability, at- the sick, often with amazing re- of them as brothers and sisters tention, understanding, sharing, sults. In the recent times medical in need. They are neighbours in benevolence, patience and dia- research has shown consistent need and you are to be the Good logue.”44 It is about personal em- proof that faith and prayer have Samaritan to them (Lk 10, 29-37). pathy with the concrete situation positive results for the sick. Holy

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Scripture illustrates the power of fully seek the blessings of good sibility: first of all to yourselves, prayer, including healing prayers health…”45 through a commitment consistent for the sick. Such prayer is based Similarly, prayers ought to be with your Christian vocation; and on faith and trust in God. Thus offered for those who take care of then to contemporary culture, by the Apostle exhorts us to offer and assist the sick in our commu- contributing to recognizing the prayers of faith and not just wish- nities. It is important to remember transcendent dimension of human ful prayers: “Is any among you that “health care is a ministerial life, the imprint of God’s creative sick? Let him call for the elders instrument of God’s effusive love work, from the first moment of its of the Church, and let them pray for the suffering person; and, at conception. This is a task of the over him, anointing him with oil the same time, it is an act of love new evangelization that often re- in the name of the Lord; and the for God, shown in loving care of quires going against the tide and prayer of faith will save the sick the person. For the Christian, it paying for it personally. The Lord man” (Jm 5: 14-15). is an updated continuation of the is also counting on you to spread Convinced of the therapeutic healing love of Christ, who went the “gospel of life”. power of faith, Christian tradition about doing good and healing eve- In this perspective, hospital holds prayer to be an instrument ryone”.46 The service rendered by departments of gynecology are of healing. In this regard, prayers the health-care worker is also an privileged places of witness and can be offered by the sick person, expression of love for Christ, who evangelization, for wherever the for the sick person and with the assumes the face of the suffer- Church becomes “the bearer of sick person. Oftentimes people ing brother and sister (Mt 25:31- the presence of God”, there, too, ask for healing or for the grace or 4). Catholic nurses and midwives she becomes the “instrument of ability to accept sickness in a spir- should therefore accompany their the true humanization of man and it of faith and conformity to God’s work with prayer so that they may the world” (Congregation for the will. The healing obtained by the be strengthened and guided by the Doctrine of the Faith, Doctrinal power of prayer takes different Holy Spirit to be effective instru- Note on Some Aspects of Evange- forms. It could mean the resto- ments of this mission. lization, n. 9). ration of physical health or a re- By fostering an awareness that establishment of the sick person’s the human person in his frailty psychological, social and spiritual 5. Conclusion stands at the centre of all medical harmony even when the complete and healthcare work, the health- physical healing is not achieved. We live in times in which there care facility becomes “a place in Indeed prayer helps one to trans- is a strong cultural war between which the relationship of treat- form illness into a journey of faith the culture of life and the culture ment is not a profession” – your that gradually helps the sick per- of death. There is indeed a wide- relationship of treatment is not son to strengthen their relation- spread cultural, social and spir- a profession – “but a mission; ship with God, learn the lessons itual crisis, which poses a great where the charity of the Good Sa- of human weakness and limited- challenge to the Church’s work of maritan is the first seat of learn- ness, have a renewed adherence evangelizing the family, the cra- ing and the face of suffering man to the fundamental options of life, dle of human life. is the Christ’s own Face” (Bene- grow in solidarity with those who The challenge of the anti-life dict XVI, Address at the Catholic suffer and deepen their faith in mentality certainly touches the University of the Sacred Heart, 3 eternal life. core mission of Catholic health- May 2012). It is therefore praiseworthy care workers, as custodians and Dear nurses and midwives you that the faithful ask for healing servants of life. Catholic nurses are called to care for life at its in- for themselves and for others. and midwives are called to pro- itial stage; remind everyone, by Moreover the Church in her lit- claim the gospel of life and pro- word and deed, that this is sa- urgy