VADE ET TU FAC SIMILITER: from HIPPOCRATES to the GOOD SAMARITAN 69 AIDS As a Disease of the Body and the Spirit the Hippocratic Oath Robert C

Proceedings of the Tenth International Conference

organized by the Pontifical Council DOLENTIUM HOMINUM for Pastoral Assistance No. 31 (Year XI - No.1) 1996 JOURNAL OF THE to Health Care Workers PONTIFICAL COUNCIL FOR PASTORAL ASSISTANCE TO HEALTH CARE WORKERS

Editorial Board: FIORENZO Cardinal ANGELINI, Editor Rev. JOSÉ L. REDRADO O.H., Managing Editor Rev. FELICE RUFFINI M.I., Associate Editor Rev. GIOVANNI D’ERCOLE F.D.P. Vade et Tu Sr. CATHERINE DWYER M.M.M. Dr. GIOVANNI FALLANI Msgr. JESUS IRIGOYEN Rev. VITO MAGNO R.C.I. Fac Similiter: Ing. FRANCO PLACIDI Prof. GOTTFRIED ROTH From Hippocrates Msgr. ITALO TADDEI To the Good Editorial Staff: Rev. DAVID MURRAY M.ID. Samaritan MARIA ÁNGELES CABANA M.ID. Sr. M. GABRIELLE MULTIER Rev. JEAN-MARIE M. MPENDAWATU

Editorial and Business Offices: Vatican City Telephone: 6988-3138, November 23-24-25, 6988-4720, 6988-4799, Telefax: 6988-3139 1995 Telex: 2031 SANITPC VA In copertina: glass-window P. Costantino Ruggeri Published three times a year: Subscription rate: one year Lire 60.000 (abroad or the corresponding amount in local currency, postage included). The price of this special issue is Lire 80,000 ($ 80) Printed by Editrice VELAR S.p.A., Gorle (BG) Paul VI Hall Vatican City Spedizione in abbonamento postale 50% Roma Contents

6 A Man Went Down to Jericho 42 Hippocrates in the Documents of the Greeting Addressed to the Holy Father Church and in Works of Theology by Cardinal Fiorenzo Angelini Gottfried Roth 7 Address by the 45 The Care of the Sick Holy Father in the History of the Church John Paul II Jesús Alvarez Gómez 9 The Hippocratic Oath and the 48 The Charter for Health Care Workers: Parable of the Good Samaritan A Synthesis of Hippocratic Ethics and Christian Morality 10 The Meaning Bonifacio Honings of a Historical Trajectory 53 Healing Wounds: The Rachel Groups Fiorenzo Angelini John O’Connor 12 Where There Is Love for the Art 56 The Sacredness of Life of Medicine There Is Love for Man in Pagan Philosophy Vincenzo Cappelletti Jean-Marie Meyer

15 “A Man Went Down from 59 The Religiosity of Medicine Jerusalem to Jerico” (Lk 10:30) Luigi Maria Verzé Paul Poupard 65 Primum Philosophari? Sergio Cotta VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 69 AIDS as a Disease of the Body and the Spirit The Hippocratic Oath Robert C. Gallo 22 in the Development of Medicine Diego Gracia Guillén 72 The Integral Training of the Physician The Ethical Dimension of Hippocratic for Care of the Sick 29 Medicine and Its Specific Gottieb Monekosso Relationship to Christian Morality Bruno Zanobio 76 Medicine and Christianity Contemporary Ethical Codes Francisco Eduardo Trusso 33 of Professional Conduct Gonzalo Herranz Rodríguez 78 Judaism Elio Toaff 37 Care for the Sick and the Fathers of the Church 82 Medical Ethics and Islam Carlo Cremona Ahmed Zribi 86 Language 133 The Civilization of Sadness and the Dissemination and the Culture of Joy of Medicine Stanislaw Grygiel Alessandro Beretta Anguissola 137 The Responsibility of the Medical 88 The Doctor-Patient Relationship in Doctor and the Life of the Patient Medical Textbooks and Manuals of the Wanda Poltawska Eighteenth and Nineteenth Centuries Massimo Baldini 141 The Embryo: A Sign of Contradiction 93 The Doctor: A Man for All Elio Sgreccia Domenico Di Virgilio 143 Jérôme Léjeune: 98 The Biblical Icons of Life A Scientific and Christian Profile Ignace De La Potterie Marie-Odile Rethoré 104 The Hospital: 146 The Cultural Anthropology The Temple of Suffering Humanity of the Right to Life Pascual Piles Adriano Bausola

107 Secular Thought on the Mission 150 The Origin of the Concept of the Person: of the Medical Doctor Four Variations on the Suggested Theme Anton Neuwirth Tadeusz Styczen 155 110 The Family as the Subject The Horizons of Fetal Medicine of Health and Illness and Its Ethical Consequences Salvino Leone Emmanuel Sapin 159 115 The Technological Challenge Respect for Life and Biomedical Research of Modern Medicine Bruno Silvestrini Johannes Bonelli 163 The Human Brain: From Hippocrates 119 Respect for to the Present Development the Patient's Privacy of the Neurosciences Erwin Odenbach Carla Giuliana Bolis 124 The Hippocratic Example 168 The Overcoming of Emphasis of the Neutrality and Universality on Pain in the Christian of Medicine Conception of Suffering Karl-Otto Habermehl Cettina Militello 127 Suffering and the 173 Palliative Medicine Meaning of Life and Christian Eschatology Jesús Conde Corrado Manni 178 Women in the History 215 A Free Gift of Care for the Sick and an Act of Solidarity An Verlinde Fernando Antezana, 182 The Primacy of Life Under All Conditions, ROUND TABLE: With Special Reference to Africa THE GOOD SAMARITANS Bernardin Gantin 218 Marcello Candia 186 Health Care and Quality of Life: Ennio Apeciti Taiwan's Experience Yaw-Tang Shih 226 Albert Schweitzer Richard Brullmann 190 The Primacy of Life George Alleyne 230 Florence Nightingale Susanna Agnelli 194 The Pedagogy of Pain 235 Henry Dunant Francis Arinze Cornelio Sommaruga 237 Raoul Follereau: 198 The Good Samaritan (Lk 10:29-37) Apostle of the Lepers Biblical Hermeneutics of the Parable André Recipon Albert Vanhoye 240 Abbot Hildebrand Gregory 203 The Good Samaritan as an Simone Tonini Anthropological Category Ignacio Carrasco De Paula 244 Dr. Janusz Korczak Janusz Bolonek 206 The Model of the Good Samaritan in the History of Hospital Care 248 Pastoral Medicine in Bosnia and Angelo Brusco Herzegovina During the State of War, with Special Reference to Sarajevo 211 The Virtues of the Good Samaritan: Vinko Puljic Health Care Ethics in the Perspective of a Renewed Moral Theology 252 War Medicine J. Augustine Di Noia Bozo Ljubic

The illustrations have been taken from the book Giorni del Medioevo. The miniatures of the “Très Riches Heures” of the Duke of Berry Italian Edition, Rizzoli, Milan, 1989. 6 DOLENTIUM HOMINUM

GREETING ADDRESSED TO THE HOLY FATHER BY HIS EMINENCE CARDINAL FIORENZO ANGELINI A Man Went Down To Jericho

Holy Father, once again you have wanted to expression of evangelical and rational values. take part in the conclusion to the annual inter- Indeed, if it is true, as Evangelium Vitae af- national conference organized by the Pontifi- firms, that “in life there is certainly a sacred cal Council for Health Care Workers. This is and religious value, in no way does this value the tenth such international conference. concern only believers: if it is a value which Your contributions, Holy Father, to the sub- every human being can understand, in the light jects of great relevance discussed by these of reason as well, and which therefore neces- conferences constitute vital points of reference sarily concerns everybody” (no. 101). for doctrine and practice in the vast, intricate For you, Holy Father, the road which goes and ever more complicated field of the rela- down from Jerusalem to Jericho is the road tionship between science and its practical ap- which traverses our whole planet: a road plication, and between biomedicine in its which you have gone down and continue to widest forms of expression and moral law. walk along tirelessly in order to meet the innu- We thank you greatly for your fatherly par- merable victims of the violence of our times ticipation, a participation which is another ex- and our days. ample of the extraordinary and providential at- Just as the illuminated medieval scribe tran- tention paid by you to the very serious ques- scribed the Hippocratic oath in the form of a tions and problems which now concern the cross, so you have made the advancement and world of health policy and care. the defense of life the meeting point for the On the tenth anniversary of this Council, Gospels, for knowledge, and for belief. whose establishment you sought in order to Thank you, Holy Father, for this secure and demonstrate that the solicitude of the Church strong guidance which gives us the hopeful infor the suffering and the sick, and for health telligence and the exemplary courage to fight a care workers at all levels of responsibility, is difficult—because decisive—battle. an integral part of her mission, this tenth inter- We have already begun our preparations for national conference has addressed itself to the the next international conference, which will subject: “Vade et Tu Fac Similiter: From Hip- be held in 1996. The general subject of the pocrates to the Good Samaritan.” conference will be: Allow me, Holy Father, to observe that your “In the Image and Likeness of God: Magisterium and ministry are the living, Always? The Disturbances of the Human courageous, and most authoritative realization Mind.” of this task. As you yourself stressed at the general assembly of the United Nations last The subject is of extraordinary relevance and October: “There is nothing which is genuinely directly concerns about a billion people in the human which does not find an echo in the world. We want, Holy Father, to go on being Christian heart.” very willing to help at all times, to be authentic Your forceful defense of fundamental hu- Samaritans for everybody, but especially for man rights—and above all else the right to life, all those—without distinction—who suffer in its sacredness, inviolability, and dignity—and the body, in the spirit, and in the mind. the constant preaching of the gospel of suffer- Thank you, Holy Father, for your longing have presented the world with the highest awaited and enlightening words. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 7

ADDRESS BY THE HOLY FATHER

Be the Good Samaritans of Modern Times

1. I am happy to be addressing all of you, 2. This year you have chosen to conduct very dear Brothers and Sisters, during this In- your reflection in the light of the Gospel ex- ternational Conference, which has now be- hortation: “Vade et Fac Tu Similiter: From come a traditional appointment each year Hippocrates to the Good Samaritan.” In this bringing together so many generous people twofold allusion the whole history of medicine marked by enthusiasm and fidelity who are in- may be well summarized. As, indeed, Pope volved in the world of health policy and care. Pius XII, of venerable memory, recalled, “The This year, in addition, we are recalling a writings of Hippocrates, beyond all doubt, special anniversary: ten years have in fact contain one of the noblest expressions of pro- passed since the Pontifical Council for Pas- fessional conscience, which particularly im- toral Assistance to Health Care Workers was poses respect for life and dedication to the instituted. The success of the Conferences held sick” (Address to Those Attending the Four- until now is tangible proof of the fruits ripened teenth International Congress on the History through the tireless and fervent activity con- of Medicine, September 17, 1954: Discorsi e ducted by this Council, whose aim is to “dis- Radiomessaggi XIV [1953-1954], 148). The seminate, explain, and defend the teachings of Gospel page on the Good Samaritan enriches the Church in the field of health and foster the Hippocratic heritage with the transcen- their introduction into the practice of health dent vision of human life, which is a gift of care” (Apostolic Letter, Dolentium Hominum, God and is called to share in eternal commu- no. 6). nion with Him. I affectionately greet Cardinal Fiorenzo An- With rigorous attention to the serious and gelini and thank him for the kind words with urgent problems challenging medical research which he has conveyed the sentiments of all and science in our time, during the sessions those present. I reiterate my deepest apprecia- held in these days you have journeyed anew tion of those responsible for the Pontifical along the road traveled by health care Council for Pastoral Assistance to Health throughout history, identifying in the en- Care Workers, who, with assiduous and con- counter between Hippocratic humanism and stant dedication have promoted and organized Christian humanism a decisive factor for this meeting. I also respectfully address the progress towards a civilization increasingly distinguished scientists, researchers, scholars, worthy of this name. Furthermore, the scien- and experts on problems in medicine, the bio- tific contributions presented by scholars and medical sciences, and morals who have of- experts from all over the world have demon- fered this encounter for study and reflection strated that, in attention to those suffering and the valuable contribution of their competence commitment to quality of life worthy of the and experience. Finally, I extend my cordial person, an anthropological vision is shaped in welcome to all present. which it is possible for people of different cul- In your persons I see and greet all the health tures to find a point of encounter. This is con- workers who, everywhere in the world, as ser- firmed by the personal and social experiences vants and guardians of life, witness to the of so many “Good Samaritans” of modern Church’s presence alongside sick and suffer- times, among whom you have appropriately ing people. wished to recall people such as Henry Dunant, 8 DOLENTIUM HOMINUM

Florence Nightingale, Albert Schweitzer, which “reflection and dialogue Ð among be- Janusz Korczak, Ildebrando Gregori, Raoul lievers and nonbelievers and also among the Follereau, and Marcello Candia. “Whoever believers of different religions Ð on ethical embarks on the little boat of defense of life,” problems, including fundamental ones regard- Albert Schweitzer wrote, “is not a ship- ing man’s life, are fostered” (Encyclical Evan- wrecked person cast adrift, but a bold traveler gelium Vitae, no. 27). who knows where to go and firmly holds the 4. The unified and constructive path of sci- rudder in the right direction” (La civilisation ence and faith desired by the Second Vatican et l’éthique, 63-64). Council (cf. Message to Men of Science, De- cember 8, 1965) tends to affirm basic human 3. From Hippocrates to the Good Samari- rights centering on the advancement and de- tan, from conscience guided by reason to rea- fense of life and its dignity. Faith stimulates, son enlightened by faith, the announcement of encourages, and supports this convergence, the Gospel of life must be single; indeed, its which has revealed itself to be favorable to the advancement and defense “are not the monop- achievements of reason, for there is nothing oly of anyone, but the responsibility of all” genuinely human which is not echoed in the (Encyclical Evangelium Vitae, no. 91). And it heart of Christians. is certainly a providential sign of the times The field of health policy and care, in the that faith in Christ’s message is today called to varied spheres of health education, preven- support and strengthen the rational foundation, diagnosis, therapy, and rehabilitation, of- tion for the common duty of serving life in all fers numberless proofs of the concrete possi- phases of human existence. It is, indeed, a task bility of an association between reason and which is at once human and Christian, in such faith, to construct, in freedom and full respect a way that “only unified cooperation among for the human person, the civilization of life, those believing in the value of life can avert a which, to be truly such, must also be a civi- defeat for civilization with unforeseeable con- lization of love. sequences” (ibid.) The Good Samaritan of the Gospel parable 5. In the building of such a civilization, the challenges every human conscience aspiring Good Samaritan, in whom the love of the Son to truth and attentive to the future destiny of of God is mirrored, is a model for the duties mankind. The long road traveled by health and tasks of health care workers. This model care, however, could not be accounted for if it reaffirms, dearest Brothers and Sisters en- had some purpose other than the safeguarding gaged in health care and pastoral attention and recovery of health; in reality, health care, to the sick, that your service is first of all a because it is rooted in respect for life and for mission, rather than a profession, sustained the dignity of the human person, is also a by a growing awareness of solidarity existing school for giving value to suffering and the among human beings. This awareness is service it calls for. Therefore, the parable of strengthened and encouraged by faith, to the Good Samaritan pertains to both the which I exhort you to offer generous witness, Gospel of life and the Gospel of suffering: as heralds of trust and hope in man, called by “And here we touch one of the key points of all God to fulfill himself in self-giving. Christian anthropology. Man cannot find him- With these wishes, for all of you and your self fully except through a sincere gift of him- service to the sick I invoke the protection of the self. The Good Samaritan is the man capable Most Blessed Virgin, to whom I entrust the of precisely such a gift of himself” (Apostolic plea for salvation and comfort arising from Letter Salvifici Doloris, no. 28). suffering humanity. May Mary, the Mother of For these reasons I am happy to express to the Divine Samaritan of souls and bodies, ac- those responsible for the Council for Pastoral company all your meritorious activities, im- Assistance to Health Care Workers my deep pressing upon them the maternal characteris- satisfaction over their having drafted and pub- tics of loving receptiveness and inexhaustible lished the first Charter for Health Care Work- generosity. May you also be accompanied by ers, whose indications, open to contributions my Apostolic Blessing, which I cordially be- by all men of good will, represent a happy al- stow upon all of you present here, upon your liance between Hippocratic ethics and Christ- associates, and upon those you assist in your ian morals. It is, in fact, a synthesis through daily work. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 9

The Hippocratic Oath I swear by Apollo the Physician, Aesculapios, Hygeia, and Pancea, and call all the gods and goddesses as witnesses that I will integrally observe this oath of mine with vigor and intelligence. I will regard the Teacher who taught me this art as a father, and in a grateful spirit I will give him what he needs to live and what he may require, and I will consider his sons as my own brothers; and if they wish to learn this art, I will teach them with no compensation or contract; I will share my lessons and presentations and all that concerns the medical discipline with my sons and the sons of my preceptors and with those who have declared themselves in writing to be my disciples and have sworn an oath, but not with anyone else aside from these. As regards the care of the sick, I will prescribe the most appropriate regimen, according to my judgment and knowledge and will defend the sick from all harm and disturbance. Neither will any request avail to induce me to administer poison to anyone, nor will I ever so advise. Similarly, I will not operate on women for the purpose of impeding conception and procuring abortion. And, in truth, I will keep my life upright and my art immaculate. Nor will I perform operations to remove stones from those suffering therefrom, but will let surgeons expert in this art do so. I will enter any house solely to bring aid to the sick and will refrain from every unjust action and immorality, as well as from all impure contact. And, in practicing my profession, I will keep silent, unless given permission, about all that I see and hear in the common life of men, even if independent of the medical art. If I unalterably keep faith with this oath and am able to observe it loyally, may I be granted every satisfaction in life and in the art, and may I always enjoy a well-deserved good reputation among men. But if I should not keep my oath or should swear falsely, may just the opposite befall me.

The Parable of the Good Samaritan (Luke 10:30-37)

(30) “A man who was on his way down from Jerusalem to Jericho fell in with robbers who stripped him and beat him, and went off leaving him half dead. (31) And a priest, who chanced to be going down by the same road, saw him there and passed by on the other side of the road. (32) And a Levite who came there saw him, and passed by on the other side. (33) But a certain Samaritan, who was on his travels, saw him and took pity at the sight; (34) he went up to him and bound up his wounds, pouring oil and wine into them, and then mounted him upon his beast and brought him to an inn, where he took care of him. (35) And the next day he took out two silver pieces, which he gave to the innkeeper and said, “Take care of him, and on my way home I will give you whatever else is owing to you for your pains”. (36) Which of these, do you think, proved himself a neighbor to the man who had fallen in with robbers? (37) And he said, “He that showed mercy on him”. Then Jesus said, “Go your way, and do likewise.”

Read by BENEDETTO NARDACCI The Vatican Television Center 10 DOLENTIUM HOMINUM

FIORENZO ANGELINI

The Meaning of a Historical Trajectory

“Go on your way, and do likewise.” From Hip- * a mainly participatory vision of the exercise pocrates to the Good Samaritan. of the art of medicine. The subject “From Hippocrates to the Good There is, therefore, an evident precursory ele- Samaritan” does not express a general juxtaposi- ment within the Hippocratic Oath which leads on tion. In the same way it does not amount to a con- to the Christian vision of life—a vision which ad- trived or artificial tandem. Look at the back of the heres to (and enriches) all of these four features of program of this international conference and you the oath. But it is, above all, in the full and total will see why this is so. In the past this fact was un- defense of life that the position of this great Greek derstood. But today, in many quarters, it seems doctor and physician created a receptivity to the that there is a desire that it should be forgotten. acceptance of the Christian belief that life is par- Nobody had ever sought to put a cross or a Chris- ticipation in the life itself of God projected into tian symbol on the frontispiece of works by Aris- eternity. And it is here that there is a crucial point totle—works which even such an outstanding at which the thought of Hippocrates and Christian theologian as Thomas Aquinas adjudged precur- thought coincide—in the exclusion of any possi- sors of Christian thought. Nor had anyone ever bility of discrimination in relation to the notion of sought to do likewise with the works of Cicero, a life. Hippocrates sees the promotion and the de- figure whom Tertullian called “anima naturaliter fense of life as a criterion and guide for the prac- christiana.” But such an act was performed by an tice of his profession and as a measure by which enlightened Medieval scribe when he transcribed to judge the honesty and correctness of the med- the Hippocratic oath in Greek in the form of a ical doctor. He knew full well that the acceptance cross. The manuscript is kept in the Vatican li- of possible distinctions which involved excep- brary. The inference is obvious: he who read the tions to this principle would mean that this princi- Hippocratic passage with care perceived in it the ple would become fragile and vulnerable. And he teaching of Christ. is so convinced of this fact that his oath draws There is an undisputed continuity between the near to a religious view of life. Indeed at the be- content of the Hippocratic oath and the content of ginning of the oath the physician from Kos refers Christian morality. This continuity lies in a shared to the divinities of the Greek pantheon and at its commitment to promote and defend life from its close he seems to echo these initial words when conception to its natural ending. This is a conti- he wishes every ill to befall him if he should ever nuity which is emphatically observed by the Holy diverge from his oath. Father John Paul II, among many others. In the There are two other elements in Hippocratic encyclical Evangelium Vitae His Holiness refers ethics which have an almost Christian aspect. to the “ancient and ever relevant Oath of Hip- They are, in the first place, the need for the med- pocrates, according to which every medical doc- ical doctor in the practice of his profession to be tor is called upon to be committed to absolute re- at the service of the sick person and not to act in spect for human life and its sacredness.” his own calculated and selfish interest. And he is The Hippocratic Oath, indeed, has four general so convinced of this that he sees a non-utilitarian features, and these are: reward as the prize for the correct exercise of his * a profound respect for nature in general; profession. Indeed, the person who is called to the * a unified and integral conception of the hu- bed of those who suffer well knows—as the man being; Schola Salernitana of medical thought makes * a rigid and strict relationship between per- clear—that the doctor is forgotten about when the sonal ethics and professional ethics; illness or ailment has passed away and that as a VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 11 result there is a temptation to present the bill for which constitutes a real bridge towards justice professional services when the patient is most in and peace. the grip of his infirmity. Here we can see the con- Indeed, such an ecumenism of works is more temporary relevance of a Christian defense of the than an aspiration—it is a necessity. And the de- Hippocratic Oath, especially in an age such as cision to link together Hippocrates and the Good this, when we find that side by side with great ad- Samaritan of the Gospel parable is an attempt first vances in the realm of science and technology we and foremost to demonstrate that it is especially are threatened by their being placed at the service in her solicitude for the sick and the suffering, and of wrongful goals and by their employment as in- in the advancement and the defense of life and the struments in the achievement of wrongful ends. dignity of the human person, that the Church— A careful analysis of the Hippocratic Oath en- being at the same time the heir to the highest val- ables us to come to a simple conclusion: few pro- ues of each and every civilization—wants to fessional categories can so agree upon the essen- place herself at the vanguard of the difficult ad- tial principles of their activity as those who are vance towards that civilization of love to which, engaged in service to health—I am referring here, indeed, there is no alternative. of course, to health care workers. Through an FIORENZO Cardinal ANGELINI identification of the Christian view of the world with the vertical and horizontal beams of a cross, and its encounter/comparison with the non-Chris- tian view or views, we might imagine service to health—and thus to life—as the exact point at which the two beams meet. It is certainly true that in this field as well the very newness of Christianity is expressed in the doctrine and practice of the attribution of value to suffering when that suffering, notwithstanding the efforts of science and of every other means, cannot be removed. But in truth few truths are so rational as the attribution of value to suffering— something which draws upon all the resources of man and enables him to reach the highest and noblest points of what he really is. It is not true, therefore, that only faith can supply the strength by which to accept and give value to pain. It can be of decisive importance in this endeavor, but the support it provides can also involve the placing of roots in human reason and intelligence, elements which themselves are also gifts of God. The placing of Hippocrates and the Good Samaritan in tandem is constantly encountered in the whole history of medicine and health care. During this history the Church, during her two- thousand years of life, has shown herself to be a pioneer. This reality illuminates another truth, a truth which has been referred to by the Holy Fa- ther. In serving those who suffer, a meeting of all men of good will becomes possible, a meeting which in other fields has proved difficult, if not impossible. Philosophical, religious, political, economic, and social ideas can experience insu- perable differences and divergences. Service to anyone who suffers, on the other hand, because it involves an encounter with the most universal and deeply felt of human aspirations—namely, the safeguarding and recovery of health, and thus the advancement and defense of human life— renders an ecumenism of works possible, a reality 12 DOLENTIUM HOMINUM

VINCENZO CAPPELLETTI

Where There Is Love for the Art of Medicine, There is Love for Man

The subject of this tenth international confer- tion posed by the learned man of law who wanted ence organized by the Pontifical Council for Pas- to know how man could gain eternal life. Here we toral Assistance to Health Care Workers requires touch in essential terms upon the core message of an understanding of the relationship between Hip- the Good News: upon the idea that love should be pocrates and the Good Samaritan. This should take at the center of being. This, of course, was how place before the reading of the papers on the vari- God had presented himself to Moses. Love in God ous subjects which form a part of the program of for the world and for men, love in men for God but this conference. The subject of the conference also for all other men and for ourselves, and with- emerges clearly in the title of the first paper: out differentiation. Love informs everything and “Where there is Love for the Art of Medicine, redeems everything, even the relationship between There Is Love for Man.” A failure to deal with this our egos and ourselves. subject at root would mean that it would be impos- Love is a fundamental and universal expression sible to deal with the specific question expressed in of an awareness of a rule which tells us how we the title of this paper in a suitable and convincing should be at all times. This rule is parallel to the fashion. primary relationship which exists between God The Samaritan is at the center of a very impor- and the world which He created, a relationship tant allegory related when Christ was preparing for which includes man. This rule springs from a uni- his journey to Jerusalem. The Samaritan is the cen- versality which is rooted in divine origins. But let tral symbol of a definitive lesson on the essence of us return here to our analysis. The Good Samaritan the divine and the meaning of the Incarnation. The is a polysemic (as we would say today) symbol. He figure of the Good Samaritan is used to make peo- is also the model for the relationship between a ple understand the law of love which had previ- doctor and his patient, a model which has as its ously been written into the text of the Old Testa- pre-condition the idea that the doctor embodies the ment but which from that moment on was to be of universality of Christian love and the full spectrum primary importance in the New Testament. A man of its expressions. But that doctor would not be a of law asks Christ what he must do to obtain eter- Good Samaritan unless he had what the Good nal life and Jesus refers him to the precept of the Samaritan symbolizes: love. But was there love, ancient law. According to this law one must love we may ask, in Hippocrates? God with all one’s heart and one must love one’s Here we must pause for a while to give our dis- neighbor as oneself. cussion a richness which it would not otherwise The figure of the Good Samaritan is employed have. If Hippocrates were foreign to the concept of to explain the meaning of the concept “neighbor.” love and of reality lived in human love, the rela- The man who is robbed by thieves and left for dead tionship between the Good Samaritan and Hip- on the road is our neighbor. The Samaritan who pocrates would appear to be a rather contrived was traveling on the road sees him, helps him and linkage—full of good intentions certainly, and takes care of him. This story told by Christ is both generative of uplifting thoughts, but in essence sublime and of an astounding simplicity. The love without historical foundation. of God who is love enters into the relationship be- But such is not the case. At the time of Hip- tween these two men, two individuals who come pocrates there was a debate about love and a pro- into contact with each other on an unimportant found theory was current about its meaning and road on their journey through life. The Gospel ac- role. First of all let us establish some historical and cording to Luke is certainly built upon oral tradi- chronological dates. Hippocrates was born in Kos tion and perhaps upon written tradition, and it cer- in 460 BC and died in Larissa in Tessaglia in about tainly has great charm. Yet in this parable it 370 BC. Socrates was born in 470 BC and died in reaches one of its highest points. 399 BC, the victim of Athenian democracy. Plato The parable of the Good Samaritan presents was born in Athens in 428 BC and died in 348 BC. lived and expressed love as the answer to the ques- Plato was the youngest by a generation of these VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 13 thinkers. Pericles is also of importance when we it is probable that the former was known to the lat- consider the political and cultural background of ter. The circle of the optimates was narrow and we interest to our inquiry. Pericles lived between 495 know from his biographers that Hippocrates spent and 429 BC and was a vital and dominant figure of much time in Athens and held his medical school Athenian life, especially in the three decades be- in that city. This circle acted to form and promote tween 461 and 429 BC. In the lives of all these per- a number of relationships and friendships, such as sonalities the two decisive victories of the Atheni- that between Hippocrates and Thucydides, which ans over the Persians, those of Marathon in 490 we come to learn about more through the existence BC and Salamina in 480 BC, clearly cast a very of shared ideas than through written evidence to long shadow. the effect that certain individuals knew and spent Our question can be re-formulated: Was there a time with certain other individuals. spiritual need during the Athenian age of Pericles In this way the approach of Socrates, and of the to approach the subject of a relationship not only intellectual world around him, towards loving and between man and man, but also between man and love could not fail to reflect the basic formative el- the nonhuman, within a context of love, a context ements of the conceptual framework employed by framed between desire and giving, between pos- Hippocrates, and in the same way could not fail to session and good will? And if there was, it is clear leave a profound mark on that framework. The de- that Hippocrates could not have been alien to it or velopment of the dialogue in Phaedrus is magnifi- have ignored it. Equally, by one or by many of the cent but the argument about love which Socrates roads by which human thought pervades the expounded, or is said to have expounded, in the world, the argument and search for love must have house of the playwright Agathon, and which we touched and shaped the starting points in part im- learn about through the Symposium, is worth noth- plicit and in part explicit—of that extraordinary ing. Agathon attempts a praise of love but Socrates structure which was the Hippocratic doctrine of says it does not convince him. Agathon, he says, medicine. reminds him of Gorgias and the fallacy of the The subject of love certainly found real space Sophists: he believes he must say the truth about and importance in the Athens of Pericles, and more the object which is to be praised, and at the same specifically in a circle to which Hippocrates be- time attributes to that object great and beautiful longed—the circle of the Kaloi Kagathoi, those things whether the object actually possesses them men who had the privilege of being able to dedi- or not. cate themselves to discussion, debate and ban- But the truth must be said about love and quets. The same may be said for all the debates and Socrates declares that he follows the path outlined all the friendships of those years which are to be to him by a foreigner from Mantinea, a woman found in the Dialogues of Plato. Hippocrates ap- called Dìotìma. She is a foreigner, it should be ob- pears on two occasions, in the Phaedrus and in the served, in the sense that she is outside the Athenian Protagoras, because of the fame and the prestige polity. She performs the same role that the for- which his thought had won for him. eigner from Elea performs in convincing fashion In the Phaedrus, in particular, Hippocrates in the work of the Sophist school she raises doubts, looms very large because of the observations made opens up new perspectives, and displays uncer- by Socrates regarding the relationship between be- tainty about the proposed meaning of being. havior and the nature of the soul, and between the Dìotìma had explained to Socrates, who then re- nature of the soul and the nature of everything. peated the idea at the banquet given by Agathon, Phaedrus declares: “if Hippocrates is right then that love is the wish for something which one does one cannot understand the body without a similar not have; it is something between the mortal and approach”—without, that is to say, an overall view. the immortal; it is a great demon which transmits Hippocrates is referred to in the Protagoras in a the world of men to the world of the gods and the less incisive and overt fashion. Socrates asks Hip- world of the gods to the world of men. pocrates, one of the participants in the dialogue but Love was born because Penia (poverty) was in fact a mere namesake of the Master of Kos, made pregnant by Poros by means of a trick at a what he would expect to receive from Asklepiades banquet given to celebrate the birth of Aphrodite. in exchange for money. The answer of the doctor Love is as poor as its mother and as rich in cunning Hippocrates is that he would expect to receive as its father. Furthermore, “what it manages to acknowledge about medicine. quire always slips away through its fingers.” Love The Protagoras is dedicated to an analysis of is the lover and not the loved. For all people, great sophistry but the Phaedrus is concerned with love and treacherous love is a wish for what is good and and sees it as a madness in the sense of a divine ex- for happiness. But at the summit of happiness there altation, a delirium which comes from the gods is immortality. This is to be reached through phys- and which is expressed in prophecy and poetry. ical and ideal procreation, achieved by the child Socrates and Hippocrates were contemporaries and by the outcome of thought. There is a love of and also of the same age. They both left a lasting ideas and of science, and in these love finds its mark on the civilization of subsequent centuries. own identity which lies in the poor condition of The latter was certainly known to the former, and man, in poverty. 14 DOLENTIUM HOMINUM

Love, it should be repeated, is in the lover and this out of love of, or rather yearning for, the un- not in the loved. And for this reason the idea does known. Hippocrates loved the sick man is a So- not love, and thus it does not love the highest of cratic sense, as is borne out by the passage which ideas—God—in the works of Aristotle. Attempts expressed the conceptual framework of his diag- have been made to go straight from the Symposium nosis approach and its associated semiology: to the twelfth book of Aristotle’s Metaphysics in “These are the phenomena connected with ill- order to deduce the presence of another concept of ness from which I draw my conclusions—conclu- the divine and to explore the possibility that love sions based on what is shared and what is particu- might be found within that concept. Or to see, lar in human nature; on illness, on the sick, on diet rather, if perhaps the highest of the classical mean- and on who prescribes it (upon which depend ings of God might be that of a God who loves the many favorable and unfavorable consequences); cosmos of nature and thus also loves man who on the general and specific constitution of heav- forms a part of that cosmos. enly phenomena and of each region; on the cus- No trace of love is to be found in the God of toms, regime, the way of life, and the age of each Aristotle. The ideas and observations of Socrates person; on what is said; on characteristics, si- reflect and express the insights and intuitions of a lences, and thoughts; on sleep and insomnia, on whole world, an entire wisdom, a whole culture. dreams—when and how they are experienced; on We read: “If, therefore, God is eternally in that involuntary gestures—the pulling of hair, scratch- happy condition in which we sometimes find our- ing, and crying; on paroxysms, faeces, urine, spu- selves, then he is a wonderful thing. But if he is in tum and vomit; and on the connections between a higher condition then he will be an even more illnesses Ð those which come from the past and marvelous thing. Well, He is like that. And He is those which will arise in the future; on abscesses, also alive. This is because the act of understanding and, if they are not a sign of death or crisis, on is life, and He is that act—that act which, being for sweating, shivering, cold, coughs, sneezing, hic- itself, is in Him supreme and eternal life. We be- cups, breathing, belching, flatulence (whether lieve that God is the perfect eternal living being, silent or loud), hemorrhages, and hemorrhoids. and that He has constant life and eternal existence. The analysis is carried out on the basis of all these We believe that this is God.” elements and what they lead to.” Being has united itself with life and with Christian medicine, carrying on from the Good thought, and thought has itself as its object—” Samaritan, would not only bestow love upon suf- noesis test noeseos.” This is another achievement fering but would also continue the path trodden by on the road which leads to the Christian Good Hippocrates by becoming a theory and metatheory News, something which concentrates upon a love of life and constituting a rich source of insights and which is not poverty but wealth, which is not only hypotheses which act through observation, as a reality of the lover but also a reality of the loved, takes place is all branches of science. The wonder- and these opposing elements are united by the ful flowering of hospitals and similar institutions same force. This force is that substance of life would not be the only element to receive the fruit which Aristotle drew near to through his linking of of a love-wealth which comes from God who is it to the divine. Poverty, desire-wealth, gift—here love. Medical science would also gather that fruit. we have an obvious analogy which stares us in the We cannot not declare ourselves Christians—to re- face. On the one hand the relationship which Hip- peat the title of a very famous work by Benedetto pocrates had with the spiritual horizon to which he Croce which was published in 1942—in the sphere belonged. On the other the Good Samaritan and of modern science and in its powerful expression, his relationship with the truth which he perceived namely contemporary science. and experienced. Hippocratic medicine loved suf- Love, life and logos-thought represent circumin- fering and death principally in order to discover cessio—a splendid concept which comes like their causes, their mechanisms, and their symp- many other fundamental concepts of its time from toms. the conciliar period—in the conscience of man. Hippocrates is a metaphysician and not a mere One loves through knowing and one does not physician as described by Socrates in the Phae- know except in God and with God, humbly bear- drus. As a metaphysician he had elaborated a no- ing witness to his definitive substance love. Love- tion, the idea of “hekaston,” a concept which pre- charity is love-knowledge: this is what the open ceded the Aristotelian notion of “tode ti.” In Hip- tradition of the example of the Good Samaritan pocrates the individual is this last in Aristotle, and owes to the Good News. But all this is everything this last is a transcription of “ousia,” the substance. in medicine, in basic terms and in each individual The first and third books of Epidemie, one of the act which the doctor performs every day and dur- most perceptive of the texts which can be attrib- ing every hour of his work. uted to the Homer of medicine which Hippocrates was to become, reflect an approach which is almost ecstatic in its observation of illness and the Professor VINCENZO CAPPELLETTI sick person, death and the dying. There was so Vice President and Scientific Director much to learn, to record and to investigate. And of the Italian Encyclopedia, Rome VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 15

PAUL POUPARD

“A Man Went Down From Jerusalem to Jericho” (Lk 10:30)

Introduction Church. Therefore every threat to human dignity and life must necessary be felt in the Among the most powerful, personal, pas- Church’s very heart; it cannot but affect her at toral and practical parables that Jesus taught is the core of her faith in the Redemptive Incar- that parable of the Good Samaritan. It is a nation of the Son of God, and engage her in parable that is powerful, for it speaks of the her mission of proclaiming the Gospel of life power of love that transcends all creeds and in all the world and to every creature (cf. Mk cultures and “creates” a neighbour out of a 16:15).”1 It is precisely this commitment and complete stranger. It is a parable that is per- concern that will engage our reflection and sonal, for it describes with profound simplic- sharing over the next three days of this Tenth ity the blossoming of a human relationship International Conference organized by the that has a personal touch even physically, Pontifical Council for Pastoral Assitance to transcending social and cultural taboos, as Health Care Workers. On paging through the one person binds the wounds of another. It is agenda of this Conference, I notice that vari- a parable that is a pastoral, for it is replete ous speakers have been assigned topics, that with the mystery of care and concern that is at will throw light of, from a diversity of inter- the heart of the best in human culture, as the disciplinary dimensions, the phrase “From Good Samaritan reaches out and ministers to Hippocrates to the Good Samaritan”. Suffer- his new—found neighbor who is in dire need ing, the care of the sick; healing wounds; the of help. It is a parable that is primarily practi- doctor, a man for all; medicine and morality; cal, for it poses a challenge urging us to cross women in the history of the care of the sick— all barriers of culture and community and to are some of the themes that will be dwelt on. go and do likewise! On my part, as President of the Pontifical Whenever we read and reflect on this para- Council for Culture, I propose to offer a ble of the Good Samaritan, we are moved by prayerful but practical meditation on the Para- the depth of its simplicity. It speaks to our ble of the Good Samaritan. heart. It can even trouble our conscience. It is The man, we are told, was on his way from a parable that proves convincingly “that the Jerusalem to Jericho. Jerusalem was the holy word of God is something alive and active: it city where the Temple was located, where cuts more incisively than any two-edged Yahweah had chosen to make His dwelling sword” (Hebrews 4:12). And similar senti- place. It was thus a symbol of the divine and ments stirred within me as I listened to the the sacred. In contrast, in Scripture we often Hippocratic Oath. find Jericho standing for the world. As Origen Even though the Oath and the Parable stand put it, “...the man on his way from Jerusalem centuries apart, there is a bond that links them to Jericho falling among thieves, represents together for they both express and share a Adam driven from paradise into the exile of common concern: a commitment to, I would this world. And when Jesus went to Jericho like to state, “the gospel of life”; a commit- and restored the sight of the blind men, they ment that stems from a profound respect and represented all those who in this world suffer concern for the human person. “Every indi- from the blindness of ignorance, to whom the vidual, precisely by reason of the mystery of Son of God comes.”2 Jericho is in a sense a the Word of God who was made flesh (cf. Jn symbol of secular culture. And that man who 1:14), is entrusted to the maternal care of the was on his way from Jerusalem to Jericho rep- 16 DOLENTIUM HOMINUM resents the whole of humanity, as a matter of closed for it does not bear fruit in action. At fact all of us. Like him, are we not too on a the most, pity ends with a sign or a mere shrug journey? For are we not all pilgrims travelling of the shoulders. Compassion, on the other together? Somewhere along the path, we are hand, urges us to move out of ourselves. For it waylaid and robbed, deprived and stripped of makes us not only feel for but feel with those what is best in us, the spark of the divine and who suffer. To show compassion, therefore, is the sacred! Religion, which expresses our re- to suffer with the wounded and the suffering, lationship with God, like the sacred, is at the to share their pain and agony. While it is true very heart of culture. And yet as Pope Paul VI to say that we can never fully enter into an- has noted: “The split between the Gospel and other’s pain and that we more often than not culture is without doubt the drama of our remain outside as silent spectators to an- time, just as it was of other times.”3 What is other’s agony, compassion helps us in some our response as Church, to this body of hu- small way not only to feel with but to feel in manity that lies wounded and waylaid? Do we the one who suffers. This is how Jesus, the not need to tend it and restore it to its pristine Good Samaritan par excellence, showed com- health and glory? I propose to approach this passion. He suffered with and suffered in the great story from three angles. It is a parable persons to whom he ministered. He felt their that calls for Compassion, challenges us to hunger, He sensed their sorrow, He under- Commitment and ends with the joy of Com- stood their pain, He sympathised with and be- munion. friended sinners, He touched the ostracised. Jesus assumed a back that He might feel the pain of being scourged “for the high priest we 1. The call to compassion have is not incapable of feeling our weaknesses with us, but has been put to the test in There is a world of a difference between exactly the same way as ourselves, apart from mere pity and compassion. Pity begins and sin” (Hebrews 4:15). Centuries before He ends with self. And even though it may make was born the prophet Isaiah had stated: “Yet us feel for the suffering, it remains self-en- ours were the sufferings he was bearing, ours the sorrows he was carrying...; he was being wounded for our rebellions, crushed because of our guilt; the punishment reconciling us fell on him, and we have been healed by his bruises” (Isaiah 53:4-5). Compassion, does not leave us indifferent or insensitive to another’s pain but calls for solidarity with the suffering. Solidarity “is not a feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far. On the contrary, it is a firm and persevering determination to commit oneself to the common good; that is to say, to the good of all and of each individual because we are all really responsible for all.”4 At times we can be like the priest and the scribe who, on seeing the wounded man, passed by on the other side. We can be silent spectators afraid to involve ourselves and soil our hands. We can easily find parallels in contemporary culture. The visual media today bring right into our homes horrifying scenes of war and violence, of hunger nad want, of sickness and disease, of natural catastrophes like floods and earthquakes. We run the risk of being lulled into a culture of watching passively, of doing nothing. Instead of being actors, we end up by being mere spectators. Compassion demands that we get out of ourselves as we VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 17 reach out to others in need. It makes us of Mary; His life was interwoven into the emerge from the comfortable cocoon of our prevalent social and cultural fabric of His self-enclosure and reach out in love and ser- time. As the Word of God He spoke in human vice to those who need our help. language, a specific language with a definite The concept of health need not be so narrow cultural heritage. Cultures have been analog- as to be restricted to mean mere physical or ically compared to the humanity of Christ. By bodily well being. In a symbolic sense health the mystery of the incarnation, He entered takes on a much wider significance. There are into culture from within purifying it and reori- whole societies and cultures “on the other enting it to God Who was to be worshipped in side of the road” that lie “wounded,” waylaid spirit and in truth.”5 Just as the Good Samar- and deprived by the dis-values of con- itan entered into the situation of the man lying sumerism and materialism, stripped of what is wounded and half dead and ministered to him, best and most beautiful in human culture, be- so must the Church enter into these cultures cause they are devoid of, and at times hostile, that are wounded and sick and revitalize them if not indifferent, to God. We have been, cul- by offering them the Gospel of Life. turally speaking, so dehumanized as to have lost the sense of God. And, over the years, we have gone a step 2. The challenge to commitment further by nurturing non-belief, resulting in religious indifference. Indifference is worse Commitment is one word that perhaps best than hostility. The hostile person at least ac- expresses the attitude and action of the Good knowledges the presence of the other while Samaritan. He could have, like the priest and reacting violently to it; the indifferent person, the Levite, passed by on the other side. He on the other hand, ignores the other and treats could have closed his heart and refused to re- him as if he did not exist. spond to a genuine need. That was the kind of indifference and insen- But he stopped. He stopped to stoop. He sitivity shown by the priest and the Levite stooped to conquer. At that very moment who passed by on the other side, leaving the when he stopped and stooped to serve this wounded and waylaid traveller unattended. It is alive in today’s anti-culture of isolation and triviality. But our greatest depravity is that we can lose our sense of God. And with the loss of the sense of the Fatherhood of God, it must of necessity follow that we lose also in the process the sense of the brotherhood of man. Even though we may deny or be indifferent to the existence of God, what fills us with hope and optimism is that the God of the Christian is a God Who rises from the dead, a God Who revives and renews, a God Who restores hope as He rises phoenix like from the ashes. It is precisely to such cultures that have become godless or religiously indifferent, that have become dormant and dead, that the Church as a continuation of Jesus Christ, the Good Samaritan in time and space, needs to reach out and minister and to offer the Good News. These are the very cultures that silently plead for our active involvement. When the Church, and together with her the Christian faith, enters into the flesh of culture the mystery of the incarnation is relived. The Word becomes flesh and dwells among us. He becomes like unto us in all things but sin. “Without the incarnation there is no salvation: Christ was not born in a void. He took flesh in the womb 18 DOLENTIUM HOMINUM stranger who had fallen into the hands of ban- and executed! dits, a neighbor was born. Compassion that is The Church, like the Good Samaritan, is prompted by love is “creative”: it creates a committed to health and life. What makes the neighbor! “Thus one would be able to speak reaching out of the Good Samaritan even of a sacrament, of a sacrament of love: when more poignant is the fact that there was no re- one person makes available his living being, lationship between Jews and Samaritans. But his heart and strength and energies, God it is from this reaching out in love that two un- causes his creative power to enter and there related persons now begin to relate in love emerges the miracle of the relationship with and a neighbor is born! Is it not love that calls the neighbor.”6 the neighbor into existence? Ours is indeed a world that is constantly The Gospel text from Luke, Chapter 10, challenged by a growing insensitivity to suf- simply speaks of “a man (who) was once on fering. We have grown so accustomed to suf- his way down from Jerusalem to Jericho....” fering, sickness, and starvation that we can Have we ever stopped to reflect that this man pass by the most gruesome sights without so has no name or nationality, no particular cul- much as batting an eyelid. We have become ture or community, no race or religion? He so used to seeing soaring skyscrapers provide was just a man. Yes, any man, any person in the background for stinking slums. Did not need. Every person in need is my neighbor. the world community watch as silent specta- “Everyone who crosses my path and who tors when thousands were eliminated in one needs me, no matter of what name, race or re- of the most massive genocides recorded in ligion. Let us not waste time trying to know history? Life itself has become so dispensable these things; let us not pass by on the other that we have invented euphemistic expres- side. We have to be interested in one thing sions to quell the qualms of our conscience. alone: that this poor person needs me and his We speak today of “termination of preg- name is Jesus!”7 nancy” and “euthanasia” as if we could delink them from the sacredness of the human person whose death is being contemplated 3. The joy of communion The world we live in is an ocean of suffering. I think of the millions suffering physically in Hospitals, Homes for the Aged, and Terminal Care Clinics. I call to mind little infants too small to understand the mystery of suffering but already big enough to experience it; I remember strong young men crying out with unbearable pain; I know of the aged, so weak and feeble, struggling and gasping for the last few breaths of life. I think of the mental suffering that so many experience: the loneliness of separated spouses, the isolation of orphans who have never known the warmth of a home or the caress of a parent; the agony of the drug addict; the anguish of those who mourn a departed one; the pain of being alone far away from near and dear ones. Suffering is indeed our common heritage. Has suffering a meaning? What is the Christian meaning of suffering? As Paul Claudel has succinctly stated: “God did not come to take away suffering but to refill it with his presence.” Jesus did not eliminate suffering; He elevated it. And what ought to be our attitude towards those suffering? “The parable of the Good Samaritan belongs to the Gospel of suffering. For it indicates what the relationship of each VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 19 of us must be towards our suffering neighbor. and its soft rays kiss the earth, gilding it with We are not allowed to “pass by on the other gold, the day has begun.” But this response side” indifferently; we must “stop” beside did not satisfy the rabbi. Yet another disciple him. Everyone who stops beside the suffering ventured: “When the birds begin to chorus of another person, whatever form it may take, their lauds and nature herself bounces back to is a Good Samaritan. This stopping does not life after the night’s slumber, the day has be- mean curiosity but availability.”8 In short, our gun.” This reply, too, did not please the rabbi. compassion for the suffering that makes us One after the other, all the disciples made committed to action to meet their pain, ends bold their answers. But with none of them in communion when every man and woman was the rabbi pleased. Finally, they gave up who suffers becomes my brother or sister. and all, agitated, asked: “Now, you tell us the It is strange but true that suffering unites. It right answer! When does the day begin?” brings us closer to those who suffer and per- And the rabbi answered calmly: “When you haps even closer to ourselves! For when we see a stranger in the dark and recognize in are laid low and rendered weak and helpless, him your brother, the day has dawned! If you we sense more acutely not only our creature- do not recognize in the stranger your brother liness before God, but also our solidarity with or sister, the sun may have risen, the birds the rest of humanity. We might forget those may sing, nature herself may bounce back to with whom we have laughed; but we never life. But it is still night and there is darkness in forget those with whom we have cried! It is your heart!” It is love that gives us eyes to this bond that leads to communion. “There is see, a heart to feel, and hands to help. “The something of the clairvoyant in love: a capac- call of the Christian is to share this (love) ity to see through that which lies hidden; to generously on the different roads travelled by understand that which is not yet presented; to humanity today, roads that are new and some- discern that which is to occur.”9 But there is times dangerous, but always open to people yet another Person with whom we enter into on the move....”10 My earnest prayer this communion every time we reach out to and morning, as we begin our deliberations, is that serve the sick and the suffering. That Person each of us may be filled with that light of is none other than Jesus Christ Himself. In no uncertain terms He Himself tells us: “In truth I tell you, insofar as you did this to one of the least of these brothers of mine, you did it to me” (Matthew 25:40). We love and serve God as much or as little as we love and serve our neighbor in need. In the last analysis, it is love that counts. St. John of the Cross has summed it all up so beautifully when he says: “At the evening of life, you will be examined in love.” Compassion, Commitment, and Commu- nion summarize the message of the parable of the Good Samaritan. It is compassion that makes us feel with and in those who suffer; it is this fellow feeling that leads us to commit ourselves in love and service to them in their need; it is this commitment that brings about a communion of love not only with those who suffer, to whom we minister, but also with God Himself.

Conclusion I would like to conclude this meditation with a little anecdote. A rabbi was once in- structing his disciples. In the course of his teaching he asked them: “When does the day begin?” One answered: “When the sun rises 20 DOLENTIUM HOMINUM love, that will urge us to move out of our- all law, all old law. We are challenged into the selves and reach out to others in need, just as commitment and communion of the new the Good Samaritan did to the man who was commandment of Christ. on his way from Jerusalem to Jericho, to this PAUL Cardinal POUPARD body of humanity that, on its earthly pilgrim- President, Pontifical Council for Culture age, lies wounded and waylaid, stripped of what is deepest in its culture, and infuse into it 1 JOHN PAUL II, Encyclical Letter Evangelium Vitae, 1995, no. 3. anew a sense of hope, health, and happiness 2 ORIGEN Homilies 6,4 quoted in Office of the Readings for impregnating it with the divine and the sacred Thursday, Week 10 of the Year. 3 PAUL VI, Apostolic Exhortation Evangelii Nuntiandi, 1975, no. and thus restoring it to its pristine glory. In 20. those telling words of St. Irenaeus: “The 4 JOHN PAUL II, Encyclical Letter Sollicitudo Rei Socialis, 1987, no. 38. glory of God is humanity fully alive and the 5 Rooted in Cultures... Fruitful in Christ, Office of Education and life of humanity is the vision of God.”11 Then Student Chaplaincy, F.A.B.C., Manila, 1995, p. 16. 6 ROMANO GUARDINI, Volontà e Verità, Morcelliana, 1978, p. will this parable of the Good Samaritan come 149. alive and speak to our hearts today, for then 7 EDWARD CARDINAL PIRONIO, “Homo Quidam,” Dolentium Hominum, 1986, no. 1, p. 8. we shall know who is our neighbor and fulfill 8 JOHN PAUL II, Apostolic Letter Salvifici Doloris, 1984, no. 28. the command of Jesus to that lawyer in the 9 ROMANO GUARDINI, op. cit. p. 150. 10 CARDINAL PAUL POUPARD WITH MICHAEL PAUL GALLAGHER, Gospel narrative: “Go, and do the same your- What Will Give Us Happiness? Dublin, Veritas, 1992, p. 124. self.” We are invited into something beyond 11 Adversus Haereses IV, 20,7. Vade et Tu Fac Similiter

From Hippocrates to the Good Samaritan 22 DOLENTIUM HOMINUM

DIEGO GRACIA GUILLEN The Hippocratic Oath in the Development of Medicine

Introduction medical doctor, therefore, like the sacrum facere, from which we ob- priest, was a person who was conse- tain the noun sacrificium, and also The thesis which I will seek to crated to a form of ministry, and as a derive the appellation of sacerdos to propose and to advance in this paper part of this process this fact was pub- describe those people who perform is that the Hippocratic oath has not licly recognized. this kind of service. only been the most valuable docu- During the Medieval period the I have outlined the linguistic roots ment of the entire history of Western term professio did not lose its origi- of these terms in order to understand medicine and the paradigm of med- nal meaning of religious consecra- not only the specifically and clearly ical ethics but has also been the guid- tion. Indeed, the opposite was more religious realities they describe but ing model for all codes of profes- the case. The classic examples of also those forms of activity which sional ethics. The message of the “professions” in this sense were the are not so characteristically reli- Hippocratic oath is that professional professio monastica (participation in gious, medicine for example, or activity is a form of public obliga- the rules of monastic life through a more generally what we today term tion, a compact made before God public and solemn undertaking to re- professional activity. Leaving aside which requires the practitioners of spect vows and rules, and this after a the question of whether the practice that profession to achieve and pro- year of trial or of being a novice), of medicine was at the outset an ac- mote the very highest grades of per- and professio canonica (the public tivity linked to the role and duties of fection, that is, to achieve excellence recognition of the jurisdiction of the priests, it is nonetheless clear that in itself. bishop by his clergy and those faith- the most advanced forms of human In order to advance and defend ful to him). During the last centuries culture, such those to be found in an- this thesis I have divided this paper of the Medieval period it was from cient Greece and ancient Rome— into three parts. The first part will an- this background that the term “pro- where indeed medicine had acquired alyze the sacred or religious charac- fession” was introduced into the a very well defined secular status— ter of a profession. The second will Latin-based languages but at the the medical doctor continued to be to seek to show how the Hippocratic same time the original religious a certain extent “sacred” or “conse- oath is a paradigm for the promotion meaning of the term which involved crated.” and achievement of professional ex- the idea of public profession of faith This was not because the physi- cellence. And the third, to conclude, or of religious consecration kept its cian was a priest in the narrow sense will study professional excellence in sense. Even today in our languages of the term but because in a certain medicine and will analyze the liter- expressions such as “profession of way he had God as a witness or ary traditions which revolve around faith” or “to profess a religion” are guarantor of the rectitude of his pro- a figure who is repeatedly described still used, and the original meanings fessional activity. Hence the phe- as “the perfect physician.” of such words and phrases are still nomenon of the signing of a pact or more than present. of swearing to exercise his profes- The medical doctor, like the per- sion in a correct and upright way I. The Profession: son who “professes” in the Medieval which was expressed in the taking of A Sacred Activity sense of the term, is a consecrated an oath. There were also activities person in the strong or religious which were so important, even The word “profession” has a reli- meaning of the expression and not in though they were not directly religious origin. The Latin word profi- the broad or weak sense of dedica- gious in character, that they needed a teor, to profess, like the term confi- tion to a ministry. We should re- religious bond such as that expressed teor, to confess, had a religious member that the word sacrum, un- in the taking of an oath. And God meaning in Latin and thus by exten- like the term profanum, evokes the himself performed the function of a sion in the Latin based languages as idea of belonging to a world of the witness in this procedure. Both reli- well. This religious meaning referred divine and that the verb consacrare gious and non-religious oaths thus to the public profession of a faith or involves the dedication of something became of great importance in peo- to religious consecration. A “pro- as an offering to a divinity, the idea ple's lives. fessed” person, therefore, was a per- of offering it to the gods or of putting We know that some professions son consecrated to a ministry who it at the service of the gods. This is were formed in Greece along the “confessed” this fact in public. The the original meaning of the phrase lines of the profession of priesthood. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 23

For this reason they developed the mutual consent. Thus it is that it ap- vice versa. idea of a form of professional re- pears that one can speak about two Professions which are professions sponsibility which was more reli- kinds of responsibility, one which is in the authentic sense involve the gious in character than legal. We “strong” or moral and one which is highest level of moral responsibility should remember that the word “to “weak” or legal. The first would and thus also enjoy absolute legal respond” and all its present-day de- seem to be that which is present be- impunity. By legal impunity I mean scendants to be found in the Latin- tween marriage partners in a histori- de jure impunity, and thus the ab- based languages come from the cal sense and the second appears to sence of legal rules or regulations Latin word spondeo whose original be that kind of responsibility which which would allow the practitioners meaning refers to committing one- is necessarily involved in any kind of of these professions to be judged or self to a solemn undertaking which is legal contract. What do we mean by put on trial. If one analyzes the his- religious in nature. The most fre- professional responsibility and of tory of medicine one can see the nar- quent example of this was where the what does it consist? Is it a weak or a rowness of these norms and their cir- father undertook (spondet) to give strong form of responsibility? My cumstantial character. This explains his daughter (sponsa) in marriage. answer is that just as there are two that de facto impunity was practi- We can thus understand more clearly types of responsibility—those which cally total. Except for certain very the nature of the ceremony of “be- are weak and those which are exceptional cases the medical practi- trothal” (sponsalia). strong—so in the same way there are tioner has in fact enjoyed marked From the term spondeo we derive impunity, even though, circumstan- the word rispondeo which means to tially, he has not enjoyed this im- respond or to answer but in the pre- punity because of written law. cise sense of “fulfilling an undertak- Furthermore one can observe, ing which has been solemnly agreed without fear of falling into error, that to.” A. Ernout and A. Meillet add in traditional terms not only has that this term at the outset belonged moral responsibility usually been to religious language. This is seen separated from legal responsibility especially clearly in the language of but that the first has been protected the ancient Greeks where spendo from the second. The authentically refers to the rite of libation and to the responsible professional was by his obligation which springs from that very nature immune to legal process. rite. This religious rite involved the Naturally enough those professions pouring of a certain quantity of wine that I have deemed strong profes- on the ground, on the altar, or on the sions or professions in the strict victim of the sacrifice, at the time of sense of the term involve a lower the declaration of the pact. When this number and range of human activi- pact had been made it then had reli- ties, which in basic terms are three in gious and moral force. Thus it was number: priesthood, kingship (and that spondere came to mean “to un- by extension the dispensation of jus- dertake,” to “commit oneself” and tice) and, finally, medicine. By tradi- “to promise.” To respond thereby tion these professions involved con- means to pledge oneself to someone secrated people who bound them- or to promise something, and the re- selves by a public oath before God sponsibility, the quality or the condi- two types of occupations, those and who were called upon to have tion of who promises or becomes which are strong and those which are great ethical responsibility, a status pledged. weak. Traditionally these latter have which was accompanied by broad le- It is important not to neglect this been called, in the first instance, gal impunity. The classical thesis initially religious meaning of re- “professions,” and in the second, was that penal and legal control suf- sponsibility because it can clarify the “occupations.” In Western history ficed in the case of manual occupa- “prelegal” or “metalegal” element the strong professions or the profes- tions but that in the case of the pro- which is to be found at the roots of sions in the strict sense of the term fessions what was required was a to- this term. For this reason it is very have been characterized by having a tal commitment and undertaking, helpful to once again refer to the par- kind of strong responsibility just as something which in itself had to be adigmatic example of the responsi- the occupations have always had a religious and moral in character. bility which is to be found in the responsibility of a legal character, promise to give oneself in marriage. and the same time the professions in The commitment to an absolute and the strict sense of the term have had II.The Hippocratic Oath: eternal giving of oneself can thus in legal impunity in order to be bound A Paradigm of Professional the final analysis only be understood by strong or legal responsibility. Be- Excellence as being based on reasons which are cause of this one can safely assert “extralegal” or “translegal.” The act that in a historical sense both forms The Hippocratic oath can be fully of indissoluble marriage can be an of responsibility—that is, both moral understood when placed within this enormous act of responsibility be- responsibility and legal responsibil- general context and framework. My tween two individuals but it seems to ity not only have not accompanied thesis is that this oath was the para- go beyond the boundaries of normal one another but have been in opposi- digmatic document of this “priestly legal categories. A legal contract be- tion. Thus it is that the enjoyment of role” or “professional role” of tween two people can always be re- strong responsibility has been ex- priests, kings, judges and medical vised; indeed, it can be terminated by empt from legal responsibility and doctors. This role was characterized 24 DOLENTIUM HOMINUM by the possession of a basis which serve why the term xyngraphé can be Freedman draws attention to the spe- was chiefly religious and fused the translated by “pledge.” cial character of “professional very highest “ethical responsibility” This promise is more religious morality” as opposed to “ordinary with the most complete “legal im- than legal in its meaning. This has al- morality.” In the opinion of this au- punity.” All these characteristics, as ready been observed when we con- thor, professional morality always has already been observed, give a sidered two terms which are philo- has a character which is not ordinary very special status to professions logically related to the word xyn- or which is extraordinary, and as a which distinguishes them in marked graphé: namely the word spondé result of this the professional can do fashion from occupations. For these which refers to a libation which seals or fail to do certain things which are reasons it is possible to affirm that a treaty or an alliance and acts to be- prohibited by ordinary morality as the Hippocratic oath is not merely stow a solemn or holy character on far as ordinary mortals are con- the paradigm of modern ethics but of that agreement, necessarily ensuring cerned. In Benjamin Freedman's professional ethics in a strict sense as that responsibility is involved as opinion this explains why profes- well. well. The other word is fassio, the sional morality is acquired through The Hippocratic oath is a religious Latin term which means both “to an undertaking or contract and he document which was probably com- confess” and “to profess.” From here goes on to observe how it distances posed and structured with reference we can take another step forward in itself from ordinary morality through to the wider framework of the dog- our argument. the employment of such instruments matic religions of the time. These re- It becomes clear that the pledge or and methods as the concept of the ligions began the phase of initiation undertaking of the Hippocratic professional secret. of the novice with the declaration of physician, as expressed in the first A little later Mike W. Martin pub- an oath which involved the neophyte part of the famous oath, formulates lished an article in the same review pledging himself to respect a certain on the subject of “Rights and the set of rules and regulations. In the Meta-Ethics of Professional Moral- case of the Hippocratic oath these ity.” In this article he sought to show norms include an undertaking to how the obligations specific to pro- avoid causing harm, to act to the fessional morality lack meaning greatest benefit of the patient, to when they are divorced from the practice the profession in a pure and laws of ordinary morality. He also holy fashion, to be faithful to the stove to demonstrate that these principle of professional secrecy, to obligations can only be justified with refrain from inducing abortions, and reference to the laws of ordinary so forth. By means of the public dec- morality. Martin thus went on to ar- laration of this oath the novice was gue that the obligation to uphold the able to enter the category of those professional secret is based upon that who “professed,” or to put it another principle of ordinary morality which way, of professional practitioners. In holds that each and every human be- this context the term “profession” ing has two fundamental and invio- had a strictly religious meaning and lable rights—the right to intimacy this characteristic communicated the and the right to confidentiality. fact that an inner, private or moral re- Freedman answered these argu- sponsibility was present. At the same ments in the same year in another ar- time, however, this responsibility ticle entitled “What Really Makes was accompanied by a strictly en- Professional Morality Different: Re- forced and upheld external, public or sponse to Martino.” In this article legal impunity. Freedman sought to draw attention This fact enables us to give a and defines the “professional re- back to the nature of these differ- rather precise meaning to the term sponsibility” of the Hippocratic ences. Arguing that the base is al- xyngraphé, a word which appears physician in a moral and religious ways the same, he stressed the fact three times in the text of the Hippo- sense, rather than in a directly legal that professional ethics are distant cratic oath. In this way we will also one. The professional figures par ex- from ordinary ethics and places their be able to grasp the real nature and cellence, namely the priests, the sov- practitioners on a different and new significance of the Hippocratic ereigns, and the medical doctors, es- level. Thus he proposed that: “Pro- “pledge” or “commitment” which tablish a kind of relationship with fessional morality obliges us to en- the oath promotes. This undertaking those around them which involves gage in acts (or to abstain from them) to which the text refers is not primar- very great moral responsibility but whose omission (or actual commis- ily or immediately of a legal charac- contains the idea that they cannot be sion) would be immoral, except in ter. Indeed the term xyngraphé is a legally charged for what they do. the case of the professional identity Greek word made up of two other The moral pledge involves legal im- of the actor.” This argument can be words: the adverbial prefix xyn, punity. In my opinion, this is the true carried even further. Professional which means “with,” and the noun meaning of the Hippocratic commit- morality at a practical level helps to graphé, which has a number of ment. distance certain men from a set of so- meanings amongst which “written In recent years an interesting con- cial relationships which belong to a document” or “legal text.” We can troversy has grown up around the determined group and to place them observe that what is written commits meaning of professional morality. In in a situation which can be defined people to something, it is a kind of an article entitled “A Meta-Ethics for with reference to the following five solemn promise, and here we can ob- Professional Morality,” Benjamin concepts: “election,” “segregation,” VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 25