prays for the health of the mote a mentality that is more cred – at each phase and at every sick. In celebrating the Sacra- open to life, offering couples age – that it is always valuable. ment for the Anointing of the proper support and guidance on And not as a matter of faith – no, Sick, the Church commends her responsible parenthood, and pro- no – but of reason, as a matter of sick members to the Lord, that he tecting the human life from con- science! There is no human life may raise them up and save them. ception to its natural end. This is more sacred than another, just as “Obviously, recourse to prayer a mission that you are to accom- there is no human life qualitative- does not exclude, but rather en- plish as individual Christians, as a ly more significant than another. courages the use of effective nat- professional group at your places The credibility of a healthcare ural means for preserving and re- of work, as an association, as well system is not measured solely by storing health, as well as leading as in the communities by being efficiency, but above all by the at- the Church’s sons and daughters involved in the family apostolate. tention and love given to the per- to care for the sick, to assist them At this point, I wish to conclude son, whose life is always sacred in body and spirit, and to seek to with the exhortation of Pope Fran- and inviolable. cure disease. Indeed, part of the cis to Catholic health-care work- Never fail to ask the Lord and plan laid out in God’s providence ers: “be witnesses and spreaders the Virgin Mary for the strength is that we should fight strenuous- of the “culture of life”. Your being to accomplish your work well ly against all sickness and care- Catholics entails a greater respon- and to bear witness courageous-

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ly – courageously! Today courage 12 John Paul II, Encyclical Letter Evan- 30 Charter for Health Care Workers, n. 40. gelium Vitae, 89. 31 John Paul II, “Message for the Eighth is needed – to bear witness cou- 13 John Paul II, Encyclical Letter Evan- ,” n.13, in Dolentium rageously to the “gospel of life”! gelium Vitae, 1. Hominum 42 (1999), p. 9. Thank you very much.”47 14 Charter for Health Care Workers, n.1. 32 Francis, Address to Participants in 15 Ibid, n.6. the Meeting Organized by the Internation- 16 Synod of Bishops, III Extraordinary al Federation of Catholic Medical Associa- General Assembly: The Pastoral Challenge tions, 20 September 2013, n. 2. Notes of the Family in the Context of Evangelisa- 33 Ibidem. tion, Instrumentum Laboris, Vatican City, 34 Charter for Health Care Workers, n. 1 Synod of Bishops, III Extraordinary 2014, n. 121. 121. General Assembly: The Pastoral Challenge 17 Ibid., n. 130 35 Cf. Congregation for the Doctrine of of the Family in the Context of Evangelisa- 18 Cf. Paul VI, Humanae Vitae, n. 12. Faith, “Responses to Certain Questions of tion, Instrumentum Laboris, Vatican City, 19 Benedict XVI, Encyclical Letter Car- the United States Conference of Catholic 2014, p. 1. itas in Veritate, n. 28. Bishops Concerning Artificial Nutrition and 2 Francis, Apostolic Exhortation Evan- 20 Charter for Health Care Workers, n. 15. Hydration,” (1 August 2007), in AAS 99 gelii Gaudium on the Proclamation of the 21 Cf. Synod of Bishops, III Extraor- (2007) 820. Gospel in Today’s World, Vatican City, dinary General Assembly: The Pastoral 36 Cf. Congregation for the Doctrine of 2013, n. 61. Challenge of the Family in the Context of Faith, Declaration on Euthanasia, 5 May 3 Cf. John Paul II, Post Synodal Apos- Evangelisation, Instrumentum Laboris, n. 1980. tolic Exhortation Chistifideles laici, 38. 128. 37 John Paul II, Address to the partici- 4 Congregation for the Doctrine of Faith, 22 Francis, Address to Participants in pants in the International Congress of the Declaration on procured abortion, 18 No- the Meeting Organized by the Internation- Omnia Hominis Association (August 25, vember 1974, n. 11 al Federation of Catholic Medical Associa- 1990) n. 3. 5 Cf. John Paul II, Encyclical Letter tions, 20 September 2013, n. 2. 38 Charter for Health Care Workers, n. 131. Evangelium Vitae, 53. 23 John Paul II, Discorso in occasione 39 Cf. Charter for Health Care Workers, 6 GS, 22. dell’anniversario di fondazione della scuola n. 2. 7 Cf. John Paul II, Encyclical Letter per infermieri professionali “Armida Barel- 40 Cf. Charter for Health Care Workers, Evangelium Vitae, 2. li, 27 maggio 1989. n. 7. 8 Cf. CCC, n. 2288. 24 Benedict XVI, Africae Munus, n. 70. 41 Cf. Care Workers, n. 7 9 John Paul II, Encyclical Letter Evan- 25 Benedict XVI, Message to Partici- 42 John Paul II, Salvifici Doloris, n. 4. gelium Vitae, 1. pants in the 25th International Conference 43 Benedict XVI, Spe Salvi, n. 38. 