“privilege,” “authority” and “im- other physiological and demonstra- feeling of disappointment when punity.” The Hippocratic oath ble religiosity. The Pre-Socratics had faced with the idea that the gods had demonstrates this in perfect fashion. begun this criticism of traditional re- really done such things. For this rea- The practice of medicine is not a ligion and its associated elements. son Socrates presented Eutriphón mere “occupation” but a “profes- The Sophists brought this critique to with the following question: “Do sion.” The professions are very spe- the point of embracing evident lack you really believe that such things cial and particular forms of activity of religiosity. Socrates was the heir really happened as is commonly which do not only oblige their practi- of both these strands of thought and said...? Do you really believe that tioners “to do good” (occupation) sought to go one step further and to wars take place between the gods, but to achieve “perfection” (perficio, establish the basis for a new physio- and that the terrible enmities and perfectio). One can thus understand logical form of religious thought and struggles and the many other things the clearly “priestly” character of the practice. Of what did this consist? of the same kind which have been role of the sociologist and the ethical His subject matter, that of his life described by the poets and which are and religious content of the formula and his death, is what concerns us represented by artists in the various of his commitment. The Hippocratic here. The great theme of the thought sacred ceremonies actually took physician was not a priest in the way of Socrates was piety or holiness place?” Eutriphón replied in the af- that the medical doctors of ancient (hosiótes) . Eutriphón, on the other firmative and gave his own defini- Egypt or Mesopotamia were. He was hand, acts the part of the defender tion of what constitutes holiness: “A a person who had a role which was and the interpreter of the traditional holy man is a man who pleases the typically priestly in character. Of Olympian beliefs. Eutriphón is a gods, and an impious man is a man equal relevance here is the fact that wise and respectable Athenian citi- who does not please the gods.” the term xyngraphé expresses and in zen who is a prophet and seer. As an Socrates answered this statement a certain way summarizes the whole with the observation that if the gods of the first part of the text of the Hip- fight amongst themselves it is be- pocratic oath. cause they are in disagreement, be- In the second part of the famous cause what pleases one of them does oath the physician is called upon to not please another, and so forth. This defend his own life and his skill and means that if the criteria of Eut- expertise in a “pure” and “holy” con- riphón are employed things can be at dition. These terms acquire the the same time both holy and impi- whole of their meaning when con- ous. In order to avoid this paradox sidered in the context of the dispute the definition has to be altered and it between ancient Greek philosophers has to be argued that what is holy is about the nature of sacredness and what pleases all of the gods and what holiness. At a more specific level is impious is what displeases them this debate can be found in one of the all. Socrates goes on to ask: is what Socratic dialogues of Plato. This dia- is holy approved by the gods because logue is entitled “Perí Hosíou” but is it is holy or is it holy because it is ap- more commonly known as the Eu- proved by the gods? In so doing tiphrón because of one its principal Socrates turned Eutriphón's criteria protagonists. The action takes place against him, criteria which argued on one of the days immediately be- that things are either good or bad, ei- fore the death of Socrates. Eutriphón ther holy or impious by nature, and meets Socrates a long way away that this is why the gods love them. If from the latter's lyceum, and more on the one hand Eutriphón believes specifically near to the Gate of the that what is holy is by definition that King where judgments are pro- oracle of the gods he thinks that he which pleases the gods, on the other nounced. Surprised by the question knows the secret of who is holy and hand Socrates maintains that the posed to him as to whether some- who is not. He makes this very clear gods are pleased by what is holy, that body has made some accusations indeed at the beginning of the dia- is, by that which by its very nature against him, Socrates replies that a logue. Socrates speaks and outlines has this “essential characteristic.” certain Meletos: “says that in this what enables somebody to know so What is this characteristic? In or- way he had acted like a creator of much good—“what he considers der to set out his definition, Socrates gods (poiotéstheos), and that in seek- holy and what he considers impi- contrasts holiness with justice. Hó- ing to make new gods and thus in not ous.” Eutriphón then goes on to ex- sios is what is owed to the gods believing in the old gods the accusa- pound the concept of holiness which whilst díkaios is what is owed to hu- tion against me was made.” is propounded by the religion of the mans. One can also say that holiness Socrates was accused of “promot- time. This concept is certainly more is a part of justice, justice towards ing innovations in the field of the di- narrow in character than that ad- God, divine veneration or service, in vine” and of being guided in this en- vanced by Socrates. It involves the a word Therapeía. (This word, as is deavor by the daímon. Socrates was explanation of a number of strange well known, refers more to the wor- said to be “impious” (anósios) in events such as why the best and the ship or to the fear of the gods than to basing morality and religion not most just of the gods—Zeus chained the medical treatment of humans). upon the theogonic traditions of up his father or why, in turn, the fa- Eutriphón likes this approach, an ap- Homer and Hesiosos but upon nature ther of the father of Zeus committed proach indeed which agrees very and reason. This involved con- an act of mutilation. well with his “priestly” style: fronting archaic religiosity with an- Socrates could not conceal his “Socrates displays a respectful simi- 26 DOLENTIUM HOMINUM larity to how slaves behave in rela- cure illness but it also has its original lows both meanings. The abilities or tion to their masters.” religious sense of purging or purifi- habits emerge from the repetition of Just as the therápaina or female cation. From this point we arrive at certain actions. When the habits slave dedicates herself to caring for the pharmacological clause which which are acquired are good they are her master so the priest places his life calls upon the physician to have “pu- called “virtues” and when they are at the service of the divine. In doing rity.” A medicine purifies a sick per- bad they are called “bad.” Moral per- this and thus in enslaving himself in son and this requires the purity of the fection is achieved and expressed relation to purity and goodness, the physician. This purity is both moral only when the ethical consistency priest makes holiness his profession. and physical in nature but it also has and coherence which exists between At the end Socrates and Eutriphón a religious dimension. We should ideas and actions has become deeply seem to be in agreement. One imme- not forget that the virtues are a gift embedded and present over a diately sees, however, that such is from God. The dynámeis of medi- lengthy period of time, when ways not the case. Eutriphón thinks that cines are the manifestations of the of acting have become a matter of somebody is holy because that per- dynamis of God. Here we encounter second nature, and thus when virtu- son is at the service of the divine. a clearly religious meaning which is ous habits are put into practice with- Socrates, on the other hand, thinks not present in the regulation of the out the stress and strain of effort and that somebody is at the service of the díaita, a term which was not origi- even with pleasure. This is what divine because he is holy. Eutriphón nally religious in meaning but moral. Aristotle called bíos, or “way of then proceeds to defend the tradi- For this reason it is necessary to act life.” When thought comes to be a tional Olympian priest with all the in harmony with the moral virtues of kind of second nature of man, as paradoxes he can draw upon. justice—whatever may be the claims happens with the philosopher, the However, at the end of the dia- of holiness—that religious virtue par practice of the dionoetical virtues be- logue Socrates declares: “I become excellence. comes a way or form of life, and thus aware that you would not be pre- become bíos, bíos theoretikós. The pared to instruct me.” By thus down- man who has a brilliant idea is not a grading Eutriphón, Socrates seeks to good philosopher—he is a man who discredit his attributed capacity to be has made the practice of dionoetical a mediator or a pontifex between virtues his way and form of life. The men and the gods, that is, he seeks to same is true of the practice of moral discredit his role as a priest. In doing or ethical virtues, the consequence of this Socrates initiates a new kind of which is the appearance of a way or priesthood, his own, towards which form of life which is truly ethical, and for which he lived and which something which Aristotle called would bring him to his own death. bios politikós. If what a man ex- After this analysis of Socrates' presses in his habits is vices rather ideas of “justice” and of “holiness” than virtues, then another form of let us now return to the actual text of life appears—what Aristotle termed the Hippocratic oath. What is the bíos apolaustikós. meaning of the term hósios which is Next to these elements there is a present in the second verse of the specific bios, namely bios iatrikós. second chapter? First of all there is This is the form or the way of life of no doubt that its meaning is physio- the virtuous physician. In order to be logical rather than mythical. The au- a good medical doctor it is necessary thor of the famous oath is much to possess the intellectual or dianoet- nearer to Socrates than to Eutriphón. ical virtues to the highest degree and But there is a second problem. In the extent. But given that medicine is an physiological sense should we un- active force and not a matter of mere derstand the term as having a wide theoretical knowledge it needs its and rather vague meaning, or, on the III. Profession and Excellence: own specific moral and ethical other hand, as in the dialogue of The Search for the virtues. In this way bios iatrikós is a Plato, should we see it as referring to Perfect Medical Doctor specific form of bios politikós. It is service to the divine rather than to known that Aristotle believed that humans? Without doubt we should The content of the Hippocratic ethics formed a part of politics. In follow the second path. For this rea- oath has given rise during the course addition it should be said that the son a distinction should be made be- of medical history to a tradition same was true of medical ethics. The tween the criterion of “justice” and about the idea of the “good doctor” medical doctor can manage to be the criterion of “holiness.” The first or “perfect doctor.” From the med- “good” or “perfect” only when he should be understood with reference ical doctor, as from the priest or the has managed to transform his techni- to díaita or to the way in which a life sovereign, perfection is expected. cal ability and his moral virtue into a is governed and the second should be But this cannot be reached without kind of second nature, a way of life. identified with the idea of phár- the practice of virtue. As Aristotle The perfect physician is the virtuous makon. What should be observed declared, to know what justice is physician. about this latter idea? does not necessarily mean to act in a The literature on the “perfect med- The word “medicine” or “drug” (a just fashion. ical doctor” began with the early stir- pharmacological entity) has a techni- To act does not have here only the rings and developments of Western cal and medical meaning here. It in- meaning of “act” but also that of medicine. Aristotle himself spoke volves the use of natural products to “ability.” The Latin term agere al- about the téleios iatrós (the perfect VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 27 physician) and Galen spoke about keep a secret, he must not gossip, nor a surgeon of virtuosity. Equally ob- the áristos iatrós (the optimal physi- must he speak ill of people, flatter or viously, we are well able to distin- cian). The adjective áristos is the su- be envious. He must be prudent, guish between a surgeon of virtue perlative of agathós, a word which moderate and not excessively bold... and a surgeon with virtuosity. It means “good,” and when applied to He should know how to control him- should be pointed out that the Greek the medical doctor it means that he self, and he should be honest and re- term areté is more descriptive of the must possess to the highest degree served. He should be a physician first example than the second. This is and extent both the dianoetical or in- dedicated to learning and diligent. because a surgeon cannot have tellectual virtues and the moral and He must work on his art and avoid virtue if he does not have virtuosity. ethical virtues: the pursuits of pleasure. The physi- Obviously enough, technical and "Because in order to know the na- cian must be educated and know practical virtuosity is the pre-condi- ture of the body, the differences be- how to give explanations to all kinds tion to moral virtue. tween the various forms of illness, of people." So far we have been able to grasp and the signs which show which It cannot be in the least doubted that Plato and Aristotle did not hesi- remedies are required, it is necessary that during the eighteenth century (as tate in the least to speak, for exam- to be the master of rational science, will be described below) this ethic of ple, about the areté of a being with- and in order to persevere in their “virtue” received a severe blow. It out reason such as a horse. A very study it is necessary to despise was replaced by the idea of “rights” important passage exists in relation wealth and be moderate... Indeed, and “duties.” After the Enlighten- to this point: the man who despises wealth and ment of the eighteenth century we all "It should be said that virtue per- practices moderation, even though live, as Macintyre has rightly ob- fects the condition of the individual this may involve a certain inconve- served, “after virtue,” and for this who has that virtue and does good to nience, is not afraid. This is because his work. For example the virtue of everything which men dare to do in the eye does good to the eye and to unjust fashion they do under the in- its function (we can see well thanks fluence of greed or the spell of plea- to the virtue of the eye). In the same sure. Thus it is that the physician way the virtue of the horse does should also possess other virtues, good to the horse and enables him to and this is because these latter follow run, to bear his rider, and confront the former and it is not possible for a the latter's enemies.” man to have one and not the others, After the explanations which have being, as they are, linked together as been outlined above, there can be no on a string.” The most highly skilled doubt that the passage should be un- physician, therefore, is the physician derstood in a certain way: it is clear who possesses both the ethical and that Aristotle was not preaching the the dionoetical virtues. Both cate- value of the moral virtues of the gories of virtues are made up of good horse but its technical virtuosity, the habits and when they are present and fact that it is a good horse, for exam- active together they act to form bços ple that it might be a good sprinter. iatrikós, that is, the way or form of The horse which performs its tasks life characteristic of and specific to and functions well we describe in the good physician, the virtuous present-day language as being an ex- physician, or the perfect physician. cellent horse. We say that it is an ex- This classical tradition continued cellent horse and not that it is a virtu- without great changes at least until ous horse. In the same way we say of the end of the eighteenth century. In a person who is blessed with good 1562 Alfonso de Miranda wrote a reason it is the incumbent duty of us sight not that his sight is virtuous but book which bore a highly significant all to be “after virtue” in the sense of that he has excellent sight. As a re- title: Diálogo de la Perfección y pursuit. Virtue is in a certain way sult it appears more than clear that Partes que Son Necesarias al Buen one half of moral life. The good man the best term by which to translate Médico. A few years later Enrique is the virtuous man, that man who the ancient Greek word areté is not Jorge Enrçquez responded to this has turned virtue into a way or form “virtue,” nor indeed “virtuosity,” but book with his own Retrato del Per- of life. This means éthos, form of “excellence.” We can therefore read fecto Médico. All of this literature al- life, bíos (separate from zoé), and the passage from Aristotle again, re- ways had two principal features. On thus bíos politikós. placing the notion of virtue with that the one hand there was the criticism We should observe here that the of excellence. The text thus becomes of the contemporary state of medi- Greek term areté, that is, “virtue,” the following: “It should be said that cine and on the other there was a pre- did not originally mean moral virtue excellence perfects the condition of sentation of the ideal paradigm. En- but a physical condition which en- the individual who has that excel- rique Jorge Enrçquez outlined his abled an individual to do something lence and does good to his work. For ideal paradigm in the following way: well. Perhaps the most appropriate example the excellence of the eye “The medical doctor must fear the Spanish term here is virtuosidad, does good to the eye and to its func- Lord and must be very humble and which may be translated by the Eng- tion (we can see well thanks to the not proud or vainglorious, and he lish word “virtuosity.” Obviously excellence of the eye). In the same must be charitable towards the poor, enough, we can say that Michelan- way the excellence of the horse does discrete, benevolent, affable and not gelo Buonarroti was a sculptor of good to the horse and enables him to vindictive. He must know how to virtuosity, or that a certain person is run, to bear his rider, and confront 28 DOLENTIUM HOMINUM the latter's enemies.” human relationships. Perhaps for this part of his friends. “Those who expe- Aristotle does not stop there but reason Aristotle said that friendship rience pain,” declared Aristotle, continues in the following way: “if was “that which is most necessary to “feel that pain less when their friends this happens in all cases then the ex- life.” And he went on to add that come to visit them.” Filía is love but cellence of the man will also be the “nobody wants to live without a trusting and loyal love. Friendship habit by which the man becomes friends, even when that person pos- is characterized by trust and by inti- good and by which he performs his sesses all other possible goods. Even macy. It is for this reason that we say tasks well.” The good man is the ex- rich people and those who have high that certain friends are “intimate cellent man and the striving for ex- appointments and wield power seem friends.” The world of friendship is cellence is and must be the greatest to have need of friends before any- the world of trust. The three virtues human aspiration. It is no accident thing else.... In poverty and in misad- which we term theological are pre- that the ancient Greek word areté venture friends are the only true sent and active when real friends are comes from areíon, which is in turn refuge.” However it is precisely in involved. These theological virtues the comparative of agathós, mean- such hard times that friends are less are: faith, hope and charity. At the ing “good.” Areíon thus means “bet- frequent and less present. Down the center of these virtues is hope, unter” in the sense of “better” than oth- centuries the following lines, written derstood in this context as trust. In- ers, or to put in another way: “excel- by the poet Ovid, have been fre- deed, in order for a friend to confide lent.” In reality the comparative of quently quoted and cited: in someone he has first to trust that what we translate with the term Dum fueris, multos numerabis person—there has to be a “trusting “good” is “excellent,” and its su- amicos; tempora, si fuerint nubila, faith.” And the friend is confided in perlative thus becomes “most excel- solus eris. because he is loved—there is a lent.” One of the darkest moments in our “trusting love.” We can thus grasp the final and lives when we have greatest need of Friendship is more than an ethic, it true goal of professional ethics—the friends and when they become rather has much to do with religion. Agape striving for and attainment of excel- scarce on the ground, is when we are or “charity” is usually seen as the lence. The engagement with excel- ill or fall sick. The sick person does virtue par excellence of Christianity. lence is the search for perfection, for not want pity—he wants the demon- But agape only leads to perfection total quality, for work well done. Ex- stration of courage and of love on the when the benevolence and benefi- cellence means, as Aristotle himself cence which characterize this virtue said, doing something well (eu prat- are linked to intimate trust and to that tein), which is in turn a fundamental intimate trust which is the great fea- ingredient of living well (eu zen), ture of friendship. The result of this, and thus of happiness and of perfec- as Edmund Pellegrino and Warren tion. The conclusion is more than ev- Reich have so accurately pointed ident: excellence is the sole and final out, is “com-passion,” something goal of professional activity. which involves putting oneself in the The relationship between the med- position of another person and iden- ical doctor and the patient (or more tifying oneself with his experience. generically the relationship between Compassion is not pity. It is a human the health care worker and the pa- relationship based upon devotion, tient) will only be perfect if the med- upon constancy, upon respect for the ical doctor aspires to virtue, strives, individual, and upon responsibility. that is,, to achieve excellence. And It is, as Reich makes clear, a relation- given that the virtue par excellence ship with another person based upon of social and political life is in Aris- love, upon benevolence, upon under- totle's opinion filia or friendship, it standing, and upon friendship. Filça follows that the medical relationship and agape converge and complete will only be perfect when it involves each other in compassion. And it is friendship. Friendship is the moral for this reason that it is the most sub- virtue par excellence and it is thus lime of all human relationships: also the fundamental feature of the morality of those who have virtuos- I shall no longer call you servants, ity. We can thus see that the because a servant does not know Laçn Entralgo has dedicated an his master's business: entire book to what he calls “medical I call you friends, friendship.” It is usually said and ar- because I have made known to you gued that the medical doctor—and everything I have learned from my the health care worker in general— Father (Jn 15:15). must be “at the service” of the patient. I believe that this is a very serious error. The old social and legal Professor DIEGO GRACIA figure based on servility can never GUILLEN constitute an ideal for human rela- Professor of the History of Medicine tionships. Such relationships must at the Complutense University, Madrid not be based upon “service” but Consultor to the Pontifical Council for upon “friendship.” Friendship, in- Pastoral deed, is the virtue par excellence of Assistance to Health Care Workers VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 29

BRUNO ZANOBIO

The Ethical Dimension of Hippocratic Medicine and Its Specific Relationship to Christian Morality

When I was very kindly invited to will seek to approach the subject as the stimuli of this meaning which make a contribution to this impor- a scholar bound by the conventions have entered active medicine, vari- tant conference on the subject of the of historiographical method and ac- ous debates have emerged which ethical dimensions to Hippocratic customed to the investigation and have provoked and continue to pro- medicine and their specific relation- interpretation of documents, or voke an examination and the study ship to Christian morality, my first rather the many kinds of traces of of the changing relationship over instinctive impulse was to decline the past which we find in the pre- time between the values implicit in such an honor. I was immediately sent. It is not my intention to dis- the text at the time of its formula- more than aware of the great com- cuss here the many aspects of the tion and during the vicissitudes of plexity of the subject which had figure of Hippocrates or the many its evolution until today, and the been proposed to me, not least be- interpretations of his “Oath” in the values specific to medical practice cause of the approach to the subject history of medicine, nor to dwell which at times have been in har- which is usually employed in the upon the complex and well known mony with those of the text and at studies of our discipline. problems relating to the various times have been in contradiction. In particular, I immediately no- forms of transmission and diffusion On the other hand we well know ticed that the title of the confer- of the literature attributed to the Cos that the guiding principles that we ence—“From Hippocrates to the school in the ancient and medieval now express and which appear to us Good Samaritan”—went from a worlds. Obviously enough, how- as questions of ethics and profes- historical figure to a symbolical fig- ever, my paper will not be able to sional codes, do not actually come ure, namely a cardinal figure of one ignore these factors altogether. from the short text of the “Oath” to of Jesus’s parables. Or to put it an- The debate about the ethical di- which reference is made but are pre- other way: to a lesson in the form of mensions of Hippocratic medicine sent in significant, albeit less well- a story which has the purpose of has always been of notable com- known, fashion in a number of other providing a comparison and an ex- plexity. Indeed, the levels of com- texts of the Corpus Hippocraticum. ample with a moral goal. We have plexity have been such that the Jouanna has picturesquely and per- here two figures which are rather questions and problems arising ceptively defined these texts as distant from each other in terms of from the debate have never in real- “pieces in search of an author,” and time, who come from different ity been fully settled. they are pieces which are homoge- backgrounds—from Hippocrates The very definition of “Hippo- nous and yet not homogenous at the of Kos of the fifth century before cratic medicine” involves great dif- same time. Christ to the Gospel according to ficulties which touch upon matters Naturally enough, we cannot Luke (60-70 AD). But these are fig- which go beyond the mere elements dwell here upon those questions ures who have been chosen deliber- of this medicine. This is because we which have been discussed and de- ately by the organizers of this con- can interpret the phrase as meaning bated for a very long time—and ference because to a certain extent not only that approach to medicine which are still the object of inquiry they have an important element in expounded and practiced by the today—relating to the paternity of common—they are bearers of ethi- school inspired by the teachings of the “Oath” and of the other texts cal messages which touch medicine Hippocrates and largely written up which will be cited in this paper. In- either directly (Hippocrates) or in- in the Corpus Hippocraticum, but deed, as regards the “Oath” in rela- directly (the Good Samaritan). also that approach which is active tion to the specific interpretation Furthermore, the subject has al- today and which invokes the spirit which is of interest to us here today, ready been tackled from various an- of these teachings, defines, pro- we should consider the classifica- gles by a broad range of authors, claims and presents itself as such, tion given to it by the physician and this is especially true of the fa- and thereby (so to speak) confers Herozianus, who lived at the time of mous “Oath.” Of these authors I upon those teachings a perennial Nero, and in the first century AD would like here to refer to His Emi- validity. And here, it may be ob- but before Galenus (129-200) com- nence Cardinal Fiorenzo Angelini, served, I do not even touch upon the piled the oldest list known to us of to whom I extend a cordial greeting. debate about Hippocratism and the presumed works of Hippocrates. With all these reservations, how- Neo-Hippocratism. He saw the “Oath” as the authentic ever, I accepted the invitation. But I When faced with the breadth of product of the thought of Hip- 30 DOLENTIUM HOMINUM pocrates and classified it in the place from childhood in a good ical method which has close affini- “tracts on the arts” together with school of medicine and be pro- ties with Epicurus (341 BC—271/2 “law, art, and ancient medicine.” moted by passion for the calling. AD). It is not to be found in the list This classification indicates that in The piece concludes by comparing compiled by Herozianus, and ac- that epoch Herozianus was reflect- the acquisition of scientific knowl- cording to a glossary of the Vatican ing the shared meaning of a norma- edge to religious initiation into the codex “Ur. gr. 68” this text belongs tive and behavioral message which mysteries. In the same way the pro- to the Hellenistic epoch. is very evident in the text of the hibition regarding the revelation of From an examination of the “Oath” and the “Law” but which sacred knowledge to non-physi- above and from what emerges from can also be grasped by a non-super- cians carries on from the “Oath.” the literature, to which I will refer at ficial reading of the “Ancient Medi- Because of its use of the term times in textual terms, the Hippo- cine” and the “Art.” “dogma”—which does not appear cratic physician emerges as an aus- In order to help the reader I will before Plato and Xenophontes—the tere and serene man, a master of here present some brief and already text cannot be prior to the fourth himself, possessed of a quick mem- known reflections on these tracts. century before Christ. However it ory, endowed with a great profes- But I will not refer to the “Oath” already formed a part of the Corpus sional seriousness, hostile to the- both because of its fame and be- Hippocraticum at the time of atrical attitudes and poses, gifted cause it is the subject of discussion Herozianus who placed it in the cat- with abilities of a technical kind, by other authorities at this interna- egory of works relating to art imme- and in the formulation of his prog- tional conference. As regards the diately after the “Oath.” Echoing noses he avoids engaging in “div- “Oath” I would like merely to make once again Jouanna, I would like inations.” the observation that some scholars here to refer albeit briefly to certain “What the sick person is looking and experts have a rather restricted texts from the Hippocratic back- for is not embellishments but re- approach to it and interpret it with ground which contain deontological lief.” (Physician). less emphasis on its ethical content elements which at times touch upon “In many instances it is not than other commentators. Some ethics. enough to argue that something people, indeed, believe that in the Decorum. This is a short piece on should be done. Action should be “Oath” the normative dimension re- the correct conduct of the physician taken to provide help.” (Decorum). lating to the behavioral duties of the when he exercises his profession There are however many ques- physician prevail over the more au- both in his surgery or clinic and at tions raised by Hippocratic medi- thentically ethical dimension in an the bedside of the patient. It con- cine in relation to ethics. I will now overall sense. tains various kinds of advice which give two examples of this. Ancient Medicine. This belongs conform to the Hippocratic spirit. There are discussions about to the discourses originally intended This work, however, does not form physicians treating free men and to be pronounced before a public of a part of the ancient nucleus of the physicians treating slaves. These specialists and non-specialists. The Corpus Hippocraticum and does discussions are rendered difficult by reference to Hempedocles gives not appear in the list of Herozianus. the fact that the Greek term credence to its being attributed to It can be dated to the first or second “παιδσ” can mean both “young the end of the fifth century before centuries after Christ. man” and “slave.” It has been ob- Christ. The author of “Ancient Duties of the Physician (or Tes- served here that such conduct, Medicine” believes that a knowl- tament of Hippocrates). This is a deeply influenced by time and edge of man is only possible short deontological work which place, depended more upon the “so- through medicine, a view in opposi- lists the physical, moral, and intel- ciety” than upon the Hippocratic tion to those who maintained that lectual qualities which the physi- physician himself. When consulted, philosophical knowledge about cian should have. However, it does this physician paid as much atten- man is more important than medi- not form a part of the ancient nu- tion to the sick slave as to the sick cine. cleus of the Corpus Hippocraticum free man, and to this extent the Hip- Art. Generally attributed to the and can be dated to the first or sec- pocratic physician is in essential end of the fourth century before ond centuries after Christ. terms more up-to-date than Plato. A Christ, this work is a part of the dis- Physician. In this text the author similar problem arises in relation to courses originally intended to be gives advice of both a behavioral the conduct of the physician to- pronounced before a public. In this and technical character to the doctor wards the rich rather than the poor work the author tries to demonstrate at the beginning of his career. In re- and to what his professional fees that medicine is an art which is full lation to its deontological contents should be. of resources within, obviously it corresponds well to the more an- When we come to consider the enough, certain limits. At the same cient texts and one part is directly importance of the “society” of that time it is a reply to the critics and based upon the “Oath.” The work time it must be remembered that so- detractors of the art of medicine. entered the Corpus Hippocraticum cial censorship was of real impor- Law. This is the work, after the rather late, it was not known to tance and consequence and could “Oath,” where perhaps the charac- Herozianus or to Galenus, and can actually destroy the career of a med- teristic elements of Hippocratic be attributed to the Hellenistic ical doctor, even though this was a medicine stand out most sharply. In epoch or to the beginning of the period when the responsibilities of this work it is stated, amongst other Christian era. the physician were not actually cod- things, that in order to be a good Precepts. This text has essential ified in law. physician it is necessary to fuse a deontological contents (picture of Another problem which arises in serious training with natural quali- the ideal physician; criticism of bad relation to Hippocratic medicine ties, and that this training must take doctors) and has a section on med- and the field of ethics is that of the VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 31 possibility the Hippocratic physi- those aspects which take the form of always and in all circumstances. It cian has of taking the important de- chapters devoted to giving instruc- therefore goes far beyond the ethi- cision to not treat a sick person if he tions about technical approaches cal dimensions of Hippocratic med- thinks that the patient cannot be and methods. icine. cured. This approach is very differ- I will not dwell here upon the ex- Furthermore one has here a text ent from that of the Cnido school, tent to which, with what implica- which expresses its deep meaning which argued that the physician tions with regard to language, and through the example of a wounded should treat a sick person even the ways by which, Hippocratic man and through a wounding, that when a fatal illness was involved. In medicine and its ethics spread in is to say facts and realities con- reality the problem could not be powerful fashion through the an- nected to medicine. solved easily because of the varying cient world. Instead, I wish to turn Incompetent as I am in relation to influential opinions of the day. In to another subject. ethical, juridical and philosophical The Republic Plato declares that We can thus have a clear idea, questions, I will not dwell upon dis- “men with expert art, for example given what has been outlined above, cussions which have revolved the navigator and the eminent doc- of the ethical dimensions of Hippo- around this fact but I will venture to tor, know in their art how to distin- cratic medicine when the evangelist analyze certain aspects of the sub- guish between the possible and the Luke (an abbreviation of Lucan) ject which provoke the interest of impossible, and they attempt the gave an account of the parable of the historian of medicine. possible and neglect the impossi- Christ about the Good Samaritan. Indeed, one should not forget ble.” In the same way Herophilus This parable is related by this evan- that: (third century before Christ) be- gelist alone. It narrates how in go- Ð Luke, who was Antiochian and lieved that “the perfect physician is ing down from Jerusalem (740 me- Macedonian in origin, and a pagan able to distinguish between the pos- ters above sea level) to Jericho (350 by birth, soon converted to Chris- sible and the impossible.” Accord- meters below sea level) at first a tianity. He knew Greek, was a dili- ing to the “Art” it is possible to not priest and them a Levite saw a man gent and conscientious researcher, treat the impossible and Galenus, who had fallen victim to thieves and was the bearer of a notable liter- referring back to the “Art” in his who had stripped him and covered ary culture. He had these qualities “Commentary with Aphorisms,” him with wounds before leaving to such an extent that he was also a admits that one can decide not to him half dead. Both the priest and writer who paid rigorous attention treat sick people who have been de- the Levite saw him and passed on. to historiographical method; feated by illness. This leads us to After them there came a Samari- Ð he excludes himself from the list consider the problem of the modern tan—a sinner and atheist in the eyes of evangelical eyewitnesses with a day concept of therapeutic overkill, of Jewish public opinion—who sincerity and modesty which are but this is a subject which in this pa- stopped and helped the unfortunate highly praised in the large amount per I cannot even touch upon. man without paying attention to of apocryphal literature; However the position of the fol- costs, to nationality or to privileges. Ð the third canonical gospel, which lowers of Hippocrates on the cur- The figure of the Samaritan has a is the most elegant and polished of able and the incurable was not clear very deep significance. Despite re- all the gospels, presents elements cut but could vary according to gional and religious antagonism, he which are of special originality. It ideas about the possibility of ad- helped his adversary to regain his emerges as a literary work intended vance and progress in medicine. strength and to live. for pagans converted to the new But to return to the texts belong- The parable has given rise to faith and especially for Christians ing to the “Art” I would like to point many comments and approaches of the Greco-Roman world. out that they made up a part of the both for and against the behavior of Ð According to authoritative group of works defined as “thera- the priest and the Levite who both sources Luke studied medicine at peutic,” an appellation which en- ran the risk of becoming impure ac- Tarsus which was a notable cultural dowed them with the connotation of cording to certain religious rules center of Asia Minor, and that the being teachings which were indis- and ordinances. For this reason, the terminology which he used in rela- pensable to the practice of the art of moral conclusion of the parable is tion to illnesses and healing is, healing. At that time the question of that the law of charity always takes when compared to the language whether these special areas of precedence over other laws; indeed used by the other evangelists, the knowledge and instruction were a it can even rightly go against them. most detailed and the most in line component element in the complete “Charity, charity, and always char- with the works of classical medi- training and formation of the physi- ity!” as an authoritative proclama- cine; Luke was the beloved physician and thus constituted an integral tion would have it. cian of St. Paul, indeed his “secta- part of his healing powers, or The naturalness and the incisive- tor” (Irenaeus, second century after whether they had a mere normative ness of the tale told by Luke are Christ), and that he accompanied St. importance, was already being such that certain authorities believe Paul on his various journeys, in- raised. that it refers to something which re- cluding the eventful voyage (in- Our impression is that both these ally happened, and that Jesus takes volving a shipwreck near Malta) aspects were present in the litera- it as a subject so as to come to con- from Cesarea to Rome. Further- ture of the Hippocratic school and clusions about charity towards more, Luke (who died in Beozia at that our interpretation of the ethical one’s neighbor and to present the the age of eighty-five) was in Rome questions and dilemmas posed by real essence of charity. Overall, one when Paul was beheaded in that city that school enables us to understand is dealing here with a message in 65/67 after Christ. both the normative parts—which which has a universal and incon- Bearing in mind what has been seem to prevail in the “Oath”—and testable value which is to be applied said above, one can also ask if, and 32 DOLENTIUM HOMINUM

to what extent, Luke knew about on September 14, 1995. F. ANGELINI, “Attualità del Giuramento di Ippocrate,” address by His Excellency Mon- Hippocratic medicine and its For this reason, the Christianized signor Fiorenzo Angelini at the inauguration “Oath.” For this reason, the first Hippocratic “Oaths” become espe- of the academic year 1983-1984, Atti e Mem- specific meeting between the ethics cially significant and indicative, orie della Accademia dell’Arte Sanitaria, III of Hippocratic medicine and Christ- and in particular that taken from series, II year, 1983, n. 2, pp. 25-32. Hippocrates, with an English translation ian morality could also have taken Ms. Ur. gr. 64 and used for the pro- by W.H.S. Jones, vol. I (Cambridge and Lon- place during the first difficult years gram of this international confer- don, 1984) of Christianity. ence. Probably, as the Holy Father C. Lichtenthaeler, Der Eid des Hip- It is certainly true that one cannot declared in 1994, “that illuminated pocrates. Ursprung und Bedeutung, (Köln, 1984). assert this with complete confi- amanuensis of the thirteenth cen- D. Lippi and S. Arieti, “La Recezione del dence. It can only be suggested as a tury who wanted to transcribe the Corpus Hippocraticum nell’Islam,” in Atti del hypothesis and with a great deal of Hippocratic oath in the form of a I Convegno Internazionale I Testi di Medicina Antichi. Problemi Filologici e Storici, S. Mac- caution. This hypothesis and cau- cross already perceived in the ratio- erata and M. Severino, April 26-28, 1984, tion should also be present when we nal argument about the right to life a Rome, 1985. try to identify how Christian moral- value which was propaedeutic to S. SPINSANTI, Bioetica, (Milan, 1985). ity gradually formed itself into a the Christian concept of the human C.M. MARTINI, “Homily of His Eminence Cardinal Carlo Maria Martini, Archbishop of systematic body of doctrine, and person, to the sacredness of life, in- Milan, for the Diocesan Day of the Sick Mi- when we try to assess the extent to deed to the full recognition of the lan, 26 June 1985,” in Fatebenefratelli, year which, if at all, the early Christian mystery of life. This recognition VII, 1986, n. 1, pp. 10-11. writers knew about Hippocrates. I does not humble the impulse of sci- G. MOTTURA, Il Giuramento di Ippocrate. I Doveri del Medico nella storia (Rome, 1986). am referring here to such authors as ence—it encourages it and renders J.H. KUEHN and U. FLEISCHER, Index Hipp- Tertullian (Carthage, 160?-240?), it noble.” pocraticus, (Gottingae, 1986-1989). Ambrose (Treviri 340?-397), Professor BRUNO ZANOBIO S. SPINSANTI, “Christus Medicus”: Impli- cazioni Etiche di un Tema Patristico,” in Jerome (Stridon 347 c.-420), Pru- Professor of the History of Medicine Fatebenefratelli, year IX, 1987, n. 6, pp. 10-12. and Pro-Chancellor of the dentius (Spain b. 348), Augustine M. VEGETTI, L’Etica degli Antichi (Bari, (Tagaste 354-430), Isidore of University of Milan 1989). Seville (Cartagena 560/570-636), L.R. ANGELETTI, The Origin of the Corpus the Venerable Bede (Wearmouth Hippocraticum from Ancestors to Codices Bibliography Antiqui: the Codex Vaticanus Graecus 276,” 672-735), Peter Abelard (Pallet in Medicina nei Secoli. Arte e Scienza, new 1079-1142), Bernard of Chiaravalle E.MARTINI AND D.BASSI, Catalogus Cod- series, vol. III, 1991, n. 2-3, pp. 99-151. (Fontaines les Dijon 1091-1153), icum Graecorum Bibliothecae Ambrosianae E. SGRECCIA, Manuale di Bioetica (Milan, 1991-1994). Hugo of St. Victor (1096-1141), (Mediolani, 1906). Corpus Medicorum Graecorum. Auspiciis S. SPINSANTI, Bioetica in Sanità (Rome, Aelred of Rievaulx (Hexham Academiarum Associatarum Ediderunt Acad- 1993). 1109/10-1166/67), Raimondo Lull emiae Berolinensis Havniensis Lipsiensis Vol. MIRKO D. GRMEK (ed), Storia del Pensiero I, edidit I.L. Heiberg (Lipsiae et Berolini, Occidentale. Vol. I. Antichità e Medioevo (Palma 1232/35-1315). All of these (Bari, 1993). constantly cite Hippocrates in their 1927). L.BELLONI, “Iconografia Medica in Codici JOHANNES PAULUS II, Veritatis Splendor. works. Ambrosiani. 2) Trattetello Figurato dei Cau- Lettera Enciclica del Sommo Pontefice Gio- With the development of Christ- teri in un Codice Ignorato del Passionarius di vanni Paolo II circa Alcune Questioni Fonda- ian morality the concept of “Chris- Garioponto,” Rendiconti dell’Istituto Lom- mentali dell’Insegnamento Morale Della bardo di Scienze e Lettere. Classe di Scienze, Chiesa (1993). tus Medicus” became almost a tra- vol. LXXXIII, 1950, pp. 467-474. D. LIPPI, “Per una nuova Lettura del Giura- dition, and to such an extent that in M.L. GENGARO, F.LEONI and G.VILLA, mento Ippocratico,” in Medicina nei Secoli. Codici Decorati e Miniati dell’Ambrosiana. arte e scienza, new series, vol.5, 1993, n. 3, medieval medical manuscripts we pp. 329-343. at times find added to portraits of Ebraici e Greci (Milan, [1957]). Nuovo Testamento, edited by Pietro Rosso. IPPOCRATE, Aforismi e Giuramento, with Hippocrates such expressions as Third volume of La Sacra Bibbia, translated an introduction by Massimo Baldini, trans- “summus medicus est Christus.” from the original texts and with commentary, lated by Marco T. Malato, (Rome, 1994). The most important moment is edited by Enrico Galbiati, Angelo Penna and J. JOUANNA, Ippocrate (Turin, 1994). Piero Rossano. Second revised and corrected Proceedings of the Ninth International when with the passing of time we edition (Turin 1964). Conference: To Know, Love, and Serve Life, find a meeting between the Hippo- W. JAEGER, Cristianesimo Primitivo e Vatican City, November 24-25-26, 1994” in cratic and the Christian ethical mes- Paideia Greca, translated by Silvano Dolentium Hominum, year X, 1995, no. 1. sages. This meeting appears at Boscherini (Florence, 1966). J. HABBI, “L’Eredità Ippocratica dell’Ob- La Bibbia Concordata, translated from the bligo Morale nella Medicina Araba,” in Med- times to be an absorption by the sec- original texts with introductions and notes icina nei Secoli. Arte e Scienza, new series, ond of the first, and although this is edited by La Società Biblica Italiana (no place vol. 7, 1995, n. 1, pp. 79-93. of publication, 1968). JOHANNES PAULUS II, Evangelium Vitae. not always the case one could per- Lettera Enciclica del Sommo Pontefice Gio- haps at times speak of an impact L. GEYMONAT, Storia del Pensiero Filosofico e Scientifico. Volume Primo. L’An- vanni Paolo II sul Valore e l’Inviolabilità rather than an encounter. tichità. Il Medioevo. Con Specifici Contributi della Vita Umana (1995). But this does not detract anything di Gianni Micheli, Renato Tisato, Mario Veg- JOHANNES PAULUS II, Ecclesia in Africa. from the authentic and fundamental etti (Milan, 1970). Esortazione Apostolica post-Sinodale del IPPOCRATE, Opere. A Cura di Mario Veg- Santo Padre Giovanni Paolo II circa la questions to which His Holiness etti (Turin, 1976). Chiesa in Africa a la sua Missione Evangeliz- John Paul II pays repeated attention, A. CERUTI, Inventario dei Manoscritti zatrice verso l’Anno 2000 (1995). questions relating to the “moral della Biblioteca Ambrosiana (Trezzano sul S.G. MARKETOS, “La Medicina Ippocrat- teaching of the Church (1993), the Naviglio, 1977). ica alla fine del XX Secolo: Alcuni Messaggi GALENO, Opere Sicelte. A Cura di Ivan Profetici,” Paper presented to the XXXVII “value and inviolability of human Garofalo e Mario Vegetti (Turin, 1978). National Congress of the Italian Society for life” (1995), and the relationship be- S. SPINSANTI, “L’Ethos Ippocratico, in the History of Medicine, Bari-Monopoli, 5-8 tween “evangelization and incultur- Medicina e Morale, 1982, n. 2, pp. 144-159. October 1995. IPPOCRATE, Testi di Medicina Greca. Intro- A. MASSARENTI, review of K. Popper’s Il alization.” This last question was duzione di Vincenzo Di Benedetto, Premessa Mito della Cornice. Difesa della Razionalità e dwelt upon and discussed in particu- al Testo, Traduzione e Note di Alessandro della Scienza, in Il Sole 24 Ore, 29 October lar fashion at Yaoundé in Cameroon Lami (Milan, 1983). 1995. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 33

GONZALO HERRANZ RODRIGUEZ

Contemporary Ethical Codes of Professional Conduct

Introduction: member of the seminar were a careful wounds of the injured man. The Good The Four Ethical Lessons and keen reader of the Gospels and Samaritan then assesses the clinical in Professional Conduct Offered by knew about the tense relationship situation, takes out bandages, balsam, the Good Samaritan which existed at the time of Jesus be- and wine from the bag he always car- tween Jews and Samaritans—two ries with him, and provides first aid. Let us imagine for a moment that communities which greatly despised He makes sure that the wounded man the parable of the Good Samaritan each other because of their profound is in a condition to be moved, places were given to us as a case to study and religious and ethnic differences—he him on his horse, and takes him to the to examine from the point of view of would be able to make a number of nearest inn. The Samaritan settles him professional ethics. The idea, how- very opportune comments. He would in the inn and looks after him for the ever, is by no means new. The parable say that we have before us a standard entire day and perhaps for the night as was used by A. Jonsen as an exercise case of emergency aid. The parable is well. The story of the Good Samaritan in clinical cases studies to demonstrate an eloquent defense of the overcoming provides us with a third lesson on the that there are inevitable limits to the of ancestral hatred and misunderstand- ethics of professional conduct: that of possibilities and capacities of contem- ing promoted by the Gospel message medical benevolence, the feeling of the porary medicine. Let us leave aside the of love for one’s neighbor. Profes- medical doctor for the wounded man application of the parable to situations sional ethics command health care and for the sick man. which belong to the realm of the workers to employ the same dedica- Only on the next day, when the purely fantastic, and introduce it in- tion and competence in serving all pa- prognosis is favorable, does the Good stead into a seminar on medical ethics tients, whatever their condition or sta- Samaritan, after giving the innkeeper for students or for young professionals tus may be: the second lesson in mat- precise instructions about how the of medicine and nursing. ters relating to professional ethics wounded man should be looked after Let us read the parable and ask these which the Good Samaritan gives us is and after handing him money to pay young people to seek to identify the to avoid a policy of discrimination in for immediate expenses, continue on questions posed by the episode and to our treatment of patients. his journey. He also promises the pa- detect the lessons offered by the story Let us suppose that one of the stu- tient that he will return and pay him a in the light of ethical codes of profes- dents who is analyzing the case not visit and tells the innkeeper that he will sional conduct. only reads the Gospel text, but also later settle any future expenses. The Their first discovery could be that dwells upon the instructions and the Good Samaritan thus gives us a fourth the parable constitutes a paradigm for notes which are to be found at the foot lesson: the selfless duty to serve the man’s good and bad behavior—and in of the page of his annotated text. He patient without payment and to help particular the good and bad behavior knows that the author of the passage is him in a generous way. of the health care worker—when faced St. Luke, a medical doctor. That stu- My task this morning is to demon- with a demanding and difficult situa- dent could well grasp that the hagiog- strate the ways in which these four tion. If one of the members of our sem- rapher Luke, while writing his book lessons of the Good Samaritan have inar had a certain knowledge of gen- under the inspired influence of the found a place in modern ethical codes eral or professional law, he could add Holy Spirit, would not have failed to of professional medical conduct. It that the parable also comments on the continue at the same time to be a must be recognized at the outset that behavior of the priest and the Levite— physician. For this reason St. Luke in- the mission to help people in situations behavior which is, of course, so at evitably projected his personality into of emergency, to not to engage in acts odds with the exemplary conduct of what he wrote, and also transferred of discrimination, and to serve patients the Good Samaritan. Such behavior himself as a physician into the figure with loyalty, hold a pre-eminent posi- constitutes an offense which is punish- of the Good Samaritan. Our students tion in the general and fundamental able by law in many countries of to- would be able to deduce, and rightly obligations which shape the overall ac- day’s world—an offense rooted in a deduce, that the Good Samaritan was tions and role of the health care positive failure to provide help. We in reality a good doctor. worker. On the other hand, it should can thus observe that the obligation to This is shown and borne out by also be pointed out that the duties provide help in a situation of emer- what the Samaritan does: his human which require benevolent friendship gency is the first lesson of the parable heart is moved by pity. He gets off his and altruistic help occupy only a mar- of the Good Samaritan as far as pro- horse and, acting like a good profes- ginal position in contemporary ethical fessional ethics are concerned. If a sional, he proceeds to examine the codes of medical professional conduct. 34 DOLENTIUM HOMINUM

1. The Obligation to Give vision of inadequate and inappropriate of the clauses of the International Treatment and Help treatment to a wounded person or a Code of Medical Ethics (the London in Situations of Emergency sick person in the place where the Code of 1949). This clause lays down emergency takes place, has had a that one of the duties of the medical The obligation to provide treatment marked influence on the attitudes and doctor in relation to the patient is as and care in situations of emergency is behavior of medical doctors in that follows: “the medical doctor, as a hu- present as a shared rule in all present- country. Following the liberal-radical manitarian duty, must provide help in day ethical codes of medical profes- approach and style which prevails in cases of emergency unless that medical sional conduct, even though, of course, the world of North American medi- doctor is certain that other people are this obligation is stressed in different cine, the Principles of Medical Ethics ready and able to provide such help.” ways and with different emphasis ac- of the American Medical Association The framework of ethical codes of pro- cording to the countries or cultures do not lay down that there is necessar- fessional conduct in the sphere of med- which give rise to such codes. ily a duty to provide help in emergency icine is completed by the guidelines In the codes of the Latin-Mediter- cases. They observe, rather, that such and rules provided by certain associa- ranean region this duty is one of the cases constitute an exception to the tions of health care workers who are general principles of the conduct of the right of the medical doctor to choose specialized in providing services in sit- medical doctor. For this reason the oath the patients he wants to treat. The uations of emergency (that is, nurses, that the Italian doctor must take at the Fourth Principle of Medical Ethics de- hospital doctors, and laboratory techni- moment of enrolling himself in the clares that: “In giving suitable attention cians). These norms declare that in profession includes the undertaking to to his patients the doctor is free to every situation of emergency there is a “provide emergency help to any sick choose who he will treat except in situ- duty to revere life, to respect the dig- person who is in need of it.” Article 7 ations of emergency.” nity, the autonomy, and the individual- of the Medical Deontological Code of It is precisely as a result of this ity which are inherent in every human Italy of 1995 declares as follows: “The weakness in matters of ethical duty in being, and to refrain from compromis- doctor cannot refrain from acting and professional conduct that various states ing the trust of the patient. must provide help and emergency help of the Union have passed laws which It is not easy to draw valid conclu- to those who need it and always ensure have been termed “Good Samaritan sions from this survey of comparative the supply of any other kind of more Laws.” These laws lay down that med- deontology. However, it is possible to specific or suitable help, quite inde- ical doctors, nurses, and, in certain identify certain problems which should pendently of his usual specialization cases, ordinary people who have pro- be examined and discussed, such as the and in every kind of place and circum- vided help in cases of emergency in possible relationship between the stance.” The French, Spanish, Por- places outside the hospital or the doc- ethics of values and the ethics of rights tuguese, and Belgian ethical codes tor’s office and have not had suitable to be found respectively in the Protes- echo the Italian code and insist on the instruments at hand are not to be held tant and Catholic traditions, and the inescapable duty of each medical doc- responsible for their actions, in the norms about emergency situations tor to provide immediate help to a sense of both commission and omis- which prevail in those countries which wounded person or to a person who is sion. It is surprising indeed that the belong to these traditions. seriously ill: these codes make clear Good Samaritan appears on the Ameri- It would also be interesting to study that this duty is present because of the can health emergency scene because of and examine why over the last few simple fact that an individual is a med- legislative initiatives and not because decades the oldest, most competent ical doctor and disregards what the of what ethical codes of professional and most experienced medical doctors specific professional role or specialist conduct lay down. There are no spe- have gradually transferred responsibil- training of that individual might be. cific professional rules or guidelines in ity for the provision of help in cases of In different and opposing fashion the Jewish ethical tradition to govern emergency to younger doctors. What, the rules of the Anglo-Saxon world are emergency situations. But the Jewish we may ask, has caused this historical weaker and more vague. On the one tradition parallels the Christian tradi- change: the power of older doctors hand, the ethical guidelines of the tion of believing that life is sacred, a who live a life which is less stressed by British Medical Association say that tradition established and promoted by the tension and the hours worked of “in a case of emergency, it is hoped the Bible. It therefore upholds the medical emergencies, on the one hand, that all doctors will offer their help, but prevalent duty to defend life, a duty or the need to ensure that in the training the extent to which they provide such which is enforced with such insistence of the young doctor there is a period of help and the means that they employ that any legal norm which enters into tension caused by the many pains of will depend upon the nature of that conflict with this overriding command- professional formation which will pro- emergency, the possibilities of obtain- ment becomes subordinated and takes vide him with a suitable psychological, ing more expert help, the nature of the second place. The medical action of professional, and ethical maturity, on threat to the life of the patient, and the taking care of someone who is in dan- the other? Let us now pass to the sec- readiness of the doctor to engage in ac- ger of losing his life is sanctioned in ond lesson which is offered to us by the tions which are beyond the range of his such a way that the medical doctor parable of the Good Samaritan. usual clinical experience.” The Guide does not have to do penance for having to Ethical Conduct of the Medical disobeyed such precepts as respect for Council of Ireland confines itself to ob- the Sabbath day because he has come 2. The Duty to Refrain from serving in vague terms that “the doctor to the aid of a wounded or sick person. Discrimination and to Treat All must provide help in emergencies and I have not been able to come across People in the Same Way must ensure that the patient has alter- any reference to the duty to help people native forms of treatment and care in situations of emergency in the Is- The parable of the Good Samaritan available.” lamic Code of Medical Ethics. amounts to a defense of the universal- In the United States of America the At an international level we should ity of medical service. Nobody is ex- fear of being subject to court cases or take note of the positions of the World cluded from that service, neither the prosecution for malpractice in the pro- Medical Association expressed in one most hated enemies nor the most de- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 35 spised neighbors, nor the victims of the tribute—through humanitarian mis- But in essential terms above and beyond most repugnant and repellent illnesses sions—to the reduction of the tremen- his nationality he was a seriously which can exist. dous impact that wars have on human wounded man. The Good Samaritan in- In this parable, as in many others to health and human rights. Both forms of augurated what would become the be found in the Gospels, Jesus wanted service proclaim that there is only one Christian tradition, and according to this to engage in a certain exaggeration in set of ethics for the medical doctor in tradition health care workers identify order to give greater force to his teach- times of war and in times of peace. the sick, whoever they may be, with Je- ing. He wanted to give his moral mes- From time immemorial there has ex- sus Christ. This tradition would and will sage that impetus and power which isted within professional codes of med- last as long as there are sick people and would overcome ancestral and long- ical conduct the glorious tradition of will finish only when Christ says to all standing prejudices and hatreds. We not engaging in discrimination: I do men of all times: “I was sick and you can see that for the Jews of his time it not ask your race, your religion, or visited me; that which you did to them, was an extreme exaggeration to seek to your origins. I am only interested in you did to me.” illustrate the commandment to love your illness. We do not know the ori- one’s neighbor with a brief tale which gins of this phrase but we do know that involved charitable and self-sacrificing it belongs to the oral tradition of medi- 3 Reflections on the Mission service between the members of two cine. The first written exposition of the of Medical Benevolence ethnic groups who had converted their teachings of the principles of nondis- mutual hatred into a fixed cultural crimination in the practice of medicine I am happy to say that the Charter form. The fact that the victim was a seems to be found in the recommenda- for Health Care Workers of this Pon- Jew and that his savior was a Samari- tion made by a Chinese doctor of the tifical Council for Pastoral Assistance tan constituted an apodictic argument seventh century to his disciples: “Bring to Health Care Workers certainly be- in favor of the idea that there are no consolation to the suffering of every longs by right to contemporary ethical cultural, religious, or political factors human being without worrying about codes of professional conduct. Of all or considerations which should place his social rank, his economic means, these codes, this Charter is the one limits to the commandment to love his age, his beauty, his intelligence, which addresses itself with the greatest one’s neighbor, a commandment, it whether he is Chinese or not, or freedom and the greatest depth to the may be observed, of universal rele- whether he is a friend or an enemy.” question of the concerned, caring, vance and importance and of great in- Some months before the United Na- trusting, and open attitude and ap- tensity and power. In today’s world tions published the Universal Declara- proach which health care workers this commandment has become highky tion of Human Rights, the World Med- should employ in their relationship relevant because medical doctors and ical Association decided on the inclu- with the individual and the needs of nurses now have to deal with patients sion within its Geneva Declaration of the patient. This Charter declares—in who are afflicted by the AIDS virus. 1948 of the following promise by the a language which has unfortunately The most eloquent expression of the medical doctor. This promise involved long been absent from ethical codes of duty of the medical doctor and the undertaking to “rise above political professional conduct—that “to treat a nurse to serve everyone in the same doctrines and religious beliefs, nation- sick person with love is to engage in a way is, in my opinion, to be found in ality, race, and social rank, and to keep the following statement: health care such elements from acting as an ob- divine mission—a mission which has only one professional ethic and this structive barrier between my profes- alone can motivate and sustain the holds sway in periods of war and peri- sional duties and my patient.” In 1994 most disinterested, helpful, and faith- ods of peace alike. Thus it is that the at Stockholm the Association decided ful involvement possible.” first article of the Ethical Principles of to rewrite this clause in order to bring it The modern codes of medical pro- European Medicine, which was pro- up to date with these strange times of fessional conduct have formalized the mulgated by the International Confer- ours. The new clause reads as follows: relationship between the medical doc- ence of Medical Associations in 1987, “I will not allow considerations of age, tor and the patient to an excessive de- reads as follows: “The vocation of the illness, or incapacity, beliefs, ethnic gree. They have dealt with it in the medical doctor involves protecting the origins, sex, nationality, political loy- light of a bureaucratic, legal, and con- mental and physical health of man and alty, race, sexual tendency or social tractual mentality. They have turned alleviating his suffering in full respect level to act as an obstructive barrier be- that relationship into a superficial and for the life and the dignity of the hu- tween my professional duties and my technical thing which in the hospital man person...both in times of peace patient.” realities of today can become more and in times of war.” The deontology This nondiscrimination clause has than anonymous and faceless. They of the two equally honorable ways by passed from the Geneva Declaration to have abandoned what the old profes- which the function of health care work- all modern codes of professional con- sional guides prescribed about the de- ers should be expressed in situations of duct in medicine. For example, the ontological range and limits of the war is thus more than evident. What French code of 1995 declares: “The proper emotional bond between the are these two ways? On the one hand, medical doctor must listen, examine, physician and the patient, about the there is the role of military medical advise and treat all people with the same friendship between them, and about doctors and nurses who have helped to conscience, whatever their origins, their the value of benevolence—all ele- humanize armed conflict through their customs, their family context, their ments which are characteristic health dedication to wounded or ill soldiers or membership or otherwise of an ethnic care expressions of the Gospel com- civilians. On the other hand, there is group, of a nation or of a specific reli- mandment to engage in charity. the role of those who have seen the gion, their handicap or state of health, The ethical codes of professional enormous suffering and death that their reputation or the feelings that the conduct in Southern Europe contain, wars cause—in particular, in the civil- doctor may have towards them.” The nonetheless, many elements relating to ian population—and have decided to Good Samaritan did not investigate the the value of medical friendship. The declare themselves pacifists, to refuse history of the wounded man he came Code of Ethics and Medical Deontol- to take part in the army, and to con- across. That man was certainly a Jew. ogy which is presently in force in 36 DOLENTIUM HOMINUM

Spain includes on its list of doctors’ doctor or nurse and the patient than offer medical care to the poor, and ethical duties towards their patients falling prey to the temptation of excess through providing service in charitable that of making sure that their work ex- in intimacy, of romantic curiosity, of medical facilities or in shelters and presses a sense of service which flirting, or of engaging in sexual rela- homes for evacuees or ill-treated should be provided with delicate re- tionships. The Code of Medical Ethics women.” In the codes of the countries spect, with concern, and with loyalty. of the Council of Medical and Judicial of the European Union we have left to This service, according to this Spanish Affairs of the American Medical As- us only so-called “professional cour- code, should be placed before any sociation makes clear that “sexual re- tesy” as a residue of this old charitable question of personal convenience and lationships between doctors and pa- tradition. This professional courtesy should take precedence over any un- tients degrade the goals of medicine, involves a medical doctor treating a justified delay in attending to the needs exploit the vulnerability of the patient, colleague or the relative of a colleague of the patient. The Spanish Deonto- obscure the objectivity of the judg- without asking for the payment of fees logical Code for Nurses adds another ment of doctors in relation to the treat- out of a sense of friendship and as a duty to these duties—that of protecting ment they should provide, and, finally, moral reward for the trust that is re- the patient from every form of humili- prejudice the well-being of the pa- posed in him. ating or degrading treatment and from tient.... At the very least, the ethical As we know, the relationship be- any form of treatment which injures or duty of doctors requires that their pro- tween doctors and money is very com- wounds his personal dignity. This fessional relationship with their own plicated and intricate in character. This code also insists that moral or physical patients be ended before they begin relationship has been represented by force should never be used against the any kind of personal relationship with triumphant Aesculapius, who appears patient. The duties of the nurse be- those patients (going out together, ro- as an angel when he attends to the pa- come more detailed and incumbent mantic love, or sexual relations). tient, as a god when he cures him, and when the patient belongs to a vulnera- We now come to the fourth and last as a devil when he asks for the pay- ble group—that is, invalids, the handi- lesson which is offered to us by the fa- ment of his professional fee. capped, children, and elderly people, mous parable of the Good Samaritan. to whom, indeed, special and qualified Conclusion attention should be given. The parable of the Good Samaritan It is clear that a large part of the at- 4. The Selfless Duty to Serve enormously enriched the precepts of tention that doctors and nurses pay to Patients without Receiving the Hippocratic Oath. This is because their patients cannot be effected with- Anything in Exchange, Indeed, in addition to the duties of scientific out strong echoes of the actions of the the Duty to Help Them competence and respect for the human Good Samaritan—without, that is, an in Generous Fashion dignity of the patient which are incum- inner readiness for caring dedication bent upon the disciple of Hippocrates, which is expressed externally in the This tradition has disappeared from the parable also requires the health suitable and delicate way in which the ethical codes of professional con- care worker to rise to the supreme duty professional services are rendered. It duct which are applied to national of charity altruism, self-denial, non- has been said over and over again that health systems which offer free health discrimination, and generosity. These to serve is to love. Perhaps this ex- care to all citizens. But this is not the duties, whether selfless or not, fortu- plains why today’s codes of profes- case in those countries where a large nately enough have been incorporated sional conduct speak about service and part of the population has to endure into the ethical codes of professional never about love. Such contemporary both economic poverty and a marked conduct which are presently operative codes are very hesitant about dealing lack of health care. This is tragically in today’s world, or have taken the with the emotional ties which can the case in poor countries, but it is to a form of uncoded obligations which act rightly become established between certain extent also present in the upon the soul of health care workers. health care workers and their patients. United States of America, where be- The famous Oath and the parable of They deal with this subject with the se- tween thirty-five and forty million hu- the Good Samaritan have exercised, rious and grave tones of the Hippo- man beings do not have the means by and continue to exercise, a synergetic cratic Oath so as to ensure that the doc- which to obtain suitable health care. influence on the ethical codes of pro- tor and the nurse do not go beyond the Indeed, in the United States of fessional conduct in the health care limits imposed by professional pru- America the tradition of benevolent field. May the permanent memory of dence and which are required by the care for the poor patient is still very the fascinating figure of that physician, promotion of equanimity in the health much alive. The Code of Medical the Good Samaritan, inspire our pro- care field. Great emphasis should be Ethics of the American Medical Asso- fessional conduct and behavior. I will laid upon the deontological duty of the ciation says that “all medical doctors conclude by quoting the words of the doctor to avoid becoming emotionally are obliged to help in providing med- Holy Father, John Paul II, which are to involved in a professional relationship. ical help to the poor...and to work to be found in the encyclical Salvifici Do- The health care worker must keep a ensure that the needs of the poor of loris: the health care worker is the suitable emotional distance from the their community are met. Taking care Good Samaritan of the parable who patient and thus must not go beyond of the poor must be an ordinary part of draws near to the wounded man and what William Osler calls “courteous the ordinary program of work of the makes him his neighbor in charity. love” for the patient. It should be ob- medical doctor.... This can be done in a served that the sentimental or frivolous host of different ways: by receiving neglect of this rule has caused a great patients at the doctor’s office without Professor GONZALO HERRANZ many difficulties and problems in the asking for fees or asking for reduced RODRIGUEZ Member of the Executive Council world of health care. fees, through providing free service in of the Pontifical Council for Life, Indeed, nothing is more destructive hospitals and clinics, through taking Director of the Institute of Bioethics at the of a relationship between a medical part in government programs which Catholic University of Navarra, Spain VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 37

CARLO CREMONA

Care for the Sick and the Fathers of the Church

1. Whence Evil point of view of the mineral, veg- “Res sacra miser!” exclaimed etable, animal and spiritual worlds, Seneca: he who suffers in body or The subject of this paper leads us is in itself an enchanting harmony soul is a sacred being. That is to say, to think about events which are very and beauty. And man should have he is worthy of respect, pity, and sol- far-away, where our memory and enjoyed his friendship with God in idarity. human history do not reach. And the tranquillity, until the point when he Whence evil? tale which comes to us, in addition to was by his own wish received into It is difficult to answer this ques- the innate drama of every man, is of his celestial homeland. tion, and it has proved an impassable a religious or mythological charac- St. Augustine speaks in the fol- obstacle for many spirits. And not ter. By natural instinct man seeks lowing way about the human body: only for the spirit of St. Augustine stable and integrated happiness, he “So great is the rational beauty of who for many years embraced the continues to hope for it. But despite the human body, and even of the Manichean doctrine, an approach this innate vocation, this divine lower and less noble parts, that they which perceives two princes locked dream, he is that being on the earth are considered pleasant and superior in struggle: the prince of good and which can suffer both physically and to any other visible form according the prince of evil, light and darkness, spiritually. The reconciliation of to the judgment of the spirit of the the spirit and matter. Desperate in his these two real and practical tenden- eyes which are used. In painstaking search for the truth, he ended up by cies, the need for happiness and its fashion certain physicians called concluding that if one begins with denial, is the permanent drama of anatomists, moved by the harmony the experience of evil in the world, man. of the human body, have dissected one finishes by being pessimistic or Those who profess a faith in an its limbs to see if such limbs are skeptical. absolute Being in their way of think- made for a function or for beauty. If God is infinite goodness, an ing about existence, a Being who is None of these parts has a useful ocean in which everybody is born transcendent, infinitely perfect, the function without at the same time and everybody is enveloped, and if sole cause of the universe and of all having its own beauty.” the created being is immersed in that created things, can but ask them- St. Augustine concludes by refer- ocean like a sponge, then why—St. selves about a fundamental question ring to the wonders of the human Augustine pondered—is this sponge when they are faced with pain. This mind, its technological achieve- so infused with pollution? Where did question relates to the great diffi- ments (even during his own times), it absorb it from? At the outset he culty we face in crossing a frontier to and its artistic production in the drew near to the bible (the sin of free enter into an area of a metaphysical sphere of literature, in sculpture and man against God the creator, rebel- and mysterious character which painting. “A day will come.” he as- lion of his liberty to be master of an touches the responsibility of God: serts, “when we will enjoy each independent happiness without “where does the evil come from of other”s beauty alone.”(City of God, God); rationalism, pride; lack of hu- which man, contradicted by an in- XXII, 24, 22). mility and reasonableness; rejection stinct to happiness, is the principal But such beauty and the enjoy- of the supernatural and of grace—all victim? And yet, in actual fact, the ment of such beauty is in permanent of these elements led him to per- finger which made him offers all the contrast with the historical reality ceive the bible as a collection of guarantees we could need!” which man, above all other crea- tales of little literary merit! I would like to know how to trans- tures, perceives and suffers. The At a very young age he aban- late into two Michelangelo-style contradiction between the beauty doned the Christian faith of his frescoes that description of the world which informs the creation, which is mother Monica. and of man (who is its principal and given for man’s enjoyment, and the The recovery of these values was a most responsible tenant) which St. pollution in which man is immersed, very arduous process for St. Augus- Augustine makes in the City of God, is very striking. Man is both the tine. It was the outcome of reading a distinction between beauty and compelled creator of this contradic- the works of non-Christian philoso- horror of the world of which man is tion and its victim. However much phers: Cicero (who in one of his the subject. we may be materialists, we cannot works demonstrated the emptiness The world (where our life takes accept the idea of being mere toys of earthly values and proposed spiri- place!) when observed from the which are breaking up. tual values which were immutable 38 DOLENTIUM HOMINUM and transcendental); Plotinus who man is the fault of initial pride is not which could choose and a limpid in- followed Plato in demonstrating the a doctrine of the bible alone where telligence in order to choose well, spirituality, the absolute, and the in- there is indeed a description of our could become the stable master of his finite goodness of God. Plotinus ex- mysterious condition. It belongs to happy condition, together with God. plained evil not as a substance but as all cultures, to all religions, and to all However he deceived himself into the absence of substance, and in mythologies. In the autumn of the thinking that he could be happy more specific terms a wrongful lack year 385 AD St. Augustine decided without God. He lost the wager, the of the presence of God (Conf. VII, to read the Holy Scriptures for a sec- dignity of a friend, and fell... 10, 16, “And I saw a light...”). ond time, texts which he had deemed And he did not only lose grace, but He then read the works of Am- unworthy of his literary aesthetics. also other things as well. brose who was at first read out of a He was obliged to do this because For example, integrity: harmony sense of literary taste and because of of a moral and religious crisis, and between the intelligible and that his Latin eloquence which made him he engaged in his task with humility. which could be reached with the a kind of second Cicero. St. Augus- He proceeded to define the bible as a senses, between the senses and the tine then read him because of a deep masterpiece of instruction and a pic- will...Whence the inner contradic- interest in his biblical preaching. He ture-gallery with a poor entrance. tion of every man: law of the flesh then went on to the letters of St. Paul. But to cross the threshold—what against the will of the spirit (St. The letter to the Romans (pain and artistic splendor! Paul). death have entered the world Genesis describes the prohibition He lost the physical immortality of through the sin of free man) was sug- his corporeal life: (our body, a build- gested to him by the mysterious ing built with matter which by its voice of youth (“Take it and read very nature is destined to destroy it- it”) and provoked in him the experi- self...). Dear friends, if we do not ence of being thunderstruck by convince ourselves of the truth of grace. It also produced his immedi- this diagnosis, if we do not begin ate conversion to Christianity in the again from these truths, from this house of his garden in Milan. distant but always radiant revelation, As I said previously, the intense we will not be able to understand and difficult path taken by St. Au- anything about life: darkness will gustine was the path trodden by fall! And today mankind walks in the many spirits, including those who dark: rejection of the supernatural, were intellectually and morally cho- and of grace. Self-sufficiency! sen. But it was also, I might observe, We have to care for both souls and the path taken by each one of us. bodies. Given what happens in the That initial rebellion which was a world, because of a lack of moral very serious act of personal wrong- values, we doubt at times that there doing by those who carried it out is a will to even care for bodies: ill was a test. It was a way of seeing health! The substance of the bible whether the free will of man would tale is neither Judaism nor Christian- accept the supremacy of a personal ity; it is not denominationalism. and liberal God, his free gift. It was a It is truth which forces even pa- test to see if man would remain for- gans to ask themselves: ever on the side of God. That rebel- Video meliora proboque, deteri- lion is bequeathed to human descen- about eating the fruit of the tree of ora sequor (Ovid) dants like a void, a pathological in- good and evil. Adam, with Eve, dis- Veggio il meglio ed al peggior mi heritance, a lost wealth which cannot obeyed. appiglio (Petrarch) be regained and which has left a St. Paul comments: because of the Here we encounter the same thesis deep wound within the whole organ- sin of one person, disorder, evils and to be found in the Bible and in St. ism. In this process it has generated death entered the world.... Paul. Sin: the source of the river of pride, ignorance, superficiality, and There is a law in my flesh which is our moral evil and even of physical a lack of care in inquiring into the in opposition to the law of my spirit. pain and the illnesses of the body. distant and real cause of impoverish- As a result I do not do what I would Death entered with pain and was a ment and unhappiness. If man is the like to do, but what I would not like protagonist. created being of God he could but be to do.... Poor me! Who can free me “The immense corruption with created in happiness and for happi- from this body of death? which we were inundated because of ness. The reply he received was: this transgression, the agitation of Thus it is that it necessary to make Grace! My grace should be enough many strong and contrasting senti- a diagnosis of this original evil, as for you. ments, should not make us think that one does for every evil. That is to say Man was created in grace. this was a small and slight moral through philosophical inquiry, Supernatural and sanctifying grace act...” (City of God, 1. 14, c. 12). through the acceptance of the in- is friendship with God. struction of supernatural revelation. But friendship of a kind which (Plato and human navigation: the creates a loving intimacy, a sharing 2. Redemption in the sail, the oar...“unless one has a safer of nature. Incarnation means of transport which is divine He had to be confirmed by a test: so revelation.” Cf. Phaidon 85A/86B). that man, created in the image and But it was precisely from this That the radical evil suffered by likeness of God, with a free will abyss that Christian rebirth and opti- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 39 mism were born. It should have nature, but also shares its humilia- Christian era. They were great the- been an irreversible process. tion, its physical and moral pain, and ologians and profound experts in the But God accepted the challenge of its death, and all this in a dimension language of God and in matters relat- man and revenged himself with an which is the highest expression of all ing to the ancient civilizations of event of mercy, an event which was the humiliations, all the pain, and all mankind. greater than the creation of the uni- the deaths in the history of mankind. And it is here that we come to the verse, even if risky. subject of this paper. God so loved the world that he Care for the sick. This was a major gave his only—begotten Son for the 3. Christ, the Man of Pain aspect of the Redemption but was of salvation of the world. apparently secondary importance— The mystery of faith which, Isaiah: Servant of Yahweh (Is Ch. bodies are healed, but God is inter- whether recognized or not, links man 42-53). ested in souls. But man is an integral to God, even when man rebels and The Agony of Christ in Gethse- “unum” when taken as a whole. If flees from God. It offers us the mys- mane: the universal human tragedy you cannot love man, whom you can tery of the incarnation of the Son of in its first three-dimensional ex- see, how can you love God whom God, who takes on human nature, pression; from Adam, to Abel, you cannot see? This is not therefore takes on himself our sins and our and...to the death-rattle of the last a secondary aspect; it is at the very pains, and accepts death to achieve man. least “aeque principalis.” The love the redemption of man. Paradoxical! The outflowing of blood, a phe- of God is for the whole man, and in Where sin abounds, grace nomenon which doctors call its corporeal and spiritual value can- abounds even more. not be divided into two. It is a love The incarnation of Christ, the which is freely given and not won, Word of God, is a disturbing dogma and which restores the mutual which is acceptable because of an friendship between man and God, explicit and insistent revelation of and between man and man. It is a God, begun by, and intimately new right to a life of infinite happi- linked to, the sin of man. ness which is shared with God him- Why disturbing? self. God is man’s loyal friend: “an- Because human reason (see Plato, imae dimidium meas!” Who is my see Aristotle) manages to know the neighbor? The vicar of God! nature of God, who is spiritual, un- Christian redemption gave us the changing, absolute, transcendent, in- mother Church, teacher and expert in finitely good and the source of be- humanity. How could mankind ig- ing.... It manages to discover even nore the Church of Christ even if— the Word of God. while knowing that she was present But if I were to say to Plato: That and working—it neglects her, turns God to whom you refer and whom its back on her, and listens to other you define as being the highest good teachers? of man, I met on the roads of Pales- The redemption gave us priest- tine. I saw him suffer and die for the hood (that of every ministry and salvation of man. He rose again af- every baptism). It gave us grace ter death and he guides us to eternal which is more abundant than origi- life, in both body and soul.” nal grace, even though in the new or- If I said that, Plato would laugh in der we have become the objects of my face as if I were pronouncing “haematridosis,” something which pain, of illness, of death and of the some philosophical heresy. The ab- is connected to a major disturbance struggle for good. solute cannot become contingent, the of the nervous system: “Sad is my And here everything changes: eternal cannot become temporal. soul, until the moment of dying.” Pain and death are no longer pun- The spiritual by its very essence, the From the moment of his birth, ishments. They are reasons for expi- pure act, cannot become corporeal Christ wishes only to die for love of ation, of merit (think of the suffering and of the senses.... The incarnation, man: “I must receive baptism, and I of those who are innocent!). They the most ineffable doctrine of Chris- will be troubled until I receive it.” become an asset (in relation to Christ tianity but at the same time the most something which is completely difficult, opens the human intellect given; in relation to man, a question like a window so that the solar light 4. Care for the Sick and the of participation). of the intimacy of God can be re- Fathers of the Church The phrase of St. Paul is very ceived. “Believe to reason; reason beautiful (with my suffering “I to think.” The Fathers of the Church were an complete what is lacking in Christ’s expression of the continuity and the afflictions, in the Church, in me” The dogma of the incarnation has authentic interpretation of the mes- (Col 1: 24). so much importance for humanity sage of Christ and the doctrine of the There is another miracle: pain that it cannot be confined to a mere Church. (both physical and moral) can be- religious creed: it has universal They were men of holiness and come the source of great joy. “I am value. great intelligence. overflowing with joy in every trial.... The person of the Word, who re- They were great philosophers who The sufferings of this world bear no mains of divine nature, not only renewed and rewrote the thought of comparison to the future glory which unites himself in history to human the Greek philosophers of the pre- awaits us.” (St. Paul) 40 DOLENTIUM HOMINUM

The cross, that sign of ignominy, brotherhood throughout the world.” How many people have resisted becomes an instrument of triumph. (1 Pt 5:9) Solidarity! the violence of pain by looking at the “He who does not take up his “And being found in human form Cross in order to be like it. cross every day to follow me, will not he humbled himself and became obe- Chataubriand (evil breeds of be recognized by me.” dient unto death, even death on a Christianity, passim). Care for the sick and for physical cross.” (Ph 2:8). misfortune—a visible sign of the “Having cancelled the bond Christian charity which separates Messiah: “Go and tell John: the which stood against us with its legal Christians from other men, some- blind see, the deaf hear, the dumb demands; this he set aside, nailing it thing which was unknown to the an- speak, the lame walk, the lepers are to the cross.” (Col 2:14). cients, was born with Jesus Christ. In clean; and to the poor is proclaimed “But far be it from me to glory ex- his gospel it was the emblem of the the Good News.” cept in the cross of our Lord Jesus renewal of human nature. Charity, love, solidarity! Without Christ” (Gal 2:14). The first Christians shared their barriers, even towards the enemy. “For I decided to know nothing goods in order to help the needy, the The Good Samaritan...who stops at among you except Jesus Christ and sick, and pilgrims. the side of the wounded man, who him crucified.” (1 Cor 2:2). It was in this way that hospitals cares for him and places him on his “And those who belong to Christ were born! pack animal (the ambulance of those Jesus have crucified the flesh with its From that moment, works of times), and then takes him to an inn passions and desires.” (Gal 5:24; 1 mercy no longer had barriers in their to get better, paying for him with his Cor 1:13). way. It was as if compassion over- own money. This inn is the first “Ho- flowed into misery to the point of ne- tel-Dieu,” as hospitals are called in glecting it and running after it: so France! much misery but an equal amount of compassion. Here we ask: how did the ancients 5. Church-Fathers-the Sick manage without places to go when ill, without hospitals? Christ created the Church and was In order to rid themselves of the its corner stone. For twenty centuries poor and the unhappy they had two she has watched over mankind and solutions which Christianity did not guided humanity with her divinely recognize: infanticide and slavery! guaranteed Magisterium. Some Sun- Are the ruins of hospitals or hospices days ago John Paul II referred to the to be found amongst the ancient thirty years of the life of the Coun- monuments of Rome or of Athens? cil’s Constitution Gaudium Spes. He Some local hot baths dedicated to declared that it tackles “the problems some divinity had the mere appear- of the contemporary age: marriage ance of a health care structure, like and the family, culture, socioeco- Hepidaurus. nomic reality, politics, the promo- (Lucretius: “Mussabat tacito med- tion of peace and solidarity between icina pavore” (the plague of Athens). peoples.” (Martial: “I was rather ill. I called Christ...spouse...without blemish the physician, Heliodorus, who ar- or wrinkle...The mystic and visible rived with a band of his disciples: body of Christ down the centuries forty cold hands pressed my stom- (“Total-Christ...”). “But we preach Christ crucified, a ach. I did not have a temperature—I The root is him, the good tree can- stumbling block to Jews and a folly do now!”) not produce bad fruit. “Rooted in to gentiles” (1 Cor 1:23). charity and founded on charity.” In The funds raised by Paul from the As the Church gradually acquired the Church, as in a mine, there is the churches in Asia for the impover- freedom of action (the apostolic pe- golden vein of charity. ished Church in Jerusalem. riod, great monks, and then the great Immediately after being born Fathers of the East and the West) there is nothing but continuity be- The Church and her apostles, true hospitals, leper colonies and isola- tween the work of Christ and the to the teaching of their Master, are tion hospitals (this last in Latin being emergent Church: concerned with both souls and bod- derived from the name of poor The Church seeks to welcome the ies, and in equal measure. Lazarus from the Gospel parable) sick as Christ had done: In unique fashion the Christian re- sprang up. “They carried the sick (to Peter) to ligion promises that the body, as well In these institutions monks or be healed by his shadow alone.” as the soul, will have eternal life. mere Christians engaged in volun- The Eucharist: “the sacrament of Before Christ there was Stoicism: teer work with joy. Without any re- pity, a sign of unity, or a bond of “substine et abstine”...Resistance to pugnance at all they bore the pres- charity!” To the sick: heal, soothe, pain. ence of all forms of human misery in comfort... (Justinian). Christ gives us the ability to over- order to serve Christ in person within Apostolic Church and the preach- come suffering and to smile: St. their sick brethren. ing of the suffering Christ. Francis and the cure of eyes with “I was sick and you came to me, Peter: “Resist him, firm in your red-hot tears...And then the sick helped me, and took care of me.” faith, knowing that the same experi- woman in an iron lung: “My special Some Examples ence of suffering is required of your Ferrari with a red head”. St. Basil created a hospital-town VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 41 in the environs of Cappadocia. They who are heavy laden and I will give two thousand years. These figures called it “Basiliade”. you rest.” are: Camillus de Lellis, John of God, John Chrysostom, the great He gave a fine sermon on the Cottolengus, Orion Guanella, Gio- Christian orator who was also called transfiguration of Christ where Peter vanna Antida. In our times we can the “panegyrist of alms” was exiled said: “It is well that we are here; let think of Padre Pio, Follereau...and by the Empress Eudoxia. He had deus make three booths, one for you thousands of others, everywhere, nounced her publicly for having and one for Moses and Elijah” (Cf missionaries in the leper colonies. wrongfully gained the vineyard of a Mk 9:4; Mt 17:4). But let us not speak only of the widow which had been destined for The Holy Doctor said: “But come past. Let us speak also of the present, a hospital for the poor which he ad- down Peter.... Yes, it is well! But not of those who are alive today. Mother ministered. The protector and the now. Come down, there are poor Theresa, and many, many others ig- defender of the poor, he was con- people to help, sick people to care nored amidst the fire of warriors. soled by their defense when he was for, the gospel to preach and to bear This is what the official world persecuted by the powerful. Helping witness to.... Come down immedi- knows how to do: not to love but to the sick gave John Chrysostom the ately; the vision will come after- kill! chance to get to know doctors and wards.” All the good of which man is ca- to observe their humanity in their There was a similar statement pable is the exclusive gift of God. care for the terminally ill (the sick when Marta was in the kitchen Outside this there is only misery and person has a fragile psychology preparing lunch for the guest and her sin. which is in need of help, and the sister Maria was in the living room And yet the created being has a slightest thing can depress his spir- positive value which God does not its). have—suffering! He describes how a sick alcoholic God envied man this condition was desperate for a mouthful of and took it upon himself by being a wine. The understanding doctor victim of suffering. made a small earthenware jug out of St. Paul says, “Not only man, but clay impregnated with wine. He the whole of creation is waiting for filled it with water and heated it on a the moment of birth.” stove. He pulled down the blinds of And St. Peter says, “There will be the window to darken the room and new heavens and a new earth.” took the jug to the sick man. The al- St. Augustine, echoing Plato’s in- coholic was deceived by the smell of vocation of a safe means (a divine wine and drank the mixture with sat- revelation) by which to reach the isfaction. Chrysostom praised the shore of happiness, suggested its sensitivity of the physician. character: “So that there could be a St. Jerome in letter number means by which to go, he to whom we LXXVII to Oceanus gave great wanted to go came from the beyond. praise to a certain Fabiola, a woman And what did he do? He prepared the who was the subject of much gossip wood with which we could cross the but was a convert to Christianity. sea. Nobody can cross the sea of this Fabiola had paid for the creation of a age without being carried by the hospital for the poor. cross of Christ” (Com. Jn. Tr. 2, 2). “She was the first person to estab- On one occasion Jesus asked: lish a hospital for all the sick people “When the Son of Man returns, she found in the street: deformed enchanted by the voice of Jesus. will he still find faith on earth?” noses, empty eye sockets, withered This episode gave rise to the dis- Perhaps we can reassure him: arms and legs, extended stomachs, pute about the relative supremacy of “Faith, Lord? Who knows?” skeletal thighs, rotten flesh full of the value of the contemplative life or “Hope! We believe in the capaci- worms.... How many times did she the active life. St. Augustine pro- ties of men but they always make us herself carry those suffering from vided the answer to the debate with lose hope.” leprosy to the hospital on her shoul- one of his usual general summaries: “But charity, no. There will not be ders...She fed them with her own —Caritas Veritatis (‘love for con- less charity. Because you, suffering hands and gave a spoonful of broth templation’)—Mary; and living with us, are charity. You, to those living corpses” (Letter num- —Necessitas Caritatis (‘emergency who promised to be with us until the ber LXXVII). action’)—Martha. This emergency end of time.” Augustine of Hippo, according to action is of primary importance in “Fides, spes, caritas: tria haec! his biographer Possidius, only went certain circumstances because of the Maior autem horum: Charitas!” to homes where there were orphans needs of one”s neighbor: poverty, (1 Co 3:3). and the sick. In the rules of the hunger, or illness. This is an action FAITH belongs to man.... monastic order he established there which is: Delectatio Caritatis et Ver- HOPE? Also! is a special chapter relating to caring itatis (joy in loving God in one’s CHARITY belongs to God.... for the sick. He presents Jesus as the neighbor, recognizing Him and con- It is not biodegradable! great physician of humanity who templating Him). does not write a prescription for the “In caritate fundati et radicati!” chemist but creates the medicine The root of this charity is truly vigor- with his own blood, in the exercise of ous, for it has animated the Church Rev. CARLO CREMONA his Humanity. “Come to me all you and inspired important figures for Vatican Correspondent for Italian RAI TV 42 DOLENTIUM HOMINUM

GOTTFRIED ROTH

Hippocrates in the Documents of the Church and in Works of Theology

This paper is a survey of Hip- doctor employed to swear to uphold were inherent in the advances in pocrates and the presence of his prin- the ethics of the medical profession. medical science: cipal clinical-medical, philosophi- This broad-ranging subject can “It is clear that these new inven- cal-medical, and ethical ideas and only be dealt with here by analyzing tions should not in any way preju- beliefs in the documents of the key moments. Indeed, the research dice the exercise of a medical ideal Church and in works of theology. It which lies behind this paper perhaps which has guided medicine for mil- therefore carries on from the study indicates that an overall and general lennia and has been expressed in a already conducted into references to picture may well not be possible. tradition based the oath of Hip- Hippocrates in papal documents, There are also various other ques- pocrates, a figure who was a de- works which have already been pub- tions which must be addressed, and fender of life. A pollution of this car- lished.1, 2 In this paper I will dwell most specifically the actual authen- dinal principle would involve a fatal upon those passages in the speeches ticity of the ideas which are pro- step backwards which would have and addresses of popes Pius XII, pounded in the works attributed to disastrous consequences. This is Paul VI, John Paul I and John Paul II Hippocrates and of the texts which something which you will be aware which emphasize the ethical impor- constitute the Corpus. of more than any other category.”5 tance of this famous physician of an- Under the title of “The Illustri- cient Greece. ous,” Pope John Paul I wrote a num- This collection of quotations and 1. Hippocrates in Papal ber of imaginary letters to important citations is not an exercise in med- Documents historical figures, one of whom was ical history which aims at creating a Hippocrates—” a contemporary of collection of documents. Nor is it an In the works of Petrus Hispanus, a Socrates and like him a philoso- attempt to engage in a kind of liter- medical doctor with academic quali- pher.” Pope John Paul I called the ary history. It is, rather, a collection fications who then became the doc- Greek physician: of ethical observations and guide- tor to Pope John XXI, we can find “The author of a famous oath...of lines which are to be found in surviv- two comments on Hippocrates3 an ethical code of unending worth. ing ancient Greek texts and which namely De Regimine Auctorum and Doctors swear by this oath to pre- correspond in certain ways and Prognostica. scribe suitable treatment for their pa- forms with Christian ideas and be- In our times, and more precisely in tients and to protect them from injus- liefs. 1954, Pope Pius XII defined the tice and above all else from what is We can safely state that during the medical-ethical significance and harmful. They solemnly promise to great periods of the history of West- meaning of the works of Hippocrates never induce an abortion; they un- ern civilization there have always in the following way: dertake to go to a home solely in or- been examples of the influence of “The works of Hippocrates are der to treat sick people and promise the ideas and ethical principles of without doubt the noblest expression that they will not take bribes. In ad- Hippocrates. of a professional conscience which dition, they swear to uphold the sa- At the time of early Christianity, above all else calls for respect for life credness of the professional secret.”6 the essentially Christian basis and and self-sacrifice in relation to sick With this list of ethical-medical character of central Hellenic ideas people and also pays attention to per- undertakings and promises Pope was demonstrated by the fact that in sonal factors: self- control, dignity, John Paul I blessed the incorporation the preamble to the Hippocratic oath reserve. He knew how to present of the ancient Greek code of profes- the introductory words “Apollo moral norms and to integrate them sional conduct into the outlook and soter” came to be replaced by the into a broad and harmonious pro- approach of the Christian medical phrase “Christus medicus.” gram of study, and he thus gave a doctor. The doctrine of Hippocrates could present to civilization which was As early as 1978 John Paul II re- easily be transplanted into the patris- more even more magnificent than ferred to Hippocratic ethics during a tic and scholastic traditions because that made by those who built em- reception for the Association of Ital- it well corresponded to the integral pires.”4 ian Catholic Doctors. He warned and personalist ideas of Christianity Pope Paul VI had similar observa- those present against the dangers of and because of the authority of tions to make and sought to warn using medicines and drugs which “Christus medicus,” the phrase the doctors about the dangers which “not only contradict Christian ethics VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 43 but every form of natural ethics and Carthage, Gregory Nazianzen, Gre- himself but also Euclides, Hip- which are in open contradiction with gory of Nyssa, and Eusebius of Ce- pocrates, Galenus and Archimedes. those professional duties expressed sarea all held to a theory of the nat- The philosophical, mathematical and in the famous oath of the ancient pa- ural sciences about the origins and medical works of these authors were gan doctor.”7 causes of illness which went back to first translated from Greek into Syr- In his address to the members of Hippocrates. However there were iac and then into Arabic.19 The con- the General Assembly of the World also magical and demoniacal theo- cept of “potentia” can be attributed Union of Doctors John Paul II, when ries. to the Greek concept of “dynamis” discussing the question of genetic It should also be observed that Eu- which is also to be found in the Cor- engineering and its capacity to re- sebius makes repeated reference to pus Hippocraticum where it is used duce the human being to an object, Hippocrates in a chapter on the the- with reference to illness.20 proffered the following injunction: ory of illness, in reflection upon free The recent computer work on the “Let all medical doctors be faithful will, and knew the ancient Greek’s writings of Thomas Aquinas gives to the Hippocratic oath which they theory of diet. He was also familiar us greater confidence and security in take when they graduate.”8 During with the motto: “nature is the best relation to our subject. In discussing his speech to the members of the In- physician.” Eusebius also invokes the meteorology of Aristotle, ternational Congress on the Human- Hippocrates when stressing the im- Aquinas makes a number of refer- ization of Medicine held in 1987 portance of prognosis and in ex- ences to Hippocrates. He does so John Paul II spoke about the need for pounding the idea that the soul is of when discussing the meaning and men to be aware of their true duties primary importance in the relation- role of stars in the cosmic order, the- in the exercise of their profession: ship between the body and the soul. ological questions, metaphysical “You should be deeply convinced of (14, 15) In discussing the Patristic principles, scientific theories, astron- this truth because of a long tradition tradition reference should also be omy and astrology.21 which goes back to the intuitions of made to the ethical-medical chapters Hippocrates himself.”9 And when of the Didaché of the first century af- nominating the members of the Pon- ter Christ: you must not induce the 3. Pastoral Medicine tifical Academy for Life John Paul II abortion of a child and you must not made an explicit reference to Hip- kill a newly-born baby.16 Another category of sources pocrates when he spoke about the Research into Hildegard of Bin- where we find Hippocrates cited and need to “carry on the Hippocratic gen (1098-1179) has drawn a blank quoted in church and theological tradition.”10 as far as references to Hippocrates documents is that of textbooks dedi- On November 26, 1994 Pope John are concerned. Heinrich Schipperges cated to pastoral medicine. Indeed Paul II referred again to Hippocrates writes: there is a close relationship between when he spoke about a Vatican “Hildegard of Bingen does not of- the Corpus hippocraticum and theol- codex which contains the Hippo- fer an explicit theory in this matter. ogy not only because the Hippo- cratic oath transcribed in the form of He does not repeat the oath of Hip- cratic writings constitute a tried and a cross, the symbol of the Christian pocrates and he does not speak about tested system of diagnosis and treat- understanding of human nature, of medical ethics. We do not find direct ment but also because of their human holiness, and of the mystery of hu- references to the goals of health care image, their essential Christian basis, man life.11 and no methods are offered in rela- and their stress upon the notable sim- Under the unifying influence of tion to caring for the sick person. ilarities between sick and healthy the model of Christus medicus, Hel- There is nothing which offers in- people. lenistic naturalism and Semitic per- struction and nothing of a dogmatic We should also take note of the sonalism were fused together in character which could give rise to a ethical-medical chapters of the Di- early Christianity, and this was a di- theory on duties and their categoriza- daché and the way in which they rect result of a new diagnostic ap- tion. However his works are a contri- correspond to the writing and ideas proach to the origins and causes of bution to Medieval deontology and of Hippocrates. The Greek physician illness. Without doubt it is to Hippo- are all the more valuable because is referred to on two occasions: when cratic thought that we must attribute such works were absent at the time. the behaviour of the marriage part- the move towards a sense of ethical But because they are often not pre- ners during pregnancy is discussed, responsibility which in turn gave rise sented in a serious way they cannot and where there is a debate about the to the creation of medical oaths be considered seriously.”17 therapeutic opportunities offered by which had preambles with a Honorius Augustodunensis, who folk medicine in cases of epilepsy, monotheistic character and conclu- died after 1150, wrote the following something, of course, which today sions with explicit reference to a of Hippocrates: “per medelam cor- appears highly disputable.22 transcendental reality, to God, be- porum deducit ad medelam ani- In 1893 E.W.M. di Olfers referred fore whom such oaths was sworn.13 marum.” 18 to Hippocrates in his book on pas- Knowledge about Hippocrates toral medicine. He was much ahead and about the Corpus was kept and of his time in his definition of 2. Hippocrates in the Patristic and handed down by Nestorian-Syrian epilepsy as a “holy disease” in the Scholastic Traditions Christianity. This branch of Chris- same way that every other illness is tianity dedicated space in its schools holy, and observed, in addition, that During the patristic age there was and monasteries to the conservation it was no more holy than any other.23 an abundance of quotations from the and transmission of philosophical August Stohr makes repeated ref- authentic works of Hippocrates and and scientific learning, and gave es- erence to Hippocrates, in part be- from the Corpus, and these have sur- pecial room to the Aristotelian part cause he wants to attack a certain vived to us. Indeed, Cyprian of of this inheritance: not only Aristotle form of medicine proposed by the 44 DOLENTIUM HOMINUM ancient Greeks, a form of medicine at its base a fusion of biological, an- naria della Pontificia Accademia per la Vita which has much in common with the thropological, medical-human, so- (Rome, 1994). 12. PEDRO LAIN ENTRALGO, Heilkunde in therapeutic treatment of the soul. In cial, and ethical-metaphysical con- Geschichtlicher Entscheidung (Salzburg, addition Stohr refers to Hippocrates siderations, elements, and factors.”27 1956). when he discusses the classical idea 13. GOTTFRIED ROTH, “Die Monotheistis- chen Präarmbeln und Schulßformen in den of sex res non naturales and dwells Professor G. ROTH Ärztlichen Eiden,” in Wissenschaft und upon diet and upon general customs Professor of Pastoral Medicine at the Glaube, 3 (1990), pp. 115-121. 24, 25 14. and habits of an individual’s life. University of Vienna O. TEMKIN, Hippocrates in the World of When considering the middle of Pagans and Christians (Baltimore and Lon- don, 1911). the twentieth century we can cite Al- 15. KARL-HEINZ LEVEN, Medizinisches bei bert Niedermayer who makes fre- Eusebios von Kaiserea (Dusseldorf, 1987). quent references to the Corpus Hip- Notes 16. Didaché 1, 6, 2, in Fontes Christiani. Di- 1. dache, traditio apostolica (Herder, Freiburg, pocraticum and to its ethical-med- GOTTFRIED ROTH, “Hippokrates in Päp- Basel, Vienna, Barcelona, Rome, New York, ical high-point, the famous Hippo- stlichen Dokumenten,” in Acta Medika 1991), p. 103. Catholika (Belgica), 2 (1995), pp. 101-102. 17. cratic Oath. Like many other authors 2. HILDEGARD VON BINGEN, Heilkunde (Lichtenthaeler and others) he be- GOTTFRIED ROTH, “Hippokrates in Päp- (Salzburg, 1957). stlichen Doukumenten, 2, Erweirte Fassung,” 18. CHRISTIAN PROPST, Der Deutsche Orden lieves that this oath forms an authen- in Mitteilungen der Katholischen Ärztegilde und Sein Medizinalwesen in Preu§en (Bad tic part of the Hippocratic writings. Österriechs, 246 (1995), pp. 3-6. 3. Godersberg, 1969). M.A. ALONSO, PEDRO HISPANO: Sciencia 19. In the work of Niedermayer there JOSEF PIEPER, Scolastik (Munich, 1960), Libri de Anima (Barcelona, 1961). p. 141 f; Johannes Hirschberger, Geschichte are arguments in favour of Hip- 4. PIUS XII, “Zur Geschicte der Medizin, der Philosophie, vol. 1 (Basel, Freiburg, and pocrates but also controversial state- Ansprache am September 19, 1954,” in Pius Vienna, 1965), pp. 417 ments, especially in the gynaecolog- XII, Discorsi ai Medici. S.349 f. (Rome, 20. LEO J. ELDERS, Die Metaphysik des 1959). ical field. 5. Thomas Von Aquin (Salzburg and Munich, PAUL VI, “Das Ärztliche Ideal Nicht 1985), vol. 1, p. 124. Albert Niedermayer has clear Beeinträctigen,” L’Osservatore Romano 21. S. Thomae Aquinatis Opera Omnia. Co- ideas about the importance of Hip- (German edition), January 19, 1973. 6. mentarium in Aristoteles et Alios. pocrates: “Even though he was a pa- POPE JOHN PAUL I, Illustrissimi (Padova, (Stuttgart/Bad Cannstatt, 1980). 1970). 22. FR. X. BRITZGER, Handbuch der Pastor- gan he could today—some two thou- 7. JOHN PAUL II, Wort und Weisung im Jahr lalmedizin (Regensburg, 1859). sand years after Christ’s preaching 1979 (Rome and Kevelaer, 1979). 23. 8. E.W.M. VON OLFERS, Pastoralmedizin. of the Gospel—act as an example JOHN PAUL II, Der Apostolische Stuhl 24. AUGUST STÖHR, Die Naturwissenschaft 1983, S. 1155 (Rome and Köln, 1983) and model for doctors who proclaim 9. auf dem Gebiete der Katholischen Moral und JOHN PAUL II, Der Apostolische Stuhl 26 Pastoral (Herder, Freiburg /B, 1893), p. 141f. themselves Christians.” Albert Nie- 1987, S. 1699 (Rom and Köln, 1987). 25. 10. AUGUST STÖHR, Handbuch der Pas- dermayer anticipated later overall Pontificia Academia Pro Vita, Rome, toralmedizin mit Besonderer Berüchsichti- 1994. and Wholistic approaches to medi- 11. gung der Hygiene (Herder, Freiburg /B 1900). JOHN PAUL II, Discorso del Santo Padre 26. cine when he expressed his belief A. NIEDERMEYER, Compendium der Pas- in Occasione della Conferenza Internationale toralmedizin (Vienna, 1953). that a true and authentic doctor has a 27. Promossa dal Pontificio Consiglio della Pas- A. NIEDERMEYER, Grundrib der Sozial- vision of his profession which “has torale per gli Operatori Sanitari e dell Ple- hygiene (Vienna and Bonn, 1957), p. 30. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 45

JESÚS ALVAREZ GÓMEZ

The Care of the Sick in the History of the Church

1. Concern for the Sick Belongs to century AD in communities with a the community possessed, the poor the Mission of the Church in large number of believers. and the sick. Terms of Both Her Founding In the early communities the per- Although the principal figures of Purpose and Her History son who was ultimately responsible authority and responsibility were the for everybody was the bishop. The bishop and the deacon, in actual fact When Jesus entrusted his apostles most important qualities which the all Christians had to be personally with the mission of teaching the faithful required of a person to be responsible for the poor and the sick. Holy Law of the Lord to every crea- elected to such a position was, ac- In the Apostolic Tradition of Hip- ture he gave them the power to man- cording to the Apostolic Constitu- politus of Rome (235 AD), the can- ifest the same signs with which he tions, love for the poor he should didates for baptism were asked: had shown that in Him were ex- “love the poor.”2 The Didascalia de- “Have you honored the widows? pressed those promises which God clared: “Remember the poor, extend Have you visited the sick? Have you had made to the people of Israel: the a hand to them and feed them.”3 In performed all kinds of good banishment of evil spirits and the this task the bishop was helped by works?”9 And the godfather of every healing of the sick (Lk 16:18). the deacon, who “had to be the ear catechumen had to guarantee the From the first community of of the bishop, his mouth, his heart, good behavior of his godchild before Jerusalem until today, the Church and his soul”4. As a result, the dea- the whole community. has woven a wonderful garland of con was ordered to search out the love around all of the weak and all of sick, to study each case in practical the poor. But sick people, above all terms to see if greater care could be 3. Concern for the Sick after the else, have been the primary object of given, to bring them the Eucharist, Peace of Constantine her love. which had been consacrated during the Sunday liturgical assembly, and From the year 313 AD onwards, to help them in a more material the Church could organize care for 2. Concern for the Sick in the sense5. The Didascalia also encour- the poor and the sick on a very large Early Christian Communities aged the deaconesses and widows to scale indeed. Institutions bearing a dedicate especial attention and care whole variety of names sprang up The early Christians did not have to sick and poor women.6 everywhere and with increasing fre- before them any institution which This practice outlined in the Di- quency. Their names reflected the gave them an example of how the dascalia is supported and promoted kind of people they cared for: “hos- sick should be treated. In Egypt, in the fifth century by the Testament pitals” for the sick; “homes” for the Greece, and Rome there was no spe- of the Lord7, which ordered the dea- elderly; “hospices” for pilgrims; and cific system by which care was of- con to “go into the inns and taverns “orphanages.” fered to the ill. to see if there was a sick or poor per- It was the mother of the Emperor It is not easy to determine with son there, or a sick person who had Constantine, St. Helen, who founded precision how the Christian commu- been abandoned.”8 the first hospitals bearing the sign of nities dealt with sick people because At the outset, when the communi- the cross, and it was Constantine this was a category which was de- ties were very small in size, the himself who built the hospital at fined in relation to the more general bishop or the deacon looked for a Constantinople. The first hospital practice of “helping the poor.” Christian family which was prepared specifically for pilgrims was that of Nonetheless, there are some com- to take in and care for poor people or Sebaste (365 AD), which also took ments about the subject in the early sick people without relatives to help in sick people, and especially lep- liturgical and pastoral writings of the them. But when the number of sick ers.10 first centuries of Christendom. Our people grew, as happened in Rome During a period of famine in attention is drawn primarily to the in the middle of the third century, the Odessa, St. Ephremus (373 AD) be- Didascalia,1 a document which de- first hospital-like institutions were rated the rich for their indifference scribes the lifestyle of a small Chris- created. The acts for the martrydom and with the donations he then re- tian community where bureaucracy of St. Lawrence tell us that he cre- ceived created an “emergency hospi- had not as yet emerged, phenomenon ated a sanctuary/hospital to care for, tal” with three hundred beds. This present by the middle of the third and protect, the greatest treasure that hospital took in the poor and the sick 46 DOLENTIUM HOMINUM drawn from the city and the suround- of evangelization. This great Bishop fourth vow to care for the sick. The ing countryside.11 Towards the end of Caesarea in Cappadocia promoted most famous of the brotherhoods of the fourth century the community a great social initiative16 which was was the Augustinian brotherhood of of Antioch became famous for its subsequently called the Basiliade17 Hotel-Dieu in Paris, and the statutes charitable activity in the health in his honor. It was a veritable town of this body were imitated by nearly sphere. St. John Chrysostom (407 built around his episcopal seat18 and all the others. In the diocese of Paris AD) tells us that there were three brought forth the deep praise of St. alone there were more than fifty hos- thousand widows and maidens in the Gregory Nazianzenus. This great pital brotherhoods. The Beguine lists of the poor of that community friend of St. Basil praised him for communities were also concerned and that these were cared for daily. “having imitated Christ’s behavior with care for the sick, and did so In addition, there were “the sick and towards the sick, and in particular to- sometimes in the home of the sick the convalescent in the hospitals”12. wards lepers.”19 person and sometimes in the hospital In the West the first hospital-style In practical terms all of the institu- centers of the Church. instituitions emerged between the tions created from the beginning of The Medieval period witnessed fourth and the fifth centuries AD. the fifth century onwards for the care the first religious orders dedicated to The Greek term which was used to of the sick of Constantinople, Syria, hospitals, such as the Hospitallers of describe them was undoubtedly in- Palestine, and Egypt were in the the Holy Spirit and the Hospitallers fluenced by the Eastern model. To- hands of monasteries run by monks of St. Anthony.23 wards the year 400 the rich lady of and nuns. The Emperor Justinian The military orders also estab- high social rank, Fabiola, created the gave a special legal status to these lished hospitals, in both the Holy first Roman hospital (nosocomium) hospitals and he himself set up a cer- Land and Europe, and especially in in the real sense of the term. This tain number. These were well en- the Iberian peninsula, where they hospital was built on the banks of the dowed, entrusted to the administra- took care of pilgrims who visited Tiber and was divided into different tion of monks and nuns who were Santiago de Compostela. Certain wards containing different kinds of helped by a lay staff employed by military orders were famous for their sick people. In addition, the patrician contract, and were always under the service to the sick, namely the Hos- Pammachius established a hostel for watchful supervision of the local pitallers of St. John of Jerusalem, the pilgrims in the port town of Ostia bishops.20 Templars, the Knights of Santiago, and St. Paola and her daughter Eu- In the West during the Medieval and the Teutonic Knights.24 stochia constructed eight hospitals in period, when there was no specific The profoundly humanitarian and Rome itself.13 network of hospitals, hotels, and compassionate spirit of the mendi- St. Augustine built a Xen- inns, the monasteries gave hospital- cant orders was expressed in the cre- odochium at Hippo, and he himself ity to travellers—emperors, kings, ation of a large number of initiatives observed that institutions of this kind nobles, and even mere vagabonds. to help the poor and the sick, and in were already known in Africa before However, primary importance was this endeavor their “tertiary orders” this Greek term became widespread always given to sick pilgrims and to played a primary role. in the Latin world.14 the sick from the countryside.21 The Benedictine rule ordered that such people be treated as though they 6. The Great Hospitaller Orders 4. Monks and Care for the Sick were Christ in person. In the monasteries medicine was The hospital centers for the whole Desert monasticism in the strict taught and botanical gardens were of the Medieval period were holy sense of the term, whether expressed created which had every kind of places and as such were placed under by anchorites or by cenobites, did medicinal plant available. Lengthy ecclesiastical jursidiction. In order to not emerge as a specific attempt to prescription books derived from ex- carry out their tasks these hospitals care for the poor and the sick. How- tensive experience existed side by were usually endowed with a large ever, the first hermits, notwithstand- side with medical texts, and, accord- amount of wealth and in time such ing the few resources they had at ing to the catalogues of their li- wealth attracted the greedy eye of hand, opened their hearts to the poor braries, both were very large in num- laymen and also of a number of and to the sick of the nearby villages, ber. History records the names of clergy. The most prosperous hospi- and at times shared their meager many monks who were specialists in tals fell into the hands of unscrupu- goods with the poor and sick of the field of medicine (22). lous trustees who rapidly despoiled Alexandria. They always did this these institutions. Thus it was that with the pilgrims who stopped out- many hospital institutions disap- side their cells. 5. Hospital Brotherhoods and peared and on the eve of the Council The colonies of semi-anchorites in Orders During the Medieval of Trent care for the sick was almost Egypt, Syria, and Palestine and par- Period at an end, notwithstanding the fact ticularly the Pacomian monasteries that the Oratories of Divine Love followed close behind in organizing Brotherhoods or congregations had established a large number of social activity through the creation were created for the hospitals estab- hospitals for the incurably ill in Italy. of hospices for strangers and hospi- lished by kings and corporations. During the Renaissance a variety tals for their own monks who had These bodies were independent and of organizations with a social pur- fallen sick.15 were composed of “brothers” and pose began to concern themselves It was, however, St. Basil who in- “sisters” who lived together in com- with hospital care for the poor. Thus tegrated monasticism into the chari- munities, and in addition to taking a large number of royal, municipal, table and social work of the Church. the three vows of chastity, poverty, and guild hospitals came into exis- He saw it as a powerful instrument and obedience, they also took a tence. But this initiative to create VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 47

public hospitals was by no means mercy” as humiliating for man and 8. Testamentum Domini, II, 34. sufficient for the growing number of confiscated the material wealth with 9. Apostolic Tradition, 20. 10. ST. EPIPHANIUS, Adv. Haeres, 3, 55. poor and sick people who had been which they had taken care of the 11. SOZOMENUS, Hist. Eccl., 3, 16, 12-25. afflicted by an increasing number of poor and the sick. In this way, how- 12. ST. JOHN CHRISOSTOMUS, In Mat. Hom., epidemics, and particularly those ever, not only did these governments 66, 3; Ad Stagyr. Conc., 3, 13; In Act. Hom., who had fallen victim to the constant fail to solve the problem of poverty 45, 4. 13. ST. GERONIMUS, Epist. 27 Ad Oceanum; wars of the epoch. and illness, but they actually in- PL 22, 694 and 697; Epist. 108, ad Eusto- Once again it was the Church creased it because in actual fact the quium; PL 22, 878. which gave rise to a large number of poor became poorer and the sick 14. ST. AUGUSTINE, Sermo 355, 2; In Job tr., hospital and charitable institutions. were less cared for. 97, 4. 15. J. ALVAREZ GOMEZ, Historia de la Vida The Church did this through the new However, the Spirit of the Lord Religiosa, I, (Madrid 1987), pp. 215-218; cf hospital congregations and orders Jesus gave life to a splendid flower- Paladian, Historia Lausiaca, 7. 16. Ep 176, 653; Ep 94; Ep 150, 653 c. such as the Brothers of St. John of ing of religious congregations dedi- 17. 27 SOZOMENUS, Storia Ecclesiastica, VI, 34; God, the Ministers to the Sick of St. cated to care for the sick. Pg 67, 1397 a: “Basiliade, the very famous Camillus De Lellis, the Daughters of The presence of the Church in to- hospice for the poor founded by the Blessed Charity of St. Vincent de Paul and day’s hospital world must not be Basil from whom it takes the name which it St. Louise of Marillac, and through a seen as a mere “support mechanism” has today.” 18. GREGORY NAZIANZENUS, In Laudem host of diocesan congregations. for civil society. Christians who Basilii, PG 36, 577; Ep 143, 593 a, 488 b-c-. These institutions were especially work in health care practice a profes- “Go a little out of the town and look at the new directed towards those social areas sion, but they are also engaged in a town”; cf S. Giet, Les Ides et l’Action Sociale of marginalization and illness which salvific mission. Their professional de Saint Basile, (Paris, 1941), p. 421, note 2. 20. Cod. Just., 1, 3, 32 and 34. were least cared for by the public au- expertise is required for their profes- 21. M. ZUNIGA CISNEROS, La Seguridad So- thorities of the time. sion, but it is also necessary to their cial Y su Historia, (Caracas, 1963). The first real hospital institution to salvific mission. 22. U. BERLIERE, L’Ordine Monastique des be dedicated to psychiatry was that Origines au XIIe Sicle, (Abbaye de Mared- sous, 1924), pp. 119-120. created in Valencia in Spain in 1409 Rev. JESUS ALVAREZ GOMEZ, 23. J. ALVAREZ GOMEZ, op. cit., pp. 187-190. by the Venerable Father Juan Gi- C.M.F. 24. B. RIGALT Y NICOLAS, Diccionario His- 25 torico de las Ordenes de Caballeria, labert Joffr (1363-1417). Professor of Church History at A new and vast field for the hospi- (Barcelona, 1858); F. CRADINI, Le Crociate The Institute for Religious Life of the Sons tra il Mito e la Storia, (Rome, 1971); J. AL- tal work of the Church then opened of the Immaculate Heart of Mary VAREZ GOMEZ, Historia de la Vida Religiosa, up with the discovery of America. (Claretians), Madrid, Spain II (Madrid, 1989), pp. 183-186. This has been emphasized by Cardi- 25. I. TALAMANCO, Vida del Apostolico Padre el Beato Fr. Juan Gilabert, de la Real y nal Fiorenzo Angelini: Militar Orden de la Merced, (Madrid, 1735); “Concern for those who suffer, Notes J. ZAPATER Y UGEDA, Biografia e elogio de for the sick and the week, as a funda- Fray Juan Gilabert Joffr, Fundador del Hos- mental and unifying element in mis- 1. The Didascalia or Catholic Doctrine of pital General de Valencia, (Valencia, 1883). the Twelve Apostle and the Holy Disciples of 26. CARDINAL FIORENZO ANGELINI, La Prima sionary activity...was one of the fea- our Redemmer comes from the first half of the Evangelizzazione in America Latina e l’Atten- tures of the first evangelization of third century AD. It was written by a bishop to zione della Chiesa al Mondo dei Malati, (Vat- Latin America, when hospitals and a community in the north of Syria. It was a ican City, 1992), p. 22. health care facilities were set up, and guide for church discipline and was especially 27. C. LANGLOIS, Le Catholicisme au Femi- this was done first and foremost by concerned with the sick. The author possessed nin. Les Congregations Franaises Superieure extensive medical knowledge. Generale au XIXe Sicle, (Paris, 1984); J. AL- 26 2. the religious orders.” Apostolic Constitutions, II, 50; cf ST. IG- VAREZ GOMEZ, La Revolucion Francesa y la NATIUS OF ANTIOCH, “Letter to Polycarp,” 4; Vida Religiosa, Vol. III, (Madrid, 1990), pp. JUSTINE, 51 Apolog., 67; HERMAS, Pastor, 503-619; J. CHARRY, “Le Nuove Fondazioni Sim., IX, 27, 2; St. Ireneus, Adv. Haeres, IV, di Congregazioni dopo la Revoluzione 7. From “Works of Mercy” to 34. Francese,” in Vita Consacrata, 5, (1985), pp. 3. “Social Justice” Didascalia, XIV, 3, 2. 600-612; RAPONIN, “Vita Religiosa e Carità 4. Didascalia, XI, 44, 4. nei Modelli Storici dell’800 e del 900,” in 5. JUSTINE, i Apolog., 67, 6. Consacrazione e Servizio, 7-8, (1989), pp. 37- The advanced governments of the 6. Didascalia, XV, 8, 3. 46; C. NASTORG, “Les Religieuses dans le eighteenth and nineteenth centuries 7. Strongly influenced by the Apostolic Tra- Monde de la Sant en France, au XIXe Sicle,” considered the traditional “works of dition of Hippolitus of Rome. in RESPA, 320, (1988), pp. 275-281. 48 DOLENTIUM HOMINUM

BONIFACIO HONINGS

The Charter for Health Care Workers: A Synthesis of Hippocratic Ethics and Christian Morality

I have the honor rather than the ment of its separation from the body man. This is why Jehovah, when he task of presenting the Charter for at death. Not only this but the revealed the ten commandments of Health Care Workers to this interna- Church also teaches that this soul is the Covenant, put the command- tional conference. When I thought united once again with the body at ment “Thou shalt not kill” at the about the best way of doing this it the moment of the final resurrection. center of this Covenant, a fact which seemed to me opportune as well as The life of the human being, of deserves special attention. God useful to take a broad overall view. every human being, is not the prod- makes himself not only judge of With such an approach it would be uct of parents or of a laboratory pro- each violation of the commandment possible to give a clear presentation jected and constructed by man. Hu- in defense of life but also and above of the chief concern which pervades man life, and the point is not in the all else he makes himself the de- the text, namely that of helping the least open to discussion, has a divine fender of a commandment placed at health care worker to serve human origin.2 the very basis of the whole of social life from its beginning until its nat- A sentence from the Book of Job is coexistence.6 For good reasons, ural end. Such service is fully hu- very significant here: “If he (the therefore, Christian morality has al- man and specifically Christian. This Lord) should take back his spirit to ways proclaimed and defended and paper of mine thus seeks, and this is himself, and gather to himself his still proclaims and defends today the a very important point, to show im- breath, all flesh would perish to- incomparable value of the life of mediately how the Charter is in very gether, and man would return to each human person. practical terms a synthesis of Hippo- dust.”3 Of no less significance is But Hippocratic ethics, expressed cratic ethics and Christian morality. Ezekiel’s comment on the resurrec- in the ever relevant and contempo- In order to achieve this rather ambi- tion: “And I shall put my spirit within rary famous oath, have also pro- tious goal I will begin by emphasiz- you, and you shall live.”4 Without the claimed and defended this value of ing the divine origins of each human “vitalizing breath” of God man each human life and has done so for life and its destination towards God would indeed merely fall back into over two thousand years. It therefore himself. After this I will describe nothing. But if God gives a soul to comes as no surprise that within this how the figure of the health care the body—that is to say, if he gives permanently valid set of ethics there worker is a servant to this life and life—then it is more than right that are to be found four key features, as thus, and above all else, to the Au- He, and only He, attributes to Him- Cardinal Fiorenzo Angelini has thor of this life. Finally, I will trace self the inalienable and inviolable pointed out, and these are: “a pro- the path of human existence: gener- right to manage and order the life of found respect for nature in general; a ation, life, and death, all of which each human being from the moment unifying and integral conception of are central reference points for ethi- of conception until natural death. human life, or rather, of the human cal-pastoral reflection and thought. John Paul II does not hesitate for a being; a close and rigid relationship moment to proclaim, with a certain between personal ethics and profes- solemnity, the existence of this di- sional ethics; and a largely active vi- 1. God: The Alpha and Omega of vine right: “Human life is sacred be- sion of the practice of the art of med- Human Life cause from its very beginning it icine.”7 For Hippocratic Ethics as bears the ‘creative action of God’ for Christian morality, therefore, the When there was no man who and it always remains in a special re- life of each human being is a value tilled the soil or who brought forth lationship with the Creator, its only which cannot be called into ques- water from the earth to irrigate its end. Only God is the Lord of life tion—it must be defended and surface “the Lord God formed man from its beginning until its end: no- watched over. In a word, it must be of dust from the ground, and body, in any circumstances, can served. If this imperative applies to breathed into his nostrils the breath give to himself the right to directly everybody, it must apply first and of life; and man became a living be- destroy an innocent human being.”5 foremost and above all else to health ing.”1 From this creative act of God Here we encounter the central care workers. This is what the Char- the Church derives her teaching that feature of Christian morality in rela- ter makes clear, a Charter which (as each spiritual soul is created directly tion to the sacredness and the invio- I have made clear above) I have the by God and is immortal—that is to lability of human life, of every hu- honor to present to this great and au- say, that it does not perish at the mo- man life, of the human life of every gust assembly present here today. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 49