10 Pontifical Council for Pastoral As- Organized by the Pontifical Council for 44 Charter for Health Care Workers, n. 2. sistance to Health Care Workers, Pastoral Health Care Workers, 15 November 2010. 45 Cf. Congregation for the Doctrine of Care in Health and the New Evangelisation 26 Charter for Health Care Workers, n.11, Faith, Instructions on Prayers for Healing, for the Transmission of the Faith, Velar, see also nn. 21-34. n. 2. Gorle 2014, p. 43. 27 Ibid., n. 35. 46 Cf. Charter for Health Care Workers, 11 Pontifical Council for Pastoral Assis- 28 Cf. Congregation for the Doctrine of n. 4 tance to Health Care Workers, Charter for Faith, “Instruction Dignitas Personae on 47 Francis, Address to Participants in Health Care Workers, Vatican Press, Vati- Certain Bioethical Questions,” 8 September the Meeting Organized by the Internation- can City 1995, n.1. Henceforth Charter for 2008, n. 4. al Federation of Catholic Medical Associa- Health Care Workers. 29 Charter for Health Care Workers, n. 40. tions, 20 September 2013, n. 3.

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Pope Francis’ Theology of Accompaniment Keynote Address sent by Archbishop Zygmunt Zimowski

Pope Francis’ Theology of Accompaniment: Bioethics Applications 25° Bishop’s Workshop February 2-4, 2015 Dallas, USA

H.E. Msgr. and all suffering contradicted, but 1. Seeing Christ in the Faces Zygmunt Zimowski it is affirmed that in Christ pain of the Sick and the Suffering the President of the and suffering are a reality which Pontifical Council in their final analysis open up to A first answer of Pope Fran- for Health Care Workers, another form of life. While they cis to this question is when in the Holy See walk in history, Christians do not the apostolic exhortation Evan- ignore evil and pain but they do gelii gaudium he expresses all of know that in it God – through the his suffering in the face of a sub- ver since her beginnings, the incarnation of His Son – placed a culture ‘of rejection and throwing EChurch has always borne wit- seed of eternity and salvation. away’, in the face of indifference ness to special care and concern The parable of the ‘Good Sa- towards the very many who suffer for sick and suffering people maritan’ in the Gospel of Luke because they are sick, poor and through the work of her members (10:25-37), which has already abandoned, and in the face of the and her institutions, upholding the been quoted, offers a summary very many forms of suffering that inviolable human dignity of such of the teachings and the action are caused by a bad use of human people during these special mo- of Christ about what taking care freedom. 2 ments of human existence as well. of sick and suffering people as a Medieval thought about the In the parable of the Good Sa- Church means. For this reason, it face of Christ – which was maritan, which has been a model is no surprise that some Fathers wounded, stained with blood and and a guiding image for the care of the Church emphasized how disfigured – continued Patristic institutions of the Church, the the first great ‘Good Samaritan’ thought about Christ present in most specific message relates not is Christ himself. He was the first, the poor, and Pope Francis has only to the duty to care for those as the Son of God who took on taken up this thinking about the who are wounded, in this case a our humanity (as they said in their face of Christ in order to see in ‘man who is half dead’, but also language), to get off his ‘mount’ him the wounded and disfigured the obligation to provide that care and draw near to man wounded by face of suffering humanity.3 which is specific to the command- sin; he cared for him and took him The thought of the Pope as re- ment to love one’s neighbor. to the ‘inn’ (the Church) where he gards the sick starts, therefore, This care and concern has its left as a gift what was needed for from Christ, following in this way fundamental motivation in the his complete salvation (the Word the vision and the teaching of the mandate ‘go and heal the sick’1 of God, the sacraments of faith, Fathers of the Church, starting which was entrusted by Christ to and the nearness of pastors and with chapter XXV of Matthew on his Church. This specific man- the community). The attitude of the final judgment. date, on the basis of the teaching the Samaritan was described as an There is another strong image and the action of the Lord Jesus, attitude of compassion (‘seeing that Pope Francis has offered to confers on the Church the task of him he had compassion for him’) express this silent presence of taking care of and healing people and practical accompaniment: ‘he Christ in the suffering and in the who are sick, suffering, poor and drew near to him’, ‘he bandaged sick – that of the flesh of Christ, in need of support. his wounds and poured oil and present almost physically in the Side by side with providing wine on them’, ‘he put him on his