2. The Figure of the Health Care essence of the existential condition constant ethical-religious formation Worker of man on earth. From this point of in moral questions in general and in view the health care worker, if he is a questions relating to bioethics in par- The activities of the health care Christian and thus a follower of the ticular. In the presence of clinical worker are the expression of a deeply Good Samaritan or even if he is not a cases which become ever more com- human and Christian act of service Christian and thus a follower of the plicated and intricate in character be- precisely because such service is not most human “secular” figure of Hip- cause of advances in the realm of only of a technical character but also pocrates, easily understands that his biotechnology, all health care work- and above all else because it involves profession is a mission and thus a vo- ers—but especially medical doc- devotion to, and love for, one’s fel- cation. His medical-health care actors—cannot and must not be left low man, one’s neighbor. In their tivity is thereby a response to a tran- alone to be burdened by responsibil- care and concern for the lives of scendental call which takes concrete ities which can not be borne. This is other people, health care workers form in the suffering and imploring becomes even more evident if we re- perform an action which involves the face of the patient entrusted to his flect upon the fact that many of these prevention, cure and rehabilitation of care. His loving care for a sick per- advances are still at an experimental human health and the stewardship of son, characterized by sympathy and stage and are of great social rele- life, an action which is truly Christ- empathy, becomes an act of service vance when we come to consider ian and human. For this reason the which is similar to that related by the matter relating to the whole world of primary and emblematic form of parable of the Good Samaritan and health and health policy.14 We can such care is to be found in their con- also that required by the oath of the state with certainty that the true and cerned and committed presence at Hippocratic physician. authentic humanization of medical the side of the sick.8 This is why profession, vocation science and technology is clearly at This is why medical and health and mission meet each other in the stake. In other words, it is evident care service implies an interpersonal figure of each and every health care that in the field of medicine we need relationship which is very special: it worker, and in the light of the Chris- to bring about that “civilization of is, indeed, an encounter between tian vision of life and health the love and of life without which the trust and conscience. It is a relation- health care worker is a minister of existence of individuals and society ship of “trust” on the part of the per- that God who in the Holy Scriptures loses its most authentically human son in need of treatment and care be- is presented as a “lover of life.”10 To meaning.”15 Such, then, is the princi- cause he is afflicted by illness and serve the life of the sick man be- pal aim of this Charter: to guarantee thus by suffering, and of “con- comes, indeed, service to God and the ethical faithfulness of the health science” on the part of the person also cooperation with God: the ges- care worker so that he can build— who is able to respond to this need ture of loving welcome of the weak both in his choices and in his behav- through a fusion of care, treatment and sick life in order to give health ior—that civilization of love and life and healing. For the health care becomes the giving of praise and invoked by the eminent author of the worker the sick person is never or at glory to God.11 Evangelium Vitae. And it is for this least should never be a simple clini- It is no surprise, therefore, that the reason that the Charter takes as its cal case which should be examined Church “has always seen medicine reference point for ethical and reli- “scientifically.” He is always a per- as an important support of her own gious reflection and thought that son who is in special need—because redemptive mission in relation to path of human existence which con- he is sick—of sympathy or perhaps man. Indeed, service to the spirit of sists of being created, of living and of empathy, in the etymological man cannot take place fully if it does of dying.16 sense of these terms. not place itself at the service of his “Scientific and professional skill psycho-physical unity. The Church are not enough, personal participa- well knows that physical ills im- 3.1. Responsibility Towards tion in the practical situations of each prison the spirit in the same way as the Dignity of Human individual patient is what is needed.” the ills of the spirit enslave the Procreation That is to say one needs: “readiness body.”12 The figure of the health care to help, attention, understanding, worker is, and thus should always in- The creation of a new human be- sharing, benevolence, patience and creasingly become, a live image of ing is an event which is both pro- dialogue.”9 In order to achieve a bet- Christ the Good Samaritan. “Doc- foundly human and highly religious. ter and more precise understanding tors, nurses, other workers in the This is because it involves the uni- of this Charter it is very important to world of health, and volunteers,” tive love of the marriage partners, a observe that this total dedication on John Paul II makes clear, “are called reality which is itself an act of coop- the part of the health care worker to upon to be the alive image of Christ eration with God the creator. Be- serving each sick person finds its and of his Church in love towards cause of this it is more than evident truest “objective” basis and its most the sick and the suffering: witnesses that health care workers are called pressing “subjective” basis—that is of the ‘gospel of life.’”13 upon to help the parents and mar- to say its most involving basis—in riage partners to “procreate with re- an overall vision and understanding sponsibility, to favor the conditions of the sick man himself. 3. Ethical-Moral Faithfulness and of such procreation, remove obsta- Understood at their roots, illness the Sacredness and Inviolability cles to it, and safeguard it against an and suffering are in reality phenom- of Life invasive ‘technologicalism’ which is ena of human life which pose ques- not worthy of human procreation.”17 tions which transcend medical sci- The profession, mission, and vo- In this service true morality rightly ence and technology. This is because cation of the health care worker nat- distinguishes between the therapeu- they touch upon the axiological urally requires a solid training and a tic manipulation and the alternative 50 DOLENTIUM HOMINUM manipulation of the human genetic workers to promote this Christian ment of fertilization. Health care patrimony. “No social or scientific and human conception of sexuality workers and in particular gynecolo- usefulness and no ideological moti- is more than right and just. In this gists and obstetricians should “watch vation could ever justify intervention way the knowledge required for be- with great care over the wonderful on the human genome which is not havior which is responsible and re- and mysterious process of genera- therapeutic in character, that is to say spectful of the special dignity of hu- tion which takes place in the mater- in itself directed towards the natural man sexuality in general, and the nal womb in order to follow its cor- development of the human being.”18 conjugal act in particular, is made rect development and promote its The reason for this “absolute no” is accessible to marriage partners and happy outcome through the coming to be found in the very dignity of hu- above all to young people.21 into the light of a new creature.” 23 man procreation, and this is because Health care workers should in the They must remind themselves first the new human being who is born first place help marriage partners to and foremost of the singular dignity from conjugal union “carries with understand the anthropological and of each human life: the dignity of the him a special image and likeness of moral difference between natural as- person created in the image and like- God himself: in the biology of gener- sistance and artificial substitution in ness of God. Health care workers ation is inscribed the genealogy of matters relating to procreation. In re- must above all else be aware that the person.”19 The conception and lation to the last question health care each person is a unity of body and generation of a new human being is workers should stress the wrongful- soul, and realize that for this reason not the outcome of the laws of biol- ness of in vitro fertilization with em- the person himself in his practical re- ogy but constitutes, rather, an event bryo transfer, whether it is heterolo- ality becomes achieved through the of conjugal cooperation in the con- gous or homologous in character. body. “Each intervention on the hu- tinuation of divine creation. Obviously enough, this moral judg- man body does not act only upon tis- Here the Charter makes clear that ment concerns only the methods of sue, organs and their functions, but the procreative cooperation prac- fertilization and not the human being involves the same person at different ticed by the marriage partners is not in question who must always be wel- levels.”24 From this it follows that the only the criterion behind the anthro- comed as a gift of God and brought body, by being a reality which is a pological and moral difference be- up with great love22 Service to life property of the person because it re- tween natural and artificial methods performed by health care workers veals the person in his relationship of procreation but also constitutes begins, therefore, with the promo- with God, with other human beings, the evaluative criterion in matters re- tion of this very great respect for the and with the world, is the basis and lating to artificial procreation. “The originality of the generation of hu- source of moral requirements. The dignity of the human person requires man beings. body cannot be treated like an object that he comes into existence as a gift which belongs to somebody, like a of God and fruit of the conjugal act thing or an instrument of which we which belongs to, and is specific to, 3.2. Responsibility Towards are owners and arbiters. This is the the unitive and procreative love of Human Health and Life reason why not everything which is the marriage partners, an act which technically possible can be consid- by its very nature cannot be substi- The marvelous process of a new ered morally acceptable.”25 tuted.”20 This is why the appeal to the human life begins under the wise and The intrinsic purpose of the pro- sense of responsibility of health care loving protection of love at the mo- fession of health care workers is the VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 51 upholding of the right of man to life those who call for religious assis- professional ability, of health care and to his dignity. Their duty (which tance, whether implicitly or explic- workers, beginning with the doctors flows from this reality) lies, there- itly, to receive such assistance. “In- themselves.”30 This is the moment fore, in the preventive and therapeu- deed, experience teaches us that man when dying should be withdrawn tic stewarding and promotion of when in need of both preventive and from the realm of medicine, con- health and the improvement of the therapeutic help reveals needs which cerned as this is in large measure lives of people. “Illness and suffering go beyond the confines of the pathol- with the biophysical aspect of the ill- are not experiences which only affect ogy of the body which afflicts him. ness. At this stage the most impor- the physical dimension to man but He expects from the medical doctor tant form of care lies in a loving man in his entirety and in his so- not only adequate and suitable presence which is full of attention matic-spiritual unity.”26 Diagnosis, care—care which sooner or later will and concern, and which instills trust treatment and rehabilitation, there- be shown to be insufficient and with and hope, replacing, thereby, a re- fore, not only aim at the well-being obvious fatal consequences—but fusal of death with its acceptance. and the health of the physical body also the human support of a brother Powerless as we are when faced with but also seek the integral well-being who knows how to ensure that he the mystery of death, Christian faith of the person in a more general sense. participates in a vision of life which is in such a context the only source At this point there arises the ques- provides him with a meaning— of serenity and peace. For this rea- tion of what happens when it is im- amongst other things—to the mys- son, the bearing of witness to faith possible to cure the sick person. In tery of suffering and death. And and hope in Christ by the health care such a case the health care worker is where can be found a peace-giving worker is of crucial importance. The always required to effect and prac- answer to the supreme questions creation of a presence of faith and tice all suitable forms of treatment about existence if not in faith?”29 hope is the highest form of human- and care but he can also quite rightly ization and Christianization of dying interrupt forms of treatment and care which doctors and nurses can pro- which are not suitable or appropri- 3.3. Care and Assistance Until the mote. ate.27 Here the question of the hu- Natural Conclusion of Life In the case of the terminally ill the manization of pain through the use right to life becomes the right to die of analgesics or anesthetics is very When conditions of health deteri- in all serenity and with the greatest important. Even though for the orate to an irreversible and terminal possible human and Christian dig- Christian pain has a great penitential level, or rather when man enters into nity. This right rules out every form and salvific significance, Christian the final stage of his earthly exis- of therapeutic overkill and, to an charity itself also calls upon health tence, health care workers are called even greater extent, every attempt to care workers to alleviate suffering.28 upon to give special care and help to put an end to life.31. “Euthanasia up- And here in more pressing fashion the sick person. “Never should life sets the relationship between patient comes into play the fundamental be celebrated and exalted so much as and doctor. With regard to the pa- right of the sick person to pastoral in nearness to death and at death it- tient this occurs because the patient care and to the sacrament of the self... Behavior towards the termi- enters into a relationship with the anointing of the sick. Each and every nally sick is the acid test of the sense doctor which is based upon this latter health care worker is required to cre- of justice and charity, of the nobility providing death. With regard to the ate conditions which will enable of soul, of the responsibility and the doctor this occurs because the physi- 52 DOLENTIUM HOMINUM cian is no longer the guarantor of and gains new strength by which to sible, a sincere giving of oneself life—the sick person fears, instead, combat the temptations of evil and which expresses one’s essential hu- that the physician will proffer death. the anxieties of death.”37 The same is man and Christian call to love and The relationship between the doctor even more true when we consider communion.40 and the patient is a relationship the Eucharistic encounter, some- The intention of the Charter for based upon trust in life and it must thing which is a viaticum of the body Health Care Workers is paradig- remain as such. Euthanasia is a and blood of Christ. In the words of matic with regard to service to life, ‘crime’ in which health care workers Christ it is a pledge of the resurrec- that is to say, in relation to respond- who are always and only guarantors tion: “who ever eats of my flesh and ing to the call of Christ: “Vade et fac of life can never participate.”32 drinks of my blood will have eternal similiter.” The same is true of abortion even life, and I will raise him up on the if the health of the mother, a child last day.” Rev. BONIFACIO HONINGS, OCD too many, a serious fetal deforma- Member of the Pontifical tion, and a pregnancy caused by sex- Academy for Life, ual violence, all involve very serious Conclusion Consultor to the Congregation for the questions. Indeed, life is such a pri- Doctrine of the Faith, mary and fundamental good that it I hope that I have demonstrated Consultor to the Pontifical Council for can be placed on an equal footing (in what our president, Cardinal Pastoral Assistance to Health Care Workers a situation of equality or even of in- Fiorenzo Angelini, wrote in the pref- feriority) with certain very serious ace: that none of the complicated and 33 disadvantages. Here the evident intricate problems and questions Notes (*) synthesis of Hippocratic ethics and raised by the inseparable existing re- Christian morality cannot be con- lationship between medicine and 1. Genesis 2:7; see also 2:5-6. tested -both Hippocratic ethics and morality can, at the present time, be 2. Catechism of the Catholic Church, 366; Christian morality regard all forms considered a sort of neutral ground hereafter CCC. 3. Job 34:14-15. of direct abortion or direct (whether in relation to Hippocratic ethics and 4. Ezekiel, 37:14. active or passive) euthanasia as ille- Christian morality. For this reason, 5. JOHN PAUL II, Evangelium Vitae, 53; gitimate because one is dealing with the Charter for Health Care Work- hereafter EV. 6. Ibid. an act which destroys a prenatal life ers has given rigorous respect to the 7. FIORENZO ANGELINI, Quel Soffio sulla and with an act of murder which no- need to offer an organic and com- Creta, (Rome, 1990), pp. 377-378. body can justify.34 plete synthesis by the Church, begin- 8. Pontifical Council for Pastoral Assistance Hence the difference from the ning with Pius XII, on all matters to Health Care Workers, Charter for Health Care Workers (Vatican City, 1995), fourth right to die with human and Christ- concerning the upholding, in the edition, no. 1; hereafter Charter. ian dignity. “This is a real and legiti- field of health policy and care, of the 9. Charter, 2. mate right which health care staff are primary and fundamental value of 10. Wisdom 11:26. 11. Cf. Charter, 4. called upon to safeguard by taking the life of each and every human be- 12. Charter, 5. care of the dying person and accepting from the moment of conception 13. Quoted in Charter, 5. ing the natural ending of life. There to natural death.38 14. Cf. Charter, 8. is a radical difference between I would like to conclude with a 15. EV, 27, quoted in Charter, 9. 16. Cf. Charter, 10. `putting to death’ and `allowing to special reference to the progress and 17. Charter, 11. die’: the first is an act which destroys spread of the medicine and surgery 18. JOHN PAUL II, “All’Unione Giuristi Cat- life; the second accepts life until of transplants, phenomena which tolici Italiani,” 5 Dec. 1987, in Insegnamenti, death.”35 guarantee the treatment and the cure X/3 (1987), 1295, quoted in Charter, 13. 19. Charter, 15. It is precisely in this acceptance of of many sick people who until only 20. Charter, 22. the end of earthly life that each faith- recently found themselves in a termi- 21. Cf. Charter, 20-23. ful servant of life watches over this nally ill condition. Here we en- 22. Cf. Charter, 24.30. 23. Charter, 36. fulfillment of the will of God. He counter a challenge to love of a to- 24. Charter, 40. does not for any reason whatsoever tally unprecedented character: lov- 25. Cf. Charter, 44. consider himself the arbiter of death, ing one’s neighbor through the dona- 26. Charter, 53. in the same way as he does not for tion of organs so that he can go on 27. Cf. Charter, 64-5. 28. Cf. Charter, 68-71. any reason consider himself the ar- living. The removal of organs for ho- 29. JOHN PAUL II, “To the World Congress biter of somebody’s life.36 Indeed, it moplastic transplants from live or of Catholic Doctors,” 3 October 1982, in In- is this context, more than at any dead donors can take place, but natu- segnamenti, V/3, 1982, p. 675, quoted in Charter, note 212. other time, consoling for the dying rally enough within the limits im- 30. 39 Charter, 115. person when the health care worker posed by human nature. In the first 31. Cf. Charter, 119; 147-8. bears witness to the fact that full par- case the removal is legitimate as 32. Charter, 150. ticipation in divine life is the goal to long as the removal does not imply 33. Cf. Charter, 141. 34. Cf. Charter, 139; 147. which man on this earth is called to serious and irreversible damage for 35. Charter, 148. and oriented towards. In such a con- the donor. In the second case the 36. Cf. Charter, 114. text, more than at any other time, is it body of the dead person must be re- 37. Cf. Charter, 111. comforting for the terminally ill to spected as belonging to a human be- 38. Cf. Charter, p. 5. 39. Cf. Charter, 83. experience the sacramental presence ing, even if it no longer has the dig- 40. Cf. Charter, 86-91. of Christ, “Word of life,” through nity of an individual and the value (*) The quotations from the Charter for the anointing of the sick. “The whole bestowed by a person who is still Health Care Workers have been translated from the Italian edition. The English edition of man receives help through this alive. The medical act of transplanta- (Vatican City: Pontifical Council for Pastoral sacrament to achieve salvation. He tion, therefore, makes the act of Assistance to Health Care Workers, 1995) is feels strengthened by trust in God oblation on the part of the donor pos- now available - ED). VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 53

JOHN O’CONNOR

Healing Wounds: The Rachel Groups

Permit me to begin by reading And the second: ability to find help, on October 15, two letters. The first is addressed to “I’ve just attended the healing 1984, in the Archdiocese of New the priest-director of our Archi- service, “At Peace with the Un- York, I announced that any woman diocesan Project Rachel movement; born,” held at (our) church. The of any race or religion from any- the second is addressed to me. feeling of peace in my heart right where, pregnant and in need, could “I’ve been wanting to write you now is beyond belief. The grief and come to me: that we would ensure since meeting with you last Decem- burden that has been with me for too free medical care, hospitalization ber. I have been referred to Project many years is lifted. It was a totally and legal assistance or counseling Rachel via a friend...who is very beautiful and purposeful service! either to keep her baby or offer it for much involved in the anti-abortion I pray that this service reaches all adoption. I have repeated that offer movement and serves it so well. women who share its need. Thank many times since. Thousands of The purpose of this note is to say you for bringing this service to us. women have responded; their babies “Thank you.” I’m not sure why it Sincerely, have been saved, their own lives has been so difficult to articulate the A Catholic who has come home.” kept relatively intact. profound effect the meeting had on This will be a straightforward, un- But this effort to prevent abor- me. Words seem inadequate in this dramatic account of an effort to re- tions is obviously retroactive. For instance to express my gratitude. I spond to the multiple tragedies con- those who have already suffered have struggled greatly with the af- sequent to abortion. The horror of abortion we offer Project Rachel, termath of my abortion. My previ- abortion itself provides more than named after the scriptural “Rachel, ous attempts to reconcile were un- enough “drama.” weeping for her children; she re- successful. What was different this In the United States today, annu- fuses to be comforted for they are time was the absolute and complete ally since the infamous Roe v. Wade dead” (Mt 2:18). Their need for acknowledgment of the baby de- Supreme Court ruling of 1973, ap- healing is profound. stroyed. It was no longer just a “little proximately 1,500,000 unborn ba- Project Rachel is a healing min- bit of tissue” or a “blood clot” that bies are destroyed. The estimate istry of the Archdiocesan Family ceased to exist. So much of the pain since 1973 is a total of 30,000,000 Life/Respect Life Office. Trained I’ve felt through the years has been babies. priests, psychiatrists and psycholo- for that unborn, discarded, and de- The overall destructiveness of the gists provide individual, spiritual nied human being. single action of abortion defies cal- and psychological counseling as So when you said, “You can name culation, in terms of the lives of well as sacramental reconciliation your baby,” something shifted for countless numbers of mothers, fa- for women (spouses and friends) me. I will never forget those words thers, siblings, abortionists, and as- who have suffered the trauma of an because he then became a baby, at sistants. Only the baby dies. The abortion. last retrieved from the garbage pail mother and others often live or try to Each case varies; sometimes the into which he was so brutally tossed. live with souls churning with guilt, priest and the professional counselor Thank you for acknowledging him, minds in turmoil, normal patterns of work in tandem, sometimes inde- for helping me recover him, for behavior turned upside down. Some, pendently. restoring the dignity I denied him. I believing themselves forever be- Referrals are made by parish can now be a little easier with my- yond redemption, yield to a vicious priests, youth ministers, high school self knowing he’s been taken care circle of promiscuity, pregnancy, principals and guidance counselors, of—that he’s been lifted from the abortion, time after time, or give up campus ministers and word of depths and placed so lovingly in all faith; if Catholic, they avoid mouth. God’s care. I’ve named him Mass attendance and the Sacra- The Project Rachel office re- Matthew Joseph. I hope you’ll say a ments, believing themselves unwor- ceives an average of 4-6 referrals a prayer for him. thy of the forgiveness promised in week (approximately 250 per year). I have one more “thank you”— the confessional. In each case the woman is referred thanks for representing Jesus Christ Recognizing that many abortions to a priest and/or professional coun- so well with me”. are the result of fear, poverty, or in- selor for individual care. 54 DOLENTIUM HOMINUM

Since Project Rachel is at work in Sacramental confession, persons ex- uncommon for them to believe that a many dioceses throughout the perience a psychological and spiri- miscarriage is a punishment of God United States, many, many thou- tual healing with God, the Church for a past sin. Their feeling of guilt sands of women and often those re- and with themselves. This program is often unbearable, not only for the sponsible for their pregnancies and has proved to be an effective witness past sin or imagined sin, but because abortions have found peace—often to the healing power of Christ and now they believe they are “responsi- the kind of spiritual peace they have serves also as a source of evange- ble” for the death of a child, even never known before. Further, recidi- lization for those who have left the though they desperately longed for vism is almost certainly excluded Church because of their abortion. the child to live and to be safely for the future. Ten regional programs are con- born. Project Rachel is taken to another ducted each year. Approximately I would be remiss if I concluded plane by way of a more recently de- 500 women experience this program without reference to a newly- veloped and gratifying effective on a yearly basis. Since the program founded religious community of

healing program called At Peace was initiated in 1989 (the attendance women, the Sisters of Life, as our with the Unborn. figures have remained consistent) latest instrumentality for helping At Peace with the Unborn is a we have reached approximately women who have suffered abortion program designed by the Archdioce- 3,500 women. to pick up the pieces of their lives. san Family Life/Respect Life Of- A special dimension of At Peace Still in its infancy, the charism of fice. It provides regional communal with the Unborn is that this spiritu- this community is the sacredness of prayer and reconciliation services to ally-oriented program has attracted, human life itself. They take the tra- those who have suffered the trauma as well, significant numbers of ditional vows of poverty, chastity, of an abortion. The mothers are fre- women who have not had abortions, and obedience plus a fourth vow of quently accompanied by spouses, but have experienced a natural mis- dedication to the preservation and parents, and friends who feel they carriage. Many of us are learning enhancement of human life, particu- had a “part” in the abortion. that a great number of women bear larly the lives of unborn babies and In the context of Scripture, the spiritual and emotional scars of a their mothers. They are contempla- prayer, personal testimony, and miscarriage for many years. It is not tive-apostolic, spending half their VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 55 lives in prayer, half in action as an trained in Clinical Psychology I by a counselor, not only by herself, extension of prayer. value such efforts), the spiritual byt by God. These mothers must The Sisters of Life are already car- wounds of abortion run deepest. come to believe that God loves ing in a small way for pregnant Spelled out in a brief paper like this, them, despite, or in a profoundly women, but our goal is to open a abortion-prevention and post-abor- mysterious sense, even because of major retreat center for both the tion support programs sound almost their weakness. pregnant tempted to have abortion mechanical-programmatic orga- They have to see themselves and women who have already suf- nized efforts at social reconstruc- standing with Mary at the foot of the fered the tragedy of one or multiple tion. Cross, uniting the crucifixion of abortions. Such women will be per- The trouble with every abortion is their own child with the Child of mitted to remain in the retreat center that is, profoundly and inescapably Mary. They have to know that hav- in an atmosphere of prayer and of works havoc on an individual and ing shared in the crucifixion, they love, until their babies are born, or, unique person, who fits no mold, share His forgiveness, that it is

in the case of those who have suf- falls into no organized category. If about each of them that He is speak- fered abortions, until their lives are she has ever had a scintilla of faith, ing when He cries out to His Father: restored sufficiently to face the of religious conviction, of moral ed- “Father, forgive them for they know world again. ucation, she is crushed with guilt—a not what they do.” They must know The Sisters of Life consolidate guilt that may be driven deep into that it is to each of them that he both Project Rachel and At Peace the unconscious by whatever forces promises from the Cross: “This day with the Unborn, incorporating both are at work—but which are then a you will be with Me in Paradise.” into their own lives of prayer and of cancer in the very soul. This is the hope, the shining goal, love. The mother who has given her the fervent prayer of Project Rachel. I cannot emphasize too strongly children up to death, for whatever that, helpful as medical, psychiatric, motive or however confused and Cardinal JOHN J. O’CONNOR psychological, and therapeutic pressured, needs passionately to be Archbishop of New York counseling and similar support ef- convinced more than anything else Member of the Pontifical Council for Pas- forts can be (and as one personally in the world, that she is forgiven, not toral Assistance to Health Care Workers 56 DOLENTIUM HOMINUM

JEAN-MARIE MEYER

The Sacredness of Life in Pagan Philosophy

Before defining and describing the The unsurpassed Virgil offered a tion to the nature of things, and tell ways in which pagan philosophy saw definitive observation on this initia- himself what experience makes evi- life as sacred, I would like to outline tive. He spoke of a rerum cognoscere dent: that man comes to understand the character and contours of this pa- causas. With regard to the Arabs, it truth gradually and in a progressive per. De nominibus non curat sapiens should be observed that it is thanks to fashion. was an important maxim here in their translators that most of the This approach places philosophy Rome many centuries ago. As a works of Greek philosophy have between what we call science and philosopher here in Rome today I come down to us. what we term religion. Like science, cannot say that I myself have such a What have these different expres- philosophy seeks to be objective and prerogative. Indeed, it is of essential sions of philosophy taught us? First methodical in character, but like reli- importance to set out the nature of our and foremost they have demonstrated gion it strives to explore the mystery inquiry. that except for the example of revela- of man, it wants to extract intelligible tion (I am here referring to pagan phi- gleams from the depths of his charac- losophy), men are in fact amateurs in ter. Philosophy is respectful of the so- I. The Sacred: Religion the field of wisdom—they are, that is ciety of men but believes that the and Philosophy to say, philosophers and not wise gods of the city-state cannot cancel men. It was at this point that ancient the religious meaning of nature. It is The religions of the world have al- Greece broke with the rest of the thus no accident that pagan philoso- ways seen life, love and death as part world. China and India, for example, phers were often the subject of the of the relationship between man—or have expressions of wisdom—and hostility of their fellow citizens. more precisely religious man—and very deep wisdom at that—but they Socrates was neither an atheist nor what is above him. These three fun- do not have a philosophy in the strict was he irreligious. He merely wanted damental aspects of existence have sense of the term. However the fa- to show the Athenians that a philoso- never been seen as merely secular el- mous rerum cognoscere causas to pher could serve the city through the ements. Over the last hundred years which Virgil referred well set out the dedication of his life to the cause of religious anthropology has demon- real purpose of philosophy. Accord- truth. Much which was bad was thus strated (beyond every reasonable ing to this approach, the philosopher said about him: the philosopher did doubt) that from the very early years must draw back from myth, accept not give suitable reverence to what of mankind, life and death have been the limits of his intelligence in rela- was divine in the cosmos, and thus he understood, experienced or cele- did not respect the gods of the Athe- brated in funeral rites as instruments nians. This was true because for by which to come into contact with Socrates the essence of things was God or the gods. This contact has not to be found in the stars, it was to been seen by social communities as a be located in the hearts of men, in process which transforms human re- their free decisions. It was here that alities and endows them with some- the ultimate meaning of existence thing which is divine and sacred. was to be found and it was here that From the point of view of the natural what was really sacred in life re- religions, there is nothing difficult or vealed itself, namely the covenant be- problematic about the idea that life tween man and transcendental Jus- has a sacred character. It amounts to a tice. mere statement of fact. Everything, It is here that we come up against however, becomes complicated when the fundamental point of disagree- philosophy enters the stage. ment—or at any rate the difference— Like me you know about the des- between ancient Greek philosophy tiny and history of that strange disci- and the natural religions. Greek phi- pline practiced first of all by the losophy wanted to recognize and to Greeks, a discipline which owes its reflect upon the originality of the hu- survival in the modern world to the man person. It thus became necessary Romans and to the Arabs. to distinguish the human person from VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 57 the cosmos, and for this reason the sa- infinite spaces of the human soul. which can involve immortality. It is cred character of life had to be redis- Man, therefore, should not be seen certainly true that the ancient Greeks covered by means of a different ap- as a small world (a microcosm) recognized and practiced the immor- proach. It is precisely this new ap- which is more ordered than the great tality of the hero. Indeed, in the figure proach which we must now subject to world around him (the macrocosm). of the hero they detected the realized analysis. Although the human body has sen- image of the good citizen. All their sibility, its sensibility is of a nature philosophers, and both Plato and known to no other animal. More than Aristotle, sought what was better and II. The Sacred and the Essential any other creature man can feel, can what was higher. What they wanted in Man be struck, in a word, can suffer. This, was to discover “the true virtues of it should also be observed, is the great man and of the citizen” (The Apolo- I would like to propose the follow- approach of Greek tragedy. Knowl- gia of Socrates). They also wanted ing thesis: pagan philosophy (and in edge is given by experience of life “to become immortal” (Nichomaean this instance the philosophy of Aris- and the vulnerability of our body is Ethics, Book X). What does this totle) rediscovered the sacredness of the pre-condition to every act of spir- mean? Perhaps that every man can man by two routes, both of which re- itual progress. Aeschylus had this discover the truth about man by trav- spect and throw light upon the rela- perception in mind when he ex- eling deep within himself. Here also tionship between man and what is pressed this tragic wisdom in a sim- mere adaptation does not guarantee above and beyond him. ple phrase—we learn through suffer- success. For this very reason Pericles a) Above all, man is taken back to ing! At another level, Aristotle under- was not the mere product of a city- his origins and it is here that the sa- stands the existence of the hand as a state but a unique and universal cred is to be found. Indeed, Aristotle translation, a writing into the flesh, of model of what the political man was very concerned with understand- the power of the intellect. If man has should be. By loving and serving his ing the soul of man and with placing hands, instruments which are univer- city, Pericles gave a definitive and man within the cosmos. In a famous sal, it is because he thinks, that is to universal demonstration of the truth page from his “The Generation of say he rises above his feelings. As a of the man committed to, and in- Animals” he declares that in the em- result the intellect comes from out- volved in, his polis. This example of bryo only the intellect comes “from side nature, governs matter, and en- political conduct was fused with a without” and that it alone is “divine” ables the body to take part in its own lesson in ethics and metaphysics. in the strict sense of the term. Its fashion in the power of the spirit. The This is because what takes place in processes, therefore, and what it does, enigma is thus to be located in the human life rises above both the polity are separate from the body. Although deepest parts of man and radiates out and what is biological. In the action the soul is a natural reality and thus a as far as his face and his hands. In which truly and authentically in- phenomenon which is intrinsic to the overall terms, what makes me that volves the human person, there can living being, the intellect does not which I am comes from something be found, beyond any temporal mea- come from within the individual but which is higher than me, and the se- surement, that agreement between from outside him. cret of my existence transcends na- now and always which contains a sa- The consequences of this belief are ture. cred dimension. All things consid- immense. It naturally follows from b) Aristotle was the heir to a heroic ered, therefore, the holiness of life this assertion that the phenomenon civilization and developed a pro- has two features. On the one hand, it which determines the originality and found and beautiful conception of the is the source of the intellect which the unity of man has nothing to do human act in his ethical thought. In asks questions about the world, and with nature. Indeed, at the very heart his opinion a paradox informs our on the other it is the achievement of of the being of man there is some- whole life, and it is this: the mortal man when individual life fully ac- thing higher and better than the being which we are can do something quires its final and definitive value. merely biological. The intellect, in its actions which is definitive and I do not believe that we can find therefore, places man on the frontiers texts in pagan philosophy which ex- between the material and the spiri- press this idea with concepts and no- tual, and although philosophy must tions alone. In order to clarify and in- be cautious about the origins of this vestigate this observation I will cite intellect it is equally true that the the arguments and words of philoso- philosopher ought to be constantly phers who are not usually recognized amazed by the phenomenon of man. as such. Indeed, man cannot be defined in terms of adaptation to nature because from his very beginnings he is III. The Message of Antigone: marked by an ability which endows The Sacredness of Life him with a higher destiny. Man at one and the same time is in nature and Through his Antigone the great above nature. His condition, there- Sophocles provided us with much fore, is by no means easy. However more than a message. He offers us a splendid the star-filled sky may be, it vibrant meditation, a veritable cry, on is not enough. the holy places which unite men after And whilst wise men may search their deaths. Creontes denies the cele- for God by observing the heavens, the bration of funeral rites to his brother philosopher rediscovers what is sa- after the battle against the city. Only cred in man by turning instead to the Antigone refuses to accept the de- 58 DOLENTIUM HOMINUM crees of the Lord of Thebes and in- above the spirits of her time. is indeed an act of “madness” as her sists on celebrating these rites. And For Creontes the situation is very frightened sister proclaims but—and because she dared to disobey she was clear: Heteocles died to defend the this is the hinge point -Antigone condemned to be walled up alive. city but Polynices died fighting it. knows how to love those people that And here, as you will have fully real- The first, therefore, is a hero but the she loves (Antigone, verse 101). ized, we touch upon the heart of the second is an enemy. For Antigone, on There was no better way to demon- subject of this paper. Her gesture has the other hand, death puts an end to strate how the weakness and the a sacred element and Antigone tells this antagonism and her lucid sight fragility of man conceals the incom- us much about life through her looks beyond death to the reconcilia- mensurable greatness of love than strange and unusual death. In order to tion of the dead brothers. The city is through the features of Antigone. In support this observation I will throw certainly important but cities are here giving us the figure of Antigone, light on certain aspects of this excel- on earth and do not encroach upon Sophocles made this clear. As Hof- lent play by Sophocles. First of all, the spirit of the heavenly horizon. Be- mannsthal happily points out: “Ich the heroine is a woman and this can yond the limits imposed by time and bin der Schwesterlichen Seele nah, but surprise us when we recall that by the city, Antigone understands and ganz nah, die Zeit versank, von der women had a very circumscribed role recognizes that her brother remains a Abgründen des Lebens sind die in the Greek polity. It is certainly true brother. And she communicates this Schleir weggezogen” (“I am near to that wives took part in family rites message at great risk to her own life. my twin soul, nearer, time no longer with their husbands but outside the “Antigone with a soul of Light, exists, the veils have been drawn walls of the home, and this was espe- Antigone with violet eyes,” declared back on the abysses of life”). cially true in ancient Greece, the po- D’Annunzio in 1904. I perceive It is certainly true that Antigone is litical role of women was of minor something sacred in the gesture of mortal, she knows this and she says it. importance. This fact brings out the Antigone. Her self-sacrifice is an an- She also weights the consequences of great moral force of Antigone who swer to the act of sacrilege committed her actions. She could have accepted performs her religious duty whatever by Creontes. In this descent into the the human love and happiness but the cost may be and does not fail in tomb Antigone demonstrates to us like others at other times she is drawn her duty because of reasons of social unprecedented faith in the value of further on by a sense of obedience. It convention. However it seems to me the good life, a life which constantly is for this reason that Swinburne that we should focus our inquiry challenges death. This challenge in- makes her speak thus to the elders of more closely. volves two directional paths. One is Thebes: “People, old men of my city, At first sight this action of existential because the just woman lordly wise and hoard of head, I a Antigone seems to call the social or- finds herself face to face with the spouseless bride and crownless, but der of Thebes into question. At the threat of death. The other is meta- with garlands of the dead, from the same time a new question is posed: physical in nature because Antigone fruitful light turn silent to my dark what was Antigone’s approach to the knows that in her act and in her being childless bed.” sacred or holy if she felt impelled to there is something which can never This descent into the tomb contains challenge social convention in this die, something which death has never something which is sacred and holy way? Was not the ancient city-state been able to destroy. We certainly do because we able to see that we are an inextricably bound up religious not believe that the distance in time face to face with an exchange with and political association? Would a which separates us from Antigone her brother and with the final gift of compromising of religion not have prevents her message from reaching what she is. She has received her life led automatically to a compromising our present epoch. from her race and from her city. What of the political structure? A perennial greatness is to be will she do? What should she do? The Antigone adopts an extremely found in service to the dead and it timeless wisdom of men enables her clear stance. The rites certainly have seems to me that the religious to know that life is nothing but a their social significance and act to Antigone is a witness and perhaps an breath and that Hades will have the strengthen the ties between the living educator for the universal conscience. last word. But this is not the essential and the dead. At the time of thing. Antigone, therefore, they had an ob- In a fragment of time and space, in vious and evident political meaning. IV. Conclusion this brief life, the pagan philosopher But precisely because of this fact they saw that the relationship between had to be linked to justice or, to em- This woman, because she loved, mortals and the divine was decided ploy the excellent phrase of the cho- revealed from the very heart of what upon. “Amongst so many wonders of rus, man had to “unite the laws of our was sacred for the ancients in both re- the world, the greatest wonder of world with eternal Justice.” A rite, ligious and political terms that there them all is man” exclaims the heart of therefore, had to be assessed and is something irreducible in man in re- Antigone. Sophocles described the evaluated in relation to justice and lation to nature (the cosmos) and in value of life when he contemplated without this act rites themselves be- relation to the city-state (the polis). the fragile Antigone and argued in fa- came a mere arbitrary decree, like She also showed that this “irre- vor of an act of piety. Before entering those of Creontes. Without justice re- ducible” presence unites the living the silence of death he observed the ligion is nothing but a collection of and the dead when love is present and definitive light of justice shine forth rites without meaning and without a operative. But Antigone did even like a lamp. soul. But this religion does not allow more than this. She showed by means Antigone to respect just laws or even of the eloquence of her tragic gesture Professor JEAN-MARIE MEYER to truly and authentically love her that man must place himself in nature Associate Professor of Philosophy, Paris own brother. It is for this reason as and the polis precisely because of Professor at the Faculty of Comparative well that the ill-starred heroine rises that which is above him. Perhaps this Philosophy of Paris VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 59

LUIGI MARIA VERZÉ

The Religiosity of Medicine

The subject assigned to me, “The An organizational-technological to the Pharaoh Soser, architect, doc- Religiosity of Medicine,” set within view of medicine does not alter its tor, and priest subsequently deified the context of the general theme of religious aspect; on the contrary, it on account of his therapeutic powers this Tenth International Conference, exalts it if the global and organic by that refined Egyptian civilization, entitled “Vade et Tu Fac Similiter: value of man is recognized. The which, with rare splendor, managed From Hippocrates to the Good whole world is for man and all the to combine art, wealth, medicine, Samaritan,” dictates two fixed laws of the universe confirm and re- and a relationship with divinity. points which I will deal with in my inforce his supreme value. Hippocrates, without yielding to short paper. However, I feel that it is It is by virtue of this that Medicine either sophism or empiricism, incumbent upon me immediately to is not only an ars sacra but, as such, adapted the art of medicine to the make a statement concerning my the crossroads of scientific, philo- Greek philosophical conception of honest testimony to culture and per- sophical, and theological knowl- cause and effect . sonal experience: real medicine, to- edge—i.e., of general culture. But, in truth, the school of Kos, day as in the past, with all its input Medicine is not therefore only an founded by Hippocrates at the sanc- of technology and science, cannot exchange between the doctor and tuary-hospital of Asclepius, had the disregard the fact that man and his the patient, especially if by health enormous advantage of focusing its life belong to God, whose living im- we understand perfect health rather attention on both the person as a pression or image and semblance than the absence of disease—i.e., a value and rationality. This was, in man bears. eucrasic balance among all the com- fact, the opposite of the school of This implies that the action di- ponents of man: his physical state, Cnidus, which tended to give prefer- rected towards man’s well-being is his psychological well-being, and ence to the study of disease without proportionate to the overall view of his spiritual life. reference to the individual, a ten- the objective: man, a bio-psycho- Eucrasia and dyscrasia still in- dency which, after Hippocrates, has spiritual entity. Therefore, he is a sa- volve Hippocratic epistemology, penalized medicine right up until to- cred identity, and mankind as a which refers to the physical compo- day. whole, a sacred intersubjectivity that nents of man as considered at that I would therefore say that Hip- “crisis,” or being ill (this is a Hip- time. pocrates, far from exalting medical pocratic term), rather than obscur- Today, it has been shown that science at the expense of the sacred- ing, tends to bring out even better. only the integration of matter, intel- ness of the disease and the cure as In other words, I am stating that, lect, and the spirit frees the vision of professed in previous ages, added a today, more then ever before, a pure man from—and heals it of—an “ob- fundamental attention to the human and simple mechanistically material jective” interpretation of the indi- value and to the laws of nature cre- conception of medicine is revealed vidual as a series of organs; im- ated by God which he, as a “peri- as something unreal. mense room for the elevation of the odeuta,” or itinerant, studied while If man is not seen, above all by physician is thus revealed which roaming from region to region. the doctor, as a living organic part of transcends technocratic strategy and The main theme of the Corpus the universe and God, he is annihi- by his action acquires a validity Hippocraticum is therefore the cen- lated, and with him medicine is re- suited to the value of the subject, a trality of man, the foundation of its duced to a new type of empiricism sublimity that is more solid, more so-called deontology, which I would which degrades its charm as an art coveted and more gratifying than call the imperative of responsibility, because the scientific content which the expert and immediate result. an enormous advance with respect is indivisibly biological, psycholog- History attributes to Hippocrates to Hammurabi’s Code, abounding in ical-intellectual, and spiritual is di- the merit of having freed medicine tariffs for services rendered and a vided up into parts. from the theurgic conception of the deterrent for medical errors. In fact, while it is one thing to school of Asclepius, from the Theo- The Oath of Hippocrates begins have a generally high consideration cratic-Hebrew view, and from the vi- as follows: “I swear by Apollo the of man, it is another, according to sion inspired by the Egyptian current doctor and Aesculapios and Hygeia Cicero, to perceive a masterpiece of of Osiris (the fisherman of souls), and Panacea and by the gods and God, the bearer of a particula div- whose school boasted the great all the goddesses, calling them to inae animae. champion Himhotep, Grand Vizier witness..., that I will adapt my way 60 DOLENTIUM HOMINUM of life for the good of my patients.... cal-Christian notions, was only able grate itself into the human sciences, In whatever house I enter, there will to anchor the ultimate direction of such as philosophy, anthropology, I go for the benefit of the sick. What- his medicine upon the testimony of logic, ontology, psychology, and ever things I see or hear concerning the gods. theology. the life of men, in my attendance on Jesus Christ, who ordered his dis- It cannot limit itself to being a cu- the sick or even apart therefrom, ciples to heal—to heal uncondition- rative medicine: it must, above all, which ought not to be spread ally as he did—restores human be preventive—i.e., it should pro- abroad, I will keep silence thereon, value in the mystery of God, in the mote the veneration of the body, in regarding such things as sacred se- face of which there is nothing but re- which intelligence and the soul are crets.” All this contains that wealth flection, coherent operative adher- included. of culture and medical knowledge of ence, and love: “Go forth and In short, in order for medicine to which Hippocrates, a contemporary heal—you have received freely and be complete and consequently reli- of Socrates, Plato, and, above all, freely you shall give.” gious, the best in intellectuality Pericles, was and still is an aristo- Reducing medicine to pure profes- should be invested in it. This means: cratic example. the study of the organization of mat- There is enough information to ter, of the language between one cell justify the comparison between the and another, between molecules, be- Good Samaritan and Hippocrates. tween proteins, between genes and The Samaritan is definitely not in all this communicating, one might conditioned by class or by religious say, at minimal levels, and the rela- beliefs. He does not resort to myste- tionship with the organic degrees of rious mediations. He only does what various systems, including the neu- reason and his human share in re- ronal and cogitative ones. sponsibility impose upon him, from Bio-imaging, chemistry, physics, subject to subject, which is like say- telemedicine, and the engineering ing from neighbor to neighbor. For of macro- and micro-structures are him, too, it is the human value that involved at the highest levels. I am transcends racial discrimination and thinking of the mechanism, which projects him with all his belongings, has today been facilitated, of optic bag included, towards the salvation fibers, computerized systems, and of that value: man. information science, which should Hippocrates’ pact is medicine/art render the relationship between two to be regulated according to the di- people, the patient and the doctor, mension of man, an art to be both the patient and the healthcare learnt and transmitted, governed ac- worker, as close and as immediate cording to its operative contents, as possible, not only for psycholog- which render it sacred—much more ical reasons but also from a point of than simple anthropological reason- view, of intervention and collabora- ing. tion. The human value is saved only by Religious medicine is also occu- relating it to God. pational medicine because it is so- He who dictated the law applied cial medicine. It is easier and more by the Samaritan gave it its ampli- intelligent to construct a machine tude by taking on a human measure. that is strong and well-equipped God made himself human and pro- rather than to repair damage and de- nounced the formidable basic rule of ficiencies. On the contrary, damage all ethics and all professional deon- sionalism, however hyperspecial- and deprivation are the downfall of tology: “Love one other as I, the ized and technologically superso- medicine and consequently of sci- God-Man, have loved you.” It is a phisticated it may be—or even thor- ence and the entire society. dimension infinitely wider than the oughly humanized—without this In the same way as the underesti- Levitic precept, “Love thy neighbor transcendental breath—which not mation of an adequate tropical med- as thyself.” even Hippocrates, as the founder of icine that forces us to reassess our All our medical science that stud- biomedicine was able or wanted to consolidated microbiological and ies the combinations among cells, free himself from—will always pathogenic paradigms would, as molecules, proteins, and genes fits yield an impoverished, mechanized with AIDS, become a multiple de- within this dimension. medicine, at best more philanthropic, feat. Our increasingly advanced tech- or, at worst, prostituted for objec- For a complete and realistically nology also falls within it. The mod- tives that are unworthy of a holy art. religious medicine, as a thriving civ- ern concern for the true humaniza- At the cost of being labeled a re- ilization headed, without any possi- tion of medicine also falls within it, actionary, I must honestly express bility of return, towards the shared with something left over for an all- my conviction that if medicine is not identity of a global multi-ethnic vil- encompassing medicine projecting religious, it is not curative, nor is it lage, the mentality that no one can man towards a perfectly eucrasic useful in its role as a promoter—or, feel sufficiently healthy as long as body, intellect, and soul, as God rather, recreator—of the whole man. there is a sick man in the world planned him and wanted him from A religious medicine, on the other urges us on, in the same way as no the beginning. hand, cannot lack professionalism one can feel sufficiently cultured or Hippocrates, devoid of theologi- or modernity, nor can it fail to inte- well provided for as long as illiter- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 61 acy and starvation still exist. that I will deal with further on. Man is an indivisible whole of Real and consequently religious The Christian hospital is the di- complex parts. When one takes up medicine cannot fail to be bio-ethi- rect heir of a centuries-old cultural one of the parts without taking the cal—indeed, the expression of the and religious tradition rooted in the physical and metaphysical whole most mature form of ethics. depths of man as such—i.e., as cre- into consideration, one fragments From the little that I have men- ated by his Maker. the mosaic, thereby running the seri- tioned until now it is fairly clear that Therefore, the Christian hospital ous risk of failing to understand the the sacredness of man and his life is a temple where medicine is a sa- idea which is the beauty of the mas- lies within his own being and that cred ministry, where research at the terpiece—man taken from the exist- from there, and only from there, are service of life is compulsory, where ing universe like a magnificent plausible medical ethics created, in science and faith are twins with the sculpture that inspiration sculpts the same way as it is from there that same dignity, where all sciences— from the marble mass endowing it we will reach our guarantor, who is biology, clinical medicine, philoso- with a profound and deep personal- God himself. phy, anthropology, and theology— ity. Hippocrates, the scientist, doctor, When creating man, the Omnipo- and humanist, had already de- tent endows him with his indestruc- nounced the insufficiency of the tible soul, thus producing a complex ethics of responsibility (a subject and complete work. later put forward by Max Weber) or Allow me to deduce that the of the categorical imperative, which amazement—vidit quod erat among other things, at the very end, bonum—on the part of both the as- Kant also recognized as being too tonished creation, whether intelli- weak; so much so that he decided to gent or non-intelligent, and its artist, associate it with the idea of God. In is perpetually concentrated in human the Hippocratic approach, it is clear reality, understanding to be reality that responsibility stems from everything that man is, not what we within oneself; it resounds in nature; normally assume because we do not it is rooted in the fellow-citizen of yet know ourselves well enough. the world. And when, above all, Hence the reason and the aim of this you, the doctor, find yourself deal- research from Hippocrates until to- ing with naked, lonely men, it forces day and right up to the end—i.e., un- you to be a man, and, as such, to as- til the conquest of the whole truth sume the kind of responsibility that about man and his habitat. transcends space and time, encour- To miss the target is impossible; aging you to form an alliance with one can delay it, by virtue of the ad- the Eternal. mirable endowment which is free- The ethics of responsibility, to be dom, but not miss it. This would be such, cannot be born or die within the same as admitting the failure of the doctor himself, here and now. systems, methods, and the achieve- The history of the universe is the ments attained in all fields. Man, the spectator of an epic factor which is real man, cannot fail without causing the life of man in which all his intel- the failure of God himself, who for ligence, by virtue of his nature, is man has played his own card: Christ. involved and, with him, God him- Therefore, the success of man is self. directly and gradually proportionate In my modest everyday life I con- to the knowledge of the physical, tinue to observe how the power of form a coalition, without sinister psychophysical, and spiritual man the doctor-scientist is gradually be- guardians, in defense of the whole and the architectural gestures of ginning to espouse the awareness of man. Life with everything that com- God, who created him. responsibility, almost like a code of poses it, including suffering, is not Blood, phlegm, yellow bile, and ontology, intra et extra personam. an inaccessible mystery, but rather a black bile: Hippocrates had only The awareness, that is, that what personal mine that can be learnt these vital humor at his disposal, not one is and one’s relationship with about through intelligent explo- electrons, molecules, cells, capillar- others is the essence of one’s own ration. ies, chromosomes, genes, physio- existence. The divide between sci- The religiosity of Medicine? logical systems, etc. Yet he did pos- entific research and the value judg- When one says that man is the im- sess the concepts of awareness, ments fought for, almost in desper- age of the Infinite (and every doc- equality, and a social, moral, and ation, by Max Weber in his denial trine, all philosophy, and all civiliza- aesthetic sense, fundamental prod- of the enlightenment, historicism, tion do everything possible to ucts of the religious sensibility that Darwinism, and materialism, is un- demonstrate this and interpret it), induced him to cure and to educate convincing, just as a man who is cut one is dealing with a subject of gi- with religious seriousness. in half is also unconvincing. The gantic proportions: from the organi- If we can accept, as affirmed by passion for biotechnology and ge- zation of living material—cells, the atheist Ludwig Feuerbach, that netic engineering is a demonstration molecules, proteins—to relation- religion is the basic distinction be- of this. ships with the cosmic and meta- tween man and beast, we must also And at this point I must rush physical environment to inalienable affirm that only religion can give ahead towards a strong conviction supernatural needs. one an intuition of the authentic and 62 DOLENTIUM HOMINUM integral dimension of man, of his mind, the starting point to enter, af- holy act. potential, of his limitations and the ter the industrial, tertiary, and tele- Hippocrates made an anthropo- resources to overcome them. There- matic age, into the age of wisdom, logical science of it. His medical fore, far from rejecting science, as as I dream of it, the adult age—i.e., doctrine advanced the theme of a so- urged by Claude Bernard in a mo- of a humanity where science, cial pact by virtue of which the doc- ment of anarchistic need, far from thought, and love will expand to- tor is recognized as having a power perceiving in science the enemy or wards truth according to a design controlled by a triple authority: con- step-sister of religion, we see that and an itinerary illuminated by wis- science, kolis, and gods. In this way science and religion are integrated dom and knowledge. all the old and new masters had an by the knowledge and the relaunch- Everything that I have said until inkling of the sacredness of man, his ing of man and the formidable patri- now is only a very modest and indis- existence, and his life. mony that exists within his head and pensable preliminary to what I now The religiosity of Medicine? his soul. want to say about the religious con- I will here forego, to my regret, The universe expects the life of cept of medicine contained in et tu mention of the religiosity of Mo- thought from man. hammedan medicine, or what is re- Indubitably, health care has made ferred to as alternative medicine, enormous advances. Many infec- normally rejected by advanced soci- tious diseases have been overcome; ety, but which it would be particu- others are under bombardment by larly useful to acquire and include. I scientific research. But the increase am referring to natural medicine and in mental diseases (and drugs are a the Oriental Chinese type, each of sign and a product) does not meet which is far from devoid of wisdom. with a proportionate counter-attack. I will save room for a brief reflec- It would appear that here, above tion on the Medicine of God— all, room should be given to the “im- Raphael-Ref-El—as presented in plementation of preventive and person by Jesus, the Christ, son of recreational medicine, the only David. medicine worthy of modern man, be- With Christianity—or, rather, cause this is the scientific medicine with the irruption of God into flesh of the future, towards which evolv- and blood in the history of man—the ing man is oriented as a personal religiosity of medicine is the medi- subject with this preordained voca- cine practiced by God himself, tion” (Faith as a Work, p. 160). which we therefore can and must I mean mental healthiness, bal- borrow: “Go forth, teach, and ance, and development. heal.” A command/charism to Can it be affirmed that the aver- “heal” which makes the doctor an age improvement in good looks and authentic priest, a scholar who then physical well-being corresponds to becomes a teacher—”Teach”—and an improvement in the average level which binds him to an anthropolog- of health-care and consequently ical—indeed, theoanthropologi- mental and moral development? cal—universalism: “Go forth.” Authentic religious medicine can- “Everything that you do unto even not fail to notice that the best part of the least will be considered as hav- the admirable human complex is the ing been done unto me,” God, the mind, on which the rest depends; ap- son of man. preciation of man’s own nature de- A charismatic command capable pends upon it, along with reflex fac similiter—i.e., simply do what of producing hospitals/temples, as knowledge of ourselves and the the Samaritan did who is Christ, foreseen by the Greek genius fas- grasping of our connatural transcen- doctor and priest, and who is anyone cinated by man in Kos, Epidau- dent dimension. The real dimension who has decided to continue his rus—Alexandria: temples-citadels of man lies in the knowledge of him- work. of living medicine, of art and sci- self and his own mind. My problem lies in the shortage ence, of philosophy and the wor- Man’s instant, which is valid for- of time assigned to me. ship of divinity, the proud friend ever, is drowning in a collective I will venture forth with the syn- of man. psychology of overcrowding and thesis in this sea where I feel I can It is hard to say whether Christ noise. The space for thought is be- swim more easily because it is more spent more of his time teaching or coming frighteningly restricted. familiar to me. healing. He did not need to study. Man, the measure for everything, I mentioned that the Egyptians He healed everyone, even when runs the risk of not having the considered the sense of life too ex- the sick ran after him beyond the strength to withstand the scientific ceptional not to give it tombs—the lake, in the shelters where he product of his own mind if he does prelude of eternity—and not to rec- rested. not make the mind able to reflect, in ognize the art that preserves life, Matthew says that Jesus wel- fact, about everything. when this art is intelligent and effec- comed sick people even late at Hence the priority of curative and tive, like that of Himhotep, compa- night, to the point where his closest preventive medicine for that princi- rable only to divine nature. helpers complained because they pal component of man which is the I also mentioned that Asclepius did not even have time to eat (Mt equilibrium and development of the considered medicine a sacred and 9:35; Mk 3:10; Lk 6:18-19). Jesus VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 63 the doctor teaches, heals, and prays his desire, his failings, and his suf- and thus the chance to experience at the same time. fering. them in wisdom while combating It must be recognized that the The message and coherent prac- them with all the potential of science ministry of Christ was developed tice of Christ, starting from the bo- and social organization, in order to between two types of manifestations som of his father, with his entrance overcome them. that are inseparable from each other, into the world of flesh, through the To undergo suffering and death like two arms of the same body: a) cross and until the resurrection of religiously is not the same as to un- caring for minds and souls through the same flesh, do not leave any dergo them with passive resigna- the communication of the new, rev- room for doubt or errors. tion. olutionary message; b) caring for Suffering? How is this reconciled Hippocrates taught something people’s skin, a care included in that with the precept of healing? The an- similar when he said that fever message. This is exactly the same swer always lies in Christ: in the should be seen as something posi- legacy handed down to his disciples: same way as the beatitudes of tive, as a sign of an ability to combat “Go forth, teach and heal.” Not: poverty, affliction, and persecution which heralds victory: crisis for eu- “Go forth, teach, heal,” but “Go crasia. forth, teach and heal.” Almost as if Compassion and comfortable pity teaching without healing loses effect are the echo of resignation, syn- and healing without teaching means onyms of surrender and disengage- only halfway healing. ment, in contrast to the book of Wis- When Jesus comes up against se- dom, which says: “God did not cre- rious disease or death, he prefers ate death; he created everything for strong prayer and then works unerr- existence; the creatures of the world ingly even when it is a question of a are healthy; in them there is no poi- putrefying corpse (Mk 7:34; Jn son of death”; and I say that the poi- 11:41-42). son that exists should be eradicated Nothing could be more spiritually according to the following logic: sublime, more bodily human. From God gave the virgin world to man in the Father, the origin of life, to mat- order for him to perfect it gradually. ter and to the complex mystery of Quite the opposite of a contrast man, with the intermixture of power between religion and science, be- and fragility, of ethereal aspirations tween body and soul, between secu- and apparently profane ties. larism and the confession of faith, In Jesus, son of David, everything between science and values! relative to man—hunger, ignorance, Like man, medicine is sacred— sin, disease and death included—are indeed, it is a priestly service insep- brought back into direct relation to arable from others. The true doctor God the Father. is a truly religious person—in fact, Indeed, the acute phases of human he is a true priest of God on high. life, such as disease and death, are The Gospel of Jesus Christ leaves an acceleration of the agreement or no doubt: man is a single biopsy- alliance between God and man. chospiritual unicum. Nothing could be more realistic and Here lies the choice: either we ac- at the same time more existentially cept the Gospel at its word, and we religious. must be sure that our deeds fit our Disease and death attack man’s faith, or we accept it in part—i.e., as roots, but from that very place, alan excellent abstract doctrine—and most by osmotic pressure, they dis- are reconciled with the parable of consequently we must also accept till the religiosity or sacredness of Epulone, with the admonishment the definition of the atheist Jew Sig- medicine and suffering. about compassion (“Be compas- mund Freud: too many Christians If medicine eludes this evidence, sionate and you will find compas- are only baptized half way. it commits an omission: like causing sion”) and about condemnation The Holy Father, Pope John Paul a plant to lose its color or become (“Do not condemn and you will not II said that the credibility of the dry by keeping it in the dark. be condemned”). Gospel is decided in terms of holi- “Be healed and sin no more.” This Suffering is an exquisitely human ness. The notion of man poses the is Jesus’ pharmacological formula heritage, but this should not frighten care of his life as an exercise for all which, starting from the roots of the us in the scientific battle against dis- knowing and doing, an exercise for individual, invites him to look ease, against death, and against ig- which religiosity is the reason and within himself; it heals the body and norance. the objective. recomposes it eucrasically in the re- Consequently, the modern hospi- An exaggerated evaluation of lationship with its creator. tal cannot but be a Temple of Medi- man? Without Christ it would be. Jesus the doctor heals man in his cine—science and suffering. Indeed, without Christ, man would entirety, not only his organs. This To relegate suffering and illness be his own enemy, as many who did would appear to be obvious, above to the obscurity of futile dissolution not know Christ, starting from Plato, all, for those who are familiar with is not proper to an intelligent being. considered man in terms of insur- Christian doctrine. But reality is To render them sacred is not mountable dualism. very profound and involves the en- enough, if we remove from illness And what medical person work- tire human being, his intelligence, and death the attribute of interiority ing for the good of life can ignore 64 DOLENTIUM HOMINUM

Christ? God has decided to graft himself ganizes himself and works on his Inevitably, he will work as a onto humanity in a vital encounter. own. He pays, although this is not medicus naturaliter Christianus. In Life has become a new divine power required by law. The index of com- fact, God by his incarnation in because God, after creating it, expe- mitment is love alone. The only way Christ, takes the entire universe with rienced it in his own person. Healing to practice medicine and to teach it. him in polyphonic harmony. thus lies within the logic of the irre- Love enables us to recover aware- This is the mysterium Dei, or the sistible redemption that the divine ness of the unitariness of man and secret of the king as revealed by the seed provides without respite. the real active core that balances the archangel Raphael to Tobias’ fam- The new appreciation of the life universe of his cells and his meta- ily. In my experience, I have veri- of the body is the effect of Christ, physical structure. fied that the true doctor, even the who restored it to its correct sense, This living core is individual in- doctor who considers himself an ag- that of the children of God, all telligence; it is the immortal soul in nostic, feels a mysterious vocation equally opposed to hate, injustice, whose depth truth lies: God has cre- stirring within himself. and discrimination based on race, ated everything for love and per- I hear my public asking a ques- nationality, or class. vaded it with love. tion: Is an achievement of this reli- Every form of renouncing the Love is the principle with which gious-cultural and structural scope healing and veneration of life means life itself is associated; it is the sub- possible today? forsaking both science and God. No- stance, the cause, the goal and even I think that it is, on condition that body has believed in man so much the most efficient and overwhelm- one is able to overcome the mental- as God, who is incarnated in man, ing means of caring for it and mak- ity of opposition between science bestowing upon him all the neces- ing it vital. and faith, between secularism and sary resources for both bodily and Love is an essential voice that religious conviction. spiritual growth which will lead him moves without stopping from the Professional Medicine? Yes. to measure himself against God unknown depths of Immotus: an Sophisticated Medicine? Yes. himself, to become body and soul eternal ontology made of love. Anthropological Medicine? Yes. with the divinity. Man and myriad beings welcome I propose and, as an advocate of a Every effort that preserves life it. They themselves, the product of new medicine, I promote a sacred and renews it is addressed both to- love, shine with love and are ani- medicine based on the concept that, wards God and towards civilization. mated by it; they transmit it through thanks to the incarnation of the Christ orders us to heal and gives their works, those for life in particu- Word, the seed of God is infused us the power to do so. All this is by lar, like a hymn of pure prayer. into man’s entitative substance. virtue of an important precept: love Medicine, the crossroads of of they neighbor, of which the global culture, uncovers this and Gospel is a unique tapestry which Rev. LUIGI MARIA VERZÉ President of the Centro San Romanello derives energy by magnetizing the cannot become frayed. del Monte Tabor Foundation, laws of the universe for perfect The Samaritan becomes a health- Scientific Institute, St. Raphael’s Hospital, health care. care worker by virtue of love; he or- Milan VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 65

SERGIO COTTA

Primum Philosophari?