painful and wounded flesh of the care we should place the pro- mule’, ‘he took him to an inn’, ‘he sick.4 This is a real, almost Eu- claiming of the Kingdom be- took care of him’. charistic, presence: just as Christ cause in the light of Christ hu- Faced with the merciful behav- who offers himself on the cross is man pain acquires new meanings. ior of Christ, the Church has al- present in the consecrated bread What pain represents in human ways been called upon and asks and wine, so the wounded and life is not minimized, nor is its herself still today how in present- suffering Christ is within the suf- psychological and spiritual as- day situations the merciful action fering flesh of the sick and the pect denied, nor is the obligation of Christ towards the sick and the poor, in the wounds of the sick, to relieve pain and to prevent and suffering can made present in a wounds within wounds, flesh counter the causes of every illness more faithful way. within flesh.5 For Pope Francis,

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these very wounds are the me- 2. The Sick are a Precious that he bore, our sufferings that diation between Jesus in heaven, Treasure for the Church he endured’. This is done almost who shows us his wounds, a sign to highlight how in the compas- of victory and of hope, and us Frail and suffering people have sionate action of Jesus one can here on earth, when we care for witness to bear, an apostolic role see the sign of the participation the same wounds in the person of to perform. One is dealing with of God Himself in the suffering a sick brother or sister. appreciating and valuing their of man. For health-care workers and for presence, developing pastoral This participation of God in anybody who cares for a sick or care that includes them, in parish- the suffering of man is pointed suffering person, the question is es and in Christian associations.11 out to the Church by the empha- immediately posed of the reason With their sufferings, bearing ses in the letters of St. Paul and for human suffering. Pope Francis them with patience, with joy of in the Gospel of John on ‘being states that Jesus ‘did not remove the heart, the sick constitute, in Christ’ and ‘living in Christ’. illness and suffering from human Pope Francis observes, a ‘pre- This is also done with extraordi- experience but by taking them up- cious treasure for the Church’.12 nary force and clarity in the Gos- on himself he transformed them This is, says the Pope, a ‘charism pel of Matthew (25:31-46) where and gave them new meaning. of the suffering’, a charism that Jesus assimilates himself to all New meaning because they no makes a person who suffers with sick people, suffering people, longer have the last word which, hope and peace in his or her heart poor people, and all those in need instead, is new and abundant life; a ‘gift for the Church’.13 who are cared for, telling those transformed them, because in un- Health-care workers and all who have cared for them ‘what- ion with Christ they need no long- those who dedicate themselves ever you did for one of these least er be negative but positive’.6 to accompanying sick people in brothers of mine, you did for me’ As regards human suffer- their trials are thus invited by (25:40). ing connected with illness, Pope Pope Francis to go beyond simple This is a declaration made in Francis observes that ‘Health is accompaniment, beyond the duty the context of the ‘final judg- certainly an important value, but of solidarity, and really appreci- ment’ which calls on us constant- it does not determine the value ate the presence and the witness ly as a Church and as Christians of a person’; ‘health in and of it- of frail and suffering people, not as regards how to relate to, and self is no guarantee of happiness’. only as recipients of evangelizing take care of, sick and suffering ‘This may occur even in the pres- work but also as active subjects people. Pope Benedict XVI ex- ence of poor health’. There is no of this apostolic action itself.14 pressed himself with extreme contradiction between ‘the full- clarity in his encyclical Spe sal- ness towards which every human vi when he observed: ‘The true life tends’ and ‘a condition of ill- 3. Accompaniment Following measure of humanity is essential- ness and suffering’. ‘The call to the Example of God who ly determined in relationship to human fulfillment does not ex- Shares in Human Pain suffering and to the sufferer. This clude suffering’.7 holds true both for the individual But here we find the problem Faith, observes Pope Francis, and for society. A society unable of today’s culture. This is that ‘illumines life and society. If it to accept its suffering members ‘widespread mentality of the use- possesses a creative light for each and incapable of helping to share ful’ which Pope Francis calls, as new