The title I have given to this paper philosophical knowledge. Nor could man of knowledge. In conditions is neither a challenge to common it actually do this, and this is because which are culturally and psycholog- sense nor an official defense of a there is a shared belief that the world ically normal, the man of knowledge category of knowledge philosophy of values is the theater of operations is a clinic known for its diagnostic or of a caste of philosophers, a chal- of philosophy whereas the world of and active capacities and abilities or lenge, that is to say, promoted in or- facts is the realm and kingdom of sci- rather, in emblematic fashion, he is a der to lower the prestige of medical ence. That “then” thus indicates the medical doctor. The sick person science and its promoters and practi- subordination of philosophizing turns to him before all others (or to tioners. To do such a thing here at both as regards relevance and real ef- him only) in order to ensure that his this conference would be absurd, fectiveness in relation to the science health is promoted and defended he first and foremost because it is a of living (if we can term it thus) and does not turn to the philosopher. challenge which could be so easily also in matters relating to cognitive The philosopher in the strict sense defeated. and operative abilities and capaci- of the term, in my judgment, is un- This title should be understood in ties. able in practical or rational terms to the light of a paradox, and a paradox Living therefore takes pride of dispute the validity of the above out- in its most authentic message does place over philosophizing at the lined arguments. He is, however, not aim, as is often believed, at the level of facts and the reasons for this able to support and promote lines of creation of wonder at its purposeless are as follows. In the first place there thought which are not incompatible extravagance. It aims, rather, at re- is an elementary reason: not all of with such arguments—lines of vealing an aspect of truth which has the living are philosophers but all thought which are by no means of hitherto remained in the back- philosophers are living. And no consequence. In truth the ordi- ground. An initial recognition of philosophers have a primary need to nary man, and not only the philoso- truth is a part of the essence of para- live in order to be philosophers. It is pher, is not content with any kind of dox, and the same may be said for no accident that the suicide rate life, and not even with that healthy the reasons for that which is not amongst this category of people is life which the medical doctor can paradoxical but which is a shared very low, and this despite the fact provide him with through his sci- and trusted way of perceiving and that in their writings they praise sui- ence and knowledge. He also wants thinking. cide. In the second place most of a serene life, a life which is, so much In our case we have before us an modern philosophy argues in favor as this is possible, happy; naturally ancient maxim which has been re- of the relativism of values. Living, enough, good health is an important peated for centuries it is no accident however, requires the certainty of component part of such happiness. that it is spoken in Latin! This maxim facts and not the certainty of opin- But it is not the sole element which upholds the primary importance of ions. In the third place, has to be present. Other factors living the philosophical life. We Indeed, in searching for certainty which are not connected with the should not however halt and stop at the sick person can become inextri- world of medicine also come into the interpretation given to it by the cably involved in what the great an- play and these enter into the sphere individual who is forced to accept thropologist Claude Lévi Strauss of competence of the philosopher events or by the libertine who seeks called “the thought of the wild (in the broad sense of the term, re- only to live as he pleases whatever state”—that is to say, thought which ferring also to the theologian, the the outcome of his actions may actu- is emotional and not reflective and master of spirituality). ally be. If we look closely, the maxim which is very immediate because of In this way of looking at things we have before us does not immedi- the urgency of the real situation the value of life is not called into ately set one value against another it which is present. In such a state of question. What is important is life as does not involve, that is, a choice be- affairs the sick person could also a value or rather, in order to escape tween living, on the one hand, and turn to a charlatan or to a practiced the imprecision of words, the ab- philosophizing, on the other. On the healer. But this does not demon- soluteness of the value of life. A contrary, it establishes a scale of val- strate that in such a situation he number of real reasons which are by ues between these two separate op- needs or feels the need to turn to the no means of little import call this ab- tions—a first and a then—which cer- person who really knows (or thinks soluteness into question. They take tainly does not exclude the value of he knows)—that is to say, to the many forms and can be incremental 66 DOLENTIUM HOMINUM in their character and effect. I will and which includes great poets and ern epistemological distinction is limit myself here to dwelling upon their works such as Dante and his fully respected, a distinction which three principal categories. Divine Comedy or Goethe and the fi- attributes to science the study of On the one hand there are the nal triumph of Faust, a work trans- facts involving that which is, and at- many reasons for unhappiness lated into music and spread through tributes to philosophy the study of which spring from serious and dam- the universal musical sounds of values, the evaluative assessment of aging conditions of health (chronic works by Gounod and Boito. that which must be done, which is a or incurable illnesses or illnesses From all these points of view, moral task. which are in their terminal stage, however different they may be, the The so-called “Hume’s law” is in- handicaps and so forth) or from eco- contribution of philosophy is deci- voked here. This law argues that it is nomic, sentimental or moral condi- sive in relation to the criticism lev- fallacious to infer what must be tions. I am not referring here to eled at the absolute value of life. done from what is. But it is precisely cases which lead to suicide, a minor- Even though relativized, the value to the field of life and health that this ity phenomenon which is nonethe- of life nonetheless remains of the ut- “law” is not applied in real terms less, and in worrying fashion, on the most importance because it consti- (and indeed it could not actually be increase. I am thinking instead of tutes the necessary condition behind applied in rigid terms). On the other situations which are far more wide- whether the individual decides to re- hand, this is not implied in the spread, situations where life seems thought of Hume, a philosopher who to be a very heavy burden to bear, a was careful to adapt feeling to utility kind of trial and tribulation. (even to the point of justifying disin- On the other hand, there are the di- terested and selfless sacrifice). In- ametrically opposed reasons: those deed, it is precisely the practical re- touching upon strength of the spirit lationship between medical doctor and which involve taking upon one- and patient which brings out the re- self, for oneself or for others, a great ality of the curative synergy which and onerous burden—a weighty bur- exists between the scientific diagno- den which can even go so far as to sis and the human understanding of confer upon the voluntary sacrifice the sick person. of one’s own life the very dignity of a But although it may well be easy solemn and commanding duty. This to justify and propose this synergy duty, when neglected, can well lead in theory, it is by no means an easy to the loss of one’s own personal task to achieve it in practice. The identity. An ancient Roman maxim most common method chosen today of Stoic origins has given lapidary is that of the creation of committees expression to the basic features of made up of experts drawn from var- these positions: “Propter vitam, ious fields: doctors, psychologists vivendi perdere causam”—in the and moralists, whether believers or name of life one loses the reason for non-believers. It is difficult to assess living. and evaluate the results of such ac- Finally, the value of life comes to tivity, results which are often the lose its absoluteness not in a painful noted fruit of compromise. It is also fashion as is the case with the first more than probable that more can- example, nor in burdensome fashion not be achieved given the present as is the case with the second, but state of Western culture which has through a process of sublimating become strongly influenced and hope. I refer here to the convinced conditioned by relativism. This pro- religious belief in personal immor- cedure of creating expert commit- tality which is shared by the great tees, however, remains notably in- religions and in particular by those adequate. It would be rather difficult which can be traced back to Abra- for a comparison and an encounter ham. Christianity expresses this be- spect life (and to what extent he between a plurality of forms of ex- lief in another succinct formula should do so) or whether he aban- pertise in such varied and variegated which is much more enlightening dons it. In taking these decisions he fields of knowledge to give rise to than the Stoic aphorism, a formula makes a judgment of value (which is rigorous and verifiable forms of which runs: “vita mutatur, non tolli- thus philosophical) and not of fact truth. tur.” Life—that is, our life— (which is thus scientific). Further- Given all these above-outlined changes form, but is not taken away. more, when one is dealing with the considerations, it is possible to say Indeed, we are given real life, as St. defense and promotion of health it that the contribution of philosophi- Paul declares with radical incisive- seems reasonable to propose that the cal knowledge is certainly of evi- ness: “for me living is Christ and dy- knowledge (science) of the person dent relevance. This is because such ing is a triumph.” who is qualified in matters relating knowledge is able to enforce and up- This is certainly a religious belief to health—the medical doctor— hold the case for, and the arguments but at this point the tradition of great must not only precede but must also of, morality in the field of health and philosophers adds great persuasive prevail over the knowledge of the health care, both in relation to pre- force. This is a tradition which goes philosopher or of the person who vention and as regards cure. The from Plato and his Phaedus to Kant takes his place. It should be noted role of philosophy is not merely of a and his Critique of Pure Reason, above all else that in this way a mod- residual character but at the same VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 67 time it is not confined to the realm of roes of the epoch of war such as morality. It is evident that in the cul- morality, as is usually believed. The Hector or Achilles accepted its ture of Western modernism the term fact is that medical science and phi- course, as indeed did the pained but “nature” either, on the one hand, de- losophy share a common purpose in unbowed victims of the tragedies, scribes a purely passive or neutral their pursuit of knowledge, and this and more precisely figures such as reality which is to be disposed of ac- marks them out from such scientific the Antigone of Sophocles or the cording to the will of man or, on the disciplines as physics or chemistry. Medea of Euripides. other, portrays a negative reality This subject is living man, in him- Why, then, so much solemn rigor which must be fought. self, in his indivisible psychoso- and strictness in relation to abor- In classical culture, however, “na- matic entirety (in the broad sense of tion? In reality, there is no contra- ture”—as a word, a concept, an en- the term), man the living synthesis diction at work—the destiny of tity, and in terms of sensibility and of physiological-impulse and spiri- death is endured almost as the other sensitivity—has a strong and posi- tual-reflexive nature. It is this an- side of the coin of glory and forti- tive value and significance. From all thropological constitutive synthesis tude; abortion, on the other hand, is these points of view nature models which gives existence within us to looked for and the outcome of free the whole of the world: that anthro- that phenomenon of morality which will. The first follows nature and is pocosmic global universe the in turn is an ability to judge our own thus accepted, the second is against knowledge of which constitutes a actions and our own deeds. From guarantee of integral truth. This is this point of view curative synergy because what is involved is a knowl- is not only a practical necessity by edge of everything through various which to effect technically sound component parts and not through treatment and care. It is also an an- parts which are not connected to swer to the profound moral need to each other or disjointed. A truth, defend and promote the individual therefore, which is overall in charac- human being for what he really is. In ter, within whose framework the this way the contribution of the phi- truth about man becomes under- losophy to the field we have under standable, and more specifically the consideration here lies in uniting the truth about man in relation to the (morally) good life with the (scien- characteristics and properties which tifically) healthy life. are specific to him. For this reason, But the task of philosophy is not in the analysis of the truth concern- confined to determining moral re- ing the understanding of this “every- sponsibility in the field of health and thing,” science and philosophy can- health care. It is able to supply a jus- not be distinguished. They are, in- tification for itself which goes even stead, brought together in the term deeper. Here today it is not only a epistéme which is at the opposite duty to refer to the testimony of Hip- pole to the false science of opinion. pocrates—for the philosopher such It is symptomatic of the under- a reference is a necessity. It is cer- standing of the unity of knowledge tainly true that the anti-abortionist that the truth of the complicated and oath which bears his name is to be highly intricate anthropocosmic uni- placed within the realm of morality. verse—which is reached through a This is so for two reasons. The first unitary and unifying epistéme—is reason is of a formal nature: an oath expressed through what are termed establishes what must be, and this “laws.” This term has been valid for “must be” (the sollen or the ought) is centuries both in relation to the reg- the form that morality takes. The ulating laws of the physical and ani- second is of a substantial character: mal world and in relation to the fun- this oath obliges and commits those damental and not arbitrary laws of who swear it to respect human life at the human world. And it is by no the moment of the emergence and nature and is thus condemned. What means accidental that the human appearance of life. is of crucial importance in determin- sector which was considered most All this is very obvious, but only ing its unforgivable seriousness bound and linked to law and to le- at a primary level of observation. A (hence the reference to the sacred- gality (even though in actual fact it more careful examination might ness of the Hippocratic oath) is the was much more arbitrary), was in lead us to be amazed at the categori- fact that the person who commits it that culture always the sector of pol- cal tone of the conclusion. Classical is precisely that person—the physi- itics, of power. The “Good Life” Greek culture had a high sense of cian—who is the steward of life be- proposed by Aristotle for the politi- life which was seen as a radiant con- cause he is an expert on nature and cal community was based upon dition which operated in opposition thus a scientist of man. “government by law” and not upon to the desolate and inert darkness of The reference to nature which is submission to “government by the World of Shadows—Hades. essential to an understanding of the men.” However, life is seen as being sub- Hippocratic message requires, how- An old testament biblical text of ject to destiny, to the sacredness of a ever, further investigation. This en- seminal impact enables us to under- fate against which nobody can rebel ables us to understand in what ways stand how the strong classical sense and whose truth nobody can deny or nature is invoked in the oath and of nature continued to exist, albeit in fail to recognize. The glorious he- why it forms the basis of that oath’s changed form or rather in a different 68 DOLENTIUM HOMINUM form, through the centuries of to be found placed between two brings out the specific and charac- Judeo-Christian cultural molding. In poles the most rigorous forms of teristic ways and forms by which he the Book of Wisdom the creationist science on the one hand and the is present within the world. principle is expressed in a way most penetrating forms of philoso- The whole of major Christian which is of especial significance for phy on the other. From this point of philosophy is aware of this and has our inquiry and analysis. The in- view we gain sight of the special always understood human nature in spired writer presents the following figure of man, a figure which is at this sense and not in a merely bio- sentence: “All things...are yours, O first sight of a paradoxical character logical-naturalistic sense. But here Lord who love the living. For your and nature. Indeed, man is in the in this august assembly I think it immortal spirit is in all things” world, lives by the world and can- would be more suitable to quote the (Wisdom 11:25-26 and 12:1). not live outside the world. But at the lucid testimony of one of the great- It may be said per incidens by the same time he is beyond the world est philosophers of our time—Lud- philosopher that I am and not by the because of his ability to understand wig Wittgenstein. In his Tractatus theologian that I am that modern the world, to interpret it, and to Logico-Philosophicus (in German!) science has demonstrated the fal- judge it. we find the following statement: lacy of the ancient and classical idea However the paradox is only ap- “The meaning of the world can only of the eternity of matter (and thus of parent, an appearance created by be found beyond it” (Tract., 6.41). the presumptuous affirmation of This statement is argued with a Laplace). Today’s scientist well happy combination of rigorous for- knows that the journalistic “Big- mal logic and penetrating empirical Bang” is at the origins of that which observations. “Beyond the world” is measurable by the highly modern is certainly God for Wittgenstein as chrono-spatial measurement of well. As a philosopher he desig- space and time. But it is not the ori- nates this as being das Mysteicke, gin in itself—it is itself the product the Mystical, in relation to which and outcome of further origins. man can understand the world as We are not returning here—and being reality made up of “delimited the point should be underlined—to totality” (Tract., 6.45). Very recent the ancient lack of distinction be- astrophysics is convinced of the tween scientific knowledge and same thing. Man, therefore, by his philosophical knowledge. This very nature, is within and outside would be an ill-advised endeavor the world because his knowledge because of the great distance which enables him to determine its limits. has now grown up—and rightly The paradox which I have cited, grown up—between these two areas namely “Primum philosophari,” and their separate methods: on the now appears as a very simple, even one hand empirical methods of ob- banal, truth. In order to live we must servation in the formation of hy- understand life and to understand potheses, and reflective introspec- this we must understand the nature tion about man in himself and in his of man in his bivalent relationship social projections on the other. with the world. For this reason we We are dealing rather with grasp- must begin with philosophy, but ing the fact that in both spheres of from that form of philosophy which inquiry and knowledge the same does not repudiate nature but ac- subject is always present and at cepts that it is a fertile terrain for in- work, namely investigating man, a vestigation. being who is always searching in And a renewed philosophy of na- both fields for certainty and truth. ture enables the philosopher, and This man is not satisfied by partial above all the medical doctor, knowledge but is aware of its limi- whether scientist or practitioner, to tations—he thus seeks complete that philosophy which seeks to deny meet and to cooperate, because they knowledge. This is something that man has his own special nature are united in taking care of man in which he needs. But this need is not and asserts that he has a nature his overall unity. It is precisely in the special prerogative of scholars which merely goes on mutating. the act of care that both understand and men of learning, whether they “Man does not have a nature, he has and perceive (indeed they must un- are scientists or philosophers. Even a history” is the emphatic and derstand and perceive) that they can the most ordinary of men feel this peremptory declaration of Ortega y become fulfilled men through an in- need and respond to it, albeit in sim- Gasset, a declaration which per- tegration of scientific knowledge ple, ingenuous and imaginative fectly expresses the thought and and philosophical knowledge, in an fashion, doing so in a “wild state” to outlook of idealism but which also act of dedication to man which, at employ the phrase of Lévi-Strauss. reflects modern empirical pragma- root, is love. Investigation, therefore, is the tism and more in general anti-meta- special characteristic of living man. physical thought. In reality, this Professor SERGIO COTTA Professor of This latter is thus the unifying and special participation in the world the Philosophy of Law at shared source of the anxiety, the and at the same time this being be- La Sapienza University, Rome need, to know. Knowledge which is yond the world is the specific and President of the International indefinite in its origins but which is characteristic nature of man and Union of Italian Catholic Jurists VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 69

ROBERT C. GALLO

AIDS as a Disease of the Body and the Spirit

Your Eminences, ladies and gen- cine, only to return just as unexpect- fare, significant migration occurred tlemen, I thank Cardinal Angelini edly. In short, medical science must from country-side to city. This was for his invitation and for the privi- remain humble in the presence of associated with increased prostitu- lege of being here to speak to you nature, and remember that microbes tion. The rain forest had come to the and to learn. have always been with us from the city. The topic I was asked to address beginning and will remain with us Global major social changes also is AIDS as a disease of the body and to the end. The second lesson, re- occurred in the decades after World spirit. The former is relatively easy; lated to the first, is that though we War II. The enormous increase in the latter is open to several interpre- may divide the world into economic air travel and sexual promiscuity, tations. My perspective will be from orders, such as “first world,” “sec- the nightmare development of intra- the view of a biomedical scientist. ond world,” and the far more fre- venous drug abuse as a way of life We arrive at the end of our mil- quently used phrase ”third world,” for many, and the medical use of lennium with knowledge of and the microbial world the world of blood (transfusions) and blood pride in the great achievements of viruses is increasingly becoming products going from one person to medical science in this century. one. Moreover, the prior attitude another and even from one nation to This is true and the pride justifiable. that such diseases were only limited another ensured that a rather diffi- However, these achievements, this to far away places, not for “us,” was cult-to-transmit virus, once rare and pride was over-extended sometimes a striking example of social arro- remote, could rapidly become com- to the point of arrogance. During gance and one which flies in the mon and global. The rain forest was the 1970s it was not so uncommon face of the theme of this meeting. now everywhere. belief in some western medical cen- What is the origin of the AIDS What is the status of the epidemic ters that infectious diseases were epidemic? First, we need to con- now? I do not keep a very close eye “passé.” The serious ones for us sider the origin of the viruses. Bio- on the monthly figures. I repeat were all “conquered.” Serious in- medical scientists have convincing what most epidemiologists say: that fectious diseases were only a prob- evidence that the AIDS virus (HIV), by 2,000 we will have some 30 to lem for the “third world.” Indeed, like most of life, originated in the 50 million infected people. Every- some prestigious medical schools African rain forests, and may have one knows of the devastating ef- went as far as abolishing depart- entered humans many times from fects of AIDS on many African ments of microbiology. Confidence monkeys which are often used as a countries and of the recent great in- was high. But microbes have been food source. One suspects that by crease in infected people in some with us since humanity began, and cleaning such food many opportuni- Asian nations. My colleague, Dr. will continue with us to the end. At ties for infection could occur by ac- Robert Redfield, recently told me this very period the AIDS virus, like cidental wounds. Though this prob- that the average age of death of a a lion on top of its prey, had already ably happened many times in the man in Uganda was 46, but now be- leaped from the rain forest, vi- past, we are all aware that the epi- cause of AIDS it is 37. There are ciously, unexpectedly, fiercely demic is recent. The first cases were many other appalling statistics. making its presence felt. By 1981 discovered in the U.S. in 1981, and Who is now infected? The great- the first causes of AIDS were diag- these patients were likely infected est rise is in women, infants, and the nosed in the U.S. and by 1982 the in the 1970s and possibly earlier. poor. realization that a great new epi- Early infections in the African rain What is the future of the epidemic or pandemic was at hand. In forests were probably rare, random, demic? Because the epidemic is still fact, AIDS was destined to be the with the infected trying alone with in flux, it is not easy to predict. Fur- contemporary plague. the disease. From social studies I ther, the transmission of HIV is fa- What are the lessons? The first suspect the beginning of the epi- cilitated by the presence of other and most obvious one is the re- demic occurred in the decades post- venereal diseases, and who is able minder that great epidemics come World War II, when colonial pow- to predict the future of human and go, often unexpectedly; epi- ers left central Africa. People had habits? We also have some impor- demics of the past have often disap- not learned well the new ways and tant new results from our friend Dr. peared for a few centuries without perhaps forgot the old ways. Cou- Max Essex, Director of the Harvard the great advances of modern medi- pled with outbreaks of tribal war- AIDS Institute in Boston, which 70 DOLENTIUM HOMINUM lead us to be concerned about possi- much or more suffering and over a social contacts and death. ble rapid changes in the nature of longer period of time than any What can we say about blame and the epidemic depending upon the known disease, wrecks families, has the various “risk groups”? Should entry into a population of special undermined entire nations, makes we blame the infant infected from strains of HIV. He found that HIV many other diseases much worse, his or her mother? I think not. strains dominant in Asia and Africa and can allow for the development Should we blame the woman in- are much more able to infect cells of of other epidemics caused by other fected by her husband? I think not. the surface of the female vagina or microbes (consider the return of a What of the prostitute? I do not be- male urethra than the dominant more virulent tuberculosis). Re- lieve most necessarily freely choose strains in America and Europe. search in AIDS has direct relevance this type of work but can be driven to Therefore, the Asian and African to many other diseases. it from poverty, drugs, or an unfortu- strains are probably much more What can we briefly say about nate family background. Should we transmissible by heterosexual sex. AIDS as a disease of the body? blame her? I think not. We come

It is possible that such strains will Simply put, probably AIDS pro- closer to what is often perceived as soon come to Europe and the Amer- duces as much suffering or more the difficult issue, that of the homo- icas. than any known disease. Patients sexual. How important is AIDS com- become emaciated; infected with AIDS as a disease of the spirit was pared to other diseases? Not infre- innumerable other microbes be- also a topic assigned to me. Many in- quently I hear statements such as: so cause of the incapacitating effect dividuals are more qualified to dis- many more people die with heart HIV generally will finally have on cuss this than I am, particularly disease or from cancer, etc. This is a the immune system, microbes those in the “front lines” of the dis- question we must respond to with which can sometimes disfigure the ease—those who give primary care great care because it is a useless ex- person; the brain is infected by to the dying, those that help the indi- ercise for medical scientists to com- HIV, and this can lead to psycho- vidual endure the chronic suffering, pete for their “favorite disease,” and logical problems as well as neuro- etc. This includes, of course, those the response must not intensify such logical changes; and certain cancers Catholic hospitals that provide the feelings. Simply put, we can say develop. Needless to report here, bulk of such care, as we see, for in- that AIDS is new, still increasing, there is also the fear of the suffer- stance, in New York City and in usually affects the young, causes as ing, the economic ruin, the loss of many underprivileged countries. As VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 71 a scientist and as an individual who haps in particular the Church. or more drugs which target HIV has now known several such pa- I will end these brief comments were combined produced far more tients, my observations suggest that on a positive note. I believe that at impressive suppression of HIV than the biggest sickness of the spirit in the end of 1995 there is some good one alone. AIDS is despair and fear despair and news. First of all, it is my impres- Third, a consensus in the research fear, of being prejudiced against, of sion that there is indeed a marked field is emerging, indicating that being judged, of financial ruin, of improvement in understanding and early and “hard” anti-HIV therapy loss of family, of possible loss of concern by society as a whole is the correct approach. However, job, of being avoided like lepers of (though I am still sometimes con- these approaches involve chemicals the past, of family destruction, of cerned by complacency in some which can be toxic when given over suffering, of death. Sometimes these quarters). Second, the slow and time. We are working on some new feelings are transformed to guilt or steady gains made from basic scien- approaches which utilize biological hate or rage. tific studies of this disease and its approaches against HIV, ap-

AIDS as a disease in need of all virus are beginning to open doors proaches which may be minimally society. I do not know of any dis- for what may very well mark the be- toxic or not toxic at all so that their ease so dependent upon so many ginning of the end of AIDS as the administration may be long term, as segments of society. Obviously, incurable horrible disease. The pos- life long therapy against HIV well there is continued need of the pri- sibility that HIV infection can be very likely to be required. We will mary health care professionals—the manageable and that a person may make better therapy against HIV the nurses, physicians, paramedics, and be able to live well with HIV seems primary goal of the new Institute of administrators who make hospitals to be at hand. There are several rea- Human Virology at the University and hospices work. There is the sons for this. First, there is the rela- of Maryland in Baltimore. constant need of involvement of the tively new information that a subset educator. There is the need of fam- of HIV infected people, albeit a ily and friends, of political support small fraction, live long and well. Professo ROBERT C. GALLO and leadership, of substantial finan- Consequently, there is new confi- Director, Institute of Human Virology, cial investment from society over a dence that bringing this condition Medical Biotechnology Center, period of years, of many kinds of under control is possible. Second, University of Maryland at Baltimore scientists, of organized bodies per- recent clinical results in which two USA 72 DOLENTIUM HOMINUM

GOTTIEB MONEKOSSO

The Integral Training of the Physician for Care of the Sick

The Good Samaritan was not a the challenge of restoring the a local health service for the bene- physician. He was a caring citizen. “care” to medical and health care. fit of the community. Medicine is a caring humanitarian They must aim for the highest pos- profession. In the past few decades sible globally acceptable profes- however, the rapid growth of sci- sional standards; through a reform 3. Professional Thinking and ence and technology has virtually of basic medical education, which Problem Solving transformed physicians from the would be reinforced by postgradu- classic profile of humanists to that ate and continuing education pro- Professional thinking typical of a of competent technologist. Global grammes. There is a need to coor- competent physician, has been de- political, social and economic dinate and integrate the large num- scribed as critical reasining, evi- changes have also shaken the foun- ber of disciplines and specialties dence based medicine, clinical de- dation of medical ethics this cen- which to into the makings of a doc- cision making and problem solving tury. We hope that the twenty first tor of medicine. This is probably capability. These characteristics century will restore the balance be- best done by describing the behav- are generally derived from the tween technology and humanism in iourial characteristics or profile of study of a number of scientific dis- medical practice. the model student at the end of the ciplines applied to medicine - The prescribed period (years) of med- scientific basis of medical practice ical studies. medical practice. The most impor- 1. Crisis and Change in Medical tant of these are Anatomy, Physiol- Education ogy, Pharmacology, Biophysics, 2. Profile of the Competent and Biochemistry, Pathology, Microbi- Medical schools currently Caring Physician ology, Immunology, Histology, overemphasize the acquisition of Embryology, Parasitology and En- biomedical scientific knowledge. The physician would demon- tomology. It has been suggested Little attention is paid to profes- strate problem solving capability that these can be crystallized in a sional attitudes; furthermore, be- identified as Professional Think- few key disciplines. Professional cause of super specialization, skills ing; this would be associated with thinking can be reinforced by re- are fragmented and the majority of clearly identifiable Professional viewing clinical physiology, clini- practising physicians focus on dis- Attitudes, combined with a range of cal pathology and clinical pharma- ease entities rather than the sick psychomotor abilities described as cology. person. Professional Skills; he/she will Students and teachers of medi- also be a living encyclopaedia em- cine world wide are increasingly bodying a well integrated “infor- 4. Professional Attitudes: conscious of current distortions mationn base” - Professional Humanism and Caring from the Hippocratic tradition and Knowledge. The sum total of these the spirit of caring exemplified in behaviourial characteristics would Caring for the sick and unjured, the parable of the Good Samaritan. bve the goal of integral training of equal consideration for all persons, There is a global movement for the doctor. These elements would consciousness of economic costs to change, a search for quality med- be crystallized around Medicine’s patients, adapting to different so- ical education under the leadership central theme - Clinical Methods; cio-cultural environments, aware- of international organizations, es- i.e. taking the history of a patient’s ness of his/her own limitations, and pecially the World Federation for illness, select and interpret results a deep ethical respect for life - Medical Education. of investigations, give advice on these are some of the professional Recent changes in the organiza- treatment, rehabilitation and pre- attitudes expected of physicians. tion of medical care and health ser- vention; educate the patient, family They may be inculcated or ac- vices have resulted in the diminu- and community; work “in healt quired through the study and appli- tion or loss of “caring”. Medical centres or offices” with other cation of a number of disciplines schools everywhere must now face health team members and manage which focus on the physical, men- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 73 tal and spiritual well being of peo- educators need “to crystallize” es- 8. Combining Science ple; as individuals, families sential knowledge for medical with Humanism (households) and communities. practice. This has been summa- These disciplines Ethics, Anthro- rized in three major themes as A strong scientific background pology, Sociology, Psychology, recognition of ill health, manage- with emphasis on the application of Demography, Genetics, Econom- ment of ill health, and prevention science and technology will help to ics, Management would provide of ill health in individuals, house- ensure problem solving profes- the Humanitarian basis of medical holds and communities. Profes- sional thinking. The acquisition of practice. It has been suggested that sional knowledge for medical doc- skills and knowledge would make these can be cristallized in a few tors is presented in a bewildering it possible for the problem solving key disciplines. Professional atti- array of disciplines but can gener- physician “to do something” and tudes can be reinforced by review- ally be classified in the above three demonstrate his/her capacity to ing health care ethics, health care categories: “care for the sick”. But, in the final sociology, health care economics. Ð recognition of ill health: Med- analysis, it is the physician’s pro- ical, surgical and gynaecological fessional attitudes that would de- pathology and related disciplines termine to what extent, to what de- 5. Professional Skills Ð management of ill health: gree these skills and knowledge Broad Clinical Medicine, surgery, obstetrics and benefit the patient. In other words Abilities gynaecology, paediatrics, geri- the degree of caring. As in the atrics, psychiatry etc. parable of the Good Samaritan Medical students acquire many Ð prevention of ill health: Public does the passer-by continue his skills during basic medical educa- health and related disciplines; epi- journey without stopping, or does tion, and these are generally further demiology, nutrition, environmen- he go the whole way, and even developed during the exercise of tal health, maternal and child commit his resources on his return medicine. Skills are however health, occupational health, and journey. Nevertheless, even the highly fragmented in a wide vari- disease control. best intentions, the most desirable ety and a large number of special- professional attitudes would be in- ties. Integral training can however adequate in the absence of profes- be assured by organizing for med- 7. Quality Medical sional thinking (problem solving ical students practical “hand on” Education capability). The scientific and the experiences in three main areas.- humanitarian bases of medical patient care skills, reinforced by There is a dire need for physi- practice must go hand in hand. laboratory/investigative skills and cians oriented to the overall care of community management skills. the sick person, his/her household, These are the Professional skills his/her community, and whose pro- 9. Renaissance for medical doctors. Patient care file is in keeping with the above be- of Humanism skills are strengthened by working haviourial characteristics—Physi- in Medicine in clinical medicine with paedi- cians, family physicians, commu- atrics, geriatrics, psychiatry; in nity physicians whose main role The World’s faculties of medi- clinical surgery, and surgical spe- would be to care. These physicians cine have accumulated consider- cialties; and in obstetrics and gy- would have a Quality medical edu- able experience in the teaching of naecology. Laboratory investiga- cation. biomedical science; the second half tive skills are acquired by working They would also be capable of of this century has seen the devalu- in clinical pathology, clinical radi- teaching other health personnel and ation of medical humanism; and ology, and clinical investigation undertake quality health research, with it a significant drop in the role units. Community management in the art and science of healing the and the place of physicians in soci- skills would be developed by sick. It has been suggested that ety. An important challenge for working with and learning from quality (a difficult characteristic to medical schools and the medical people during practical assign- apprehend—it is in the eyes of the profession in the 21st century ments in community health, health beholder) depends upon two appar- would be to bring back the pendu- statistics, health planning and man- ently contradictory variables—ex- lum. For this reason further consid- agement, healt care financing, and cellence and relevance. A medical eration of integral training of the working with community groups school and its graduates can be ap- physician will focus on the teach- e.g. in health committees, develop- preciated by the scientific commu- ing and conscious inculcation of ment committees, and participating nity (excellence) and the local desirable professional attitudes. In in community/household surveys. community (relevance). The this area role models are important world’s medical faculties and their - an ounce of “example” is worth individual departments can proba- more than several pounds of “pred- 6. Professional Knowledge bly be characterised as dedicated to icating”. Teachers of medicine sig- Basic and Integrated the pursuit of excellence, dedicated nificantly influence the behavior of to the pursuit of relevance, and their students, and the manner in Professional knowledge has ex- those that are achieving quality (of which medicine is practised in a panded rapidly with the growth of care) by combining excellence and society will determine how medi- science and technology. Medical relevance. cine is taught. 74 DOLENTIUM HOMINUM

10. Cultivating Humane munity leaders, community coun- Physicians are aware that poor Attitudes cils; locally managed health care of people are more frequently ill and community based activities, dis- often more severely so. The burden From a pedagogic standpoint trict/local health planning and of sickness is higher in poorer prerequisites for entry and the management, health information, countries. methods of selection of students are community health financing; sup- important. Current methods favour plies of essential health commodi- cognitive functions. But assessment ties (e.g. drugs and vaccines). 16. Adapting to Different of non-cognitive functions and the Circumstances quality of school or college experiences are also looked into; espe- 13. Awareness of Professional Physicians learn to adapt to cially the candidates participation Limits varying socio-cultural environ- in extra-curricular activities. As- ments. Their first challenge may be sessments of character and socio- Awareness of his/her own pro- the language, culture and people cultural background are sometimes fessional limits and capabilities as around their medical school. The attempted. And once in medical a physician, as well as the opera- local language is vital in clinical school the student’s progress in atti- tional capacity of the hospital, practice. Solving the prevalent lo- tudinal development should be health centre or institution to which cal health problems is the first step monitored alongside growth in he/she belongs, adapt to this opera- to national and even international problem solving, skills and knowl- tional capacity, refer patients to renown. Adapting to a local or na- edge. A number of themes on the better equipped centres and to ap- tional culture is a major step to- humanitarian basis of medical prac- propriate specialists and services. wards the capability of performing tice would be integrated into the Awareness of professional limits efficiently in another country if core activity of a practising doctor’s would be helped by feedback from called upon to do so. Physicians life - Clinical methods. Some of teachers and peers, journal clubs, should master at least one of the these themes follow. tutorials and discussion groups etc. major international languages. Students would be advised to keep All these call for “open minded- a diary of their experiences. ness” ad a willingness and hum- 11. Caring bleness to learn, and continue to for the Sick learn many things - apart from bio- 14. Equity and medical science. Caring for the sick, concern for Social Justice Adapting should, however, not people, willingness to help others mean lowering professional and (going out of one’s way, like the Equal consideration for all per- ethical standards. Good Samaritan), being accessible sons, male or female, high, middle to people, a friendly welcoming or lower class; independent of race, disposition; caring comes before religion, tribes/class, wealth, coun- 17. Ethical Respect money or any other consideration, try, province or district of origin. for Life handling persons with care—re- There should be special considera- specting their autonomy, respect- tion and care for special groups— Profound ethical respect for life ing confidentially of the doctor/pa- drug addicts, alcoholics, sex per- takes us into the depths of health tient relationship, interest in the verts, Hiv/Aids, etc. The student care ethics; it begins with equal person’s life situation not just “an and practitioner will consciously consideration for all persons and interesting case”, and providing attempt to identify his precon- respect for the autonomy of the in- continuing, integrated total care of ceived or unconscious discrimina- dividual. It embodies the well the whole person. This caring in- tory tendencies and endeavour to known principle of doing no harm cludes acquiring some of the attrib- overcome them. (premum non nocere). Changes in utes of a good nurse. social behaviour (or what is acceptable social behaviour) and devel- 15. Awareness of Costs opments in technology now impose 12. Community Health of Health Care on each and every physician the Concerns need to fully apprehend and take The physician should be fully responsibility in the domain of Extending caring to the person’s aware of the costs of health care to ethics. household and community; people the patient, his relatives, friends Abortion, euthansasia, care or centred care with a focus on the and household; and indeed to the sacrifice of severely disabled new- person’s life situation - infant, community and nation. It is an ex- born children, care or otherwise of child, adolescent, youth, adult, se- tension of the caring for the sick— the mentally ill, transplantation of nior citizen; community based care the economic costs are not only fi- tissues and organs (donor, recipi- organized for family/household nancial, but loss of time from ent, physician relationships), in- members in defined communities school and work, with consequent vitro procreation (test tube babies (rural villages, city blocks) such as loss of productivity; loss of oppor- etc.), dying in dignity, none partic- in health centre practice or office tunities for interpersonal and fam- ipation in torture, not to mention practice, with involvement of com- ily relationship. the rapidly growing impact of ge- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 75 netic engineering on medical prac- for care of the sick we believe will a major reorganization or restruc- tice. These complex questions can- require the reorientation of medical turing of any medical faculty. It not be taught through abstract case education programs along the lines will require, however, a fundamen- studies but reviewed as they arise proposed here. Teachers and learn- tal acceptance by teachers and in the course of day-to-day profes- ers alike should ensure that while learners alike that medical schools sional experiences alongside bio- observing the trees in detail they do exist first and foremost for the inte- medical issues. not lose sight of the countours of gral training of physicians for care the forest. We believe that all med- of the sick. ical schools can set themselves a Conclusion goal of producing physicians that Pr. GOTTIEB L. MONEKOSSO Emeritus Regional Director for Africa are GLOBALLY COMPETENT of the World Health Organizations, Integral training of the physician AND CARING. It will not require Cameroon 76 DOLENTIUM HOMINUM

FRANCISCO EDUARDO TRUSSO

Medicine and Christianity

The title of a previous interna- and he delivered them from up his head, and in the presence of tional conference has already sup- their distress; great plied us with a definition of how the he sent forth his word, men he is admired. The Lord created Christian should understand the con- and healed them, medicines from the earth, and a sen- cept of life: Gloria Dei Vivens Homo and delivered them from sible man will not despise them... (“The Glory of God is Living Man”). destruction.” (Psalm 107) And he gave skill to men that he In the Bible we can see that the might be glorified in his marvelous psalmist repeatedly returns to the “Afflicted and close works. By them he heals and takes idea and conviction that life is a spe- to death from my youth up, away pain; the pharmacist makes of cial blessing of the Lord: I suffer your terrors; them a a compound.” “The dead do not praise the Lord, I am helpless. In addition Holy Scripture pro- nor do any that go Your wrath has swept over me; vides guidelines by which to treat ill- down into silence, your dread assaults destroy me.” ness and the Lord is called upon to But we will bless the Lord provide medicines which will from this time forth for evermore.” “Every day I call upon you, achieve a cure: (Psalm 115) O Lord; “My son, when you are sick do not “Precious in the sight of the Lord I extend my hands to you. be negligent, but pray to the Lord, is the death of his saints.” Do you work wonders for the and he will heal you. Give up your (Psalm 116) dead? faults and direct your hands aright, Do the shades rise up to praise and cleanse your heart from all sin... “I shall not die, but I shall live, you? (Psalm 88) And give the physician his place, for and recount the deeds of the Lord, And the psalmist also speaks the Lord created him; let him not The Lord has chastened through the mouth of the man who leave you, for there is need of him. more sorely, has been healed and through the There is a time when success lies in but he has not given me mouth of the just man who lives out the hands of physicians, for they too over to death.” his long life in good health: will pray to the Lord that he should (Psalm 118) “The righteous flourish like grant them success in diagnosis and At the same time a life which lasts the palm tree, in healing, for the sake of preserving long enough for the just man to see and grow like the cedar life.” the children of his own children, the in Lebanon. During the first centuries of Chris- third and fourth generations, is con- They are planted in the house tianity there were on the one hand sidered a blessing of the Lord by the of the Lord, the anchorites who withdrew from authors of the psalms. they flourish in the courts the world in order to devote them- But the bible does not only speak of our God. selves to the glory of the Lord in so about death as an evil and life as a They will bring forth fruit in doing they placed themselves en- blessing it also holds the same opin- old age, tirely to the hands of God. On the ion about illness. Indeed, the they are ever full of sap and other hand, and in similar fashion, psalmist calls on the Lord to restore green.” (Psalm 92) there was also a certain asceticism his health so that he can then give The subject of medicine and med- which despised everything which thanks to the Lord for his release ical doctors is also given extensive was associated with the body and from illness: consideration in Holy Scripture. In- perceived in illness and the neglect “Some were sick through deed, in Ecclesiasticus (38:1) we can of the body a kind of blessing of the their sinful ways read: Lord. This way of thinking and be- and because of their iniquities having was paralleled and matched suffered affliction; “Honor the physician with the honor by a total repudiation of human cul- their loathed any kind of food, due him, according to your need of ture and by an exclusive dedication and they drew near to him, for the Lord created him; for to thinking about, and reflecting the gates of death. healing comes from the Most High, upon, theology and the Holy Scrip- Then they cried to the and he will receive a gift from the tures. Care for the culture of the Lord in their trouble, king. The skill of the physician lifts spirit and the body was associated VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 77 with a pagan attitude and approach. ment is seen not only as a stage on the with reference to acts of charity but This belief, which bore the influ- journey to the next life but also as a also as a subject for study and re- ence of Plato and the agnostics, was specific form of treatment and ther- search in the development of science not shared by the principal Fathers of apy. It is for this reason that emphasis and of technology in the widest pos- the Church and failed to leave a ma- is placed upon the fact that this sacra- sible sense of these terms. jor mark on Christian traditions. In ment should not only be given to sick The informed consent of the pa- opposition to Plato, who believed people who are in danger of dying it tient, the relationship between med- that the body is the prison of the soul should also be given to those people ical treatment and the destiny and fu- to which it is bound as a form of pun- who are suffering from illness and ture of the patient, the limits in the use ishment—as a result of which the who want to recover and regain their of methods and instruments by which body is an obstacle to the achieve- health through the sacrament of the to defend life and health, the tech- ment of complete virtue, Christianity anointing of the sick. niques of intensive care, euthanasia, offered the Tertullian concept of In the gospels it is repeatedly ob- the limits to the application of various caro cardo salutatis (“the flesh is the served that Jesus performs his min- kinds of therapy, and all the rest, are cornerstone of salvation”—from istry by healing the sick. We should subjects which have been considered Resurrectiones Carnis, 8). This is an not see this as being merely an ex- and debated by Christianity and idea which is at the very center of ample of the use of miracles by which are at the present time dis- our faith and expressed in the con- which Christ demonstrates his divin- cussed by the world of medicine. cept of the “Word made flesh.” ity and the power of the Father. It is In a large number of speeches Pius St. Irenaeus provided the words also an expression of the concern of XII dwelt upon these subjects. Espe- which form the introduction to this the Son of Man for the health of his cial reference may be made here to paper but also coined the famous brethren. The fact that Jesus wept on his address on the subject of a num- phrase: “caro possidere in regno a hearing of the death of Lazarus is a ber of questions relating to new spiritu potest” (“the flesh is pos- good example of this. methods of intensive care which was sessed of the spirit”). Christianity believes that the ulti- delivered on November 14, 1957. This principle lays down that the mate goal of man is supernatural The Congregation for the Doctrine body should be cared for with per- life—that time and condition when of the Faith has dedicated great at- sonal hygiene, with rest, with useful there will be a glorious resurrection tention to the subject of euthanasia. and controlled activity, and through of physical bodies. For this reason Also of importance here is the article avoidance of those forms of activity, Christianity is not afraid of sick, by Manuel Cujás S.J. entitled: “The those foods, and those kinds of handicapped, wounded or suffering Rejection of Treatment.” In another lifestyle which destroy the body or bodies. On the contrary, Christianity work this author makes the follow- which seriously endanger its health. takes care of them and is concerned ing observation: “Health and life, It is interesting to observe in relation about them in very a special way. thought about in organic and psy- to this point that St. Thomas Aquinas Following the principles of its chological terms, are not the final suggested that the taking of a bath in earthly teaching, our religion has goal of moral behavior. They are a the evening was an effective means taken care of these bodies and has means whose importance should be by which to treat “sloth” or sadness, dedicated much of its activity to the judged in relation to its effectiveness the condition which we now term de- bringing of comfort and help to in reaching an individual’s perfec- pression. This holy theologian be- them. It naturally sees an evil in ill- tion and destiny. This is what we lieved that such specific forms of ness and in malformation but this is were created for and it is the high- treatment for the body were a means not an absolute evil which must be point of the plan for each individ- by which to achieve the overall distanced at any cost and with dis- ual’s life. Moral theology has always health of the human spirit. dain for questions of humanity and produced and formulated suitably At the beginning of the evange- morality. Christ said to the paralyzed precise concepts by which the indi- lization of Latin America the Coun- man: “Rise up and walk!” and he vidual can place limits both nega- cils which were celebrated in that also said: “Whoever wants to be my tively and positively to his freedom continent were already prescribing disciple must take up his cross and in the honest organization and direc- concern for health, personal hygiene, follow me.” The cross is our body tion of his life and his psychophysi- suitable rest and physical exercise, with its pains and its illnesses, and cal integrity.” and the maintenance of healthy and these are the means by which we In the address which has been salubrious homes, in their advice to unite with his redemptive action. mentioned above, Pius XII placed the native populations (see the Coun- The evident dualism between limits to the duty to defend life and cils of Lima and of Quito). The mis- what Christianity proclaims about health. He stressed the need to em- sionaries in America dedicated the need to keep the body in a state of ploy only conventional and usual themselves a great deal to the study beauty and in health through suitable methods and means and to leave the of medicine, and examined medi- stewardship, and what it says about use of other instruments to the deci- cines and medical techniques prac- the need for acceptance and patience sion of the sick person, ensuring at ticed by the local inhabitants in addi- when we suffer from illness and the same time, however, that he is tion to those which were being de- pain, is an aspect of Christianity fully aware of the conditions and cir- veloped at the same time in Europe. which St. Paul sees as imprudence cumstances which surround such a In Christian liturgy it is made clear when practiced amongst the pagans decision. that the sacrament of the Eucharist is and scandal when effected by the sustenance for the spirit and for the Jews. His Excellency body. Furthermore, one of the seven The parable of the Good Samari- FRANCISCO EDUARDO TRUSSO sacraments is specifically reserved to tan has always been present within Argentinian Ambassador the anointing of the sick. This sacra- the teaching of Christianity, not only to the Holy See 78 DOLENTIUM HOMINUM

ELIO TOAFF

Judaism

The title of this Conference, darity without distinctions between mentary amounts to a sad and self- “From Hippocrates to the Good men is contaminated by an underly- critical description of a religious Samaritan,” presents me with cer- ing bitterness—a great deal of love world which perceives the limits tain difficulties. The name of Hip- is preached side by side with a touch and the risks of ritualism and juridi- pocrates takes us back to the begin- of hostility. Here, while I give cal “technicalism,” even though it nings of the Western tradition of thanks for the invitation to partici- certainly sees ritual and law as con- medicine and to the Greek codifica- pate in this important conference, I stituting essential elements in reli- tion of the first tenets of profes- would like to emphasize that my gious life. sional ethics. But the character of role is to speak in the name of the A healthy and alive religious sys- the oath itself, which bears the name person who was absent in that para- tem must have this criticism before of Hippocrates, is still limited by an ble, in the name, that is, of that ordi- it at every moment. Judaism has initial idolatrous invocation and by nary Jew who would not have been done this from the age of the certain worries about the secret of able to study medicine in the temple prophets, and has never ceased to do the transmission of the doctrine and of Hippocrates, and who in the para- so, through its most inspired mas- the practice of the profession. The ble of Luke is not even considered ters. But as was clear from ancient name of the Good Samaritan, on the as a possible source of acts of char- times, and is still clear today, the other hand, is seen at the level of ity. question (which is of great impor- common use as the symbol of dedi- Hitherto I have spoken about the tance) is certainly not a matter cation to taking care of the sick, of a limits of the models to which this which concerns merely the priests love which rises above national and conference refers. But I am even of a religion. A priest is not only a religious differences, and which more convinced that the authentic person who has sacred duties: in the sees the sick person, whosoever he meaning of our discussions should etymological sense of the Hebrew or she may be, as simply a human lie in defining with a full conscious- word which refers to priesthood, the being to be helped. ness of the lack of comprehension priest is first and foremost a “ser- However, the parable of the Good of the past—a road which we can all vant.” For this reason one can say Samaritan, as it is expressed in Luke take in the service of man and espe- that every society has its priests, its 10, bears the signs of a polemical cially in the service of those who governors and its civil servants who laceration which seems to affect Ju- suffer. We need to perceive the “serve” it and who may forget the daism directly. At that time, as to- great insights of progress in the fundamental values of respect for day, Jewish society was divided models of the past, find their cul- human life because of an obsessive into three estates: priests, Levites tural and religious roots, and place respect for the ritualism of their and ordinary Jews. In the parable them at the service of all men. posts. Religions are the first forces the priest and then the Levite refuse Taking the parable of the Good to fall foul of the risks of a loss of to help the wounded man. A third Samaritan as a point of departure, I values, but they are also the first to person, the Samaritan, then inter- would like at the outset to empha- engage in self-criticism and re- venes; a person who belongs to a size three points. The first concerns newal. They play a key role in lead- different community and provides a the criticism leveled at the priests. A ing organized society back to a re- great lesson in humanity. In the Talmudic text (Joma, 23a) relates— discovery of values. parable, therefore, one figure is con- and almost with horror—an account The second point involves a re- spicuous by his absence—the ordi- of priests who had stabbed each flection on the phrase which con- nary Jew is not there. It has been other in the Temple over a question cludes the parable and is also the ti- suggested that the original version of precedence during the religious tle of this conference: “Vade tu et of the story spoke about this figure, service. The rabbinical comment on fac similiter.” The correct behavior but as the facts stand, the official this event (which was contempo- of a man is presented as an example text refers to a Samaritan. One of rary, if not prior to the parable of the to follow. I would like to observe the possible morals of the story is Good Samaritan) is that for some here that within the Jewish roots of that it is necessary to go outside Is- priests technical questions of ritual this invitation there is a hidden di- rael to find humanity and solidarity. purity were more important than hu- mension which is much wider and Thus it is that the great message of man life, even the life of the sons of of much greater importance. Not the parable regarding love and soli- the priests themselves. This com- only is there the imitation of a man VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 79 who behaves in an upright way, your neighbor as yourself” (Leviti- gions: from the common biblical there is also, and above all else, the cus 19:18), an imperative which is message, the statement of the imitation of God: “You shall be still a challenge for every person. psalmist to the effect that “the Lord holy,” declares Leviticus 19:2, “for But the dramatic problem—which is good to all and his compassion is I the Lord your God am holy.” In is indeed discussed in the parable— over all that he has made”(Psalms the Song of the Sea, in Exodus 15:2, is the definition of “neighbor.” 145:9), to the Rabbinical teaching there is written: “this is my God, Can we draw a line within which asks why the Bible relates and I will praise him.” “Will praise” mankind to separate the “neighbor” that the whole of mankind descends in Hebrew is “weanveu,” which from the “non-neighbor”? Is it too from a single man and goes on to without vowels can be read as “ani- easy and very mistaken from a his- answer that this is to make us under- wahu,” “I and Him,” as if I and Him torical point of view to think that stand that in potential terms each could be the same. bad Jews have replied “yes” to this man is the whole of humanity—he The Rabbis ask themselves: how question and the good Christians who destroys a single man, there- can this idea be put into practice? In “no.” In truth the question is present fore, acts as though he were de- a very simple way—by imitating within (and constantly divides) reli- stroying the whole world and he Him: “Just as He is merciful and gions and institutions, and has the who saves a single man saves the compassionate so shall you be mer- same effect on every society and whole world (Sanhedrin 5:5). This ciful and compassionate” (Shabbat is a message which Islam has taken 133b). We can see the same thing in up and diffused in identical terms. Deuteronomy (13:5): “You shall And returning to shared biblical walk after the Lord they God.” The roots, we cannot ignore (amongst Talmud (Sota) asks: but how it is many examples) the magnificent possible to walk behind the Lord? image at the end of the Book of In practice it means imitating the Jonah. According to traditional characteristics of the Lord. In the Jewish interpretation this is a sym- same way as God visited the sick, as bol of the conflict between the at- is made clear when the Lord ap- tributes of justice and of love, with peared to Abraham amongst the the last prevailing. The prophet oaks of Mamre (Genesis 18:1) when wanted the sinful city of Nineveh, the sick Abraham was resting at the the Assyrian capital, to be punished opening of his tent (he had just cir- for its wrongful acts. But the Lord cumcised himself), so must you go gave the following lesson to Jonah: and visit those who are sick. “You pity the plant, for which you As Genesis teaches us (1:26), did not labor, nor did you make it man was created in the image and grow, which came into being in a likeness of God. This is a difficult night, and perished in a night. And concept to understand given that should I not pity Nineveh, that great God is absolutely indescribable and city, in which there are more than a cannot in any way be compared to hundred and twenty thousand per- human realities. It is usually thought sons who do not know their right that the divine image of man is his hand from their left” (Jonah 4:10- intelligence. But these teachings 11). These ideas should act as qual- rise above, and surpass, this con- every state which today proclaims ifying structures for the Abrahamite cept. The divine image of man is itself civilized and democratic. The religions. As the Talmud declares: also to be found in his moral capac- temptation to shut oneself off from “He who has compassion for living ities, in the ability to express attrib- others is always and everywhere things clearly demonstrates that he utes such as compassion and soli- present. At the outset even Jesus re- belongs to the line of our patriarch darity, which are indeed human fused to heal a Syrophoenecian Abraham” (Betzà 32b). qualities but in fact derive from the woman and wanted to conserve the These reflections are the founda- divine essence. When man practices best part of his forces for Israel tion of the religious sense of solidar- these virtues—the “fac similiter” alone (which he called child, in dif- ity in general, and medical activity in with reference to the divine plan— ferent fashion to the term “dogs” he particular. If it is true that each and he discovers, revalues, lives and re- used for those who did not belong to every man is characterized and con- alizes the divine part which is in Israel, Matthew 15:21-28, Mark secrated by his being made in the di- him. 7:24-30). Every revolution breaks vine image, this applies to an even From here we come to the third down barriers but it also immedi- greater degree to the man who suf- point, and perhaps the most delicate ately creates others which are new, fers. Taking the expression of Psalm part of the overall argument. The indifferent, perhaps greater in number 41:4 “The Lord sustains him on his dividual’s obligation to express sol- but by no means less problematic sickbed” as its point of departure, the idarity and compassion spring from from a conceptual point of view. In Talmud (Nedarim 40a) declares that the divine nature which is within us. the place of the circumcised are above the sick man and literally But from the divine nature which is placed the baptized and in the place above his bed the divine presence is in each and every man there also of the oppressed are put fellow-citi- to be found, a presence which cares springs the sacredness of each hu- zens or members of the party, and for him and shares in his sufferings. man being and of every life, the ob- so on. The experience of the encounter ject of our solidarity. From this de- Here also we must re-evaluate the with illness becomes a sacred meet- rives the biblical imperative: “Love constructive potentiality of reli- ing, “bidchilu urchimu,” to use the 80 DOLENTIUM HOMINUM a sacred meeting, “bidchilu a clear set of legal and ethical rules urchimu” to use the expression dear and regulations in matters concern- to the mystics: with fear and coming bioethics. From the world of passion, with fear and love. technical operators in this area From this point of view, nothing emerge rules of self-regulation pre- could be further from the idea of cisely because there is an absence of seeing the practice of medicine as decisions (or because we are still an activity of pure research or the waiting for such decisions) on the application of scientific technology. part of society and the state. The duty of religions today is to This state of affairs helps to give make clear that medicine is an en- a new importance to the tradition counter with the sacred, an exercise of trying to render the ethics of the in what is sacred. Following the ar- profession noble, as happens with guments and observations which professional codes of practice. But have been made above, the person whilst it is true that the ethical ini- who works in this sacred area has tiatives of a professional category before him very severe injunctions deserve admiration and attention, it and warnings. is also the case that one feels dis- Priests, who are doctors and tress at the slowness which society health care workers at all levels, in general demonstrates in follow- must not lose sight of that scale of ing and developing rules for ques- values which sees human life as an tions which are so important. But essential reference point and under- even more can be said. Although it stands that questions of “ritual,” is true that the voice and con- technology, and scientific dimen- science of health care workers are sions are mere tools. Whoever has vital elements in the whole to deal with this area should be process, it is also important to aware that the divine dimension of stress that other voices must not be man, and human brotherhood and ignored. If only one group is en- fraternity, must be recognized and trusted with the work of codifica- stewarded. tion—however admirable the in- The other great task or challenge tentions of that group may be— which presents itself to the religions then not all needs and ideas are dis- of today’s world lies in making cussed and guaranteed. clear that there must be a set of I would like to give as an example ethics, a range of rules which can that which has happened in Italy act as a precise guide for behavior over the last few months. Given that and conduct. Every human act must there is no up-to-date set of rules by be governed by rules, and this is es- which to govern assisted procre- pecially true of medicine, which in- ation, Italian doctors decided to reg- volves essential aspects of the hu- ulate themselves. The national man condition and which must in- council of the Federation of the Or- deed be seen as a special encounter der of Medical Doctors met on 2 with the sacred dimension of exis- April 1995 and decided to adopt a tence. resolution. This made clear that af- The debate over bioethics be- ter vigorously calling upon parlia- comes ever broader in its character, ment and the government to pro- and at times ever more dramatic, as duce legislation on the question, it a result of what technological had been decided to establish in the progress can offer. But at the same meantime a set of rules for all Ital- time we notice that often it is very ian doctors. Those members of the difficult to reach agreement on a set federation who do not accept these of regulations in this sphere. Per- rules are to be subjected to discipli- haps this is a result of the complex- nary measures. When one examines ity of the subjects under considera- these rules and the principles upon tion and the divergence in opinions which they are based, certain points which exists in this area. We seem and questions emerge which should to have before us one of the great be discussed in greater detail. difficulties of our time, namely a In these rules one perceives that marked slowness in the develop- the essential reference point for the ment of juridical decisions in rela- evaluation of different options is the tion to questions of bioethics but at well-being of the unborn child. As a the same time great speed in the rate result such procedures as “artificial of technological advance. This oc- fertilization of women not in a state curs even though there is an aware- of early menopause” are forbidden. ness on the part of most people who It is probable that this decision will work in this area that there has to be meet with broad agreement in many VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 81 in the Jewish world many rabbis other aspect of the question—soci- would subscribe to it. But belonging ety was based upon extended fami- as we do to religions which are lies in which a mother was often ab- based upon Holy Scripture, upon sent (how many mothers died in the Bible, we cannot fail to detect a childbirth?). Within the family there certain contradiction. Genesis de- was often another woman (an aunt, scribes how Abraham and Sarah, a grandmother, etc.) who was pre- who were both advanced in age and pared to raise an orphan. For this without children, received the mar- reason we should ask ourselves velous gift of Sarah’s pregnancy. whether this strong stress upon the We are also told explicitly that right of the unborn child—a right Sarah had reached the state of which is absolutely just—does not menopause (Genesis 18:11). The involve an overly favorable empha- child born to the couple was called sis on the model and the idea of the Isaac and he thus bore a reference to nuclear and narrow family to the the laugh of the matriarch which disadvantage of the extended fam- was uttered at the news of this in- ily. And the extended family has credible violation of the natural or- been severely weakened not only by der. many serious social problems but in Given the technology which is part also because of an inability to now available, Abraham and Sarah live with one another, because of in- nowadays would have been able to dividualism and because of selfish- dispense with the need for a mira- ness. cle, and—paradoxically enough— All this illustrates the complexity with today’s norms and regulations. of the debate about bioethics, the He who is the Physician of all living need to listen to the various needs things could today be subjected to and requirements which are in- the disciplinary measures of the Or- volved, and the obligation we have der of Medical Doctors. But putting to consider and identify answers jokes to one side, all this should and solutions which will serve the make us reflect upon the inade- man who suffers. All this should be quacy of the debate and upon the done without embracing facile ex- consequences which could flow pressions of permissive thought. from (an albeit admirable) sense of Yet at the same time we should not urgency with regard to the need to fall foul of the temptation to reject decide if all aspects of the whole everything out of a fear of what is question are not taken into consider- new or because of attempts to guar- ation. antee social models whose legiti- I would like here to repeat that it macy is by no means absolute even has been decided that “the well-be- though they may well be very wide- ing of unborn child must always be spread. As the heirs to a tradition deemed the criterion to which refer- which we believe to be inspired, we ence must be made.” We all agree are perhaps both advantaged and that the well-being of the unborn privileged—our path is in a certain child must be defended to the ut- way signposted and the choices we most. But why should we ignore the make are guided. This, however, legitimacy of other requirements, does not diminish the responsibili- such as late motherhood? Today ties we must bear. On the contrary, great emphasis is placed upon the it serves to increase them. right of the unborn child to have two As Maimonedes wrote, medicine young and competent parents who is “a special activity which is one of raise him, and when this guarantee the most important known to man. It is not present the procedures of arti- is a vital path which leads to the ficial procreation are not set in mo- higher qualities and attributes of the tion. This is a correct criterion human intellect, on the one hand, which we can agree upon, but up to and to true awareness of the divine, what point must it be seen as an ab- on the other” (Chapter Five). The solute value? At what time in the profound sense of the sacred which past has this been considered an ab- inspires this idea of medicine is a solute right in all societies? In real- guarantee and a challenge for every- ity, the opposite is the case. body, for a better kind of medicine An attempt used to be made to en- at the service of man and at the ser- sure that children were born and at vice of the Creator. the same time less attention was paid to the fact of whether their nat- Professor ELIO TOAFF ural parents were alive. This was Chief Rabbi of the Jewish because—and here we come to an- Community in Rome 82 DOLENTIUM HOMINUM

AHMED ZRIBI

Medical Ethics and Islam

1. Definition of Islam and Ijmaa). This is an intellectual at- careful about ties of blood kinship.” tempt by the Aimmas to find an- The Koran says: In chronological terms, Islam is swers to questions which are not “God forbids adopted children the third monotheistic religion. It dealt with by the Koran or by the being considered as real children,” appeared after Judaism and Chris- Sunna. This gives a new evolution- Sura 33, (verse 4). tianity to which creeds, indeed, it ary dimension to the precepts of Is- “Adopted children should bear frequently refers. lam, a process which enables this re- the name of their father,” Sura 33 The Koran (‘Holy Book’) forms ligion to tackle each new question (verse 5). the basis of Islam. This book was re- (such as those relating to medical Thus it is that respect for life, for vealed to Mohammed by the ethics, to take one example) raised filiation, and for reason are the three Archangel Gabriel. The revelation by the advance of science. In this fundamental elements at the base of of the Koran was begun in 610 AD paper which I will present here to- Islamic medical ethics. and continued over a period of day an examination is presented of twenty years. the various answers provided by the Islam is a complete system which Aimmas to new questions of an eth- 4. The Nature of Islam: governs both the spiritual and the ical character. The Spirit of Tolerance civic aspects of the life of the indi- and Liberalism vidual and of the community. Islam embraces all fields of human activ- 3. The Bases of Muslim The idea of tolerance is to be ity: the spiritual and the material, the Morality found in a broad range of verses of individual and the social, and the the Koran: economic and the political. The Charia, or Islamic law, has “God wants happiness for man three principles which each individ- and not suffering,” Sura 2 (verse ual and the community must respect, 185). 2. Sources of the and they are as follows: “God does not burden men with Charia Ð Bearing witness to the faith. weights they cannot bear,” Sura 6 Ð Respect for human life. (verse 152). The Charia is a collection of Is- Ð Reason. “God does not ask from men lamic laws which apply to all Mus- Ð Filiation. more than they are capable of do- lims. The Charia draws upon, and is Ð Money. ing,” Sura 7 (verse 42). based upon, four sources: Respect for human life means re- “Let there be no compulsion in 1. The “Holy Koran,” or the true spect for the physical and mental in- faith because the upright path natu- word of God, is a collection of dog- tegrity of man. This is borne out by a rally distinguishes itself from the mas made up of 114 chapters reading of a number of verses from path of ‘error.’” Sura 2 (verse 256). (Sure). the Koran: In Islam both obligations and 2. The Sunna is a collection of the “In truth, we created man in har- prohibitions are relativized. The Ko- words and deeds of the Prophet Mo- monious forms,” Sura 95, (verse 4). ran declares: hammed which have been compiled “Do not alter the creation of “He forbids you to eat the flesh by specialists of the Hadith. God,” Sura 30, (verse 30). of dead animals, the blood and the 3. The Kyas, or analogy, is a “God breathed His Spirit upon flesh of the pig and of butchered an- method by which it is possible to de- man,” Sura 32, (verse 9). imals, but he who is forced to eat duce a religious, moral, or juridical “We conceded nobility to the chil- these forbidden things will not be rule from another rule prescribed by dren of Adam,” Sura 17, (verse 70). seen by Us as a rebel or a trans- one of the other two sources of Is- gressor. In truth, God is Merciful lam (the Koran or the Sunna). Respect for filiation means the and Compassionate,” Sura 16 4. The Ijmaa is the formulation of defense of genealogical continuity (verse 116). new rules by Muslim theologians or and of filiation itself. After outlining some of the char- Aimmas. In a Hadith Mohammad said: acteristics of Islam, and in particular The Ijtihad draws upon the last “Have a knowledge of your ge- the basic elements of its morality two sources of Islamic law (Kyas nealogies which enables you to be and its spirit, we will now consider, VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 83 firstly, the ethics of Hippocrates— Thus it is that the principle of inde- a) The Oath of Mamonide Moses ethics which to a great extent are to pendence is clearly to be found in (1135-1204 BC) be found in Muslim morality—and Muslim morality. Moses was of Jewish culture and secondly the approach of Islam to was the private doctor of Saladin the those new ethical problems which 2. Benefit Great. His oath placed great empha- have been raised by the develop- The Koran encourages charity sis upon the principles of benefit and ment of biology and of treatment and decrees it both for individuals of not doing harm. over the last three decades. and for the community. The giving of alms, or Zakat, is one of the dog- b) The Oath of the Muslim Doctor mas of the Muslim religion. The Ko- (1981) 5. Hippocratic Ethics 7 ran promises a reward for each per- This oath was adopted at the first son who does good. The Hadit, too, international conference of Muslim The term “ethics” is often con- encourages charity: medicine which took place in fused with “morality.” At the pre- “The Muslim who promotes an Kuwait and whose acts were then sent time the term “moral” refers to action or cultivation of the soil published by the Organization of the actual behavior of an individual which provides sustenance for a hu- Muslim Medicine in 1982. This oath or a community whilst the term man being, an animal or a bird, will lays down that the doctor must re- “ethics” refers more to a reflection be rewarded in the world beyond.” spect the dignity and the intimacy of upon this behavior. Both vary from “A person can avoid punishment the patient and must not divulge se- one society to another and from one in the world beyond for bad actions crets about that patient. The oath space to another.5 by planting a palm.” also stresses the principles of bene- Notwithstanding this variability, fit, not doing ham, and justice. the four ethical principles of medi- 3. The Intention of Not Doing Thus one can see that Hippocratic cine accepted by all doctors over the Harm ethics have been adopted not only last twenty-five centuries (Hip- The principle of not doing harm is by medical doctors in the land of Is- pocrates) are independence, benefit, mentioned by the Koran and by the lam but also by physicians drawn the intention not to do harm, and jus- Hadith. The Hadith says: from other religious cultures, and in tice. “Do not have difficult relation- particular those of Judaism and Independence includes respect ships. Do not be jealous of each Christianity. for the individual and the freedom other and be brothers in prayer.” However, over the last two or of the individual. Benefit involves “Each person must respect the three decades the dual revolutions in the doing of good to others. The in- feelings of his neighbors and not be the spheres of biology and medical tention not to do harm refers to the brusque in his actions, words or the treatment have raised new and duty to not do wrong to other peo- movement of his hands.” weighty problems of an ethical char- ple. acter. How have doctors approached Justice in medical ethics relates to 4. Justice these problems and what solutions the provision of care and treatment We find the principle of justice in have they found? to patients without discrimination in a number of verses of the Koran and As we have already seen, the two relation to matters of race, religion, in various Hadiths. fundamental principles of the wealth or social condition, and so The Koran says: Charia (Koran and Sunna) are unal- forth. “Those who persecute believers terable. The Kyas and the Ijmaa, on without good cause commit a mani- the other hand, provide for ethical 1. The Principle of Independence fest sin and a most wrongful act,” reflection upon the circumstances Every person feels free and inde- Sura 33 (verse 58). and the solutions to problems which pendent. He is controlled and gov- “Nobody should come to the help are not dealt with in the Koran or the erned by God the Creator alone. Is- of embezzlers,” Sura 22 (verse 7). Sunna. lam has attributed great value to re- “If two groups of believers come flection and learning. to fight, make peace between them. The first verse revealed by God to If one group rebels against the 6. Islam and the New Mohammad says: “Read in the other, fight that which rebels until Problems of Medical Ethics name of your God who created they submit themselves to the order man,” Sura 96 (verse 1). In addition, of God. If this group obeys, then Over the last twenty years the new many Hadits or words of the Prophet make peace between them with jus- problems of an ethical character lay great stress upon respect for the tice,” Sura 49 (verse 9). which have been raised by advances individual, upon reflection and upon Thus do we find the principles of in biology and medical treatment thought: benefit, of not doing harm, and of have given rise to a large number of “No prayer is of the same worth justice in Muslim morality. These Muslim seminars and conferences. as reflection and contemplation.” principles are to be found in the var- These conferences have called upon “Woe to those who read and do ious oaths of the physicians who health care workers, men of reli- not understand.” have practiced in the land of Islam. gion, and men of law to find answers “An hour of reflection is better At the beginning of the Muslim era to these problems, answers which than a night of prayer.” the Muslim sages were highly influ- are in line with the Muslim Charia. Furthermore, we have seen that enced by Greek civilization in the reason is one of the fundamental el- development of their own form of 1. Family Planning ements of Islam. Islam has placed civilization. Some of the ethical Islam certainly encourages pro- great emphasis on freedom in ques- texts of the land of Islam may now creation but it also allows family tions of religious belief as well. be cited. planning under certain conditions. 84 DOLENTIUM HOMINUM

1.1. Contraceptive Methods thus obtained in placed in the uterus ited except if the life of the mother is The technique of coitus interrup- of another woman who returns it af- in danger. tus to avoid pregnancy is not forbid- ter nine months. This practice is for- den by Islam. Although this matter bidden by Islam.2-4 2. The Contemporary Develop- is not dwelt upon by the Koran, cer- ment of Genetics and Islam tain words of the Prophet (Hadith) 1.3. Sterilization Three principles of Muslim Ð Temporary sterilization as a authorize this method. morality enable us to find a solution contraceptive device is tolerated by The Kyas, or analogy, has al- to this question: respect for the in- Islam.2-4 lowed the Ammas to authorize con- tegrity of the human person, benefit, Ð Irreversible sterilization is for- and not doing harm. traceptive methods on the condition bidden by Islam unless it is aimed at that they do not damage the health defending the health of the person 2.1. Genetic Exploration and a of women; these methods are the who is to be sterilized. 2-4 Genetic Identity Card rubber sheath, the diaphragm, the 2 The genome defines a species and pill, and so forth. 1.4. The Voluntary Interruption of an individual. This is a specific print Pregnancy which enables an individual to be 1.2. Artificial Procreation We have seen that Islam com- Islam has insisted greatly on re- recognized. F. Ben Hamida has mands respect for the physical in- said4: spect for, and the defense of, ge- tegrity of the individual. 2-4 Ð Islam must approve the use of nealogical continuity and filiation. On the other hand, Islam believes The Koran says: genetic prints to establish the rights that the embryo is a human person of filiation. “God forbids adopted children from the one hundred and twentieth being considered as real children,” Ð Islam must also approve the use day of being in the womb. of genetic prints as evidence or Sura 33 (verse 4). The Koran says: “We trans- “Adopted children should bear proof of the guilt or innocence of an formed the sperm into a clot of individual (justice). the name of their father,” Sura 33 blood, and the clot of blood into a (verse 5). piece of shapeless flesh, to which we 2.2. Prenatal Diagnosis A Hadith of the Prophet says, gave bones with which it was The prenatal diagnosis of certain “Have a knowledge of your ge- dressed: this is a new creation. Give congenital malformations or inher- nealogies which enables you to be praise, therefore, to God the All- ited illnesses involves the question careful about ties of blood kinship.” Powerful,” Sura 23 (verse 14). Mo- of the voluntary interruption of In this way the Koran and the hammed said (Hadith): “The cre- pregnancy (see above). Sunna emphasize the need to ensure ation of a person in the womb of the that genealogical continuity elimi- mother goes through the following 2.3. Genetic Manipulation—Ge- nates the risk of incest and acts to stages: forty days in the form of netic Therapy (4) defend the patrimony of a family. earth, forty days in the form of an Genetic manipulation involves adhesion, another forty days in the the modification of a gene or the in- 1.2.1. Artificial Insemination form of a piece of flesh, and then troduction of a gene which affects This technique involves the direct God sends an archangel who places an organ or the whole organism. placing of sperm in the uterine cav- the spirit within it.” The modification of an organ ity when there is a case of conjugal This explains the stance of Islam through the genetic gene is tolerated sterility. It is tolerated by Islam as in relation to the voluntary interrup- by Islam if the aim involved is that long as the sperm which is used is tion of a pregnancy. The views of of curing an illness. that of the legal husband.2 4 the Aimmas on this point vary and at The modification of a whole or- 1.2.2. In Vitro Fertilization and times move between tolerance for ganism is officially forbidden by Is- Embryo Transfer abortion before the first one hun- lam because such an action amounts Here in vitro fertilization is in- dred and twenty days of pregnancy, to the modification of a divine crea- volved. An ovule and spermatozoa tolerance when there is good rea- ture. are gathered and placed together in a son, and total prohibition of the test-tube. The ovule is thus fertilized practice. 3. The Transplant of Organs by the spermatozoa. The present-day position of Mus- The transplanting of organs has After forty-eight hours this be- lim morality in relation to the volun- undergone a notable development ginning of the embryo is placed in tary interruption of pregnancy has over the last three decades. the uterine cavity. This in vitro fer- been summarized by Jel El Hakm, In 1990 the Second Congress of tilization is tolerated by Islam as the Mufti of Egypt:2 the Society for the Transplant of Or- long as the ovule which is fertilized Ð The voluntary interruption of gans of the Middle East was held in comes from the union of the ovule pregnancy is tolerated before the Kuwait.4 This congress encouraged of a wife and the spermatozoa of the hundred and twentieth day if there the practice of the transplanting of husband. We can thus see that the is a valid reason—that is, if the life organs and deemed it a good action giving of sperm is allowed by Is- of the mother is endangered or if (Hasana) and an act of almsgiving lam.2-4 the embryo has serious genetic de- (Sadaka). 1.2.3. Hired Motherhood fects which would prevent its sur- It should also be observed that the If a woman cannot bring a preg- vival after birth or which would be Council of Arab-Muslim Ministers nancy to a happy conclusion, but has transmitted to subsequent genera- has adopted a program on the trans- ovaries, one or more ovules can be tions. plant of organs. taken from her and then fertilized in Ð After one hundred and twenty The Tunisian law of March 25, vitro with the sperm of the husband. days of pregnancy the voluntary in- 1991 on organ transplants is close in After forty-eight hours the embryo terruption of pregnancy is prohib- character to the Kuwait proposals.6 VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 85

3.1. The transplanting of organs 1. Medical research on man con- mitment to reflection and thought is tolerated by Islam except when stitutes a part of research in general. (Ijtihad) of the Aimmas, the medical the reproductive organs are in- 2. Ethical rules for medical re- ethics of Islam have been easily volved—and this out of respect for search must be established. adapted to the new problems raised genetic continuity—or when the vi- 3. The ethics of medical research by the dual biological and therapeu- tal organs are the objects of trans- must be based upon the following tic revolution which we have experi- plant. principles: enced over the last thirty years. a) such research must be for the 3.2. Live Donors benefit of man; The transplanting of organs is Professor AHMED ZRIBI b) it must not harm man or soci- Director of the Department of Internal possible as long as the donor is an ety; Medicine and Infectious adult and has the full use of his men- c) it must conform to justice in the Diseases at the Rabta Hospital tal faculties and enjoys full legal sta- sense that research must not be car- in Tunis, Tunisia tus; he must also have freely and ex- ried out on one group (or class) to pressly consented to the donation of the advantage of another group (or Bibliography his organs. class); 3.3. Dead Donors d) it must involve total trust, both 1. The Holy Koran. 2. J, SEROUR AND A. OMRANE, “Guide des Organ donation can be effected as regards the creation of a project Normes Ethiques dans la Recherche sur la for scientific or therapeutic reasons of research and its implementation Planification Familiale dans la Monde from the body of a person as long as and the communication of the re- Musulman, Le Caire,” December 10-13, 1991, Centre International Islamique pour les that person, when he or she was sults of that research project and Recherches et les Etudes des Populations, alive, did not make known his oppo- their publication. Universit d’Al Azhar, Le Caire. sition to such an action, or as long as 3. J. SEROUR, “Bioethics in Biomedical Re- the following figures (assuming search in the Muslim World,” paper presented at the Workshop on Reproductive they bear full legal status) do not ex- Conclusion Health Research Methodology, Dubai, UAE, press their opposition, and in the fol- March 25-29, 1995. lowing order of importance: chil- The medical ethics of Islam are 4. F. BEN HAMIDA, Probleme de Biothique based upon the fundamental ele- et Morale Musulmane, Confrence (March 12, dren, father, mother, spouse, broth- 1995). ers and sisters, legal guardian. ments of the Islamic religion (the 5. J. BERNARD, De la Biologie l’Ethique The removal of organs for the Koran, the Sunna, the Kyas, and the (Hachette Pluriel, Paris, 1992). purpose of a transplant from the Ijmaa) and express the ethical prin- 6. “Loi relative au Prelevement et la Greffe d”Organes Humains,” Tunis Ð Journal Offi- corpse of a minor or a person of di- ciples accepted and promoted by ciel: Loi, no. 91 (March 25, 1991), Re- minished responsibility cannot take most of the medical doctors of the publique Tunisienne. place unless there is the prior con- world from the age of Hippocrates 7. L. PORTES, A la Recherche d’une Ethique sent of the legal guardian. to our days. Medicale, (Masson et Cie Editeurs, 1964). * Translator’s note: the translations from At the same time we have seen the Islamic texts are taken from the Italian 4. Therapeutic Obstinacy and Eu- that because of the tolerance and the version of the paper delivered to the Confer- thanasia liberal spirit of Islam and the com- ence. As we have seen, the defense of life is one of the fundamental principles of the Muslim religion. In Islam nobody is authorized to put an end to his days or to the days of another person, even if that person is afflicted by an incurable illness. Islam, therefore, prohibits euthanasia even if the sick person asks for it.

5. Medical Research The first five verses of the Koran, with their praise for the pen as an instrument of human science—that is to say of the civilization and the culture of man—constitute the very first revelation made to the Prophet Mohammed. Sura 96 (verses 1 to 5). This bears witness to the importance attributed to knowledge and research by Islam. The first international congress on ethical rules for research in the field of family planning in the Muslim world, which was held in Cairo, De- cember 10-13, 1991, laid down the following rules. 86 DOLENTIUM HOMINUM

ALESSANDRO BERETTA ANGUISSOLA

Language and the Dissemination of Medicine

Communication is a technique ship with the subject of his research is sider today’s world. Nowadays the which has to be learned. The question thus very complicated and intricate. It sick person and his family environ- of language and the structure of scien- does merely involve knowledge, it ment are not without a certain amount tific information is very complicated also touches upon ethics; it is not of biological or medical knowledge. and varies greatly according to the merely scientific, but it is, taken as a We have to recognize that the modern goals which are aimed at, and in par- whole, human (or humanistic to use means of mass communication have ticular in relation to the object-dimen- the term commonly in use in Anglo- brought a number of ideas and notions sion of the communication. Saxon countries). Indeed, it draws out of the ivory towers of the various This learning should be a part of the upon the values of existence not only academic disciplines and spread them process of training the scientific re- of the body but also of the spirit, not far and wide. We are faced with a searcher and thus of the medical doc- only of the individual but also of soci- widespread cultural context which is tor as well, who, after all, is first and ety as a whole. For this reason medical certainly elementary, disordered and foremost a biologist (even if he is not information has an especial impact and incomplete but which is nonetheless of only a biologist but something rather resonance. It has, that is, a very high a sufficient standard to pose questions, different). University teaching, on the “audience share.” But medical com- ask for clarification, and even at times other hand, as it is presently under- munication, precisely because of its in- raise objections which are by no stood within the medical training pro- ner complexity (its scientific, ethical, means groundless. We have, therefore, grams, is fundamentally based upon legal, ethical and social implications to ensure that the medical doctor criteria which are now obsolete. It is and consequences), is especially diffi- speaks and explains things (of course, the expression of an outlook which cult to absorb at a technological and in a natural and prudent fashion) and was imposed by the prestigious Ger- technical level. For this reason, it uses a language which is both clear man schools almost everywhere dur- would be a good idea to make it the and effective. The patient has the right ing the course of the second part of the subject of correct and rigorous study in to be informed about the nature of his nineteenth century. This model was university training programs. illness, about the procedures and the certainly based upon great method- For the sake of clarity I would like results of the tests to which he is sub- ological rigor but it does not supply a to divide—albeit in rather arbitrary jected, and about the treatment which sufficient response to the needs and re- fashion—the dissemination of medical he is to receive—treatment which is at quirements of a form of society which information into three categories: that times intensive and intrusive. This is has changed radically, and, of course, which touches upon the individual sick necessary to ensure that the patient only natural. One of the special aspects person, that which concerns the fam- consents to the action and proposals of of the new needs and requirements of ily, and that which involves the com- the doctor in tacit if not explicit fash- today’s world is the demand for infor- munity more generally. In all three ion, and there can be no real consent mation in the sphere of science and contexts the fundamental problem al- unless such consent is based on correct technology, and particularly in the ways relates to the question of lan- and suitable information. field of biology and medicine. guage. How would it be possible to in- At a practical level we have to rec- The insertion of new scientific facts form people without a language which ognize that such information when into the tissue of codified knowledge was suitable and particularly open and supplied by the doctor is very often in- is no longer adequate. The very “new- comprehensible? But in contrary fash- adequate both as regards the language ness” of what is learnt means that this ion each profession—and perhaps the used and in relation to the content of new knowledge must be disseminated medical profession does this more than the message. It often happens that in widely, especially when it destabilizes any other—uses its own technical and the wards and corridors of hospitals the previous conceptual framework highly specific language which can and clinics the communication be- and thus has a major impact upon ex- only be understood by members of that tween doctor and patient which should isting ways of thinking and acting. profession. Speaking and writing in a take place does not take place. There This is particularly true in relation to way which is clear and simple is never are, instead, hurried and vague expres- the world of medical research. easy and this is especially true when sions or incomprehensible technical It has been said that the medical we come to consider medicine. sentences. In addition, information is doctor is not only a biologist. It is man, The acquisition of this ability is of imparted especially by young doctors and in particular sick man, who forms the essence for the medical doctor, and which is unwise, disturbing, and pre- the subject of his studies. The relation- this is especially true when we con- mature. With family relatives as well, VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 87 information is often sparse or non-ex- vital importance to everybody at all istent. Perhaps a few moments, stand- stages of life. It is certainly true that to- ing up, and communicated in public. It day’s society behaves in an irrational is almost as if by the very fact of being way in relation to health, yet docu- a patient in a ward (where perhaps he mented and objective information has been placed because of the avail- about prevention, if presented with ability of bed-space and where he does correct and effective language, could not know anything about the health in the long run obtain great results and care workers or the environment more help to change forms of behavior generally) the doctor who is to treat which are damaging to health. One him has a kind of carte blanche in re- need only think here of the very great lation to his case. It is almost as if the successes which have been achieved in doctor is not obliged to give the patient the campaigns against smoking in the information about his condition or Anglo-Saxon countries through health treatment and particularly is not re- education. Or of the very close rela- quired to obtain his informed consent tionship between man and his environ- to the decisions which will be taken on ment and of how useful it would be to to how to treat his condition. But the provide widely disseminated informa- communication of information is not tion in this very important area. But the only a necessity. If well managed in dissemination of information amongst relation to its language and its content non-experts is difficult and—as has it can be a subtle art of extraordinary already been observed—either one has effectiveness in the humanization of it in one’s blood or one does not, and the relationship between the patient this is also true of scientists and re- and the doctor. It can also be of very searchers. It is very easy to fall into great help in the actual treatment of the even major errors out of an excess of patient. enthusiasm or because of the wrong The spread of medical ideas and use of language. For example, one of concepts within the community at the most common errors is to be found large is quite another matter. It has alin the so-called use of metaphorical ready been observed that there is a language. The use of metaphors drawn high level of audience share for med- from the environment which sur- ical information and news on televi- rounds man, for example the compari- sion, on the radio and in the press. In- son of the human organism with a ma- deed, we here touch upon one of the chine, however complicated they may forms of popularization of information be, is a method of popularization which has the greatest success in to- which is very mistaken. Man is not a day’s world. The popularization of in- machine, he is homo sapiens. The formation does not of itself mean infe- medical doctor is not a mechanic who rior, rough or superficial communica- mends broken parts: he is a conscience tion. It merely means—as Escarpit ob- in whose hands trust is placed. serves—the putting into circulation of A popularization of information in scientific and technical information for relation to medicine which does not al- the benefit of non-experts. If this is ef- ways present the humanistic side to re- fected with clear and comprehensible alities gives credence to the worry that language which is free of technical modern medicine is becoming poorer terms but scientifically rigorous in in human terms in a way which is cor- character (that is, absolutely exact in related to the pace of its technological what it communicates), then the popu- advance. As its analytical knowledge larization of medical knowledge of the mechanisms of disease grows which is prudent and discreet, and ever greater, medical science runs the lacking in any element of advertise- risk of losing sight of its real concern, ment or of self-advancement, is clearly the sick man. If in addition it does not a vital and necessary feature of the manage to stop what has been termed health education of the population. In- the “hemorrhage of the soul,” it further deed, for these reasons it should be fur- runs the risk of failing in its goals at ther developed and, above all, better precisely the moment when it has directed. reached the high point of its scientific The television in particular could re- knowledge. This is why the correct ally “educate” if it were oriented not dissemination of information can per- only towards providing information on form a function in today’s world debates and interviews about human which is of incomparable value. illnesses and their treatment but also towards directly “informing” the pub- Professor ALESSANDRO BERETTA lic about the great questions of preven- ANGUISSOLA tion (an endless and essential area of President of the Italian Institute information)—questions which are of of Social Medicine 88 DOLENTIUM HOMINUM

MASSIMO BALDINI

The Doctor-Patient Relationship in Medical Textbooks and Manuals of the Eighteenth and Nineteenth Centuries

“The choice of the doctor vice which Ehrlich gave to his tion. During the nineteenth century must be based upon his pupils (“work hard, publish little”) the phenomenon of specialization good moral and personal is no longer followed by people ac- within the world of doctors began to qualities, or upon his tive in the world of research.2 emerge; during our century it has knowledge and skill. This “Big science” is the science of become widely rooted. The phe- means upon bases which specialists and specialties, the sci- nomenon of specialization is at the inspire trust and confidence ence of those scientists who deal same time both a negative and a because without such ele- with very sophisticated knowledge positive phenomenon. It does in- ments the sick man will in ever narrower spheres of reality. deed allow our scientific knowledge adopt a wrong or mis- “Big science,” as distinct from “lit- to advance but at the same time it guided attitude towards tle science,” is strictly linked to the undermines the organic character of himself or towards the doc- world of production. In other science and leads us to lose sight of tor.” words, as industry became more overall patterns and realities. ÐSalvadore Mandruzzato scientific, science itself became Thirdly, “big medicine” is not more industrial in character and ori- only a kind of medicine which tends entation. to a loss of the relationship with the 1. “Small Medicine” and During the nineteenth century patient as a psychophysical unit be- “Big Medicine” there was a passage from “little sci- cause of the above mentioned spe- ence” to “big science” and at the cialties, but it also involves a bu- In the twentieth century science same time in parallel fashion there reaucratization of relationships with and the work of scientists have un- was a transition from “little medi- the patient. The medical doctor, that dergone great changes. Indeed, dur- cine” (that of such figures as Redi is to say, tends to forget that the ing this century we have passed (to or Murri) to “big medicine.” The most important medicine is he him- use an expression favored by De medicine we have before us now self and he increasingly becomes a Solla Arice)1 from “small sci- has certain key features which en- “cold blooded vertebrate”, a sort of ence”—science characterized by sure that it is radically different gray and tired bureaucrat. isolated researchers financed by a from medicine as it was practiced The move from “little medicine” patron or out of their own pockets until the first decades of the twenti- to “big medicine” has had major and engaged in experiments and ob- eth century. consequences for the role played by servations, science that is to say as In particular the practice of medi- the medical doctor within society, it was at the time of Galileo and at cine has been marked by a massive for his prestige, and also for his de- the beginning of this century—to technological change operating at a ontological and ethical duties and “big science”, that is to say the sci- general level. The positive conse- obligations. If knowledge is power, ence of a research team, a form of quences of this transformation are as Francis Bacon said, then it is ob- science which requires large and obvious to all, although it must be vious that the more medical knowl- substantial economic backing. pointed out that the negative aspects edge expands the more complicated In “big science” the figure of the are not always readily appreciated. become those ethical and deonto- amateur scientist or researcher dis- There is a risk, for example, that the logical problems which the practi- appears. This was a figure who for medical doctor will end up by be- tioners of the art of medicine are the whole of the eighteenth century coming the appendix of a techno- called upon to deal with in the exer- and for a large part of the nineteenth logical instrument and will engage cise of their profession. This is so century made substantial contribu- in a kind of theoretical passivity. In real a phenomenon that at the begin- tions to the advance of scientific other words, there is the risk that ning of the 1980s Stephen Toul- knowledge. “Big science”, on the technological progress will cause a main, a famous epistomologist of other hand, like much other activity progressive decline of real medical the English language, was lead to of the end of the second millennium action within the medical class. observe that the biomedical sci- is crowded and rapid in pace. The Furthermore, “big medicine”— ences had brought ethics back to man of science of today’s world like “big science”—has been very life. In his opinion, indeed, thought lives in a situation which has be- much marked during the twentieth in the ethical field had been in a come strongly competitive. The ad- century by the birth of specializa- state, so to speak, of suspended ani- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 89 mation for a number of decades and De Filippi wrote: “I hope that this their merits and sacrifices and seek- had been progressively marginal- textbook will also fall into the hands ing “to inform civil society about ized within cultural debate. Ad- of people outside the art of healing, how doctors should be seen”7. vances in certain branches of scien- and that it deserves to be seen by “Who is a medical doctor?” tific knowledge, and above all in everybody who is connected with asked Giuseppe De Filippi in biomedical disciplines, acted to physicians. I would venture to say rhetorical fashion. He is a man, he draw experts in ethics out of the that if the medical doctor can find answered, who “spends his time in ghetto in which they had been pre- useful advice in this book, then so- the most severe processes of learn- viously placed. ciety may be able to find a splendid ing; is subject to all kinds of priva- truth which will illuminate it in relations; spends his nights awake; tion to the role and character of spends time in hospitals and with 2. Textbooks and Manuals medical doctors and medicine.”6 corpses engaged in activity which is for Doctors and for Patients The causes of the proliferation of more tiring than any other form of writings of this kind and character human activity. Trained in the prac- In the works of many physicians are manifold and emerge more tical exercise of his profession, he from the days of Hippocrates to clearly if we take an overall view of embraced the mission of offering contemporary times, we usually himself at all times as a voluntary find reflections and ideas of a deon- victim for the public good. It is the tological character. However medical class that can really boast greater emphasis has been given to the qualities of heroism and cold such matters when the role of the courage, something which all the doctor has experienced moments of warriors in the history of the nations crisis, and at the beginning of the could not put into the field.”8 nineteenth century this emphasis became very marked indeed. In the b) The Development of the years following the French Revolu- Conscience of the tion a complicated and difficult Medical Class process began which sought to re- define the professional figure of the Given that doctors were for the doctor, his knowledge, and his role most part surrounded by a general within society.3 lack of admiration and prestige, and For the whole of the nineteenth given that a great many unflattering century in Italy and in other Euro- things were said about them, these pean countries there was a flow of works sought to disperse the demor- tracts, academic monographs, cate- alization which pervaded the practi- chisms, and textbooks, not to speak tioners of the art of Aesculapius by of dissertations aimed at defining emphasizing their social impor- the qualities of the ideal doctor. tance and instilling a more deeply These writings were couched in dif- rooted awareness of their own pro- ferent tones. the various goals of these text- fessional status. They were polemical, apolo- books—goals which are not usually During the first part of the nine- getic/propagandistic, or moralistic) considered in isolation but are ana- teenth century medicine found itself and from their pages emerges, in the lyzed within a more general hierar- in a deep crisis of capacity—the words of Maria Luisa Betri, “the chy. successes in the field of bacteriol- image of a medical class which was ogy were yet to take place. How- disorientated, weakened and lacer- a) The Apologetic/Propagandistic ever, and even though methods of ated by internal conflict, almost be- Function of these Works treatment were still largely ineffec- sieged by the medusa head of char- tive, medical knowledge was ac- latanry, the subject of acrid popular Between the end of the eigh- quiring revolutionary new tech- satire or the skepticism of the edu- teenth century and the first decades niques by which to examine the sick cated classes. At the same time, of the nineteenth century, the figure body: “the percussion invented by however, this medical class was of the doctor was surrounded by dif- Avenbrugger, the stethoscope in- aware of the need to achieve new fidence and suspicion, hostility and vented by Laennec, and the doctrinal cohesion, to adapt practice rejection. In order to create new pleximeter invented by Piorry.”9 to unifying principles, to uphold trust in the abilities of the medical Upon the basis of such minor scien- and defend the dignity of the profes- class, in order to obtain legitimation tific steps forward, and fired by sion, and to defeat illegal practice.”4 by the state and by patients, a num- faith in the advance of scientific These were works directed first ber of textbooks and catechisms knowledge, the various writers de- and foremost at young doctors who were published in addition to tracts scribed above sought to give new were taking their first steps in their and introductory lessons to univer- coherence to the medical class, a profession but at times they were sity courses, and all of these publi- professional category which at that also directed towards “every class cations were full of praise and ad- time was largely distrusted and of educated person.”5 And in those miration for the work of medical largely divided into conflicting and works addressed to doctors one can doctors. These works had the func- factious schools. also read the secret hope (between tion of being apologias or propa- In this sociocultural context the the lines) that the pages would be ganda and they sought to restore the following statements contained in a read by non-specialists. Giuseppe credibility of doctors by praising famous and successful work by 90 DOLENTIUM HOMINUM

Roberto Sava (On the Qualities the din that they make manages to body”)16; drew attention the very and Duties of the Physician) had attract the attention of observers bad conditions of the doctor’s life the function of calling upon doctors and the curious—they are like great (he spent the best years of his life to unite in the defense of the value beetles noted for their size and “in the infected air of hospitals”)17; and the importance of their art: strange shape.”13 emphasized his efforts and his ini- “Because of the dignity of his pro- tiatives; and concluded by observ- fession the doctor finds himself in d) The Function of Being ing that “civil society” had to be fair the front ranks of society.”10 And Polemics Against and recognize the value of the art of he continued: “The doctor knows the Detractors of the Profession medicine, and thus allow the doctor no profession which is more noble to sit “in the human hall at that than his and there is no position The doctors felt themselves be- place which the importance and the higher than his. The most powerful sieged by their detractors. They nobility of the profession has raised sovereigns give up their days to were the butt of the sarcastic com- him.”18 him and blindly obey his orders. A ments of “philosophers and poets” great medical doctor is the first of but they were also criticized by the e) The Deontological Function men: by means of the advances he sick and their relatives who often of these Writings makes to improve the art of healing, the physician becomes the Between the eighteenth and benefactor of mankind. And be- nineteenth centuries medical stud- cause of his rule in relation to death ies underwent a profound transfor- he is to a certain extent the image mation. First of all, the medical of the divine on earth. In the exer- profession had acquired those cise of the functions of the doctor “practical and theoretical features are to be found all the virtues. His which made the figure of the med- ministry commands the respect of ical philosopher obsolete, a figure men and attracts the admiration of separate from and in opposition to the wise.”11 the surgeon or the phlebotomist. In the new state of affairs actual abil- c) The Function of Being a ity at the bed of the patient, which Polemic against Charlatans had previously been delegated to a and Medical Charlatanry hierarchy of subordinates, now acquired a new character and a new At the beginning of the nine- importance.”19 Secondly, members teenth century all the authors of the of the middle class or the lower above mentioned works implicitly middle class began to enroll in the attacked, or more frequently explic- medical faculties of the universi- itly attacked, the charlatans. With ties. These classes had previously “great courage and marked con- supplied most of the recruits for stancy,” the doctors were called the professional bureaucracy much upon to fight “money-makers,” “de- needed by the emergent liberal ceivers,” “quacks,” and “frauds.” In accused them of “slanderous state. this battle against impostors in the crimes.” Many academic dis- The medical faculties, therefore, realm of medicine, the sons of Aes- courses, like that given by Em- became ever more crowded for the culapius also formed a front against manuele Basevi in 1826, sought in times (“the medical studies are al- “medical charlatanry.” That is to very real terms to demonstrate that most besieged by people” wrote say against those attitudes and prac- the science of medicine really ex- Ranzi)20 and the obvious result of tices of their professional col- isted and to make clear that doctors this was that there was a lowering leagues which were too near the ac- were both useful and necessary14. of standards in relation to medical tivities of the charlatans. Against the detractors and against training and formation. The art of Sava observed that there were all those who were ready to chas- Aesculapius thus became filled many similarities between charla- tise the doctor “with wrongful ac- with new men who did not have a tans and insects: “like insects char- cusations, with prejudices and er- medical doctor or a chemist as a latans are everywhere to be found rors of all kinds, with incompetent member of their family, and be- acting in partnership; they often and erroneous judgments, with de- cause they did not have a family change their shape and form and rision for his learning and with vil- tradition behind them they required take on a thousand guises. Some ification of the art that he pro- a very careful training in relation to seem to have wings like butterflies fesses,”15 an initiative was taken of ethics and professional codes of and these are the qualified charla- a public relations character, some- practice. tans who have reached very high thing which was unique in the his- Many works of experienced doc- positions. Others are like bedbugs tory of medicine. tors were directed towards making which are recognized by their bad Many authors and authorities clear the character of the profes- smell and always have foul stressed the long periods of study sional code of conduct of the pro- smelling breath. Others live out which doctors had had to engage in fession or even the basic rules of their sad existence and like mites (“a doctor who loves learning has good behavior to which doctors seem to be almost invisible. Others languished for fifteen years in the should adhere. The medical manu- shine forth in full day, inhabit great schools and the colleges of anatomy als and textbooks took a clear posi- drawing rooms, and the noise and and the study of the human tion against the decadence of a pro- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 91 fession which had become a “a very g) The Function consensus necessary to the success low trade,”21 against the “hungry of Educating and of the medical profession. vampires” and “newly emerged lit- Training Patients tle know-it-alls,”22 the adventurers with a thirst for gold. the “idle and During the nineteenth century an 3. The Relationship Between ignorant physicians,” the “wild increasing number of people turned the Medical Doctor practitioners,” the “business doc- to doctors in repeated fashion. Ever and the Patient tors” and the “deceivers of the larger section of the population—at sick.”23 They also listed the basic first the middle class, then the lower In the textbooks and manuals for characteristics of what they consid- classes, and much later, outside the doctors and patients rules were out- ered the ideal doctor. This was a by towns and the cities, the workers of lined aimed at creating a correct and no means easy task, not least be- the countryside—knocked at the effective relationship between the cause it involved attacking profes- doors of the medical profession. doctor and his patient. The doctors, sional vices which had become Furthermore, and here indeed there it was argued, should be “charita- strongly rooted over time and which was a break with the past, patients ble, prudent, secret and modest.”29 had become even worse because of who were not in very difficult con- They had to treat “the sick with the increase in the number of people sagacity.”30 The doctor, Macappe practicing the craft. However, it goes on to say, should not be “too was an important battle because, as severe or easy with the patient be- A. Dechambre pointed out: “the cause excessive severity provokes dignity of the art of medicine and the hostility of the patient and ex- the duties of the doctor are closely cessive easiness generates mis- connected.”24 trust.”31 The doctor must have “an attitude made up of courtesy, seri- e) The Methodological Function ousness, and readiness to help”32 if of These Textbooks he wants to gain the trust, the es- and Manuals teem,and the respect of the sick people he deals with. The authors of these medical Patients, for their part, were in- textbooks and manuals and the var- vited to avoid being gullible or ious tracts on professional conduct loving marvels because such an sought to give elementary advice in approach would lead them to pre- matters relating to method to doc- fer “charlatans and charlatanry tors, nearly all of whom lived in wherever they may be found.”33 “poverty or humble mediocrity.”25 Furthermore, the ideal patient Doctors also had to compete for pa- should “employ diligence in the tients with ignorant charlatans who use of medical prescriptions”34 and were nonetheless cunning and ener- should never try to “deceive the getic, and perhaps because of the doctor with false descriptions of precarious economic condition of the use and consequences of the their families had taken “exams ditions of health were taken to doc- medicines prescribed to him.” (35) which were never severe.”26 tors for consultation. Indeed, “whoever deceives a med- This advice was concerned with Many enlightened doctors thus ical doctor offends himself and his how to put questions to the patient, began to write manuals and text- neighbor.” how to study their case histories, books expressly for patients in or- All the authors of these manuals and how to prescribe medicines and der to achieve their cooperation and and textbooks lay especial stress drugs. These works emphasized their consent to the project of direct- upon problems connected with that it was very important not to fall ing the sick towards the “helpful communication between the doctor into a sort of “plying of a trade” that medical doctor” and not towards the and his patient. Coletti writes that is, a mere “mechanistic practice” of “actual impostor.” In reality, many the doctor should “let speak rather the medical profession, as usually of these publications also contain a than speak himself; listen to what happened in the hospitals of the message of the “I tell you daughter- is not relevant and only say what is time. In order to avoid becoming in-law because I am your mother- really necessary”36. In another “doctors of routine,” victims of in-law” kind. aphorism he declares: “the doctor sluggishness of the spirit, great Indeed, although these works are should enter the room of the sick stress was placed upon the need to addressed to patients they also acted person in a careful and not hurried keep up with medical developments to criticize doctors and thereby cor- fashion; he should speak rather and progress. Medical doctors were rect their worst characteristics. The than declaim, ask questions and not also invited to be careful about authors of these publications be- suggest.”37 adopting systems (“at the bed of the lieved that if people were suffi- The eloquence of the doctor, Del patient preconceived ideas should ciently educated they would escape Chiappa asserts, must be “ingenu- not be operative; eyes must be kept the clutches of the quacks and ad- ous, upright, and noble”38 but also, from being blurred by systems,” in venturers, they would be critical in and first and foremost it must be the words of De Filippi).27 They their approach, they would cooper- “clear and limpid.”39 The medical were also reminded that “the doctor ate with doctors in describing their doctor, that is to say, must “explain determines practice just as practice symptoms and case histories, and and reason with such clarity and makes the doctor.”28 they would help to produce a social simplicity that the force of what he 92 DOLENTIUM HOMINUM

says is fully perceived. Everybody dients bearing unusual and strange 9. R. SAVA, Sui Pregi s sui Doveri del should be able to understand the names.”47 In Del Chiappa’s opinion, Medico, op. cit., p. 154. meaning of what he says, and in order to avoid behaving like a 10. Ibid., p. 10. 11. Ibid., p. 11. everybody should be convinced mountebank or quack the doctor 12. Ibid., p. 113. and struck by the rightness of what had to abandon “that scholastic lan- 13. Ibid., pp. 105-106. he says. He should not in the least guage created only by pedants and 14. Cf. E. BASEVI, ‘Degli Uffici del Medico’, in Giornale Critico di Medicina employ that technical vocabulary well designed to conceal the igno- Analitica, 1826, II. infected by inappropriate Greek rance and mediocrity of certain doc- 15. G. DE FILIPPI, Nuovo Galateo Medico, terms or softened by vulgar tors. But it is not sufficient for the op. cit., p. 5. phrases.”40 doctor to employ clear and clean 16. R. SAVA, Sui Pregi a sui Doveri del Medico, op. cit., p. 30. In truth, one of the causes of the language in a way that any noble 17. Idem. diffidence with which doctors were artist would. Nothing that he says 18. G. DE FILIPPI, Nuovo Galateo Medico, held by patients was to be attrib- should be sophisticated or mysteri- op. cit., p. 159. 19. MARIA LUISA BETRI, Il Medico e il uted to the obscurity of the lan- ous. This would be a sign of a lack Paziente: i Mutamenti di un Rapporto e le guage they used, their “empty lo- of skill and competence, and per- Premesse di un’Ascesa Professionale (1815- gomachy.”41 It was difficult for pa- haps of a corrupt or bad heart, vices 1859), op. cit., pp. 217-218. tients, and even educated patients, which should be avoided to the very 20. A. RANZI, Delle Principali Cagioni Che Portarono la Decadenza dell Professione del to find major differences between utmost because they are de- Medico, (Florence, 1851), p. 23. 48 the language used by real doctors testable.” 21. O. TURCHETTI, Dell’Influenza delle and the language used by charla- And after observing that the word Scienze Mediche sull’Incivilimento ed il Ben tans—both forms of language were of the doctor is the first instrument Essere dei Popoli e dell’Attuale Infelice Condizione dei Medici, (Pistoia, 1839), p. rather impenetrable. with which he “combats” illness, 56. If doctors wanted to distinguish this author once again criticized 22. D. B. G. R., Galeteo di Un Morto e themselves from the charlatans they those doctors who speak in an ob- Commenti di un Vivo Ossia il Galateo dei Medici, (Placido Maria Visaj, Milan, 1829), had to find a language which was scure fashion. “If a doctor is a char- p. 22ss. effective and translate their con- latan, declares Menandrus, then he 23. G. DE FILIPPI, Nuovo Galateo Medico cepts into a form which was not is a new affliction for the sick man. Ossia Intorno al Modo di Esercitare la Med- alien to their patients. In other A doctor who has a grotesque or icina, op. cit., p. 73. 24. A. DECHAMBRE, ‘Déontologie’, in Dic- words, they had to engage in differ- mysterious way of speaking imparts tionnaire Encyclopédique des Sciences Med- ent linguistic practices to those of a new and even worse illness to the icales, (Masson, Paris, 1882), t. 27, p. 489. their predecessors. patient. Whereas the first with his 25. S. DE RENZI, ‘Sui Mezzi di Migliorare l’Educazione Medico-Chirurgica in Italia’, In his cynical aphorisms of a po- tricks can at times displease some in Corrispondenza Scientifica in Rome, litical/character, Alessandro Knips people, the second, by speaking in (1847), p. 15. Macoppe had already railed during riddles, pleases no one and irritates 26. R. SAVA, Sui Pregi e sui Doveri del the eighteenth century against those and sickens everybody.”49 Medico, op. cit., p. 26. 27. G. DE FILIPPI, Nuovo Galateo Medico “doctors who employ pompous ex- Ossia Intorno al Modo di Esercitare la Med- pressions, declare themselves all- Professor MASSIMO BALDINI icina, op. cit., p. 139. knowing, and use a language which Professor of the History of Philosophy at 28. Ibid., p. 68. cannot be understood by ordinary the University of Perugia, Italy 29. L. PETRINI, Galateo de’ Medici, (Ti- 42 pografia Grossiana, Aquila, 1924), p. 18. people” and had advised his col- 30. A. KNIPS MACOPPE, Centum Aphorismi leagues not “to tolerate ways of ex- Medico-Politici, in popular form by Tito pressing oneself which can be Berti (Casamassima, Patavii, 1991), p. 35. found in the mouths of charlatans 31. Ibid. 32. Ibid., p. 67. and impostors. Notes 33. S. MANDRUZZATO, Galateo Pegli Am- He who uses such language seeks malati, (Stamperia Mazzoleni, Bergamo, 1. CF. D. J. DE SOLLA PRICE, Sociologia 1821), p. 19. to deceive the sick and not to cure 34. 43 della Creatività Scientifica, translated by Ibid., p. 23. them.” However a few lines previ- Roberta Rambelli, (Bompiani, Milan, 1967). 35. Ibid. 2. ously he had expressed the view CF. R. K. MERTON, La Sociologia della 36. F. COLETTI, Galateo de’ Medici e de’ that the doctor should “always be Scienza, edited by M. Protti, (Angeli, Milan, Malati, (Padova, 1853), p. 13. 1981). 37. Ibid., p. 16. ambiguous in formulating judg- 3. On this question see the following 38. G. A. DEL CHIAPPA, ‘Dell’Eloquenza ments about the future course of the works: MARIA LUISA BETRI, ‘Il Medico e la del Medico’, in Del Chiappa, Raccolta di illness,”44 that is to say that he Paziente: i Mutamenti di un Rapporto e le Opuscoli Medici, (Tipografia di Pietro Biz- should get over the problem by Premesse di un’Ascesa Professionale (1815- zoni, Pavia, 1828), vol. 1, p. 107. 1859), in F. della Peruta (ed.) Malattia e 39. Ibid. “formulating vague previsions in Medicina, Einaudi, Turin, 1980), (History of 40. Ibid. the style of the prophecies of the an- Italy, 7), pp. 209-232. Ibid., ‘La Crisi del 41. G. Giacomini, ‘Riflessioni Intorno al cient sibyls.”45 Ruolo Medico. I Galatei dell’Ottocento’, in Linguaggio dei Medici’, in Memoriale della This ambivalent approach which Federazione Medica, 1987, XL, 7, pp. 685- Medicina Contemporanea, 1840, vol. III. 688. 42. A. KNIPS MACOPPE, Centum Aphorismi oscillated between a real wish to 4. MARIA LUISA BETRI, Il Medico e il Medico-Politici, op. cit., p. 55. promote clarity and the need for a Paziente: i Mutamenti di un Rapporto e le 43. Ibid. lack of disclosure was slowly aban- Premesse di un’Ascesa Professionale (1815- 44. Ibid., p. 37. 1859), op. cit., p. 209. 45. Ibid. doned in the first decades of the 5. See R. SAVA, Sui Pregi a sui Doveri del 46. R. SAVA, Sui Pregi a sui Doveri del nineteenth century. The good doc- Medico, (Martinelli, Milan, 1845). Medico, op. cit. , p. 101. 6. tor, it was observed at the time, G. DE FILIPPI, Nuovo Galateo Medico 47. G. DE FILIPPI, Nuovo Galateo Medico should not use “bizarre and strange Ossia Intorno al Modo di Esercitare la Med- Ossia Intorno al Modo do Esercitare la Med- 46 icina, (Pasquale Pagni, Florence, 1839), p. icina, op. cit., p. 26. jargon;” and he should not “pre- 48. 15. G. A. DEL CHIAPPA, Dell’Eloquenza scribe medicines and cures involv- 7. Ibid., p. 12. Medica, op. cit., p. 108. ing a whole range of unusual ingre- 8. Ibid., p. 7. 49. Ibid., p. 130. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 93

DOMENICO DI VIRGILIO

The Doctor: A Man for All

Introduction fact or in a possible future, has many-faceted surface of a diamond, need.... Called to defend life, the doc- hopes and anxieties and the torments “The Doctor: A Man for All” is the tor more than any other knows the and the calm of human suffering are subject of my paper and it is certainly fragility of man and at the same time refracted, but at the same time friend- unusual. We might also say that it is perceives that spring of hope whose ship and respect, trust and admira- an idea which is not often thought intense longing is often entrusted to tion, expectations and hopes, are also about, and perhaps which is new for the responsible exercise of his pro- all fused. most of us. This is because although fession.... And the “man who is a doctor,” the figure of the medical doctor has If the doctor is a man for every- despite the centuries-old events of been analyzed, indeed considered in body he is also a man whom every- the human experience, remains un- all its various aspects ranging from body should get to know better."1 known. This is because in the great- the scientific to the professional and And if we go back in time we can est and most beautiful events he from the historical to the artistic, see that in the Iliad one of the heroes bears within himself the mysterious what I will seek to do today is to of that poem by Homer utters a sen- sign of cooperation with the Creator stress that it has received very little tence which is indeed very signifi- himself in the preservation of life. attention in scientific assemblies and cant: “The doctor is a man who is literature. Unless, that is, you have worth many men.” not had the opportunity to hold in The medical profession has al- 1. A Man First and A Scientist your hands a copy of a book of over ways placed itself at the service of Second: The Response to a Call two hundred and fifty pages which man, although obviously enough it was published in 1972, but which is has done this with the limitations im- What leads a young person to be- not now to be found. That book was posed by the environment and by the come a “medical being"? And what written by the then Monsignor various cultures of different peoples. is the “formation” of this profes- Fiorenzo Angelini and bore the title Because the service rendered by sional during the years of university of this paper. I could perhaps stop medicine affects men in what they and then, in constant fashion, during here and ask you to read it. You share more than anything else, his professional life? would find it a complete, interesting, namely pain and suffering, the med- It is certainly true that the wish to and incisive work which discusses ical doctor can in a very real sense follow the example of a family rela- the medical doctor from this point of find in his vocation and in the exer- tive is frequently evident. A yearning view in a very special way. It precise of his profession an edifying im- for a position of prestige and respect sents us with an unknown face of this pulse which allows him to express within society is also often influen- professional figure which over the himself beyond the most difficult de- tial. But this certainly does not con- centuries, and long before Hip- feats and trials. stitute the most important motive for pocrates, had and has had a unique For this reason this very special the choice of a profession which has and irreplaceable role in the life of professional figure has been an inte- at its base the ability to respond to every individual. gral part of the human experience needs which are full of ethical value And the introduction to this sub- during the history of the whole of and of suffered solidarity, needs ject, which in the few minutes avail- mankind. This is true whether he has which must find within the soul of able to me I will seek to present more been a magician or a wizard, a medi- the young person that readiness to in terms of images than through a se- cine man, a priest or a scientist. The help which rises above the techno- ries of logical steps, is dedicated to a figure of the doctor has involved a logical and scientific aspect of his presentation of this book: “Those special charisma invested with an training and formation. who have had the opportunity of ha- aura of mystery, but above all else it Thus it is that the years of study bitual contact with the medical world has been an inevitable point of en- are a crucial and delicate moment for and its constant relationship with the counter between the needs of the suf- university teachers who should en- world of suffering, well know— fering man and the healing powers of sure that the sole goal aimed at is leaving aside factious or partisan per- an individual who is always a man constantly evident, namely service to spectives—that the medical doctor is but at the same time is always en- man. There is thus a need to know and remains a man for everybody, a dowed with special powers. Thus it how to link technological and scien- man of whom everybody, in actual is that in the medical doctor, as in the tific notions with the human require- 94 DOLENTIUM HOMINUM ments which are indispensable to the guides in their lives. posed by society and by the rules of successful creation of that relation- To state the point in general terms, the profession. But even in the most ship between doctor and patient the formation and training of the unfavorable and depersonalizing which is the forerunner to success in medical doctor should not confine it- conditions the medical doctor re- every action and work of treatment self to scientific matters alone but mains a man who places his intelli- and care. should also be directed towards the gence, his culture, his sensitivity and In the post-modern era in particu- formation and training of the individ- sensibility, and his heart, at the ser- lar, with this frenzied technological ual himself. “We should thus ensure vice of another man who suffers. progress, and much more than in the that the doctor and before him the And the more conditions become past, there is an especial need for uni- student have a full awareness of the difficult and even critical, the more versity teachers to dedicate them- triple dimension of professional there is a need for the medical doctor selves to the formation of a “profes- competence which does not only to recover and rediscover within sional conscience.” consist of knowing and knowing how himself that freshness and vitality Indeed, it is daily demonstrated which will one day guide his choice that where this formation has been and his initial vocation. neglected during the years of university study or during the first years of the practice of the profession, it is 2. A Man at the Service of his very difficult to acquire that forma- Brothers and Sisters tion in the years thereafter. "The scientific and professional "Who is my neighbor?” skill of the medical doctor in itself is It has often been said that mankind not enough to create an interpersonal passes through the hands of the doc- relationship which is authentically tor without discriminations of any human.” The future doctor must be kind and with a total abandonment forged in qualities which will let sustained by the conviction that a loose talents which are necessary to man will be encountered who will his profession, such as: know how to understand, share and An ability to listen which acts to take part in his requests for health— create a climate of trust, acceptance capable, that is to say, of “taking care and welcome which in its turn proof him in a moment of a very special motes a close link between the two kind where the doctor has to pay at- key elements in medical practice; tention to the uniqueness and unre- empathy, the ability that is to say peatable character of the suffering to put oneself in the shoes of the sick person. An encounter between trust person and accompany him in emo- and conscience, the trust of man tional terms as well during the course marked by suffering and by illness of his illness; and therefore in need. This man en- sympathy, the ability that is to say trusts himself to another man who to tune into the patient and enter into takes his need upon himself and goes his feelings and his state of mind, but towards him so as to help him, treat at the same time always maintaining him, and heal him...this needs love, a suitable distance from his inner readiness to help, attention, under- condition; standing, sharing, benevolence, pa- respect for the other person, some- tience and dialogue."3 thing which involves accepting the It seems on the other hand para- sick person for what he is and not for doxical that it is precisely at the mo- what we would like him to be; to do things but also of knowing how ment when we have before us the awareness and respect for those to be. This means a capacity for rela- most spectacular successes of medi- moral values which determine the in- tionships, for understanding the cine that the traditional and funda- terior goodness of the individual."2 value dimensions which underlie the mental figure of the doctor is ever But over the last decades, at least human being, for respect for life, for more bowed and weakened. This fig- in Italy, the human and ethical for- an adequate psychology, for “friend- ure is increasingly called into ques- mation of the medical doctor has ship towards man.” As an old apho- tion because of the ever greater im- been neglected and this a has created rism of the Hippocratic school de- pact of technology, a diminishing a “vacuum” which at one time was at clared: 'Where there is love for man presence of “humanity,” and his ap- least in part filled by the human there is also love for art (medicine).'” parent transformation into a user of teachings of the young doctor's prin- Today, however, the feeling of technology and standard actions cipal guide. This figure is by now personal dedication to one's fellow which are separated from their indis- someone who almost belongs to the men runs the risk of becoming pensable ethical content. The risk of past, but when present he was not clouded in the conscience because of this is that the relationship of trust only a source of scientific knowledge the obstacles which can place them- which has acted as the fulcrum of the but also of behavioral and human selves between the spirit of the med- medical art will be put into a state of wisdom. The old masters in the daily ical doctor and the spirit of the pa- crisis and that these two poles instead life of the hospital experience not tient. These are obstacles which are of interacting will end up by not un- only helped young doctors to grow in prevalently of a technical and tech- derstanding each other or finding a scientific sense but also acted as nological character which are im- themselves in opposing and opposed VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 95 positions. Why is this so? Why? thinking can assist both believers and that we are listened to, we feel the Allow me, as well, to refer to the non-believers to help man rediscover warm sensation of being taken seri- parable of the Good Samaritan—a himself. ously and thus of being worth some- parable which over the last few days If suffering and pain are direct ex- thing in the eyes of the person we are has often been cited and commented pressions of the life of man, that is to speaking to. At the same time, we upon—in order to find an answer to say essential manifestations of his feel we are able to forge a relation- these many “why's.” human character and not tiresome ship whose nature is liable to pro- This parable, clearly enough, and passing accidents to be canceled voke special reactions because the shows us which charisms and which out, any form of activity which people involved are affected by the virtues must shape and form the man touches or meets these phenomena implications of physical intimacy, who is a doctor. It is not for him to will take part in their human charac- the dramatic quality of feelings pass by with indifference. On the ter and help in the discovery of what caused by situations which may also contrary, he must stop, and stopping it is to be a human being."4 be tragic, and by contact with pain does not mean curiosity, oppor- and death. tunism, or conventional gestures. It By listening carefully to the sick means, rather, readiness to help and person, the medical doctor can grad- understanding, and these must be- ually enter into his world. Paths come a stimulus to action which which would otherwise remain seeks to help the other man who, as closed open up and enable the doctor John Paul II makes clear, “cannot to understand feelings which are pre- find himself fully unless he engages sent and to grasp the meaning of in the sincere giving of himself.” those feelings. The case-histories Compassion is not enough if it is which we construct, when we are of- not active and effective, and techno- ten distant from the patient, are in re- logical-scientific help is not enough ality the history of a man asked to an- if it is not inspired by compassion— alyze his life. At times he brings it that is to say, by a fraternal love from the deepest part of his inner self which shares the suffering of the and offers it trustingly to another other person. For the Samaritan, the man so that diagnoses and remedies wounded man whom he helps, before can be produced. being a stranger and an enemy, is It is from listening that suitable somebody who is unknown. And yet communication is born, whether of the Samaritan recognizes that he is a an oral or a non-oral character (at man! times what meaning is expressed by It is in this meeting, which is so moving and intense silences ex- intense and shared, that compassion pressed by gestures and emotions is given. “On the one hand, it ex- which are beyond words!). presses a psychological attitude of It is a common view that the sick readiness to help which is born not person can have the most suitable from an emotional impulse but from medicines and instruments available, a rational conquest represented by an the most advanced forms of compe- acquired knowledge of the common tence of health care workers at his destiny written into the history of service, and the full satisfaction of men. On the other hand, it manifests his most immediate needs, yet at the itself in a practical expression of a se- same time all this is not enough. This ries of gestures and actions directed is borne out by his frenetic desire to towards welcoming and communica- speak, to be understood, to be in- tion. Emotional participation in the suf- formed about his condition, and the This complex patrimony of activ- fering of the patient, the understand- psychological dependence caused by ity certainly does not exclude forms ing of his weakness as an excluded a condition of inferiority which often of care and the development of oper- person, either temporarily or perma- ends up by seeking to please as a sign ations which are strictly therapeutic nently, in its positive form expresses of deference. And yet enough em- in character, but they also include itself in the feeling of “compassion.” phasis is never placed upon the im- those forms of behavior which are And a development of the ability to portance of dialogue, of the personal well suited to making the sick person be compassionate means an im- concern of the medical doctor who accept his own suffering and not re- provement in professional capacities by engaging in behavior which is un- ject the value and worth of his own and expertise. derstanding and tolerant is able to existence even though afflicted and overcome the rejection of long and struck by evil. They also allow him monotonous treatment of the patient to express a will to liberation and re- 3. Listening—Readiness to and to exercise that function which demption through pain. Help and Sharing has been defined with the phrase: In this way, although the salvific “personal placebo.” value of suffering is a conquest of Listening is certainly one of the A readiness to help is the key part faith and of Christian culture, most effective ways of establishing a of professional capacity and compe- nonetheless it is also true that certain feeling and affinity between tence because it is a complex virtue through the discovery of the human the patient and the doctor. It also ex- which is made up of altruism, pa- dimension of illness this line of presses great respect. When we feel tience, psychological and physical 96 DOLENTIUM HOMINUM resistance, preparation and training men stimulates and guides each con- For the Christian doctor, therefore, for certain situations, and persever- scientious medical doctor in his re- the mere recognition of the humanity ance. In an essay entitled “The Doc- search, what would the Christian of the patient is not enough. The final tor as Communicator,” published in doctor be able to do if, moved by di- objective is the establishment of a re- the journal of the American Medical vine charity, he strove to do his ut- lationship with him which has an Association, the journalist Norman most without sparing himself or the even deeper dimension and involves Cousins writes as follows: “Doctors care and treatment he provided for specific motives which are rooted in and writers have at least this in com- the good of those he rightly and in his faith. From this point of view the mon—communication is an impor- conformity to his faith perceived as medical doctor must adopt an atti- tant part of their activity. In the treat- his brethren?”5. tude of deep respect, of authentic hu- ment of sick people the words used This is a powerful invitation to mility, and of the greatest possible by the medical doctor have a pro- know how to link the parameters of level of sharing, and all this in the found effect upon their well-being. science with those of the spirit, in the full awareness of the interdepen- The words of the doctor can open dence of two roles. It may be added doors or close them violently. They that it would be wrong on the part of can open the path to cure or create a the medical doctor to judge which of sick person who is dependent, trem- these two roles gives the most and bling, frightened and hostile. Doctors which role receives the most. are asked to pay attention to the indi- No doctor can be of help and set an vidual, to dialogue, to solidarity and example without a deep inner life, to be experts in humanity. Further- without constantly referring to the re- more, they must communicate in a ality of the suffering Christ! way which relates to the personal "Luke, whom St. Paul called history of the patient. They need to “beloved doctor,” wrote in his enter into the history of the sick per- Gospel: “when the sun had gone son with that discretion and love down, all those who had sick people, which makes them sensitive to all afflicted with different kinds of ill- nuances and influences. Respect for nesses, took them to Him and He the sick person also amounts to an placed his hands on each one of ability to engage in progressive and them, and healed them.” Without, delicate communication. The right obviously enough, having such words can raise the morale of the prodigious virtues, the Catholic doc- sick person; they can increase his tor, who is really that which his pro- will to live. The wrong words can fession and his Christian life de- provoke a sense of desperation and mands, will see all forms of human defeat, and diminish the effective- misery create a refuge around him ness of any treatment which has been and call upon his good hand to reach prescribed.” out and be placed over them.”6 Indeed, the doctor would not cor- Your task “cannot be merely a respond fully to the ideal of his voca- matter of correct professional behav- tion if in his use of the most recent ior and endeavor. It must be sus- advances in medical practice and sci- tained by that inner attitude which is ence he did not also employ—in the rightly called 'spirit of service.' The practice of his profession—intelli- patient, indeed, to whom you dedi- gence and ability, and, above all, his cate your care and treatment, your heart as a man. studies, is not an anonymous individ- "Suffering, which is present in dif- ual to whom you must apply the fruit ferent forms and levels of intensity in knowledge that the authentic values of your knowledge. He is a responsi- all men, is also present to release of the gospels do not hinder but actu- ble person who must be called upon love from man, a love which ex- ally widen the perspectives of a sci- to be a participant in the improve- presses itself in the disinterested giv- ence which is always dedicated to the ment of his health and the achieve- ing of one's own self in favor of other service of man. ment of a cure. He must be put in a individuals who suffer.” And “suf- In his message to the Italian condition to be able to make personal fering men become similar to one an- Catholic doctors at their eighteenth choices rather than be forced to ac- other through the similarity of the sit- national conference in October 1988, cept the decisions and choices of uation, the trials of destiny, or which was held at Florence, John other people.” And John Paul II went through the need for understanding Paul II declared: “In devoting oneself on: “At a practical level each of you and concern, and perhaps through the to care and treatment of the body the cannot confine himself to be a doctor constant question about the meaning Catholic doctor cannot and must not of organs and physical apparatuses. of suffering.” (Apostolic Letter Salv- ignore the problems of the spirit, be- He must be responsible for the whole ifici Doloris, February 11, 1984). cause the object of his work is the in- person, and for the interpersonal re- dividual as a whole. For this reason lationships which contribute to the his “ministry” must be carried out well-being of the patient.”7 4. Man—Doctor—Catholic not only with professional and scien- "Indeed, experience teaches us tific skill but also with personal par- that the man who is need of care and "If the spirit of elementary human- ticipation in the actual situation of treatment, whether of a preventive or ity and natural love for one's fellow each individual patient.” a therapeutic character, demonstrates VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 97 needs which go beyond the organic a profound and completely human defeat an illness; blessed are we if pathology which is present. From the meaning to the art of medicine and we remember that in addition to bod- medical doctor he expects not only enables him to achieve a correct dis- ies we have before us immortal suitable care and treatment...but the tinction between service of man to souls, and that the evangelical pre- support of a brother, a brother who man and the subservience of man to cept enjoins us to treat them as we knows how to make him share in a man. would treat ourselves. Herein lies vision of life in which he can also The medical man and scientist the true satisfaction rather than hear- find a meaning to the mystery of suf- must know how to express himself ing ourselves proclaim that we have fering and death. entirely not only through drawing cured a physical evil when for the "But the doctor inevitably comes upon necessary technological most part our consciences remind us up against pain and death in his scien- knowledge but in particular through that in actual fact the affliction cured tific research and it appears to him as a clear vision of man, his dignity and itself.” a problem to which his spirit does not his purpose, and of that solidarity When Albert Schweitzer was thirty have an answer. He also encounters which links patient and doctor and years old and decided to embrace the death and pain in the practice of his makes them become two inseparable medical profession, answering profession and it appears to him as an parts of a shared effort aimed at af- thereby a distant call which was lost inevitable and mysterious law in rela- firming and defending shared hu- in the paradise of his childhood, he tion to which his art is often powerless manity. declared that only by taking this path and his compassion is sterile. More than any other professional would he really be able to fulfill his He is well able to formulate a di- figure, the doctor has an opportunity great dream of full service to life. agnosis based upon elements derived to observe individuals liberated from Replying like Schweitzer to an an- from the laboratory or clinic, or pre- illness but not healed in their souls. cient call, the medical doctor knows sent a prognosis based upon the re- In the same way he will experience that he will be called upon by all quirements of science. But in the defeat both intensely and with deep kinds of people without distinction: depths of his conscience, in his credo regret when he is confronted by un- believers and atheists, rich and poor, as a man and as a scientist, he feels changeable afflictions, but at the lowly and powerful. He does not that the explanation to that enigma same time will be able to understand want to knock at doors because he continues to elude him. He suffers that man can raise himself to a wider knows that he will have to answer because of this. It worries and grips and more sublime context through people's requests first and foremost him inexorably until that moment the projection of his pain into the as a man and brother, and only sec- when he asks for an answer from his sphere of the transcendental. ondly as a professional and as a sci- faith, and this answer, although not Because medicine by definition is entist. His hope, as Pius XII wrote in so complete as it is in the mystery of service to life, a man's profession and his marvelous prayer for doctors, is the plans of God, will become clear his conscience come together in this that “we are fraternal in comforting, in eternity, and at the same time will service. And because the task of the sincere in giving advice, caring in act to calm his spirit. doctor is first and foremost to serve providing treatment, distant from "And how can we justify the pow- the life of his neighbor, the profes- giving disappointment, and gentle in erlessness of the remedies which sci- sional conscience touches upon love announcing the mystery of pain and ence proposes to the relatives of the and charity when the doctor's con- death.” sick man? It is here, in this dramatic science is placed near to that of peo- and sublime moment which is unique ple who are sick. Professor DOMENICO DI VIRGILIO in its specific character but so often In this encounter “the doctor must Member of the Pontifical Academy to be repeated, that the medical doc- be aware of the limits of the look, the for Life, Chief Physician, tor takes off his professional uniform face and the situations of the sick President of the Catholic Medical Association of Italy, Consultor to the and re-emerges as a man with his in- person he is called upon to treat. He Pontifical Council for Pastoral ner capacity for sensitivity and sensi- is the best synthesis of the complex- Assistance to Health Care Workers bility, solidarity, and humanity—the ity of the evil which draws upon the only paths by which to create accep- roots of the body and the spirit, tance and serenity. which embraces the person in both a “But only a heart penetrated by a local and an overall sense, which in- Notes living and deep faith will be able to volves the whole life of the patient in 1. F. ANGELINI, Il Medico un Uomo per Tutti find the tones of sincerity and con- suffering.... And it is precisely this (Orizzonte Medico, 1972). 2. A. DE NATALE, “Fenomenologia ed Etic- viction which will be able to ensure opportunity of perceiving man in his ità della Relazione Medico-Paziente,” in that 'transcendental' answers are re- unity and of placing him in his total- Bioetica e Cultura, IV, 1995, 7, pp. 55-71. ceived in positive fashion.”8 ity, which gives rise to the subordi- 3. Carta degli Operatori Sanitari. Pontificio nation or rather the cooperation be- Consiglio della Pastorale per gli Operatori Sanitari. tween medical science and ethical 4. V. SARACENI, Orizzonte Medico, no. 2, Conclusion evaluation to such a degree that the 1984. doctor can in certain moments per- 5. PIUS XII to the Fourth International Con- The medical doctor is certainly the ceive almost visually the need to gress of Catholic Doctors, Rome, September 30, 1949. man who keeps the largest number of turn to the moral conscience before 6. PIUS XII to the Medical-Biological Union human secrets. Acting through the proceeding to act with the means and of St.Luke, November 12, 1944. instruments of science and technol- instruments of his professional skill 7. JOHN Paul II to the Fifteenth World Con- ogy which he has available, the and expertise."9 gress of the FIAMC, Rome, October 5, 1982. 8. PIUS XII to the Medical-Biological Union physician looks at the man who is be- The saint and doctor Giuseppe of St. Luke, November 12, 1944. hind the illness or ailment. It is this Moscati declared: “Blessed are we 9. F. ANGELINI, Il Medico, un Uomo per gaze to the beyond which gives such doctors, who are so often unable to Tutti, pp. 151-152. 98 DOLENTIUM HOMINUM