moment of history, it is be- their suffering and to bear it in- has been observed, the culture of cause it sets every event in rela- wardly through “com-passion” is throwing away, a culture ‘that to- tionship to the origin and destiny a cruel and inhuman society’.16 day enslaves the hearts and the in- of all things in the Father’.15 This To this statement Pope Fran- telligences of very many people’ is a faith that also illumines suf- cis adds that ‘A society truly wel- and which requires the elimination fering in order to give it meaning. comes life when it recognizes of human beings above all if they But which also invokes answers that it is also precious in old age, are physically or socially weaker.8 of care, of nearness, of hope and in disability, in serious illness The throw-away culture ‘tends to of love. This is an accompani- and even when it is fading’.17 A hide physical weakness, consider- ment that must transmit the cer- society truly welcomes life, Pope ing it only as a problem that re- tainty that every person can expe- Francis continues in the same quires resignation and pity or that rience God’s sharing in his or her Message, when it teaches people at times casts people aside’.9 pain. Not with a simple nearness to see in the sick and suffering, It is precisely because of this but with an interior, loving and si- beyond a simple appeal to as- ‘throw-away culture’, states Pope lent presence which shares in that sistance, also ‘a gift for the en- Francis, that ‘concern for human painful situation. tire community, a presence that life in its totality has become in Of significance here is verse summons them to solidarity and recent years a real priority for the 8:17 of the Gospel of Matthew responsibility’. The Pope also Church’s Magisterium, especially which, after speaking about Jesus observes: ‘this is a sign of true for the most defenseless; i.e., the who with his words casts out a citizenship, human and Chris- disabled, the sick, the newborn, demon and heals very many sick tian! Put the most disadvantaged children, the elderly, those whose people, refers to a text of Isaiah people at the centre of social and lives are most defenseless’.10 (53:4): ‘Yet it was our infirmities political attention’.18

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4. The Conditions for Service tian service is. To draw near to – in his merciful love for man and to the Suffering Person the suffering person with ‘ten- for the world – embraces even der love’, says Pope Francis, is the most inhumane situations’. But Pope Francis also speci- to bring ‘hope and God’s smile to ‘In Him every human pain, every fies the characteristics of practical the contradictions of the world’.24 anxiety, every suffering was taken accompaniment. The first condi- To bring the smile of God is ‘to on out of love, out of pure desire tion that is necessary for service do good by one’s suffering and to be close to us, to be with us’.30 to the suffering person following to do good to those who suffer’.25 The second words are to observe Christ is to adopt a specific ‘life- But this dedicating of oneself is that ‘the Church sees in the sick a style’ – that of generous devotion. not a one-way process: when one special presence of the suffering ‘The proof of authentic faith in brings the smile of God to a sick Christ’. Pope Francis then adds Christ’, declares Pope Francis, ‘is person, when one dedicates one- that side by side with, indeed in- self-giving and the spreading of self to him or her without seeking side, human suffering, there is the love for our neighbors, especially power, in a true spirit of solidar- suffering of Christ who bears its for those who do not merit it, for ity and sharing, when one draws burden together with the sick per- the suffering and for the margin- near to him or her with the tender- son and reveals its meaning.31 alized’.19 Service to the suffering ness of God, this service makes person then requires a second con- one ‘grow in humanity’ because dition, that of leaving at the door ‘those who are in great need…are 6. The Human Reaction to any search for power because ‘true true resources of humanity’.26 Suffering power is service. As he did so we But Pope Francis also has must follow him on the pathway of words that directly concern the There are, the Pope says, two service’.20 Such solidarity requires pastoral ministry of the Church reactions to suffering when it falls ‘sharing’ with the person who suf- towards the sick, specifically on the shoulders of a person and fers, recognizing ‘his dignity’ and in offering the sacrament of the totally changes his or her life and ‘his value’; it requires seeing ‘the anointing of the sick. The Pope projects. These reactions are: ask- beauty of human life’ in suffering has referred to difficulties that ing why and weeping. The first people and understanding that this this sacrament still encounters to- attitude is that of ‘why’, why this beauty ‘includes its frailty’.21 day, being marked historically by illness? Why am I in this situa- A fundamental quality for the the common view that it is the last tion? As regards this prayer of person who dedicates himself or rite, and has stressed strongly that why, Pope Francis observes, ‘In herself to service to the sick is the visit of a priest to a sick per- these moments of great suffering, knowing how to listen to them. son is not to frighten him but, on do not tire of asking: “why?” as The wounds of Jesus in the wounds the contrary, to ‘give hope’.27 children do.... And thus you draw of the sick need to be heard and to Where in the sacrament of our Father’s eyes to your people; be recognized.22 Pope Francis then anointing it is Jesus himself who you draw the affection of our Fa- asks for a final quality in the per- takes care of the suffering man ther in Heaven upon you. Like a son who accompanies a sick per- and pours oil and wine on his child asks: “Why? Why?”. In mo- son – that of ‘joy’ of the heart. This wounds, Pope Francis states that ments of pain, let this strength be is not a matter of artificially having the innkeeper is pastoral workers prayer: the prayer of the “why?”, a joyful attitude but, rather, of liv- because Christ entrusts to them without asking for explana- ing the joy that comes from faith. ‘those who are afflicted in body tion, asking only that our Father ‘A joy that is felt’, comments Pope and spirit, so that we might lavish watch over us’.32 After the ‘why’ Francis. It is no use saying ‘be all of his mercy and salvation up- comes the moment of weeping. strong, be strong’ to a sick person on them without measure’.28 This The truth, observes the Pope, is when one’s own heart has not en- is not a miracle or a therapeutic that there are many reasons for tered joy and does not spread joy effect, Pope Francis continues: weeping in life; human life and around it. To have such joy, which the comfort that the patient re- Christian life are not always ‘a is felt, to live such joy, there is no ceives from the anointing ‘comes party’.33 For a sick person, a suf- other pathway than that of faith. It from the fact that it is the Lord Je- fering person tempted by weeping is Christian faith that allows us to sus himself… who takes us by the and hopelessness, by self-closure, say to a sick person ‘be strong, be hand, who caresses us as he did says Pope Francis, it is important strong’ without this being felt to with the sick, and who reminds us to recognize that the life situation be artificial and contingent. ‘This that we already belong to him and that he or she has to address is ‘a is faith, this is the act of faith that that nothing – not even evil and trial, indeed it is the moment of Jesus asks for’.23 death – can ever separate us from trial’, announced by the Lord, the him’.29 moment of darkness in which it is However in the field of pasto- difficult to see, or one really can- 5. Bringing ‘hope and God’s ral accompaniment Pope Francis not see, joy.34 smile to the contradictions of also has words for the sick them- Jesus, says the Pope, to begin the world’ selves. The first are to assure them with invites us to have courage, to that even when they are living in overcome the trial with patience,35 Now, we can ask ourselves a condition of loneliness they are but, the Pope goes on, courage on what the objective of this Chris- not alone: God is with them. ‘God its own is not enough. There is a

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need for hope which comes from eous man who enjoys a certain ular of those who have positions the paschal light. Courage and authority and a place of prestige of responsibility. Thus state and hope together: ‘hope, because in amongst the elders of the city. His economic structures must also be the plan of God’s love even the moral stature is expressed in the finally created to retrieve the dig- night of pain yields to the light of service he gave to the poor who nity of people in need and be able Easter, and courage, which ena- sought his help and in his care for in an effective way help the sick bles us to confront every hardship orphans and widows (vv.12-13).38 and the suffering. Pope Francis in his company, in union with Pope Francis adds: ‘how many observes that ‘The need to resolve him’.36 Christians show, not by their the structural causes of poverty words but by lives rooted in a cannot be delayed, not only for the genuine faith, that they are “eyes pragmatic reason of its urgency 7. The Church is Called to to the blind” and “feet to the for the good order of society, but ‘have Compassion’ lame”! They are close to the sick because society needs to be cured in need of constant care and help of a sickness which is weakening However