IGNACE DE LA POTTERIE

The Biblical Icons of Life

Introduction wards this truth that the first two key ding and is described at the cross as words of the title of this paper really the mother of the Church. And it is We are taking part in the tenth in- direct us—the “biblical icons.” This Mary who in the Apocalypse be- ternational conference to be orga- is because in Christian art icons act comes the women dressed like the nized by the Pontifical Council for to represent all the great stages of the sun, the image of the Church which Pastoral Assistance to Health Care history of salvation—the Old Testa- is to be the Bride of the Lamb in the Workers. It is clear from the title of ment, the time of Christ, the inner Jerusalem of Heaven. Furthermore, this conference that an immediate, condition of the believer, and the es- it is Mary who invites us to drink al- concrete and practical goal is aimed chatology. They do this precisely in ways of the water of life—that is, to at. This explains why a biblical order to reveal the unity and integral live from the life of God. scholar has been invited to prepare a meaning of these stages to the Chris- There are therefore four biblical paper which has a similar goal—“the tian. It is in this spirit that I will con- icons in all—two from the Old Tes- biblical icons of service to life.” A duct my investigation into the mean- tament and two from the New Testa- reflection upon the medical ethics ing and significance of these two ment, but they all belong to the same and situations of “health service” is first words. The exact title of my pa- eschatological perspective. And it is undoubtedly what the author of this per will thus be: “the biblical icons certainly no accident that it is princi- paper is called upon to present. of life.” pally these last two figures—Jesus, But it must be pointed out that for But in what sense?, above all, I the Son of God made flesh, and a biblical scholar a direct use of the will examine the question of what a Mary the Mother of God—who have bible for such an endeavor would be painted icon really is, and this inves- been represented and portrayed over impossible. I am thinking here of the tigation will be based upon a long and over again in Christian icons in classic statement on the four mean- tradition of the Eastern Church order to provide for our inspiration ings of the bible outlined by the Cat- which is however presently being re- and our guidance. At the end of the echism of the Catholic Church (nos. discovered in the West. In the second history of salvation, therefore, it is 117-118): to the historical and literal part of the paper there will be a pre- life which will triumph. meaning of the bible must be added sentation of the principal “biblical the spiritual meaning, a meaning icons of life,” that is, I will seek to which in turn has three sub-divi- explain the message of certain essen- 1. The Icon sions. Certainly there is the moral tial figures of the history of salva- meaning which according to the old tion. These figures direct and orient What are the essential character- rule tells me “what I should do”). us towards the mystery of life and istics of a Christian icon? Yet this moral meaning is neither the thus come to be portrayed in the 1. Symbolism is of primary and first nor the principal meaning. icons of Christian art. fundamental importance. Through Indeed, it must be preceded by the To begin with there are Adam and the pictorial representation of a bibli- search for the symbolic and typolog- Eve, our first ancestors, present at cal figure the icon invites us to ex- ical meaning (“that which I must be- the beginning of the whole of human amine and discover the mystery and lieve”). However this meaning must history. Then there is Abraham who inner meaning of that figure. It is for also be open to the future through the became the father of the people of Is- this precise reason that an icon is dif- anagogical meaning (“what I must rael and the point of departure for the ferent from a painting and different move towards”), that meaning which genealogical tree which would lead from very many religious or pious shows us the eschatological purpose to the Messiah. Obviously enough, images which merely represent of the great events of salvation. This, at the center of the history of salva- Christ, the Virgin, or the saints and according to great Tradition, pro- tion we find Jesus, the Son of God their human features. An icon, on the vides us with the real interpretation made flesh, who was himself “the other hand, as we have said, is an of the scriptures—the search for the life” and “the light of the world.” But “image of the invisible,”1 “a symbol both profound and total meaning of we should also refer to Mary because (or an expression) of the spiritual the Word of God. This Words is it was through her that the Incarna- world.”2 The ultimate basis of an open at one and the same time to the tion was able to take place; and it is icon of Christ is the Incarnation of past, to the present, and to the future. also Mary who at Cana is presented the Son of God. In his fine book en- Probably unknowingly, it is to- as the bride of the Messianic wed- titled “L'Icône du Christ,” Von VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 99

Schönborn expresses this idea in the the great Italian artist (Raphael) of- tory of salvation so as to show that following way: “God visible to our fers us a gracious woman with a according to Holy Scripture all the mortal eyes: this is the central and wonderful child. He knows how to key figures of this history, in essen- unique event which characterizes the say sublime things about their mu- tial terms, communicate the same meaning of the icon of Christ tual love and their human relation- message to us, namely the message (eikôn). Jesus Christ (said St. Paul) ship. But he does not tell us that this of life, of a life which is participation “is the image of the invisible God” woman is the Mother of God and in the life itself of God. (Col. 1:15)...The God who cannot be that that child is divine.”6 This judg- understood provides a perfect image ment is certainly too severe on a) Adam and Eve of himself, his Son...and it is for this Raphael in the opinion of another Let us call to mind first of all the reason that Jesus can say: “Whoever great expert on Russian icons, Pavel fundamental biblical text which dis- has seen me, has seen the father” (Jn Florenski7. Whatever the case may cusses the creation of the human be- 14:9). A human face has thus be- be, this comparison helps us to un- ing, the creation of man and woman: come the perfect expression of the derstand in clearer fashion that there “So God created man in his own im- Son of God.”3 cannot be a real icon without refer- age, in the image of God he created But for this to be possible (accord- ence to the spiritual dimension of the them; male and female he created ing to the passage from John which image which has been painted, an them.” (Gn 1:27) has just been cited), beyond the hu- image which is itself an expression Life, therefore, is a participation in man features of the face of Jesus the of the spiritual experience of the the life itself of God because men disciple should also discern and dis- artists who painted the icon. and women are made in the image of cover, through faith in Jesus, the 3. Another point should also be God. Life itself comes from God. “splendor” of this face, the face of made, and this relates to the analogy For the human couple, the transmis- the Son turned towards the Father between the painted icon and the sion of life promoted by men and (cf. 1 Jn 1:2), and the face of he who written passage from the bible. Ac- women through marriage, means “sees the Father” (Jn 6:46). This im- cording to the Second Council of participation in the creative act of portance of the Incarnation was ex- Nicea, which in 787 witnessed the God. Amphilochios, a Greek bishop plained very well and in very precise victory of Orthodoxy over icono- cited by the Pope in the Encyclical terms by Maximus the Confessor clasm, “the Holy Scriptures and the Evangelium Vitae, said that marriage during the battle for the acceptance holy image...explain each other. A is a “generator of humanity, a creator of icons: “Through the Incarnation single testimony is expressed in two of images of God”11. It is for this rea- the Lord becomes his own predeces- different ways: through the word and son that Genesis tells us that after the sor...He becomes his very own type through the image, and both transmit creation of man and woman “God and symbol which he himself mani- the same revelation in the light of the blessed them, and God said to them, fests, he leads the created being to- same holy and living Tradition of the “Be fruitful and multiply, and fill the wards himself because he is unfath- Church.”8 For this reason, the Coun- earth and subdue it” (Gn 1:28). One omably hidden.”4 cil went on, “a veneration of an icon can thus also understand why later What was at one time true (at the involves a correct understanding of on in Genesis the bible narrates that time of the historical Jesus) for the the Holy Scriptures and vice versa.”9 “the man called his wife's name Eve, Word which was made flesh One can see, therefore, why it is le- because she was the mother of all amongst us, is equally true in the gitimate to talk in terms of “biblical living” (Gn 3:20). Church in relation to the icon of icons,” as indeed this paper has Yet it should be stressed that the Christ which portrays him. From that done. S. Boulgakoff, the great Russ- Holy Scriptures form one great moment, Von Schönborn, observes: ian specialist on Orthodoxy, de- unity. The Old Testament must be “the contemplation of the icon clared that a word from the gospels is interpreted in the light of the New means opening ourselves to this pu- “a verbal icon of Christ.” It follows Testament. The creation of Adam rifying and sanctifying Mystery of from this that the way in which cer- and Eve opens up a perspective on the Incarnation. Because of this real- tain important figures from the Bible the time of salvation, upon eschatol- ity the icon is the most evident and are portrayed in icons gives us a cer- ogy and upon future life. Let us read telling sign of the Economy.”5 tain view of how we should under- once again some verses from St. 2. With regard to other icons, it stand these figures as they are pre- Paul which come from the first letter should be pointed out that here also sented in texts from the Holy Scrip- to the Corinthians: “Mankind begins the contemplative gaze must seek to tures. The Tradition of the Church, with the Adam who became, as penetrate the mystery of the person therefore, comes down to us through Scripture tells us, a living soul; it is which the icon portrays. We can two parallel access roads. This is es- fulfilled in the Adam who has be- think for example of the icons of the pecially true in relation to the icon of come life-giving spirit...; the man Virgin, the Mother of God. Let us Christ. “The Council (of Nicea) thus who came first came from earth, listen to what Léonide Ouspenski brings word and image close to- fashioned of dust, the man who came has to say on the subject in his “Essai gether because both speak about the afterwards came from heaven” (1 sur la Théologie de l'Icône.” In this same thing: the icon, like the Gospel, Cor 15:45-47). A little earlier, in dis- work he wants to establish and bring belongs to the New Law.”10 cussing the Resurrection of Christ, out the difference between Western St. Paul wrote: “Christ has risen religious art and Eastern icons (the from the dead, the first fruits of all quotation is from T. Spildlik): “Mak- 2. The Great Biblical Icons of Life those who have fallen asleep...just as ing a comparison between the all have died with Adam, so with “Madonna del Granduca” by What I would like to do in this sec- Christ all will be brought to life. But Raphael and the Russian icon of the ond part of the paper is (rather each must rise in his own rank; Theotakos, Ouspenski concludes: boldly) to trace the whole of the his- Christ is the first fruits...and the last 100 DOLENTIUM HOMINUM of those enemies to be dispossessed all things, blessed for ever, Amen” to him: “for I have made you the fa- is death” (1 Cor 15:20, 22, 26). (Rm 9:5-6). Yet Paul is proud that he ther of a multitude of nations. I will In the vast evolution of the history is an “Israelite myself descended make you exceedingly fruitful” (Gn of salvation which is presented from Abraham; Benjamin is my 17:5). It is this promise which through the whole of the Holy Scrip- tribe” (Rm 11:1), even though he Christian icons often represent, as tures, the final act will take place was called on the road to Damascus for example is the case of the fa- when God ensures victory over to become the Apostle of the nations. mous icon by Roublev, an icon death and provides for the final tri- Indeed, he goes on to stress that which has been described as the umph of life. “God has not rejected the people he highest expression of Russian paint- Such an orientation from the be- chose.” The pagans who convert to ing. It is a representation, as is well ginning until the end of Scripture, the faith take part in what the liturgy known, of the apparition at Memre this prefigurative value of Adam calls the Israëlitica dignitas,14 when three angels came to the Patri- who announces the coming of namely that privilege of the nations arch to tell him that despite his old Christ, the last Adam, is what bible which involves becoming “sons of age and the infertility of his wife he scholarship terms biblical typology. Abraham” and participation in the would become the father of a great It is a term which also applies to Eve dignity of belonging to Israel, a peo- people (Gn 18:1-15). For Roublev who announces and prefigures the three angels represent the Trin- Mary, the new Eve12, but here such ity but because of their inseparable typology also serves to emphasize unity—a reality suggested in the the contrast between these two fig- icon by the circular composition of ures. their silent relationship—the After the sin of the Garden of painter makes the observer under- Eden, God informed the first woman stand that it is God himself who is that she would give birth to her chil- sending this message to Abraham. dren in pain (Gn 3:16). For Mary, the St. Ambrose explains that the new Eve, this pain caused by sin no mystery of the faith of Abraham lies longer exists because with her begins in the fact that even though he sees the time of salvation. For this reason three visitors it was in actual fact Mary was “transformed by grace” God who spoke to him: “Deus illi (kecharitômenê, Lk 1:28) prior to the apparuit et tres aspexit,”15 even Incarnation of the Son of God: she though from the text of the Vulgate remained a virgin both when she (Gn 18:2) the liturgy was to draw the conceived and when she gave birth formula, in Christian form, of “tres to Jesus. This is what theologians vidit et unum adoravit.” call the virginitas ante partum and in Yet “the genius of Roublev, as partu. One can thus grasp the sym- has already been observed, adds to bolic beauty and the theological pro- ple deemed by Paul: “the Israel of the density of the message by cen- fundity of the scene described by God” (Gal 6:16). tering the scene on the couple hold- Romanus la Melòde (one of the Now, the “holy root” of Israel is ing the head of the sacrificed calf greatest religious poets of the East- Abraham, the origin of the people of (sacrificed by Abraham). Under the ern Church) in one of his hymns to God, made so because of the divine sadness-filled eyes of the two lateral the Nativity. Election and the promises made to figures, this becomes a chalice, the He uses a bold poetic vision and the Patriarch. But for Paul (Rm 9:8) symbol of the Passion.”16 The sym- does not hesitate to describe Adam and for John (Jn 8:31-37) the real bolism of the three angels in the icon and Eve as being present in Bethle- sons of Abraham are not all those by Roublev thus directs us first of all hem at the moment at which Mary who descend from him in the flesh towards the Trinity, but it also di- beings Christ into the world. Eve re- but those who, like Paul, accept the rects us towards Christology and to- minds Mary that she herself, after the promises and live out the faith of wards the cross. Fall, had to give birth in pain but she Abraham, even though they may in- This symbolic vision suggested by now renders homage to the new Eve, deed come from pagan peoples. “We the Russian icon helps us to under- a woman transformed by grace who are all Abraham's children” (Rm stand more fully a mysterious word had given birth to the Son of God in 4:16), Paul is thus able to say. We which is used by Jesus in the fourth a virginal state in order to achieve re- are all the children of Abraham be- gospel. During a conversation with demption from the divine maledic- cause even though in old age Abra- the Jews about the descendants of tion.13 ham's body was already dead, and Abraham, Jesus declares that he is the womb of his wife Sarah was also the true object of the promise made b) Abraham dead, Abraham believed in God be- to the patriarch, the real cause of his With Abraham begins the history cause “God can raise the dead to joy, the spiritual Isaac. In this way he of the people of God who would be- life” (Rm 4:17). The true children of directs towards his own person the come the Church. Abraham and his Israel and true Christians are thus Messianic joy of Abraham which immediate descendants, namely those people who live the promise was experienced when the latter Isaac and then Jacob, are those made to Abraham and also live the came to truly believe that he would whom Paul calls “the patriarchs” but faith of Abraham. indeed become the father of Isaac when referring to Abraham immedi- The decisive event in the life of and of the whole of Israel. This is un- ately the Apostle adds: “and theirs is Abraham was the Covenant which doubtedly what Jesus wanted to the human stock from which Christ God made with him, and the para- make clear to the Jews: “As for your came; Christ who rules as God over doxical promises which God made father Abraham, his heart was proud VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 101 to see the day of my coming; he saw, future Passion. Let us read once fathomable profundity of the essence and rejoiced to see it” (Jn 8:56). By again the account of this episode of God. opening himself in faith to the which is given by St. Mark in his b). The other episode from the prospect of a fulfillment which was gospel: gospels which deals with the life of to express itself in Christ, Abraham “Six days afterwards, Jesus took Christ and which should be dis- became a biblical icon of faith in Peter and James and John with him, cussed here is that episode which is Christ. and led them up to a high mountain described in John 19:34. The evan- But Abraham is even more di- where they were alone by them- gelist tells us that while Jesus was rectly an icon of life, and also of eter- selves; and he was transfigured in still on the cross his side was opened nal life, according to certain pas- their presence. His garments became by the spear of a soldier. To put it sages to be found in the Gospel ac- bright, dazzling white like snow, simply, this is not an example of an cording to St. Luke. In reply to a white as no fuller here on earth could icon because the symbolic value of cunning question posed by the Sad- have made them” (Mk 9:2-3). the event was developed and recog- ducees, people who denied the resur- According to Eastern tradition the nized more in the West than in the rection of the dead, Jesus referred to icon expresses holiness but in such a East. Indeed, in the West there was a Moses: “the Lord the God of Abra- way as to be made visible to our widespread devotion to the heart of ham and the God of Isaac and the Jesus (e.g. the German mysticism of God of Jacob. It is of living men, not the Middle Ages and the revelations of dead men, that he is the God; for of Paray-le-Monial in the seven- him all men are alive” (Lk 20:37- teenth century). 38). And in the parable of the wicked However the real point of depar- rich man and Lazarus the place of ture for this long Latin tradition is to eternal life where Lazarus is taken be found in the comment of St. Au- by the angels is called “Abraham's gustine on the passage from John. bosom” (Lk 16:22) by our Lord, and The core of that passage can be this place is the final fulfillment of quoted here: “One of the soldiers the whole history of salvation. Thus opened (aperuit) his side with a it is that in her liturgy for the dead spear. The gospel was careful in its the Church expresses her hope that choice of words. It did not say struck all those who die will go to “Abra- or wounded the side...but opened. It ham's bosom,” that is, to eternal life. wanted to show at this point, so to speak, that the door of life (vitae os- tium) had been opened; (without c) Jesus, the Son of God Made Flesh this) one cannot enter into life, into And now we come to the central real life.”18 part of this paper. As has already A careful exegetic reading of the been pointed out, the theological physical eyes, made in the image of text from John enables us to perceive core of the icon of Christ is the In- Christ. Let us quote L. Ouspenski its symbolic value and its entire the- carnation of the Son of God: the in- once again: “Image of the sanctifica- ological profundity. We have to be- visible became visible in Jesus, who tion of man, it represents the reality gin with the passage itself. The blood was a man. In the development of which is revealed by the Transfigu- which flows out from the opened icons, two scenes from the gospels ration of Christ on Mount Tabor.” side of Jesus symbolizes the pro- were especially suitable to the ex- And he goes on to add the following found life that he had led prior to his pression of the symbolic force of a liturgical commentary made by the death, his total obedience to the Fa- historical event in the life of Jesus— Second Council of Nicea of 787: ther, his love for his brethren, and his the Transfiguration on the mountain “Falling to the ground on the holy Messianic awareness that he had to and the side of Jesus opened after his mountain, the greatest of the apostles fulfill the whole of Scripture and death on the cross. prostrated themselves when they found the Church at that moment, in a) In the Eastern tradition the most saw the Lord reveal the dawn of the the persons of Mary and John. The important icon of Christ was un- divine light; and now we prostrate water which flows out from his side, doubtedly that of the Transfiguration ourselves before the holy Face Hippolitus said, was “the water of which took place on Mount Tabor. It which shines forth stronger than the the Spirit.” It symbolizes that Spirit was the scene which each young sun.”17 which Jesus, by his death, communi- artist had to paint after his technical It cannot be denied that in the cated to the Church (“tradidit spiri- apprenticeship and his spiritual for- gospel text the account of the Trans- tum,” 19:30). mation, when for the first time he figuration is the most beautiful of the We should therefore say—and had to paint a real icon destined for “verbal icons of Christ” (S. Boul- here we follow a universal tradition worship. The reasons for this can be gakoff). For this reason its symbolic which is both Eastern and West- easily understood. Of all the richness would later be abundantly ern—that the Church was born on episodes in the gospels the Transfig- used in the painted icons of the East. Calvary from the opened side of the uration is that which involves the The “dazzling white” to which Luke new Adam. This interpretation is most important and forceful expres- refers (9:29) would come to be fully based first of all upon a nearness of sion of the revelation of the future represented in these icons. The reve- this passage to a declaration made by Easter and eschatological glory of lation made to the apostles on the Jesus at the feast of the tabernacle: Jesus. mountain during the fourteenth cen- “Fountains of living water shall flow This revelation was given to three tury was called the “Taboric light” in from his bosom” (Jn 7:39), which apostles after the description of the order to distinguish it from the un- John himself explained as being a 102 DOLENTIUM HOMINUM reference to the Spirit. The Church, in her womb” through the creative that the Incarnation is a specifically therefore, “was born” directly from action of the Holy Spirit everything Christian mystery. This is why they the wound in the side of Christ when became clear and she gave her joyful are so widespread. Furthermore, the she received the Spirit of Jesus. The consent. Mary thus became the cho- symbolism which is used has to life of Christ, from the moment of sen instrument of God by which to make the observer understand that the cross onwards, was thus pro- make the Incarnation of his son pos- this woman with a child in her arms longed in the life of the Church. The sible: Mary would at the same time is the Mother of God and her son is open side of Jesus on the cross, for and necessarily be both a virgin and the Son of God. Let us now examine those who contemplate it in faith, re- a mother. It was for this reason that three icons of this kind, all of which ally and authentically becomes “the the angel told her that she would portray the Virgin Mary. door of life.” It is for this reason that have “conceived in her womb,” that First of all there is the type called in the litanies to the Heart of Jesus is, that she would have conceived Galactotrofousa, the mother who the Church puts the following invo- virginally. She would give life to a breast-feeds her child, a feature cations on our lips: “Heart of Jesus, child whom she would call Jesus but which clearly emphasizes the en- source of life and of holiness,” who would be the Son of God. The tirely human aspect of this mater- “Heart of Jesus, our life and our res- fact that God himself was the father nity. Then there is the type desig- urrection.” of Jesus and that Mary would be- nated Eleousa, or tenderness, where come his mother in a virgin state is, the Child is seen tenderly embracing in synthesis, the central mystery of his mother (for example, in the fa- 4. Mary, Mother of Jesus our faith—that is, of the Incarnation. mous icon of the Mother of God by and Mother of God But given that we are speaking Vladimir) but where the expression about biblical icons let us now ask of Mary is already tinged with sad- If Jesus is the door of life, Mary, ourselves how these two aspects of ness because she foresees the pas- his mother, she who gives us Jesus the Mystery of Mary—that is, her sion of her Son. Finally, and above and leads us to him, is necessarily an virginity and her maternity, have all the others in importance, there is important icon of life. And it is as been represented in Christian art. the frequent model of the Odigitria such that Tradition has instinctively The variations are manifold. We can (from “hodos,” or road) because represented her on innumerable oc- bring to mind two models which are with her right hand the mother points casions in Christian art, both in the especially evocative and indicative. to her son, who must be the “road” West and in the East. The two most With regard to the Italian Renais- which leads us to life (cf. Jn 14:6). important gospel scenes in this re- sance we think of the beautiful An- But in nearly all these three kinds spect are: the telling of the good nunciation which was left to us by of icons, and near to the halo which news to Mary (Lk 1:26-38) and the Andrea della Robbia in a white and surrounds the head of the Virgin, wedding feast at Cana (Jn 2:1-11). blue bas-relief which is kept at La there is an inscription which affirms a) With regard to the Annuncia- Verna. the essential and unique role of this tion, it should be stressed that we pay The virginity of Mary is expressed woman in the Christian mystery: great attention to two essential as- in this picture in three ways: the dove Mêtêr Theou or Theotokos, “Mother pects which are brought out by the of the Holy Spirit is seen flying to- of God.” We can thus easily under- evangelist and which we also find in wards Mary and it is the Holy Spirit stand and grasp why the icons with Christian icons—the virginity of which will make her with child; Mary as their principal subject have Mary and her motherhood. But her Mary is next to a kneeling angel who become the icons par excellence of virginity is of primary importance. speaks to her of a garland of lilies the Incarnation—that is, of the the In his initial greeting the angel calls which symbolize her maternity; and anthropical mystery of the Son of Mary kecharitômenê, a term which at the top right of the picture there is God made man and of the com- is wrongly translated into the Vul- God the Father, who is looking care- pletely real human maternity of a gate and in numerous modern trans- fully at Mary. This makes us under- woman who was to become the lations as gratia piena, full of grace. stand that the child she will bring Mother of God. Following the old Latin version prior into the world will be the Son of In Byzantine churches this icon is to St. Jerome we should rather use God, in other words, that God will be an evocation of the triumph of ortho- the translation “infused with grace” his Father. In Eastern icons the sym- doxy, which was achieved at the (grata facta Deo). For a long time bolism is more simple: the triple vir- Second Council of Nicea of 787, a Mary had been “transformed by ginity of Mary is often represented triumph which took place after the grace,” a grace which had “made her by three stars on Mary's shawl. This crisis caused by iconoclasm and the find favor in the sight of God.” virginity is present before, during, struggle against images, both of St. Bernard said that this grace and after the birth of the child. which had taken place during the was the grace of virginity. For a long The representation of the mater- eighth century. time, because of this grace, Mary felt nity of Mary was clearly easier, and b) A few more words on the sec- the wish to remain virgin, to live in a today it may even appear banal: ond episode which has been cited, nuptial relationship with God. For there are so very many icons and so namely the wedding feast at Cana. this reason God prepared her for a many paintings which have Mary Here a brief reference to the Old Tes- form of motherhood which was to be and her child as their subject! Let us tament is called for: the prophets of- virginal. But Mary had still not un- reflect, however, upon the fact that ten speak about the daughter of Zion. derstood the whole of this mystery. these very common forms of paint- This symbolic woman represents the For this reason she was troubled at ing or icon belong to Christianity people of Israel and the role that she the annunciation of her impending alone. Nothing of their kind is to be performs in the mystery of the maternity. But when the angel told found in other religions. The reason Covenant. In essential terms she is her that she would have “conceived for this is simple and lies in the fact the spouse of Yahweh, with whom VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 103

God formed the Covenant as though coming from the throne of God: Notes it were a marriage. But she is also “Here is God's tabernacle pitched 1. Cf E. STENDLER, L'Icône, Image de l'In- called the Virgin Israel (Virgo Zion) among men...there will be no more visibile, (Desclée de Brouwer, 1982); or V. in order to show that the daughter of death” (21:3-4). This is of great con- Melchiorre (ed.), Icona dell'Invisibile. Studi God could not have any other hus- temporary relevance given that John per un'Interpretazione Simbolica di Gesù band, an act which would have in- Paul II in the encyclical Evangelium Cristo (Milan, 1981). 2. T. SPIDLIK, “L'Icône, Manifestation du volved her committing the adultery Vitae condemns the culture of death Monde Spirituel,” Greg, 61 (1980), pp. 539- of idolatry. She is also Mother Zion which dominates the epoch in which 554. for all the children of Israel who live we live. This is contrary to the deep 3. C. VON SCHÖNBORN, “Art e Contempla- in the Covenant. In the New Testa- dynamism which is present through- tion: Les Icône du Christ,” in the volume of collected essays: C. VON SCHÖNBORN et al., ment it is Mary who becomes “the out the history of the Church and L'Art et la Technique. Die Kunst und die daughter of Zion par excellence,” as unifies the history of the Church. St. Technik (Fribourg, Suirre, 1979), pp. 9-20 (cf. the Council declares. The preroga- Paul said to the Corinthians: “the last pp. 12 ff). By the same author there is one of the best works on the question: L'Icône du tives of the old Israel come to be ex- of those enemies to be dispossessed Christ. Fondements Théologiques Elaborés pressed in her and she thus becomes is death” (1 Cor 15:26). And the Entre le I et le II. Concile de Nicée (325-787), the image of the new people of God, Apocalypse communicates the same (Paradosis XXIV, Fribourg, 1976). For com- the icon of the Church. message: “there will be no more ments on the mysterious expression of John 14, 9, see my work: “Chi Vede me Vede il But in what ways can the title of death” (Rv 21:4). The last message Padre (Jn 14, 9). Dalla Storia al Mistero,” in Bride also be applied to Mary? After which Apocalypse gives us concerns AA.VV., L'Ombra di Dio. L'Ineffabile e i Suoi all, she has been called Sponsa life: “The Spirit and the bride bid me Nomi, Acts of the First Theological Confer- ence, Cinisello, 15-17 June 1990 (Paoline, Verbi, Sponsa Spiritua Sancti. Here come; let everyone who hears this 1991), pp. 53-71. we must take as our starting point the read out say, Come, Come, you who 4. Ambigua (PG 91, 1253 D). This text has description of the wedding feast at are thirsty, take, you who will, the been presented and commented upon by H. Cana given by John, an event which water of life; it is my free gift” (Rv URS VON BALTHASAR in his work: Liturgie Cosmique. Maxim le Confesseur (Théologie, obviously has a deep symbolic sig- 22:17). This water of life we are in- 11, Paris, 1947), p. 153. nificance. The wedding feast at Cana vited to drink in the holy city is the 5. C. VON SCHÖNBORN, L'Icône du Christ, p. is a great symbol of the Messianic life itself of God. 234. wedding. The real bridegroom of Let us seek to capture in a few 6. T. SPIDLIK, art. cit., (n. 2), pp. 550 ss. The author refers here to the first edition of the this wedding feast is Jesus, and the words the immense journey we have book by L. OUSPENSKI: Essai sur la Théologie bride is the Daughter of Zion repre- taken down the history of salvation de l'Icône dans l'Eglise Orthodoxe (Paris, sented by Mary and the group of dis- from the creation to the final escha- 1980). The comparison between the Russian 19 icon of the Virgin and Child and the Madonna ciples. The same reality would be tology. This long path enables us to by Raphael is not actually and formally made, present at the cross where Mary, understand the deep meaning of our but both works are reproduced respectively on with the favorite disciple, becomes existence as Christians: it is a con- pp. 164 and 165 (illustrations n. 18 and 19). “the newly-born Church.” But this stant journey towards life. Our first 7. P. FLORESKIJ, Le Porte Regali. Saggi sul- l'Icona (Adelphi, Milan, 1981 (2)), pp. 74-75. symbolism acquires its fullness only ancestors who were created in the This testimony on the experience of Raphael in the grandiose visions of the Apoc- image and likeness of God nonethe- seems to be based on a legend. Whatever the alypse, and especially in chapter XII less committed sin. Yet God, al- case may be, the judgment of the author on religious painting in the West from the Renais- where we read of a “a woman that though he indeed told them that they sance onwards must also be considered too se- wore the sun for her mantel, with the would die because of their sin, nev- vere (cf. pp. 63-64). moon under her feet, and a crown of ertheless promised them salvation. 8. L. OUSPENSKI, Théologie de l'Icône, p. twelve stars about her head” (12:1). Later he told Abraham that he would 120. 9. L. OUSPENSKI, op. cit., p. 181. This woman here is the archetype, become the son of the chosen peo- 10. C. VON SCHÖNBORN, L'Icône du Christ, the symbol, of the triumphant ple, the people who would give rise pp. 145 ff. Church.20 She is at one and the same to the Messiah, the son of Abraham 11. SEE Evangelium Vitae, no. 43. time virgin, mother, and bride. And and the son of David but also the Son 12. SEE A. M. DUBARLE, “Les Fondements Bibliques du Titre Marial de la Nuovelle one thus understands why the of God. From that moment the Mes- Eve,” in RSR, 39 (1951), pp. 49-64. Church, in the liturgy of August 15, siah would become the life of the 13. ROMANUS IL MELODE, Hymnes, II: “2 applies this great symbol to the Vir- world and his side opened on the Hymne de la Nativité,” verses 6.11 (SC 110, 95-101). gin to celebrate her victory over the cross would become a source of the 14. Oration after the third reading (on Exo- forces of evil and her assumption Spirit for the people of God, the door dus) in the office of the Holy Sabbath: “...ut in into glory. of life. Through his resurrection he Abrahae filios et in Israëliticam dignitatem, But this symbolic vision acquires would thereafter become the “one totius mundi transeat plenitudo.” The text can be traced back to the Gelasian Sacramentary even greater breadth in the last two who is alive” (Lk 24:5). But it is (Mohlberg, n. 435). chapters of Apocalypse, chapters Mary, with the Church that she rep- 15. DE ABRAHAM (PL 14, 457, 33). which describe the final eschatology, resents, who invites us to receive this 16. M. P. BADIENVILLE, “Roublev (Andrei),” namely the definitive conclusion of life, as is clear from the promise in Catholicisme, XIII, 136. 17. L. OUSPENSKI, La Théologie de l'Icône the Covenant in the heavenly made to the Church of Ephesus: dans l"Eglise Orthodoxe (Cerf., Paris, 1980), Jerusalem. The Holy City is de- “Who wins the victory? I will give p. 144. The next page reproduces a Russian scribed as “like a bride who has him fruit from the tree of life, which icon of the twelfth century which portrays the adorned herself to meet her hus- grows in the Paradise of my God” Incarnation. 18. H. SAHLIN, Zur Typologie des Johannese- band” (21:2). This bride is the Wife- (Rv 2:7). vangeliums (Uppsala, 1950), pp. 8-9. See also Church to whom we can give a hu- my work: Marie dans le Mystère de l'Alliance man countenance, that of Mary in Rev. IGNACE DE LA POTTERIE, SJ (Desclée, Paris, 1988), chapter V: “Epouse her glory. Later on she is called “the des Noces Messiniques” (pp. 183-231). Emeritus Professor of the Pontifical 20. Cf. Marie dans le Mystère de l'Alliance, bride of the Lamb” (21:9). But let us Biblical Institute, ch. VII: “La Femme Couronnée d'étoiles” (pp. read the passage by a powerful voice Rome 261-283). 104 DOLENTIUM HOMINUM

PASCUAL PILES

The Hospital: The Temple of Suffering Humanity

1. Suffering and Life which are repeated during the course tal is a place where great results are ob- of the illness. In addition, those rela- tained from which we all draw advan- Without entering into the philo- tives and friends who surround the tage but it is also a place where we ex- sophical and theological aspects of the sick person also have a specific role to perience the powerlessness of failure question, all of us have experienced perform, afflicted as they are by uncer- when confronted by the end of a life or suffering of both a moral and physical tainty not so much about the suffering by the reality of death—elements character. Some of us have experi- of the person but in relation to the ac- which, in truth, can only be accepted. enced it more than others and some tual seriousness of the illness itself. The hospital is the place where the have encountered it rarely and have sick person, his family, and the profes- thus been more fortunate. sionals who look after him all take part Worry follows on the heels of suf- 2. The Hospital as a Temple in the pain that the patient has to en- fering. I do not feel well; I do not know of Suffering Humanity dure. It is also the place, more than any what is happening to me, but I feel other, where science places itself at the bad. There thus begins an attempt to A temple is a holy place which the service of life and where it has thus to try to eliminate this suffering, to eradi- various religions of the construct to en- be characterized by great sensitivity cate, if this is possible, its causes. gage in worship of their gods, and a and sensibility. It is these factors When faced with suffering we fight, temple is specifically consecrated to which enable us to see the hospital as a we resist, we try to try to do what is this end. In the faith of the people of Is- temple. It is a consecrated place, a holy best, given the possibilities we have rael and of the Church, obviously place, because it speaks about pain, open to us. At times we even manage enough, the temple has a very evident life and death; it draws us into a sacred to do things which we would never importance. We can indeed celebrate world, a realm which is mysterious have thought possible. It can happen our faith in other kinds of places but a and final; it places us in the deepest that we suffer alone but more often temple is the first and primary place parts of our reality. St. Paul refers to other people are involved in our suf- where we consecrate the expressions our being as the temple of the spirit (1 fering. Suffering affects and afflicts of the faith of our Christian commu- Co 6:19). What is sacred enters into those who surround us. What happens nity—believing, as we do, that it is the our essence. It is in the hospital as in to us has an effect on our families, our place where the presence of God most the temple—and bearing in mind that friends, and on those who act to try to manifests itself. In fundamental terms suffering takes place in a human being, improve our condition and state of the temple is the place where we cele- that is to say, in the temple of the mind. Each person acts according to brate the sacraments, and the most im- spirit—that we celebrate one of the the relationship he has with the sick portant of these sacraments is the Eu- most important liturgies of life. person. With much due respect to the charist, the celebration of the Easter individuals involved, we can nonethe- mystery of Jesus Christ. less make the observation that the per- In metaphorical terms we can per- 3. The Easter Mystery of Human son who is afflicted by illness, namely ceive the hospital as the temple of suf- Beings Transformed into the sick person, without in any way fering humanity. This is because the a Hospital Liturgy wanting the fact, performs and plays hospital is the place where we live out out a distinctive role. He comes to ac- very intense moments of our lives. We speak about the Easter mystery cept the illness, adopts various atti- Sooner or later all of us find ourselves of Jesus Christ to express his liturgy of tudes and approaches in coming to in a hospital. It is a place where many self-giving to humanity through his terms with it and having to live with it, of us go because it is a part of our exis- death and resurrection. When we cele- and responds in ways which follow tence. It is a place where we consider brate the Eucharist, we express that certain common patterns, notwith- the future from a different perspective; mystery in relation to sacrifice and standing obvious points of variation where different kinds of initiatives and death but at the same time with full ex- between individuals. Those who treat actions designed to serve and promote pectation of the Resurrection. the sick person also have a certain dis- life come together and act together; Through identification with the tinctive role to play. These profession- and where some suffer because of Easter mystery of Jesus Christ we per- als have their learning and skill and what is happening to them and others ceive the presence of the Easter mys- their ways of applying such knowl- suffer because they take part in the suf- tery in the life of individuals. We are edge; they also have distinctive rites fering of their fellow men. The hospi- with other people. The normal process VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 105 by which each and every person comes Assistance to Health Care Workers has and we must make sure that these tem- to achieve fulfillment is through the been held under the banner of the con- ples have suitable equipment for the giving of ourselves to others and clusive gospel principle of the parable treatment of the patients. through an accompanying overcoming of the Good Samaritan: "Go on your It is unlikely that a person feels well of selfishness. It is for this reason that way, and do likewise". when he is ill but we can ensure that he we can affirm that there is an Easter Jesus identified with the Good feels less ill by creating a climate mystery in the giving of our lives Samaritan and invited the young man which is pleasant and comfortable and which can be achieved first and fore- to do the same. This is an appeal which by providing him with what he needs. most, and both consciously or uncon- he also makes to each and every one of In this way we can make sure that even sciously, through the overall process us and which we cannot in the least ig- when there is illness and pain a Sunday of suffering, death, and resurrection. nore. is not merely just another day and In metaphorical terms we can say I here suggest that we stop and re- Christmas day is not just another third that this Easter mystery of each sick flect upon three elements which are es- Wednesday of the month. person takes place in a temple—the sential to the hospital when we rightly Not all places and situations have the hospital. We can define each experi- consider it as being a temple. same emotional character and reso- ence of illness as being a liturgy nance. When death takes place in the where we celebrate the realities of intensive care unit where no relatives suffering, death, and resurrection, yet are present, or when a baby dies within in existential rather than sacramental an incubator under the near and pene- terms. trating gaze of his parents (even though Every surgical operation involves they are separated by the glass win- moral suffering and physical suffering. dows of the incubator), we are dealing Each and every person who enters the with a situation which is rather differ- operating theater experiences a sleep ent from when an elderly person dies at which can be compared to the sleep of home surrounded by his relatives. death, although, obviously enough, in In the same way, the experience of this instance a reawakening is also en- somebody who feels he has died and is visaged. At the moment when the pa- then cured and feels born again after a tient comes out of that sleep he experi- surgical operation is not the same as ences the feeling of suffering, that neg- that of a person who wants to live but ative aspect of the Easter mystery. But whose illness is inevitably leading him he then achieves resurrection in the to death. However, we have to ensure form of gradual recovery and his subse- that in the temple/hospital there is an quent discharge from hospital. This experience of resurrection despite the leads him to live the meaning of his life evident experience of death which is with renewed spirit and in a new way. inherent in every such process. Similar but less obvious processes take place when other illnesses are at work. 4.2. The Presbyters Must Serve This Easter mystery is also present the Community in those situations when the outcome is not so favorable. The role played by There are many kinds of people who suffering and death is greater when the work in hospitals. They are divided final outcome is death. But when death into different sections and departments is experienced in the light of faith, are thus not known to every patient. death itself becomes the door which Doctors, nurses, administrative staff, leads to life. Aware as we are of this social workers, psychologists, chap- stage in our journey, and in order to lains, members of male and female re- ensure that it becomes a pathway to 4.1. The Temple Itself Must be ligious orders, all these categories life, we must be able to pass along it Cared For and Looked After have a role to play, whether from near with due respect and with the wish and at hand or from afar, in the Easter mys- desire to draw near to God. For this Not all temples are aesthetically tery of every patient. reason I invite those who are at the ser- equal. However great care should be This role must be performed with vice of sick people to celebrate the taken in their construction so that the professional skill and expertise. The liturgy of the Easter mystery of each community of believers can more eas- diagnosis and the treatment which the sick person and to make a contribution ily be placed in contact with God. Fur- medical doctor prescribes is an impor- to ensuring that the hospital is a temple thermore, every kind of religious ser- tant part of this liturgy. The same may which in its daily life integrates each vice requires its own special kind of be said of nursing care, activity of sick person into the Easter mystery. preparation. We must ensure that our course which includes the application hospitals are real and authentic temples of this treatment, and of all those other for the suffering person. We must be elements in the stay of the patient in 4. Celebrations of the Easter very attentive to the character of new hospital which seek to render his time Mystery on a Small Scale buildings and to the spaces they offer; there pleasant and congenial. in Hospitals which are we must renew old buildings; we must Health care and assistance must be a Temple of Suffering keep the wards and rooms in a good and carried out with humanity. This is suitable condition for the patients and what gives the meaning of sacredness This tenth international conference their relatives; we must pay a great deal to what we have termed "celebration" of the Pontifical Council for Pastoral of attention to the quality of their meals; within the hospital, that temple of suf- 106 DOLENTIUM HOMINUM fering humanity. Such care and assis- cause, although the loss was expected drained of content are not appreciated tance must be given with reference to or foreseen, it could nonetheless only by the gods and this is especially true the needs of the sick people and those be accepted with difficulty. of the one true God. This is clearly laid who are near them. Such action must I give thanks to God because without in the Old Testament and is also be enriched by the values of hospital- out causing me too much demoraliza- stressed in the New Testament. ity which in turn must be expressed in tion he has made me experience suf- Jesus Christ, who proclaimed that practical terms in service to the sick fering. But I give thanks to God princi- the moment had arrived when the gen- person. The achievement of human- pally because he has given me the pos- uine worshippers would worship the ization in this area requires an ethical sibility to celebrate so many liturgies Father in spirit and in truth (Jn 4:23), project of assistance which uses the of illness, to take part in the temple of who drove the traders from the temple right instruments and methods to de- the hospital in the moral recovery of so they had desecrated (Jn 2:16), and who fend the rights of the patient, respect many people whom I sought, without told us that we do not have to worship in professional privacy, to inform the pa- being overly invasive, to bring near to temples alone but that we can celebrate tient at the right moment of what he Jesus Christ and to the values of life. the Easter mystery of Jesus and thus needs to know and should know, and place ourselves in contact with God to deal with the anxiety and worry of 4.3. A Meeting Place wherever we like (Jn 2:21), provides us the patient which appears when the ill- for the Community with good reasons for rendering the ness is very serious, a task, it should be hospital holy and proclaiming that it is observed, which is by no means easy. The community which comes to the the temple of suffering humanity. Here today we find ourselves in a temple/hospital is made up of two We can proclaim this because when Christian forum of believers, a forum great groups: the sick and their rela- we celebrate the Easter mystery of the illuminated by the parable of the Good tives on the one hand and the various suffering of the life and the death of Samaritan. Participation in the suffer- kinds of professional workers and staff patients and sick people, created as ing which takes place in hospital must who are at their service on the other. they are in the image and likeness of lead the professional practitioners and The temple of the hospital is built to God (Gn 1:27), figures, moreover, protagonists of this liturgy to offer serve the sick and their relatives, and it with whom Christ identified (Mt overall and integrated forms of care is to these people that we refer when we 25:35), we are celebrating a real sacra- which deal with the physical, psycho- speak about professional skill and ex- ment which by means of its redemp- logical, social and spiritual needs of the pertise and about humanity. Just as the tive value completes what is lacking in sick people who are being treated and bride and bridegroom promise them- the Passion of Christ. cared for in the hospital. selves to each other at the marriage cer- In hospitals and especially in those emony, so in the celebration of their hospitals run and administered by the Easter mystery the sick are in actual Conclusion Church we must employ an ecumenical fact the real ministers of their sacra- vision and approach and have an orga- ment. In addition, the professional staff When we consider and speak nized system of pastoral care for the pa- and workers are the witnesses, even about the hospital as a temple we do tients. Such pastoral care should help though, of course, it is they who make not do this to make sacred a space patients to discover the meaning of the whole ceremony possible. which is in itself secular. The sa- their lives and to accept the salvation In the community of the temple/hos- credness springs from the respect offered by Christ. This should be a pital there are also the professional due to the experience of the very force for liberation whose presence is staff and workers. A great effort must felt in silence, with affection, with sup- be made to ensure that they go on see- many people who find themselves in port and with words, as indeed takes ing the hospital as a temple. There is a a hospital, an experience made up of place in the celebration of the sacra- marked danger that our service be- their living, their suffering, their dy- ments of penitence, the Eucharist, the comes a matter of mere routine, that ing and their resurrection. anointing of the sick, baptism, and so we will forget about the individual All of those of us who are gath- forth. How many of us who have who is suffering, and that we will lose ered here today are bound and worked in hospitals with professional sight of the values which make our united by a vocation to cure and to skill and expertise and with humanity profession a real vocation. The many care for sick people. Today they ask have also experienced the emotion of people who are aware of this are called more questions about why they are the participation of each patient and his upon to strive to revitalize the faith of in hospital than about why they find relatives in the Easter mystery, moved ministers and professionals of the tem- themselves in temples, and because as we are by a wish to add to the rich- ple/hospital and thereby ensure that of this they have greater opportuni- ness of the reality of each patient? they go on acting in the spirit of the ties to open themselves to God How many of us have done this, tak- Good Samaritan. We must continue to through the experience of illness ing the pastoral dimension as our point be at the side of the sick person. Cer- rather than through the celebration of departure and have had the happy tainly we should not pass by on the of an outer and mediocre faith. experience of seeing many people other side of the road. In short, we Let us accept as Christians and as open their hearts completely, patients must be like the Good Samaritan. health care workers that invitation who have been enriched by their form which Christ made to us, namely to of suffering and by their acceptance of 5. To Celebrate in Spirit do in the temple of the hospital that death or who have experienced the joy and in Truth which the Good Samaritan did on of being cured of their affliction? We have often shared in the pain of rela- In all the temples of the world the the road to Jericho. tives caused by the loss of a loved one, priests must conduct services in spirit Brother PASCUAL PILES, O.H. a pain made all the more intense be- and in truth. Services which are a mat- Prior General of the Hospitaller Order of St. cause the loss was unexpected or be- ter of mere routine and which are John of God VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 107

ANTON NEUWIRTH

Secular Thought on the Mission of the Medical Doctor

1) There is no man alive who has given that both always produce pain, greater. Happiness of this kind cannot had direct and personal experi- the physician must always dedicate not be reached in time and space. ence of suffering. Indeed, man himself to giving suitable attention Such a kind of happiness can have comes crying into the world and it to these phenomena. In certain cir- its origins only in the achievement is with reddened eyes that he cumstances, if he is not able to bear of the Absolute—absolute Good, leaves it. Between these moments the pain, the patient can gradually absolute Truth, absolute Beauty, he has a sojourn on this planet fall into a state of anxiety, into a con- the sum total of everything that is which is by no means free of pain. sciousness of his own predicament, positive. This absolute has to be Each and every man is, so to into blind desperation which has transcendental. For the believer it speak, an expert on the subject of only an unhappy ending. is God and for a Christian believer suffering, and this notwithstanding Suffering affects the whole of a personal God. We can see, there- the fact that those who have replied the being of the patient, in all his fore, that the orientations of men to the question “In your opinion human dimensions, in a way that is are the same and not even the goals what is the mission of the medical different from those forms of pain of their lives can prevent them doctor?” have given very different and of illness which have more or from becoming brothers, from be- answers. less local effects. ing really near to each other. They have given answers in line with their condition of that instant: 3) Man suffers because he lives 5) Why, then, should man suffer, either they were ill or they were in out the real state of his health or if everything within him is directed good health, either they were old or another situation similar to this towards absolute happiness? If man they were young, perhaps they suf- which makes the achievement of does not face up to suffering but re- fered from some pain or other, or the goals of his life impossible. mains content with his condition had to endure the consequences of These goals, for every man, are the and turns his back on the achieve- illness, or perhaps felt death draw- same: the achievement of his comment of absolute happiness he can- ing near. plete self-fulfillment, and in sub- not attain self-fulfillment. Man is a In all the answers, however, there stance this is nothing else but the free and intelligent being but he is a common denominator: “The achievement of a state of total and has been called upon to cooperate mission of the doctor is to reduce the lasting happiness—only this can in the achievement of his own hap- suffering of man.” This is a reality satisfy him completely. piness. Man has not been created in which time has not changed at all. In The doctor helps the suffering happiness but for happiness. Life the same way, the cry of the man person by persuading him that suf- has been given to man as an oppor- who suffers—“I have no man” (Jn fering need not necessarily impede tunity for happiness (cf. Evan- 5: 7)—has not changed either. his happiness given that the patient gelium Vitae). But what man is absent? Who is is a rational and free person who is This constitutes the very sub- the man to whom that appeal is diable to take decisions which are instance of Christian optimism and I rected? In truth, a suffering man dependent of time and space. Fur- believe that it can also be a solid calls on any other man who is able thermore, suffering can work for, basis for optimism in every other to understand him and who wants and in truth does work for, a draw- outlook on life. to help him. He calls to someone ing near of the patient to the goals And it is this “real hope” (Synod, who could draw near to him, and in of his life. 1985) as a solution to each and truth every person who understands every form of suffering which the this appeal, this cry, is near to him. 4) We have said that man does medical doctor renders accessible It is above all else the medical doc- everything, consciously or uncon- to his patient if he wants to help tor who must understand him, and sciously, to be happy. This is nat- and overcome the anxiety of suffer- without paying attention to the ural and is a part of human nature. ing and if he wants to prevent his identity of the person who calls Man, however, does not want to patient from becoming unhappy. him (cf. Lk 10: 30-37). achieve mere happiness but ab- A certain medical student cut his solute happiness, a happiness hand during a legal autopsy and the 2) Pain and illness—such is the which for him will never end and wound failed to heal. For months realm of the medical doctor. But whose intensity cannot be made the diagnosis hovered between 108 DOLENTIUM HOMINUM syphilis and tuberculosis. This was feels joyful security when he at a time, it should be remembered, knows that the road of suffering when there was no penicillin or an- leads to happiness and that after tibiotics. The student wrote to his every suffering, and with every friend: “We can suffer infinitely, moment of suffering, the distant but this does not mean that we goal draws ever closer. It should be must be unhappy.” observed once again that this is an optimistic vision of life, an effec- 6) And it is this principal idea tive and practical program of “real that the doctor must place in the hope.” And it is the task of the doc- soul of his patient. This need, how- tor to maintain and strengthen this ever, is profoundly influenced by optimism of “real hope,” in every the doctor's ability to know how to kind of situation involving suffer- identify himself with his patient. ing, even when there is very seri- This is exactly what Jesus meant ous suffering. when he said that the Good Samar- itan “had compassion” for a 8) The feeling of compassion for wounded Jew (Lk 10:33). His com- somebody in a spirit of love also passion was so great that he cared means feeling it with a spirit of hu- for his wounds, placed him on his mility; it means never imposing donkey and walked with him to an one's own opinions on the sick per- inn where he paid for all his future son. The truth should be revealed expenses and asked the inn-keeper to the patient not when he has in- to look after him, thus saving him tense pain but when he is psycho- from the humiliation of acting the logically open and ready to accept part of the pauper. the truth. In order to help him get Jesus thus gave us an example of over difficult and painful moments a complicated health service and of we must explain the meaning of his a system of national insurance. pain and suffering to him during What is important, however, is that moments of peace and when his he emphasized that such behavior spirit shines forth. had to be the outcome and result of This involves taking the patient's compassion and pity. own time into consideration and Because if the doctor wants to en- choosing the right moment. First sure that his patient faces up to suf- and foremost, we must take advan- fering with optimism he must iden- tage of that moment when the pa- tify with that patient, he must tient himself expresses interest in it achieve a state of full empathy with of his own accord. him. This involves being able to judge everything from his point of 9) Naturally enough, certain ur- view. But being able to judge every- gent cases cannot be kept waiting thing from another person's point of and in such circumstances a small view necessarily means loving that prayer should be uttered and repen- person. Following the example of tance should be fostered in the soul the Good Samaritan means loving of the patient. At times the patient his patient as himself, that is to say it with joy and of his own accord will means being his neighbor in the express his agreement. At times we fullest sense of the term. have to deal with an initial negative Does this approach to the patient reaction but after a certain period the not perhaps involve satisfying his patient will ask for solace and the every whim? On the contrary. sacraments without any prompting. What is the principal idea by which 10) The spirit of the Good Samar- every patient guides his own des- itan should be matched by help of- tiny? It is that of looking for the fered by the doctor in preparing the road which leads to absolute happi- patient to take certain important de- ness, to the fulfillment of his own cisions well ahead of time. This personality and his own capacities. means that the person who foresees For the Christian this means look- certain situations which are very ing for the road which leads to the complicated and difficult, such as achievement of health. those which require an important sacrifice or even the risk of dying, 7) This concept of suffering does should consult someone—for ex- not in the least mean a masochistic ample, a doctor or a priest—decide approach to the question. It does upon what the possible objections not mean that we must be pleased could be and thus prepare the at the presence of suffering and ground for an acceptance of poten- death. However every Christian tial risks or sacrifices. This means VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 109 that we should also consider the fact 12) How, then, we should see the high as to cancel the feelings of that at the decisive moment the psy- medical doctor in the light of gratitude and the spiritual link chological pressure might be so Christian doctrine? Medicine is an which exist between the patient and great and intense that it will be im- interpersonal relationship between his doctor. The idea that the patient possible to make a decision which the doctor and the patient which is could discharge his debt to the doc- has not been previously thought directed towards the maintenance, tor by paying him a rather high fee about. In the preparation for such the development, and the return of is a false idea which involves turn- decisions, spiritual exercises can be health; towards making life bearing medicine into a market reality of use, for example, before entering able during illness; and towards the and causing its further dehuman- the work process, public life, poli- giving of help at the most impor- ization. tics, and so forth. tant moment in life—death itself. The basis of medicine is not only Given that medicine is an inte- a high level of professional skill 11) The last act of the Good gral interpersonal relationship, it is and competence, but also a mutual Samaritan was the payment. “And not only the medical practitioner integral empathy between doctor the next day he took out two denari who ensures the presence of what and patient which ensures opti- and gave them to the innkeeper, is essential, namely the health of mism—the “real hope” for com- saying,” “Take care of him; and the patient, but it is also the patient plete and lasting happiness of the whatever more you spend, I will re- himself who must help the doctor patient, even while suffering. pay you when I come back.” This in the carrying out of his tasks. The was another example of charity health of man is priceless, and for which demonstrates that compas- this reason the doctor should only sion is an act of integral empathy receive for his efforts a payment His Excellency which respects all the dimensions of which is suitable to his personal ANTON NEUWIRTH man; that is to say, his biological, and family needs. Ambassador of the Republic of Slovakia psychic, and spiritual character. The payment must never be so to the Holy See 110 DOLENTIUM HOMINUM