there is also the need in washing, dressing and eating. and frustrating it, and which can to know how to ‘have compas- This service, especially when it is only lead to new crises’.41 sion’, starting with the affections protracted, can become tiring and Accompaniment and concern of natural ties. And here Pope burdensome. It is relatively easy for the sick also involves ethical Francis observes how the first to to help someone for a few days and bioethical problems. Pope provide help are relatives, fami- but it is difficult to look after a Francis states that there ‘is no lies, who often reach the lim- person for months or even years, doubt that, in our time, due to its of their physical, psychologi- in some cases when he or she is scientific and technical advance- cal but also spiritual strength but no longer capable of expressing ments, the possibilities for physi- who continue to give help and as- gratitude. And yet, what a great cal healing have significantly in- sistance, with prayers in silence path of sanctification this is! In creased… In effect, medical and as well, with deeds of love, be- those difficult moments we can scientific achievements can con- ing at the bedsides of their sick rely in a special way on the close- tribute to improving human life, relatives. The Pope observes that ness of the Lord, and we become provided that they are not separat- ‘Only from the affective connatu- a special means of support for the ed from the ethical root of these rality born of love can we appre- Church’s mission’.39 disciplines’.42 ciate the theological life present The Church, the Pope has de- Dominant thought, the Pope in the piety of Christian peoples, clared, is aware that despite every- goes on, at times proposes a ‘false especially among their poor’. The thing good continues to be strong- compassion’ – that which believes Pope then refers to the steadfast er than evil; that very many ‘Good that fostering abortion constitutes faith of mothers ‘tending their Samaritans’ continue to work still help for a woman, that to pro- sick children who, though perhaps today and take loving care of all cure euthanasia is an act of dig- barely familiar with the articles of suffering people; ‘Suffering re- nity, that ‘producing’ a child seen the creed, cling to a rosary; or of minds us that faith’s service to the as a right rather than welcoming all the hope poured into a candle common good is always one of him or her as gift is a scientific ad- lighted in a humble home with a hope – a hope which looks ever vance, or that using human lives prayer for help from Mary’.37 ahead in the knowledge that only as laboratory animals to save, it is Those roles of a ‘Church go- from God, from the future which presumed, others, is such an ad- ing forth to all the outskirts’ and a comes from the risen Jesus, can vance as well. The compassion of ‘Church of open doors’, described our society find solid and lasting the Gospel, instead, is that com- on a number of occasions by the foundations…The dynamic of passion that accompanies during Pope, should be emphasized. faith, hope and charity (cf. 1 Th moments of need, that is to say Both are connected with the sick 1:3; 1 Cor 13:13) thus leads us to the compassion of the Good Sa- and the disabled who – because of embrace the concerns of all men maritan.43 their infirmities, often in chronic and women on our journey to- When Pope Francis spoke to or degenerative forms, and be- wards that city “whose architect medical doctors he added that cause of the extreme precarious- and builder is God” (Heb 11:10), ‘Faithfulness to the Gospel of ness of health-care systems in for “hope does not disappoint” life and respect for life as a gift many countries of the world – (Rom 5:5)’.40 from God sometimes require constitute a special form and con- But what has been said means brave choices that go against the dition of being ‘outskirts’. And that the concern to provide assis- current, which in particular cir- there is also the Church as a ‘field tance is a reality which, albeit in cumstances may become points hospital’ which should be pro- different ways together, must call of conscientious objection. This moted in the field of health care upon and involve everyone as faithfulness brings with it many and health. keepers ‘of their brothers and sis- social consequences. We are liv- In the discourse of Job which ters’. For families and the action ing in a time of experimentation contains the words ‘I was eyes to of the Church, in order to support with life. But it is harmful ex- the blind, and feet to the lame’, we the various situations of suffering, perimentation. Making children, find highlighted the dimension of of poverty, the commitment of rather than accepting them as a service to the needy by the right- everyone is needed, and in partic- gift, as I said. Playing with life.

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Be careful, because this is a sin can make a drop of balsam fall 21 Address to those taking part in the ple- nary assembly of the Pontifical Council for against the Creator: against God on the deepest and most painful Health Care Workers, 24 March 2014. the Creator, who created things wounds’. 22 Meeting with the disabled and sick this way’.44 Thank you! children of the Seraphic Institute, Assisi, 4 October 2013. And he then explained, pro- 23 Homily, Chapel of Domus Sancta Mar- viding examples, that the answer ta, 30 May 2013. to why the Church is opposed to Notes 24 Message for the XXII World Day of the Sick, 11 February 2014. abortion and to euthanasia is not a 1 Lk 10:9; Mt 10:7-8; Mk 6:12-13. 25 Address to those taking part in the ple- religious answer or a philosophi- 2 Apostolic exhortation Evangelii gaud- nary assembly of the Pontifical Council for cal or scientific answer, nor can ium, n. 111 Health Care Workers, 24 March 2014. 3 Cf. Address to those taking part in the 26 Meeting with the disabled and sick it be justified in modern thought, plenary session of the Pontifical Council for children of the Seraphic Institute, Assisi, 4 because in ancient and modern Health Care Workers, 24 March 2014. October 2013. thought the word ‘kill’ means 4 Ibidem. 27 General Audience, 26 February 2014. 5 Meeting with the disabled and sick chil- 28 General Audience, 26 February 2014. the same. St. Camillus de Lellis, dren of the Seraphic Institute, Assisi, 4 Oc- 29 General Audience, 26 February 2014. in suggesting the most effective tober 2013. 30 Address to those taking part in the ple- method of caring for the sick, said 6 Message for the XXII World Day of the nary assembly of the Pontifical Council for Sick, 11 February 2014. Health Care Workers, 24 March 2014. simply ‘put more heart in those 7 Message to those taking part in the gen- 31 Address to those taking part in the ple- hands’. And this is also the hope eral assembly of the Pontifical Academy for nary assembly of the Pontifical Council for of the Pope.45 Life on the occasion of the twentieth anni- Health Care Workers, 24 March 2014. versary of its institution, 19 February 2014. 32 To the Filipino community, St. Peter’s 8 Address to those taking part in the Basilica, 21 November 2013. meeting organized by the International Fed- 33 Homily, Chapel of Santa Marta, 30 Conclusion eration of Associations of Catholic Doctors, May 2014. Rome, 20 September 2013. 34 Cf. Homily, Chapel of Santa Marta, 30 9 Address to the pilgrims of UNITALSI, May 2014. In conclusion, Pope Francis Rome, 9 November 2013. 35 Homily, Chapel of Santa Marta, 30 points very strongly to the way 10 Address to those taking part in the May 2014 of Mary in accompanying the meeting organized by the International Fed- 36 Message for the XII World Day of the eration of Associations of Catholic Doctors, Sick, 11 February 2014. sick person and for the sick per- Rome, 20 September 2013. 37 Evangelii gaudium, n. 125. son himself or herself in finding 11 Address to the pilgrims of UNITALSI, 38 Message for the XXIII World Day of strength in hours of trial. This em- Rome, 9 November 2013. the Sick, 15 February 2015. 12 Address to the pilgrims of UNITALSI, 39 Message for the XXIII World Day of the phasis has certainly deep roots in Rome, 9 November 2013. Sick, 15 February 2015. the faith of the Pope which per- 13 To the Silent Workers of the Cross and 40 Lumen fidei, n. 57. haps find their genesis in the the Centre for Volunteers of Suffering, 17 41 Evangelii gaudium, n. 202. May 2014 42 Address to the Association of Italian words addressed to the young Jo- 14 Address to the pilgrims of UNITALSI, Catholic Doctors on the occasion of the se Mario Bergoglio and the oth- Rome, 9 November 2013. seventieth anniversary of its foundation. er grandchildren by their grand- 15 Lumen fidei, n. 55. Rome, 15 November 2014. 16 Spe salvi, n. 38. 43 Address to the Association of Italian mother who said to them: ‘Have 17 Message to those taking part in the gen- Catholic Doctors on the occasion of the long and happy lives, however if eral assembly of the Pontifical Academy for seventieth anniversary of its foundation. on some days pain, illness or the Life on the occasion of the twentieth anni- Rome, 15 November 2014. versary of its institution, 19 February 2014. 44 Address to the Association of Italian loss of a loved one fill you with 18 Meeting with the disabled and sick Catholic Doctors on the occasion of the dismay, remember that a sign in children of the Seraphic Institute, Assisi, 4 seventieth anniversary of its foundation. front of the Tabernacle, where the October 2013. Rome, 15 November 2014. greatest and most august martyr 19 Message for the XXII World Day of the 45 Address to the Association of Italian Sick, 11 February 2014. Catholic Doctors on the occasion of the can be found, and a look at Mary, 20 Homily, Chapel of Domus Sancta Mar- seventieth anniversary of its foundation. who is at the foot of the cross, ta, 22 May 2013. Rome, 15 November 2014.

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