SALVINO LEONE

The Family as the Subject of Health and Illness

1. The Family as a Subject its own normal social life. It cannot above-mentioned model, it involves Interacting with the go out with friends or be with them a greater interactive dynamism. It is Sick Person as in the past. It cannot go to the as if the triad illness-sick person- cinema, to the theater, or on holiday. family installed a kind of “vicious Within the complex dynamic Even the church community, which circle” in which each of the three which the time of the illness installs, should in some way be present, often subjects affects the other and the interaction between the sick ignores those families in its neigh- involves a reaction of adaptation person and the family certainly borhood which have a sick member. which, in turn, conditions the next occupies a primary position. This At a more analytical level, and stage of the cycle. relationship does not only involve apart from the individual reactions of Another model is the systematic reactions of a regressive kind (as a its components, there are various model in which the illness becomes result of which the family becomes a models of interaction within the an expression of the total crisis of the great maternal womb in which to family. Following the analysis of “family system.” The illness take refuge) or conflictual reactions Sandrin, it is possible to identify at becomes in this case a real and which aggravate and bring to the least four such models.1 authentic threat to the family's stabil- surface pre-existing tensions which The first is linear. In this interac- ity (especially if such stability was were previously covered by a layer tion the illness involves a direct call previously precarious). The “lattice” of apparent normality. The illness upon the family and provokes structure which the various compo- should not be seen in superficial various behavioral and emotional nents of the family create becomes fashion as a mere irritant which reactions which go from refusal to undone and can form new intercon- interferes with a consolidated family distrust or even aggression in nections which can all be directed routine or with a legitimate wish for relation to health care workers, and towards the sick person or, in a peaceful life. Each illness, from regression and self-isolation to contrary fashion, flee from him. In especially if it is serious or in a realistic trust. The linear character of other terms, if the family is under- terminal phase, involves an “adapta- the model lies in a certain directional stood as a kind of “scaffolding” in tion” on the part of the family which simplicity in the psychic interaction which each element supports the undergoes inevitable change. The by which the fact of illness affects other elements, it follows that a problems can be of seeming banality the sick person and through him the change in one of these elements (such as having to accompany the family itself. The subject which is involves a new mechanism by which children to school or having to leave afflicted becomes in relation to the to maintain the balance of the overall the office early to arrive at visiting illness a “sick person” but in relation system. In this process the sick time) or of extreme complexity to family bonds becomes a “sick person could become excluded, and (such as having to take care of a family,” and this involves a sort of thus marginalized, because he is an patient who has suffered a number of trait-d’union between family and element of instability. traumas or living with a person who illness. By such a mechanism the Finally, we come to the narrative is mentally ill). entire family becomes affected by model. This is present first and Equally, the mentally ill person the illness. foremost in cases of chronic illness. gives rise to a number of psycholog- There is also the circular model In such a model the illness is no ical processes with the family as where we encounter the reciprocity longer a transitory and accidental their specific subject: problems relat- of the reactions of the sick person fact but an event which profoundly ing to economic or work matters, and the family which are mutually effects the history of the family pain at seeing others suffer with “infectious.” In this reactive typol- which thereby becomes irreversibly oneself to blame, worry about a ogy phenomena of overprotection changed. Because of his illness, the future which could be different and arise on the part of the family sick person who is inserted into the whose character should not be members. The sick person family unit becomes so to speak revealed to the family. (especially if a child) may dismiss “shared” with the health care reali- This picture is further worsened his illness because he unconsciously ties which accompany him in the by a retreat on the part of the collec- blames the family for not being able journey of his illness. The risk here tivity. The family which has a to protect him. The model is termed is that precisely because of the member who is ill can no longer lead circular because, differently from the length of time involved he becomes VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 111 psychologically if not materially lies come into being, plots of silence, great fog of news or beliefs about “ceded” to those who are responsible double meanings, taking the doctor “dead” people who have come back for his treatment and in this way he to one side before he goes into the to life, stolen bodies, and examples becomes removed from the family room of the sick person and thus of abreathing apparatus being turned context by external forces. depriving the patient of a right which off prematurely. belongs to him and creating a Finally, with reference to the process of distrust in relation to the relationship between the family and 2. The Family as a Subject credibility of the doctor as well. health care workers, we cannot Interacting with Next to this is the question of undervalue the delicate question the Doctor therapeutic obstinacy. In part this which is inherent in the principle of can be attributed to the doctor who is professional secrecy and the possi- Hitherto reference has been made often worried that a court might bilities of its being broken in to the family-sick person duality, but declare that he has been negligent, response to a member of the family. it is necessary to expand the horizons but most of the time it is directly One is not merely referring here to of analysis and involve a third caused by the family members who classic and traditional questions of subject—the medical doctor. Or are sincerely worried about whether medical ethics relating to whether a more specifically—and here one everything possible is “really being given diagnosis should or should not uses a term which is at the present done.” This approach of the family is be revealed but to more “modern” time suspended between disappear- often supported by notions of a kinds of difficulties and dilemmas, ance and continuity—that figure religious character which ignore or such as those involving a condition who is still called “family doctor.” almost ignore what the Catholic of drug-addiction or homosexuality. In truth, and quite apart from valid Church really encourages and In this situation, as well, secrecy and necessary forms of specializa- advocates—an evaluation based must be maintained because on the tion, the family doctor continues to upon the principle of “proportionate one hand the trust the young person be an absolutely irreplaceable figure. treatment.”2 places in the doctor is not betrayed If there is indeed a professional One area where of necessity a and on the other because a basis is figure who is able to achieve an family member must be called upon thereby laid by which the doctor can overall management of the health in the place of the patient is that of establish an ever more fruitful problems of the family (and not only pediatrics (at least for the neonatal relationship of help with the young of its individual members), that stage or early childhood). In this case person. figure is the “family” doctor—the as well, the right to decide always From what has hitherto been said true and fitting “chronicler” of its belongs to the sick person and not to it is clear that there is a need for a health history. For this reason, it others. The “guardian” role of the greater awareness of the positive would be advisable to secure greater parents exists in ethical terms before contribution that members of the care and attention on the part not its existence in legal terms because family can make, especially if the only of governments but also health although the person (that is to say the patient has been hospitalized. In the care institutions (such as medical child) is the titular bearer of first place the members of the family faculties in universities or medical decisional responsibility this must be given suitable space and associations) in order to ensure that becomes transferred to others time with regard to information. It is the training of this professional because he is unable to exercise it.3 not good enough to speak quickly figure is not only directed towards a The therapeutic alliance which is when one is going down a corridor in necessary technical competence but established between the medical front of the front door of the family also towards the specific require- doctor and the patient thus becomes home. The right amount of time ments of a role which involves him a sort of three-way alliance involv- should be given, in the right environ- being the protagonist of health care ing the doctor, the parent and the ment, with the patient’s clinical which is tailored to family needs. child. record before one, and things should But there is not only this area of Another problem which involves be done and said in a clear and interaction between the doctor and the family members against their straightforward fashion. the family (even if it remains the will is that of consent for the removal Secondly, the doctor should be most important and common point of organs. Here also emotional sensitive to a consideration of family of contact). There are other moments elements, religious cultures, and questions which are as important to of great delicacy and ethical involve- medical misinformation are present. the patient as matters of treatment ment which see the family as a The emotional involvement of a and health care—weddings, the special force and, in a certain sense, person who already has to deal with military oath of a son, or conflict and an element which takes the place of the difficult situation of the death of tensions between parents requiring the sick person. a relative (more often then not suitable mediation. All this also unexpected) is in itself an obstacle to amounts to “treatment” of the health The first is when there is a a decision which should be lucid, of the patient in the widest sense of communication of a diagnosis which serene, and thought through. To this that term. predicts death. Unfortunately there is added a culture which at least in The doctor should also “get used” is often a tendency to hide the truth the Western World has not yet fully to the presence of the members of from the sick person—something assimilated a mature anthropology the family; indeed, he should strive which is requested by the family and of what the body really consists of, to ensure that they are close to the supported by the doctor (who in and at a religious level tends to sick person. To this end the doctor essential terms sees himself freed identify the cult of the dead with the should plan suitable periods of time from an unpleasant and emotionally cult of the corpse. And to complete for visits to the hospital; make sure stressful task). In this way castles of the picture all this is obfuscated by a that the patient is not distanced from 112 DOLENTIUM HOMINUM such events as a birth or small clini- at all levels should take upon anomaly in one of the two parents or cal operations; and make certain that themselves a greater degree of by a spontaneous mutation. In this the patient is not systematically participation and the implications last case the parent feels to some ex- deprived of visits. With this in mind, that this involves with regard to a tent released from his (albeit involun- and in order to ensure that this more direct influence on the tary) responsibility. “nearness” becomes a reality in health/illness dynamics which one of One phenomenon which is on the highly specialized institutions from the members of the family may increase and causing great worry is regional or even national catchment come to experience. anorexia (and its counterpart areas, the problem should be tackled bulimia), and this can also involve a at a political level as well through the causative influence on the part of the creation of adequate support struc- 3. The Family as a Subject family. In this as in other pathologies tures (places to stay of various kinds, Causing Illness which have a psychological origin in places to eat, and so forth) within the reactions to family contexts, great areas of the institutions themselves. At times it happens that in the com- care and prudence are required. An In conclusion, the educational plex set of causes which give rise to inappropriate release of information sphere should not be ignored. If there an illness the family comes to acquire bears the risk of placing excessive is to be a real appreciation of the pres- blame on the parent and thus creat- ence of the family, then the effort ing discord which will in turn render made by the doctor to go beyond the treatment of the pathology even mere “two-way relationship” with more difficult. The most important the sick person which does not in- fact here in relation to the volve the members of the family is family/health relationship is that in not enough. The members of the fam- this—as indeed in other similar ily themselves must become used to a cases—it is not possible to treat the new reciprocity. This is a difficult sick person without a parallel treat- task but it is absolutely necessary, ment of his family. and its fruits will only be seen in the Similar considerations (which are long term. An attempt must be made by no means analogous) can be to tackle medical pseudo-informa- made for drug addiction. Indeed, the tion whereby the family “know-all” traditional paradigm which detected asks for information about whether in various forms of family “malad- an exam has or has not been carried justment” one of those component out. In addition, initiatives must be elements of the genesis of such a taken to overcome the arrogance of condition, is slowly changing into a certain people (even though they are new model where the drug-addict is understandably involved at an emo- perfectly inserted into the family tional level) and to guarantee greater unit, has a regular job, and so forth. respect for timetables and public This is a model which in various structures. Finally, an attempt must ways tends to be like those which be made to bring forth that courtesy deal with other forms of addiction which the medical doctor must dis- involving such agents as tobacco or play towards his patients. alcohol. But in such cases the role of It is clear that all this will be made the family in overcoming the depen- the more easy in proportionate rela- dency is no less important (even tionship to the extent to which those though such a role may be more attitudes and approaches which are a true and authentic causative role of difficult). In order to achieve required of the patient and his rela- which it is more or less aware. This is success, it is probably the case that in tives are identified by the doctor and true above all else in the case of ge- the future one will not aim so much the health service. At a health care- netic illness which with the common at a “healing” of the family unit educational level attention must be denomination “hereditary” makes whose “pathology” has been a causal paid to certain elements which di- explicit reference to the family. A factor behind the addiction, but at rectly influence the choices and ori- transposition from the level of simple requiring a family which is already entations of the patient. First and biological reality to that of existential “healthy” to transmit values which foremost, of primary importance here difficulties takes place through an un- act as elements of true and effective is voluntary abortion for which the conscious identification of “causal- prevention with greater force and relative is often principally responsi- ity” with “responsibility.” This phe- credibility. ble—the husband who out of sense of nomenon is similar to what happens Finally, the members of the family pseudo-liberty leaves the woman when a partner blames himself for be- should also embrace the absolute alone with her decision or the mother- ing sterile. But it can acquire different and inescapable duty not to cause in-law who does not want to bear the and more intense connotations be- each other mutual harm. Laws burden of other children. cause of the “damage” caused to the which prohibit smoking in public If one really wants a family, that is child. It is very significant, for exam- places are very welcome but at a to say a community of love and not a ple, that there is a variation in the re- health level the problem of smoking mere social aggregation, to “live” sponse to the presence of a Down in private places is even more the illness of one of its members and syndrome child on the part of the par- serious, and by private places one to be helped in doing this by the ents according to whether the anom- here refers to the family context. health care workers, then everybody aly is caused by an existing genetic What should be done about this VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 113 particular problem? tive—indeed it is brought into action perhaps an approach which is more Furthermore, it is within the precisely by such a perspective. The difficult to understand. Indeed, the family that violence to young people problem it seems to me must be widespread “principle of autonomy” and other forms of domestic tackled with reference to certain or the myth of “one's own fulfill- violence are still practiced today. If guidelines which are of primary ment” obscure the fact that certain such shameful violence does not importance. things which we consider “ours” do have a permanent effect on physical The first guideline concerns the not in fact belong to us—such as, for health it leaves very deep scars on duty of the family to look after its example, health. The duty we have psychological health. own health. It is certainly true that of stewarding it thus becomes a form But even without reaching such most responsibility here is in the and expression of love towards our excesses, the thousand other forms hands of the parents but other family. In such an attitude we of more or less manifest conflict members of the family in various encounter that “culture of giving” which take place every day within ways are involved as well. One which is today so often invoked in the walls of the family home should important sphere is that of a correct relation to the donation of organs. not be ignored. Such things by that upbringing with regard to diet—one mysterious and still largely unknown of the best ways of inhibiting the route between the body and the mind 5. An Evangelical Perspective are at the base of an ever growing number of psychsomatic patholo- In tackling the difficulties and gies. Behind an ulcer or gastritis, an dilemmas of the family relatives of attack of asthma or a skin complaint, the sick person a perspective of a we often find a component which is certain interest can, I believe, be in some way to be attributed to the found in certain episodes which the family, if not indeed to a set of Gospels have left us. When examin- causes rooted in the family. ing the healings effected by Jesus normally emphasis is placed upon the miraculous episode and the 4. The Family as a Subject contextual elements which surround Promoting Health the miracle are neglected. The family relatives form a part of the From what has hitherto been ob- context and they are fully involved served, a clear dialectic emerges be- in the episode which we are told tween the family and illness. It is in- about. The attention which Jesus tricate and many-sided but overall its pays to the sick person thus reveals essential features are more than clear. itself to be “integral” attention paid The question of the relationship be- to the world of that sick person. tween the family and health, which is Furthermore, he seems in a certain the positive side of the coin, is rather sense to “redeem” certain presumed more elusive. In what terms is the devaluations of family reality, as for family involved in the “health sys- example happens with the strange tem” of the individual and society, in answer in the temple, the “repudia- its stewardship, its maintenance and tion” of blood ties in favor of those its promotion? of the spirit, the invitation to let the By now we well know the World dead bury the dead, “hate” for one's Health Organization's definition of family as a pre-condition to follow- health as “full psychological, physi- present-day increase in food related ing him, and so forth. cal and social health.” We are rather allergies and contributing to the In many of the accounts of less aware of the objections which prevention of future pathologies miracles regarding the body a family have been raised to this definition such as heart disease or cancer of the member is present who always plays which are chiefly centered upon an gastroenteric tract. One other impor- an important part in the dynamics of absence of a dynamic perspective, a tant area is that of domestic the fact. lack of involvement of the spiritual accidents (above all else affecting In the three miracles of resurrec- dimension, and in a certain individ- children) which are still responsible tion—Lazarus (Jn 11:1-44), the son ual absoluteness which involves the for a large number of maladies of the widow of Naim (Lk 7:11-17), risk that the health of other people caused by lack of care. Yet another the daughter of Jairus (Mt 9:23-26; will be abused. With these limits in area is that of “healthy psychologi- Mk 5:35-43; Lk 8:49-56)—it is mind (and thus the horizon of their cal attitudes” such as the cultivation clear that because dead people were being overcome as well) we can of feelings of mutual benevolence, involved the request for help could without doubt say that the present- the development of a critical only come from the relatives. Yet day understanding of health fully approach to the invasion perpetrated the Gospels make clear that Jesus covers the meaning of the Latin by television, and inculcating mutual shared deeply in their human salus which was not mere sanitas— listening at times of common inter- travail. This was true not only in as indeed a paper presented to this action such as meals. the case of Lazarus (with whose international conference has rightly A second guideline is that of family he had ties of friendship) but pointed out. looking after one's own health in the also for those who were For precisely this reason the light of its being something which “unknown” to him—what led to the family cannot escape such a perspec- does not belong to us. This is resurrection of the boy from Naim 114 DOLENTIUM HOMINUM was the pity that Jesus felt for his (Mt 8:14-15; Mk 1:29-31; 4:31-37). sanitaria,” in Insieme per Servire, IX, 1 mother to whom he restores him At times perhaps their absence also (1995), pp. 5-20. 2. Cf Congregazione per la Dottrina della (“and he gave him to his mother” contributes to the genesis of the mira- Fede, Dichiarazione sull’Eutanasia, 26 June Lk 7:15). In the case of the daughter cle, as in the case of the paralyzed 1980. of Jairus what is remarkable is the man at Bethseda who declares that he 3. M. CUYAS, “Il Medico e il Minore,” KOS, choice of those who should be has “no one to let me down into the V, 38, 20. present. When everybody had been pool” (Jn 5:2-18). left outside, Jesus allowed in only There are also less idyllic situa- Peter, James, John and the parents. tions such as that of the parents of After the miracle, and in order to the man blind from birth (Jn 9:1-41), Bibliography demonstrate the fullness of corpo- who out of a fear of the Jews refuse AA.VV, Famiglia e Salute, (Vita e Pen- real reality, Jesus invited them to to point out the man who has worked siero, Milan, 1987). “give her something to eat”—this the miracle and “place such a AA.VV, “Anoressia,” Famiglia Oggi, n. also is a typically familial element. burden” on their son. 60 (1992). AA.VV, “The California Health Pro- In addition to the case of the If it is true, as the Pope often says, ject,” Family Process, I, 3, 1992, pp. 231- daughter of Jairus there are other that the future of humanity depends 287. healings which are directly on the family, and if it is true that the D.DOYLE, Caring for a Dying Relative, “requested” by parents—the son of health/illness tandem involves each (Oxford University Press, 1994). the nobleman (Jn 4:46); the epileptic human being in profound fashion, C. HENRICH, “Rolle der Familie,” acts of the XV Congresso della Federazione delle youth (17, 14, 27); Mk 9:14-29; Lk then to the family dimension of such Asoociazioni Mediche Cattoliche, Orizzonte 9:37-43); the woman from Cana (Mt an existential experience in the Medico, Rome, 1982, pp. 138-141. 15:21-28; Lk 7:24-30) where praise future one cannot but give, and in a C. IANDOLO, Parlare col Malato (Ar- for faith must not make us forget the far greater measure more than today, mando, Rome, 1983), pp. 166-171. mother's courage displayed by this all the attention which such a dimen- S.LEONE, “Familiari,” in S.LEONE and S.PRIVITERA (eds.) Dizionario di Bioetica woman, who found herself in a sion deserves. (Dehoniane-ISB, Bologna-Acireale, 1994). hostile environment and replies even S.LEONE, “L’Educazione Sanitaria dei with a certain humor to the words of Professor SALVINO LEONE Futuri Sposi,” Orizzonte Medico, 2, (1994), Jesus. And this is not to include all Professor of Bioethics 15-16. those times that “they bring him” at the University of Palermo S.LEONE, “La Felicità a Caro Prezzo,” and at the Theological Faculty of Sicily Famigliaoggi, I (1985), pp. 8-16. sick people to be healed where it is A.MOSCONI and M.Tirelli, “Interazioni very probable that within such Familiari e Malattia Neoplastica,” Psichia- groups were to be found the sick tria Generale e dell"Età Evolutiva, 30, 4, person's family relatives. Notes (1992), pp. 605-614. At times it is Jesus himself who no- A.SANKAR, “La Comunicazione tra i Fa- 1. L. SANDRIN, “I Risvolti della Malattia nel miliari e i Sanitari” in S.SPINSANTI (ed.), tices a relative who is sick, as happens Tessuto Familiare,” Acts of the Convegno Bioetica a Antropologia Medica (La Nuova in the case of Peter's mother-in-law Nazionale AIPAS: “La famiglia e la pastorale Italia Scientifica, Rome, 1991), pp. 241-255. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 115

JOHANNES BONELLI

The Technological Challenge of Modern Medicine

Over recent decades medicine has Some examples can be given of this: 3) in recognizing (to conclude) that achieved notable advances in nearly The technology of in vitro fertiliza- perhaps today's medicine raises all of its spheres of action. This has tion has meant that an innumerable hopes in man which in actual fact it is been largely the work of a technolog- number of human embryos—and absolutely unable to meet. Reference ical revolution within medicine and thus human beings—end up in a state has already been made to the declara- has undoubtedly amounted to a very of being frozen, waiting, as it were, tion of the World Health Organiza- great good for the whole of humanity. for their destiny. This really means tion and its utopian goals. A reflec- However, it should be stressed that their destruction because in actual tion is necessary in relation to the im- this development has involved a fact there is no need for them. To put age that the medical doctor has of domination of medicine by technol- it in simple terms: humans are created himself and of his profession. The ogy. This domination, in turn, has by artificial means only to be de- idea that he has power over life and created a certain tension with the tra- stroyed because there are too many of that he is the lord of life and death ditional Hippocratic vision and has them. should be abandoned. cast a spell which both medical doc- On the other hand, modern medi- tors and patients have resisted with cine has led to a notable raising of In the following paragraphs these difficulty. the average life-span of people with- three challenges will be examined in This dilemma, which we might out, however, a life of good health detail. deem dialectical in character Ð be- being guaranteed to the elderly. On tween praise for technology and Hip- the contrary, an increase in life-span pocratic ethics, seems to me to consti- is usually obtained at the price of a 1. Naturalism and Teleology tute the real and authentic challenge spiritual and physical ill-being of technological medicine at the pre- which individuals find difficult to As has already been observed, sent time. Ever since the times of bear. Thus it is that the invitation to modern natural science has become Descartes we have observed an ex- euthanasia gains ever greater force. devoted to unconditional naturalism. plicit goal of the natural sciences: the It is for these reasons that John Paul This is rooted in the assumption that wish on the part of men to become the II in his encyclical Evangelium Vitae no rationally established order of the lords and masters of nature through refers to a culture of death which creation is to be found in this world. the employment of technology.1 Thus pervades our century and to which— On the contrary, it is argued that it is the World Health Organization has as I will seek to make clear—techno- man himself who determines the ends declared—and not without a certain logical medicine has made a by no of nature. This illusion of a subjectiv- arrogance—that one of the goals of means irrelevant contribution. ity, this unlimited freedom to deter- medicine is the complete and system- In such a situation it is now possi- mine things on the part of man has led atic elimination of every form of ill- ble to speak with truth of a technolog- not only to those environmental in- ness (and even the overcoming of ical challenge within medicine. This juries which give rise to so much death) for all men. challenge involves a very special ur- complaint nowadays, but also to an It is certainly true that one cannot gency. There are, it seems to me, extreme lack of understanding within deny that contemporary medicine re- three aspects to this challenge: medicine in relation to matters in- mains miles distant from the achieve- 1) going beyond an image of the volving the requirements of Hippo- ment of this goal, and this notwith- world which is mechanistically re- cratic ethics. Abortion, prenatal and standing the great advances which ductive; eugenic diagnoses, sterilization, con- have been made in the medical 2) distancing ourselves from the traception, research carried out on sphere. Indeed, contemporary medi- opinion—which is today very com- embryos, the transplanting of embryo cine finds itself in a rather confused mon—that each and every expres- tissues from aborted embryos, and all state in the face of a number of ques- sion of medical technology from a the rest, are, for example, absolutely tions and difficulties which have purely moral point of view is neither incompatible with the Hippocratic arisen and which seem without a so- good nor bad but receives its moral Oath. Yet all over the world these are lution. The situation is rather like that relevance according to the intentions carried out routinely and without the of the sorcerer's apprentice who is and circumstances with which, and least scruple. faced with the spirits he has conjured within which, that technology is The metaphysics of creation ac- up with his spells. used. cording to both the Hippocratic and 116 DOLENTIUM HOMINUM the Christian points of view, in con- subordinated. We should above all trary fashion, recognize that there is a else be aware of the dignity of man, rationally established creative order and recognize that he is both a physi- in the things of the creation and that cal and a spiritual being. This is of the man must be respected because he utmost importance, notwithstanding has been constituted as a creature of the great attraction of what can be ac- God.2 According to ancient Hippo- tually achieved by technological cratic teaching, man is not the master means. The patient is not a machine but the steward and defender of life. which functions well or not so well. For this reason, he must respect cer- He is not the casual outcome of evo- tain barriers which must not be lution. He is the living image and crossed and which have been allo- creature of God, and must be treated cated by the Creator to created reality by the medical doctor in a way which and—in special fashion—to the hu- conforms to this dignity, above all. man body. The things of the creation have their own order which is rooted in their own nature and their own 2. Technological Medicine truth. This order must also be re- Is Not Always Indifferent flected, in the Hippocratic view, in the actions of the medical doctor at The second challenge is essen- the very moment that he places his tially a continuation of the first. Until art, or rather his technology, at the a few years ago it was perhaps possi- service of this order. For this reason, ble to be of the opinion that medical every form of arbitrary manipulation technology is not as such good or carried out on the human body which bad and that its moral relevance is to is not directed at a therapeutic treat- be found solely in the motives of ment of the health of the patient is an those who are connected with it. abuse of the art of medicine. We may But John Paul II has clearly give as examples of this both steril- demonstrated in his encyclical Veri- ization, which is now widely spread tatis Splendor that there are also ac- at a planetary level, and more in gen- tions which by the mere fact that by eral practices which we may deem their very nature they cannot be re- “anti-procreative.” ferred to God constitute a moral Indeed, those who see reality and wrong, and this quite independently man himself as mere products of of the intentions involved or a general chance along the lines of an indis- balance of effects which might be criminate evolutionism, and deny drawn up.3 Indeed, certain modern God, are unable to perceive in the medical techniques involve such ac- creation any pre-established useful- tions from the very start which are in ness or any previously given themselves wrong. We may give as immanent meaning. This meaning is examples of this, once again, such established, so to speak, by man phenomena as in vitro fertilization, himself, and for this reason the cloning of embryos, and contra- questions about whether his actions ceptive methods. From a Christian are justified or not turn out to be point of view such things must be practically useless. According to this abandoned from the very beginning line of thought, the medical doctor in because they already express within his actions and approach, in similar themselves a morally erroneous form fashion, is not linked to the goal of of behavior. The person who com- care aimed at healing. Such a pletely denies that there is a natural concept of medical technology must order in the creation or that this has of course be fought given that it been placed there by God will never opens the door to a state of affairs be able to accept this challenge of where not human rights but the modern medicine—that is, he will rights of the strongest end up by not embrace the placing of limits on being placed at the base of medical himself and what he does by aban- ethics, as indeed is borne out in doning what could be achieved in systematic fashion by the practice of theoretical terms. abortion, which has by now become worldwide. To recapitulate, the first and essen- 3. The Absolutizing of tial challenge which confronts tech- Technological Medicine nological medicine today lies in the discovery and recognition of an im- The third challenge of technologi- manent meaning in the creation cal medicine lies in its constant ten- which is already present and to which dency to adopt an attitude of pre- every form of technology must be sumption and overvaluation in rela- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 117 tion to itself. A medical science Here, however, we need some- which places such trust in its own thing which goes beyond the usual power over nature to such an extent as needs of a profession and its daily to dare to guarantee not only health routines. Thus it is that in historical but even dominion over death for terms service to the sick person has everybody leads to something which always been seen primarily and prin- should not surprise us—the fact that cipally as a vocation, as a mission the citizens of this society call unre- which pervades our whole existence servedly for the right to health. A pa- and our whole humanity. The well- tient recently addressed the following being of the sick person must always words to his own doctor: “Connect and everywhere represent the princi- me to a machine which will enable pal and supreme guiding motive of me to eat better and tolerate smoking our action. Help towards the sick per- with greater ease.” The limits to these son must necessarily go beyond utopias will very soon, however, be- merely performing a duty, a question come evident, and we should not be of doing something with reference to surprised if dissatisfaction increases convention alone. Here we are deal- and if some patients lose hope when ing with helping someone, even faced with an incurable illness and go when we must endure sacrifices, risks on to seek to put an end to their own or annoyance. Indeed, this is the case existence with the assistance of their even when such things are taken for medical doctor. granted by the patient or when we are From ancient times medicine has faced with mere misunderstanding, seen its task as being not only the injustice, or even insolence and lack unconditional healing of the patient of gratitude. but also the relieving of suffering To ensure that we meet such a and the comforting of those who are requirement we need heroism, a big ill. Hippocrates saw illness not only heart and a special development of as a physical-chemical event brought our feelings. The question of about by specific causes but also as a whether a particular treatment disturbance of the essence of man in should or should not be applied to a his totality. patient is too complicated to be left A categorical use of all instruments to mere technological considera- and means which are technologically tions. Of essential importance to possible without reference to their such a question are other factors: the relativity or partiality or even without personality of the patient, his actual taking the will and the needs of the conditions of life in this world, his patient into account would mean re- scale of values, his psychic make-up, ducing medical action to a mere tech- his environment, his kinship ties, and nical reality. It would, however, be all the rest. To such matters and too reductive to see the therapeutic dimensions, however, one can only purpose of medicine as being exclu- respond with the heart and with sively a matter of dominating biolog- altruism, and with the shared consent ical laws. This is because human of all those who are involved in medicine is not a superior form of an- caring for and treating the sick imal medicine. It is, instead, medi- person. cine for man—he who always re- In order to avoid misunderstand- mains our neighbor, as indeed is well ings about what has already been expressed in the parable of the good said, I would like to express some Samaritan. Medical doctors and warnings about certain tendencies health care workers, therefore, can- which place the heart and the intel- not merely approach and treat the ill- lect in opposition to one another, see ness alone—they must always have concern for the patient as the antithe- the whole sick man before them. The sis of technological efficiency and person who employs a mere techno- competence, and set an all-embrac- logical approach in the medical ing form of medicine against sphere no longer treats man as a sub- medicine based on the conventions ject but does so with the individual as of training. There is a very great an object. Thus the advances in the danger that today the pendulum will realm of technology must not escape swing to the other side and that the control of doctors and health care humanity will become confused with workers. On the contrary, these lat- fanatical and utopian zeal and with ter—and in a very specific fashion— sentimentality.4 The consequences of are called upon to defend the human- such a development would certainly ity of man against every attempt at be negative. Authentic humanity domination of him and his dignity by would not exclude professional technology. competence and technological 118 DOLENTIUM HOMINUM knowledge but would constitute its essential terms, the answers to a very certainly much more than something basic building block. A personalistic practical situation. which has a mere therapeutic form of medicine which took the The great differences with the content—we need a restoration of form of mere sharing and self-identi- other professional worlds are to be the general humanistic formation fication would not be an adequate found in the fact that both doctors and training of the medical doctor counterweight to the danger of and health care workers cannot and health care workers in order to planned manipulation and it would retreat into forms of activity and achieve an anthropological and not promote an accurate appreciation behavior which are merely profes- philosophical culture, a culture of of the value and the impact of human sional, into a mere performance of the heart and of love which can only reason. The overall argument duty in a way which is emptied of be achieved in the sense of the good presented in this paper is directed reference to the deep meaning of Samaritan. Only in this way, it seems towards a universal way of seeing human essence in its entirety, to me, can we meet the challenges to true humanity. without thereby rendering such which technological medicine now In conclusion, a number of obser- actions automatically inhuman. We gives rise. vations should be made. When faced are called upon always to be compe- with the advance of medicine—a tent specialists and at the same time Professor JOHANNES BONELLI development which is connected men—that is, we should always be President of the Institute of Medicine, first and foremost to forms of near to our patients. Our activity is Anthropology, and Bioethics technology which exercise increas- constantly accompanied by the risk in Vienna, Austria ing dominion over man—doctors that we injure human dignity. and health care workers cannot For this reason, and without escape questions regarding the abandoning the scientific dimension meaning of what they do. All the of medicine and its practice, the ethical difficulties and dilemmas of physician and his helpers must redis- Notes the profession which are constantly cover the first and last essential point 1. E. PRAT, “Naturalismus und Menschliche arising in today's practice of of reference—man as a person who Fortpflanzung” (Naturalism and Human medicine—both as regards decisions quite beyond the natural sciences has Reproduction), in IMAGO HOMINIS, Vol. II, no. 2, pp. 121 ff. about diagnosis and actual treatment a history and a future; a free being 2. See C. Lichtenthaeler, Der Eid des and in relation to the kind of relation- bearing a meaning and a purpose, the Hippokrtaes, Ursprung und Bedeutung (The ship which should be established image of God, called to love and to Hippocratic Oath: Origins and Meaning), with the patient (and all the rest)—in devotion, the crowning element of (Deutscher Arzteverlag, Cologne, 1984), pp. 189 ff. the final analysis reflect contempo- the creation. We could not approach 3. See Veritatis Splendor, 80. rary man's questions about the such a version of man with a mere 4. See R.BUTTIGLIONE, “Die Achtung des meaning of suffering and more technological inheritance and a Unschuldigen Lebens, ein Prufstein Unserer generally the meaning of life and narrow knowledge of individual Kultur” (Respect for Innocent Life: a Test for Our Culture), in Der Status des Embryos (The being. physical functions and disturbances. Status of the Embryo), Verlag Fassbaender Upon such questions depend, in To carry out our task—which is (IMABE Hrsg.), 1989. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 119

ERWIN ODENBACH

Respect for the Patient’s Privacy

“Respect for the Patient’s Pri- 1. The Importance of the d) A handicap? vacy” / “Le respect de l’intimité du Personality of the Patient e) An interfering functional im- patient” is the subject which you pairment (faecal incontinence, in- proposed in your invitation, which Is there any need here to empha- continence of urine)? Is the patient was an honor for me and for which size the unity of the body, mind and capable of walking? Permanently I thank you most sincerely. Impor- spirit of a human being and his or confined to bed? Unable to speak? tant statements can be made on this her—immortal—soul? However, it f) Is he on an intensive-care subject in just a few words. Upon is all too often forgotten in our ward? giving the matter a little thought, everyday lives. The indestructible g) Is he receiving artificial respi- particularly when remembering dignity of the human person is the ration? one’s own experiences as a patient, prerequisite for true freedom and h) Is he unconscious? many thoughts come to mind, espe- for these thoughts I am going to i) Is he mentally impaired, men- cially if one is a doctor oneself, present to you. Respect for the pa- tally ill? Confused? some of which may appear banal. tient’s privacy is a right of the pa- Many things need to be seen to I would like to break down my tient. if someone is ill or in a life-threat- presentation into the following sec- The problems involved in realiz- ening condition—not only financial tions. ing this right are to be dealt with disputes and inheritances. Some 1. The importance of the person- here. matters have to be discussed with ality of the patient. Attention must be paid to the de- parents, between spouses, with chil- 2. The importance of the illness pendence of the personality on var- dren or with friends, interpersonal or injury. ious factors. tensions may perhaps need to be re- 3. The importance of spatial fac- a) Age. solved. tors (in the doctor’s office or hospi- b) Differentiation and intellect. Is The relationship with God, the tals, occasionally even outdoors). the patient religious? dependance on medical care and 4. The importance of the treating c) His sociableness (is he extro- nursing aid are of importance. persons, that is to say, of the staff in verted, introverted?), his openness. These considerations bring us to doctors’ offices, the out-patient de- d) His inclination and interests the spatial prerequisites. partment or hospital, and the ethical (Does he like to read? Does he lis- rules and duties of the doctor. ten to music?). 5. The importance of faith and e) The social background, such 3. The Importance of Spatial ministry. as family, friends, and visitors, but Factors (in Doctors’ Offices 6. What threats and limitations to also the absence of visitors. or Hospitals, Occasionally privacy are there, and what must be f) The ethnic situation. This can Even Outdoors) for Privacy done in order to preserve and re- differ greatly just within a country, spect it? and most certainly in the case of Privacy is very much dependent Allow me not to go into detail on distant peoples with occasionally on spatial factors (single room, mul- the definition of the English, or par- large families. tiple-bed room, open ward, inten- ticularly the American, term “pri- sive-care ward)! The possibility for vacy” and the French term “l’intim- receiving visitors (family, friends), ité”. It is worth noting that the Ger- 2. The Importance of the Illness the visiting times, recreation rooms man language only permits an exact or Injury and a cafeteria play just as much of a translation in the sense of “private role as consideration for the patient’s sector” or “private sphere,” at best. Is an acute illness or a chronic ill- illness (is it a malignant, protracted Esactly what “privacy” is, and what ness involved? Is it disease, a broken leg or an operation it covers in detail, is most easily re- a) A broken bone? An accident? not presenting a threat to life!). The alized when it is infringed upon or b) Cancer? country, the continent, the climate, when it is absent, as in totalitarian c) An infection (possibly requir- the financial resources, and the ill- systems. ing isolation)? nesses particularly common locally 120 DOLENTIUM HOMINUM have an effect on the architectural in the room, are often extremely finances. Thought must be given to design. Single rooms alone can play tactless. “How old are you?” “What the helplessness of the patients a major role. In large open wards does your husband do?” “Who are when allocating the necessary (such as still exist in some very old you insured with?” “Will you be funds. hospitals), compromises have been paying privately?” None of that is An increasing amount of home achieved by installing “booths” with anyone else’s business! And cer- care, now being provided less and their own service connections (tele- tainly not questions about the med- less by the family and more by com- phone, radio, etc.), which allow a ical history! petent, mobile professionals, occa- certain degree of privacy. However, A brief note on single rooms. sionally already supported by the large, open wards without partitions During several visits to America. I modern methods of telemedicine— leave hardly any room for privacy to noticed on various occasions that which permits constant communica- be respected. single rooms in exemplary hospitals tion between patient and care cen- In contrast, single rooms are were sometimes fitted with two ter—would make many things eas- sometimes anything but desirable for doors: a normal door closing the ier, such as the patient’s being able to young people—for instance, with a whole frame and a second “half- stay in his or her familiar surround- broken leg or during a short recuper- door”, so to speak, which vaguely ings. However, new problems of ation phase after a minor operation. reminded me of the doors in sta- confidentially also arise. These patients would like to play bles, although that is in no way This certainly also applies to the cards, chat among themselves, or meant negatively. I was told that a possibilities offered by new meth- watch football on television. For lot of patients did not like to have ods of data transmission and stor- other, highly differentiated, intellec- the normal door shut, precisely so age which, while allowing exten- tual people, it is largely a question of that they could keep more in touch sive information to be made avail- the nature of the fellow patient in a with their surroundings. able rapidly, will cause a few prob- double room, or the other patients in Quite often, the patients were lems yet as regards the accessing of a room with three or more beds: quiet standing at this half-door, looking such data by third parties. or talkative, constantly listening to down the corridor, so that their The seal of confession, main- the radio. Aesthetic problems and head and feet could be seen from tained, guarded, and defended by even revulsion can occur in cases of the corridor. This is one way of giv- the church and the individual illness. If necessary, it is the task of ing patients a great degree of free- priests for centuries, is time-proven the staff to take such factors into ac- dom, provided that they are the evidence of respect for the dignity count when assigning patients to ones who decide when and how of the individual and thus for his or beds and rooms. they want to have their rooms her privacy. In a doctor’s office or an out-pa- closed or open without giving However, privacy is not just a tient department—in the waiting everybody a full view. matter of comfort and the tendency room, for example—questions The options for providing accom- towards creating a hotel atmosphere asked in the presence of other pa- modation of this kind are to a major in a hospital. It also has an essential tients, or even other staff members extent dependent on the available bearing on - the psyche, - the spirit and thoughts, and thus on the soul. And this particularly in an era when many people seem unable, or hardly able, to bear silence any more. Closely linked to this is the problem of the room, but also of the chapel and support through ministry. Although this says nothing against the fact that some patients enjoy a change and entertainment. Thousands of people around the world are constantly getting involved in accidents. Even when receiving first-aid and emergency medical treatment—generally on the roadside—their right to privacy must not be forgotten. The reports broadcast on television—often showing the full brutality of the scene—are a flagrant violation of human dignity. The same goes for nosy onlookers who are incapable of providing competent assistance and merely get in the way. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 121

4. The importance of the treating havior, but without overdoing things 8. Right to confidentiality persons, that is to say, of the by displaying overattentiveness, 9. Right to health education staff in the doctor’s practices, which some patients may possibly 10. Right to dignity out-patient department find too familiar. The education work 11. Right to religious assistance or hospital, and the ethical done during basic medical education In all of the 11 areas named, the rules and duties of the doctor is of great importance. The appropri- focus is on the protection of the pa- ate specialization and continuing tient, his/her personality and his/her The staff in surgeries and hospitals medical education is also essential own decision. The exact wording are of great importance as regards during a long professional life, as is under “Right to dignity” is as fol- guaranteeing the maximum possible the setting of an example—an aspect lows: privacy. They bear a major responsi- where leading personalities bear par- a. The patient’s dignity and right bility in this context, but one which is ticular responsibility. Team discus- to privacy shall be respected at all unfortunately often forgotten. In ad- sions promote an understanding for times in medical care and teaching, dition to their professional compe- the individuality of each patient and as shall his/her culture and values. tence, the human touch of the staff is cast light on errors and omissions. b. The patient is entitled to relief the most important factor. The tact- The following new code is also of of his/her suffering according to the fulness they are taught when studying great importance for the privacy of current state of knowledge. medicine or training as nurses is a the patient. The 47th WMA General c. The patient is entitled to hu- task that also needs to be fulfilled Assembly in Bali, Indonesia, passed mane terminal care and to be pro- throughout life. The human factor in very recently the following declara- vided with all available assistance the staff has priority for the well-be- tion on the rights of the patient on in making dying as dignified and ing of the patient, above the eco- September 7, 1995. comfortable as possible. nomic situation of the country and the The declaration is far more com- Furthermore, Item 11, “Right to community. Privacy cannot by guar- prehensive than the preceding doc- religious assistance,” reads: anteed solely by means of para- ument on the same subject, which “The patient has the right to re- graphs, and also not solely by offer- was adopted in Lisbon in 1981. It ceive or decline spiritual and moral ing good premises and rooms. It is the consists of a preamble and princi- comfort, including the help of a task of the staff to take numerous fac- ples concerning the following areas. minister of his/her chosen religion.” tors into account when assigning pa- 1. Right to medical care of good The draft of this substantially ex- tients to beds. I have already empha- quality panded new version of the rights of sized this point, as well as the avoid- 2. Right to freedom of choice the patient was submitted by the ance of tactless questions in the pres- 3. Right to self-determination Finnish Medical Association. The ence of third parties. 4. The unconscious patient version now adopted by the world’s However, at this point, I would 5. The legally incompetent patient doctors should be appropriately pub- like to quote the old master among 6. Procedures against the patient’s licized and enforced by the medical German internal specialists, K. D. will organizations in the countries of the Bock: “Anyone who looks after se- 7. Right to information world, although it should be noted in riously or fatally ill patients, day after day for hours on end, cannot beat it without a certain degree of internal ‘shielding,’ the partial suppression of compassion and feelings. The more pronounced his or her spontaneous empathy and ability to share suffering, the less able he or she will be able to bear it. It is impossible to constantly put yourself into the wretched human situation lying in front of you and still act rationally... .” This makes it easier to compre- hend—with some understanding for various shortcomings in everyday practice and routine—that the situation of the Good Samaritan is often forgotten. This may perhaps be ex- cusable. However, things that “we” may consider everyday routine are exceptional situations for the patients, with their worries, suffering, and oversensitivity, and thus inexcus- able from their point of view. There- fore, we must make a constant effort to change this so-called routine be- 122 DOLENTIUM HOMINUM this context that these rights of the physician shall always bear in mind they have not prayed and have sup- patient are in no way only rights vis- the obligation of preserving human pressed all thoughts of God in years à-vis doctors and other health profes- life.” “A physician shall owe his of religious indifference. Thus, reli- sionals. Rather, the preamble states patients complete lovalty and all the gion acquires a special importance that: “Physicians and other persons resources of his science.” in sickness, not only when death is or bodies involved in the provision of Furthermore: “A physician shall close at hand. It must be possible to health care have a joint responsibility preserve absolute confidentially on talk to a minister, confess, and re- to recognize and uphold these rights. all he knows about his patient even ceive Holy Communion. A church Whenever legislation, government after the patient has died.” or chapel, which should be open at action, or any other administration or The “Declaration of Geneva” of all times, a minister and a sanctuary institution denies patients these September 1948 additionally reads: on the premises are important for rights, physicians should pursue ap- "The health of my patient will be practicing religion, receiving Holy propriate means to ensure or restore my first consideration.” “I will re- Communion, confession and the them.” spect the secrets which are confided Holy Mass. Possibilities for driving Allow me to emphasize that Item in me, even after the patient has patients to Holy Mass (in the case 10, “Right to dignity,” which I just died.” “I will not permit considera- of lengthy illnesses or inability to quoted, expressly mentions the term tions of age, disease or disability, walk) should already be taken into “privacy,” which “shall be respected creed, ethnic origin, gender, national- account when planning a hospital or at all times in medical care and teach- during subsequent conversion. ing, as shall his/her culture and val- There are unmistakeable signs of ues.” The task now will be to ensure growing confrontation and a trend that this decision concerning the pa- away from the “I” to the “we” (also in tient’s rights does not simply remain the church—in the style of prayer, in a declaration, but becomes a behav- devotions; the development from the ioral code that is a matter of course individual confession to the widely for all people working with patients propagated, anonymous penitential and for those bearing responsibility. devotions is also particularly impor- It will hardly be possible to achieve tant). The sick person, the patient, this everywhere overnight, but it is also wants the opportunity to be our duty to make repeated efforts to undisturbed and alone when commu- reach this goal. nicating with God. In view of the in- The Hippocratic Oath itself creasing emphasis on the “group,” already states: “...and to disciples the “community,” and “society,” the bound by a stipulation and oath question arises as to what happens to according to the law of medicine, ity, political affiliation, race, sexual the individual, the personality, pri- but to none other. I will follow that orientation, or social standing to in- vacy? The word failure, “guilt” (and system of regimen which, according tervene between my duty and my pa- thus also sin) is a concept associated to my ability and judgement, I tient.” “I will maintain the utmost re- with an individual person. The rela- consider for the benefit of my spect for human life from its begin- tionship between God and man, be- patients, and abstain from whatever ning even under threat and I will not tween you and me, between father is deleterious and mischievous. I use my medical knowledge in ways and son, between creator and cre- will give no deadly medicine to contrary to the laws of humanity.” ation is essential, particularly in anyone if asked, nor suggest any The rights of the patient have been times of illness. The seal of confes- such counsel; and in like manner, I dealt with in other declarations of the sion, maintained, guarded and de- will not give to a woman a pessary World Medical Association relating fended by the church and the individ- to produce abortion.” It goes on to to individual subjects, although these ual priests for centuries, is time- say: “Whatever, in connection with are too numerous for all be men- proven evidence of respect for the my professional practice, or not in tioned here. There can be no doubt dignity of the individual and thus for connection with it, I see or hear, in that the thoughtlessness of people his or her privacy. the life of men, which ought not to working with patients is only rarely The importance of ministry in hos- be spoken of abroad, I will not intentional, but it does lead to situa- pitals—privacy—is receiving less divulge, as reckoning that all such tions where the patient feels that and less attention in many countries. should be kept secret.” his/her privacy has been violated. This may certainly be partly due to When the World Medical Associ- the zeitgeist, but it is also not least a ation was founded in 1947, it adopted result of the problem that there are the so-called “Declaration of Gene- 5. The importance of faith not enough priests. As valuable as va” as a new version of the Hippo- and ministry lay ministers may be, they cannot re- cratic Oath. place the consecrated priest, who can This declaration was revised and "The person is the center of all administer the sacrament of confes- supplemented in the years that fol- things", is the guilding principle of sion and give absolution. Great de- lowed. The World Medical Associ- all our medical activities. mands are placed on hospital priests, ation’s International Code of Med- However, as a final refuge when and hospital ministers should never ical Ethics states, among other du- ill or troubled, God is the center of be regarded as having been put “on ties of physicians to the sick: “A all things for many patients, even if the shelf.” VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 123

6. What threats and limitations alization of medicine represents an experiment with “booths” as a to privacy are there, and what threats to privacy as a result of the makeshift solution is better than a must be done in order to increasingly extensive collection, large, open ward. Anyone who is in- preserve and respect it? storage, and exchange of data. volved with the sick can only benefit However, quite apart from such sit- from his or her own personal experi- Visits from family and friends uations where speed is of the ence of illness, injuries, operations, are generally very desirable. How- essence, data exchange via comput- or disabilities. ever, they can also become a strain, ers and chip cards has become such Only then can they realize which depending on their length, the sub- a common routine millions of time matters of course are often forgot- jects discussed, and the number of a day that there is a need for a sys- ten by doctors and nursing staff in visitors—and the subject of illness tematic study of these problems everyday situations. I would not can be a burden and cause worries. from the point of view of patient say that if I had not acquired my Training medical and nursing stu- protection and, thus, privacy. own experience with severe, life- dents and to be tactful is very im- The book entitled The Catholic threatening illness, both following portant as regards “minor details.” Hospital Today? The Future of a cranial trauma and also after op- Tactlessness, a lack of sensitivity, Hospitals Operated by Charitable erations, chemotherapy, and radia- and excessive familiarity vis-à-vis Sponsors contains a noteworthy tion therapy for a malignant tu- the patient on the part of the staff chapter entitled “Attention to Mi- mour. are often made even worse by in- nor Details” in the section “The The codification of the rights of sensitive visitors. The human factor Hospital as a Moral Subject” by the patient by the World Medical as regards the staff, and the finan- Gonzalo Herranz and Hans Association in its declaration of cial situation of the health system Thomas. It says that when patients September this year is of great sig- in the country and the community, and their relatives pass judgement nificance for privacy. However, have a decisive influence on pri- on a hospital, they often attach far paragraphs alone—as important as vacy. Politics and totalitarian sys- more importance to certain minor they may be if people are to live to- tems, as well as the economic situ- details which could appear trivial gether—are not enough if we our- ation of a country and the poverty than to the technological standard selves do not have a deep-rooted of the family, play a major role. of the institution or the scientific respect for our fellow human be- At such an important congress, it standard of the doctors and spectac- ings as patients, even though we takes a certain degree of courage to ular treatment successes. The hos- may not find them particularly like- address supposed trivialities which pital must have an inviting atmos- able on occasion! In this context, I are in fact not such for the patient phere and be a place where people would just like to remind you of the in his or her current situation. The feel safe and secure. Furthermore, many “minor details” that can be constant coming and going, people they say that as “Loudspeakers avoided even without money. opening doors without knocking, compete with beeper signals and You just have to think about and the hectic, restless atmosphere alarm bells,” an impersonal atmos- them all the time! It is perfectly prevailing at certain times can phere can develop and television natural that the love and compas- greatly irritate patients. Those who becomes the main source of noise sion of the Samaritan, who sees the suddenly see their door open while in the rooms. The pleasure of some robbed and beaten victim lying by having a wash, or while on their becomes the burden of the others, the wayside, is not always aroused way to the mini-toilet possibly inte- particularly in rooms with several in everyday practice, with its con- grated into their room, will feel se- beds. A hospital should be hos- stant confrontation with countless riously disturbed in their privacy— pitable, as the name implies, and ill and suffering people. However, regardless of whether it is the everyone working there should we must repeatedly remind our- cleaning lady arriving or a meal be- also be hospitable. selves of the exceptional situation ing brought. I may think it only nat- of need in which the patient is en- ural to knock on a door before entrusted to us. The natural right of tering, but quite a few of the staff 7. What can be done the patient and our obligation to members could consider it bother- in order to safeguard preserve his or her personal dignity some. I need hardly emphasize that privacy? may prove difficult to realize in doors should be opened quietly at primitive circumstances, when bat- night in order to take a look. You may perhaps be disap- tling with scarce resources, or over- Professional secrecy and the pointed that I have dealt with the whelmed by vast numbers of pa- obligation to maintain medical se- subject of privacy more from the tients. That we should do our best crecy are just as important as the practical side than from a theoreti- to preserve this dignity as far as seal of confession, although—if we cal, philosophical, and sociological ever possible, even in such situa- are honest—we must admit that point of view. However, from the tions, is a demand which is any- they are not always observed so standpoint of the patient, privacy is thing but new and more likely to be well. Despite all the positive oppor- primarily of great practical rele- considered banal. Let us do our ut- tunities it offers, such as rapid vance. most never to forget it, but to fulfill availability of findings—sharing of A dignified solution to the space it! data in case of an acute emergency, problem—single or double rooms— for instance—it should be kept in is a major problem when faced by Dr. ERWIN ODENBACH mind that the extensive institution- scarce funds. I have already said that Neurologist and Psychiatrist, Cologne, Germany 124 DOLENTIUM HOMINUM

KARL-OTTO HABERMEHL

The Hippocratic Example of the Neutrality and Universality of Medicine

Our life is imbedded in a series In recent decades, this issue has Evidently, the physician will be of events and perceptions. Joy and been heightened as the discipline of confronted with complex situations fear, success and failure, kindness medicine has evolved. On the one where the classical norms of med- and menaces are the kinds of expe- hand, we have seen revolutionary ical ethics are not sufficient to riences we as human beings attach advancements in areas as gene tech- guide him in the Hippocratic sense. great importance to. All of us are nology, transplants, and develop- These problems are universal and constantly confronted with health ment of pharmaceuticals. On the independent from national or geo- issues; however, a serious illness other hand, economic resources are graphical borders. which afflicts us personally can more unevenly distributed than Despite the multitude of deci- profoundly influence or change our ever, and choice of therapy is often sions, there is one maxim which re- previously held opinions. The fact influenced by economic criteria. mains unalterable: that we are ill compels us to re- This dichotomy “creates are moral “The consciousness of the doctor evaluate our existence, and alerts us dilemma for the doctor, who will with regard to his responsibility for to the finite nature of human life. increasingly find himself in situa- the patient’s inspired eternal life.” When confronted with illness, we tions where what he can do may not will generally seek the advice of a be what he is allowed to do. Situa- doctor, in the belief that he will do tions may arise where the moral 1. Criteria for Decision his best to help us. This is true principle is no longer self-evident whether the illness can be cured, but becomes a problem” (von The multitude of decisions, the whether our condition can merely Kress). large variability regarding medical be improved, or whether we seek Society’s efforts to establish indications, the individual situation understanding and empathy when ethical norms to guide doctors of the patient, and the social and confronted with an incurable dis- through ambiguous situations can be economic conditions require a ease. According to the severity of traced back 3500 years. One ethical careful consideration of procedure. the illness, the age of the patient, guideline which is still valid today Among the different criteria influ- and his perception of the situation, can be found in the Corpus Hippo- encing our decision, I would like to the doctor has to make a judgment craticum. The Hippocratic Oath lay emphasis on some examples. how to best serve his patient’s postulates that the doctor must Of current importance is the ques- needs. Whatever the case, the doc- alleviate his patient’s pain, support tion of the basis of medical deci- tor-patient relationship is one that nature and its natural balance in the sion. Subsequently, one has to dis- will profoundly influence the pa- patient’s healing, and always act to cuss so-called “over-technicalized tient’s life. the benefit of his patient. He should medicine” and the question as to After mentioning the basic ten- not administer senseless treatment how society can afford the costs of ants of the doctor-patient relation- to an incurable patient who has been these technological developments. ship, we have to focus on some of overwhelmed by his illness. To conclude, I would like to raise the different criteria on which the Though part of the postulates the question of who should bear the doctor’s decisions are based. concern professional rules, these ultimate responsibility for the doc- Evidently, the doctor’s concern are no less important for the patient, tor’s decision in a moral and legal will be primarily focused on finding since they guarantee an optimal sense. the optimal, most scientifically ad- treatment, taking into account the vanced method of treatment for his state of the art. Also in this sense, patient. Nevertheless, it is crucial they help to establish a relationship 2. The Scientific Basis that the doctor choose a therapy of mutual trust between doctor and of Medical Decision which is truly to the benefit of the patient. Formulated in Antiquity, patient, and not influenced by so- these Hippocratic guidelines of eth- Treatment of a patient according cial, economic, and philosophical ical behavior are still valid; for ex- to ethical standards requires an ob- considerations or, worse, by “fash- ample, they are imbedded in the jective and substantial medical prac- ion." 1948 Genfer Aerztegeloebnis. tice. Only when the doctor’s behav- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 125 ior is guided by strict scientific stan- a registration device. Those are the hope for such an improvement. dards he will be able to achieve an merely details, which do not change But it is precisely this hope which optimal treatment of his patients. the principle of treatment. But we will be most important to the pa- Nebulous notions about the course of do have to pay attention not to lose tient at such a time. On the other a disease or therapy, sometimes re- sight of the undiminished impor- hand, society has the obligation to ferred to as “natural methods of heal- tance of ethical norms, and of a accomplish public tasks for the ing,” result in treatments that are not doctor-patient relationship based on community. only inefficient, but outright dishon- trust. This is only possible if we These efforts can indeed improve est. consider technical support as the quality of life or even mark a We simply cannot ignore the such—support, nothing more and centennial event. Consequently, the well-established link of theory and nothing less. patient, unable to help himself in praxis in modern medicine, and the Only a careful cost-benefit analy- his present state, needs an advocate scientific way of administering sis—based on data collected in an who represents his interests. The therapy that it postulates. Not too unbiased manner—can help the doctor should fulfill his duty in the long ago, there still was a clear dis- doctor make his decision as to how Christian sense, “regarding in the tinction between theory and praxis, effective, how promising and how patient the image of God, who lives based on a notion of science which supportable a certain therapy will within him, and who demands that was developed during the renais- turn out to be. A sound analysis the patient’s dignity be respected” sance, starting with the work of Ba- presumes a detailed knowledge of (Nakamura et al.). con and Descartes. all facts relating to the disease. In The idea was to find universal modern medicine, the acquisition of laws through the strictly methodical such knowledge is simply not pos- 5. Who Takes the Responsibility observation of independent phe- sible without extensive technical for Medical Decisions? nomena (Schieder). Medicine was support. Applied correctly, techni- considered only an applied science. cal equipment will serve to benefit Even if individual medical deci- Today, this notion of science is no the patient, because it can protect sions are based on clear knowledge longer valid. According to a defini- from subjective decision-making. of the subject matter and precise tion of the British Medical Council, scientific analysis, medical deci- science today is only relevant if it sions as a whole are continuously continues, at an advanced level of 4. Problems of Financing influenced by other concerns, both research, to produce new insights, of the political and the ideological whether they are of theoretical or In connection with the increased kind. practical significance. On this basis, use of technical support in modern The opportunistic nature of the medical sciences will always seek medicine, there is a constant discus- political process, certain fashion- to optimize the patient’s benefit. sion with regard to the related costs, able ways of reasoning, or simply and how they should be distributed. the lack of attention of some legis- Those who are talking about “cost lators have sometimes led to laws 3. The Problem with So-Called explosion in our hospitals” should that cannot be tolerated from a "Over-Technicalized start out by getting their priorities moral point of view. In particular, I Medicine" straight. I want to make it very am referring to the legalization of clear that we cannot afford to give euthanasia, and the legally binding Advancing at a breathtaking up and do without our recent tech- duty for the doctor to inform his pa- pace, modern medicine has man- nological innovations. Contrary to tient about all details of his illness, aged to combine the latest knowl- the opinion of a group I like to refer which understandably produces edge of pathophysiology and of to as the “cultural pessimists,” the hopelessness and despair. At times, molecular biology, as well as com- technical and scientific progress in patients can be so horrified by the plicated technical innovations, with medicine is very much to the bene- disclosure of all medical facts that the doctor’s practical work. The im- fit of the patient. they eventually deny life-saving mense technical apparatus of a In principle, it is unethical to treatment. large clinic often frightens the pa- deny a patient a therapy for eco- These and other shortcomings in tient. He is afraid that he might be nomic reasons—meaning, because the bodies of law which rule the treated like an object in a “produc- the therapy is too expensive in the medical profession are due to our tion-line,” or worse, as the object of eyes of whatever administration. government’s efforts to strictly reg- an experiment. In fact, the opposite Making such decisions is probably ulate medical decisions which may is the case, if we follow the ethical one of the most difficult attempts affect the patient’s privacy. This is guidelines of our profession. ever, because, on the one hand, we a worrisome trend. We have to consider the technical have to consider the fact that any In reality, the doctor-patient rela- efforts in medicine in an appropri- therapeutic benefit will be limited tionship is much too complex and in- ate relation. In former times, a doc- and in all likelihood will be fol- dividual to fit into a simple pattern. tor would have set a wooden stetho- lowed by other diseases. Further- Let me quote Jaspers, who once said scope on his patient’s chest; today, more, one has to take into account that “a doctor’s treatment of a patient he is using a phonocardiogram. A the finite nature of human life. must be based on knowledge and hu- nurse once measured her patient’s What remains is usually a short- manity.” Knowledge, just like scien- pulse manually; today, she is using term improvement, or maybe “just” tific progress, is in a constant state of 126 DOLENTIUM HOMINUM flux. Humanity is even harder to 6. The Correlation of Law other hand, we are conservative in measure by conventional means. My and Ethics protecting our individual values teacher and mentor Professor von and rights. The question is, if in the Kress—a very prudent and careful When I criticize the regulatory development of mankind, one man—postulated an elite privilege frenzy of our governments, I do not should favor the individual person- for medical affairs when he said: mean that the field of medicine ality, able to think in alternatives, “The demands on the ethical disposi- should not be ruled by laws. Re- or the human capability to perfect tion of the medical practitioner are garding “the task of law and order the role one is meant to play. more pronounced in this than in any to regulate human coexistence and Which is the benchmark we other profession.” Or as Victor von to avoid or settle conflicts” should measure ourselves against: Weizsaecker stated “it is the doctor (Lauffs), we should aim for a sys- Whether we are able to defend our himself who must bear the conse- tem in which “the law and a sense own values and rights while recog- quences of his actions, without seek- of personal ethics complement nizing those of others? Or whether ing guidance from criminal law or each other, and provide a frame- we are able to adapt ourselves with human rights statutes. There exists no work which allows for—and re- a minimal amount of friction to or- moral philosophy which can replace spects—the physician’s moral ganizations, laws and regulations, his ultimate responsibility.” For these judgment” (H.G. Koch). Within which govern our lives? In the lat- reasons, the doctor’s decisions are such a legislative body, it will be ter case, we will misuse our own not always in accordance with na- possible to help the patient in the abilities and talents in such a way tional rules. The neutrality and uni- spirit of the Hippocratic Oath. The as to change our very mind-set, and versality of medicine is the dominant prerequisites of conscientious med- we will thus destroy the basis of factor. ical practice, then, are scientific ob- our free existence. Today, rapid progress in the areas jectivity, high professional qualifi- "Responsibility presumes free- of science, technology, and econom- cation, and a doctor-patient rela- dom,” as Dietrich Bonhoeffer said. ics is causing a multitude of prob- tionship built on unquestioning No authority is competent to re- lems. The citizens of our countries trust. The patient has to be confi- lease the doctor from his freedom are demanding that those problems dent that the doctor would never do for a medical decision. Let us make be solved immediately through gov- anything which could be harmful to sure that the integrity of our work ernment regulation, without personal him, even if asked to do so. continues to justify the underlying involvement or responsibility of the Let me try to look at the privi- principle that our medical service individual. Thus countless, more or leged doctor-patient relationship in should be done in “freedom of re- less pragmatic laws have been cre- a larger societal context. According sponsibility,” serving the patient’s ated, and taken effect, invading the to Mitscherlich, two opposite prob- inspired eternal life. privacy of the individual further and lems of adaptation are influencing further. Worse, it is in the nature of the individual’s development in our Professor KARL-OTTO HABERMEHL these laws that they have to be re- society. On the one hand, we are Director of the Institutes for Clinical and vised frequently, resulting in a flurry capable of skillfully adapting our- Expermental Virology of revisions and amendments. selves to our environment; on the at the Free University of Berlin VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 127

JESÚS CONDE

Suffering and the Meaning of Life

Introduction in the health field within the univer- to heal (often) in seeking to reduce sal Church and in the world as a suffering, and (always) in striving to Perhaps more than any other whole, and which seeks to serve in console and comfort. They of the reality, suffering has been described, the name of Jesus Christ. same importance to those, who, studied, thought about, and One should add that it is precisely through the exercise of their own expressed, in all its various aspects in this pastoral field that I have profession or through voluntary and dimensions. Suffering is without acquired that experience, over I pastoral or health care work, seek to doubt a reality which cannot be might add the space of twenty-six rise to the challenge of the Sermon reduced to a question of mere scien- years, which enables me to say on the Mount: Blessed are those that tific analysis; in the same way it something useful about “suffering suffer for they will be comforted. cannot be tamed through the use of and the meaning of life.” And I Bearing these preliminary obser- philosophical techniques and reflec- would like to also observe that I also vations in mind, I think one can say tion. It is perhaps for this reason that believe that pastoral work is—and something valid about: 1) what kind the discovery of a meaning and a must be—that activity which wisely of meaning can be given to one’s significance to what is a very univer- and strongly integrates the practice own life and be given to the lives of sal experience is so very problematic of caring which comes from the other human beings, who, it may be and so rife with controversy. In the gospel imperative of the Church into observed, nowadays tend more or same way, and despite the human the recta ratio agibilium, that is, into less consciously to identify with thirst for understanding and domin- the thought and reflection which is Hippocrates and the Good Samari- ion, such a quest remains notably expressed in the form of “know- tan, when there is a drawing near to unenlightened. From this point of how” in the field of pastoral action patients—in the literal sense of the view, and here an initial approach and in relation to other forms of term—with the aim of caring for may be adopted, one could perhaps medical and health care knowledge them in a way which corresponds to say that human beings are divided and practice, whether Christian or this identification2; what convergent into two major categories: on the secular, and which, through the use and what divergent features are one hand, there are those who of dogmatic theology and medicine, today displayed in general terms by believe that there is a constructive gives rise to a reawakening of the these two figures after their long and benevolent meaning to life those eloquent symptoms and forms journey through history; and3 what which is be found in, and is revealed of science which find themselves the Church can do, and in more by, suffering—and this despite the hidden in facts and experience. practical terms what pastoral assis- fact that it is an evident evil—and, Another preliminary observation tance can do, to obtain the best and on the other, there are those who is called for and this relates to the most complete union possible deny that there is any possibility of title of this international confer- between today’s versions of there being a meaning to suffering ence—"From Hippocrates to the Hippocrates and today’s Samaritans and believe that its only meaning lies Good Samaritan.” The history of to ensure that a real human and in its exclusively destructive charac- Western culture, medicine, and Christian meaning is given to life— ter. health policy and care, has bestowed that path which for us all remains a In order to deal with a subject a special importance on these two via dolorosa. which as large and demanding as famous individuals. They have that which has been given to me, I become figures which are highly think it is necessary to make certain emblematic when it comes to the 1. Hippocrates, the Good initial specific observations. In the treatment of the suffering of others Samaritan, and Suffering first place one should stress the fact which is caused by wounds or that this international conference, illness. Thus it is that when we As a priest destined by the Church like those which preceded it, has consider these two figures today they to provide pastoral help not only to been organized by the Pontifical constitute two models which are full sick patients but also to that broad Council for Pastoral Assistance to of significance and relevance. For range of other patients who care for Health Care Workers—that ministry this reason they are important them—that is, relatives, health care of the Holy See which is dedicated to sources of meaning for health care workers and volunteer workers—I the promotion of pastoral assistance workers engaged (at times) in trying have been and I am at the present 128 DOLENTIUM HOMINUM time a witness to how the members another person by the physician and Cnydos, and so forth) used the of this second category of patients its conversion into suffering—were capacities of the human mind to deal with the suffering of others and consequences which were not understand, and to understand in are affected by the suffering of unforeseen or a matter of chance but natural terms, the suffering associ- others, and how they express the were an integral part of health care ated with illness and to combat that impact of this suffering in many and sought to liberate sick people suffering through techné iatriké, a different and specific ways. In many from their suffering and alleviate the form of knowledge which was based of these people, and, above all, in the consequences of the acute attacks of upon the why and the how of the volunteers and professionals illness. Thus we can see that the procedures which were employed in engaged in health care work and inventors of the science and practice the treatment of suffering. service, I can perceive the incarnated of medicine—a rational and applied Hippocratic medicine, amongst figure and the various features of form of technical knowledge— other things, contributed to the both Hippocrates and the Good demonstrated that they were actual history of treating and caring for Samaritan. participants in the pain and suffering human suffering by producing the I will leave to historians of of their sick patients. imperative of knowing how to medicine and to bible scholars the For what reason, in what direc- provide assistance. This involved task of defining and outlining the tion, and to what extent did the the clear and evident reality that extent to which, and in what ways, followers of Hippocrates believe that when faced with the suffering of sick the two figures in question can be compassion in health care was both people good will was not enough applied to present- day realities and required and possible? The basic unless there was also an effective conditions. From what medical reason behind their stance lay in the process of treatment. For this reason history and bible scholarship says on fact that the Hippocratic struggle it was believed that the physician the matter, I would like to describe, against suffering had deep religious who wanted to be (ethically) sound from the point of view of a priest, roots. These roots, it may be had to be first of all a physician who only those features which give a observed, were also religious.4 Their was well prepared and competent in meaning to life, taking as my starting idea of being as being made up of his work. point the suffering which is experi- nature (physis) and principle (arché) To what extent did compassion in enced in caring for sick people. In in the organization of the elements the provision of assistance bind the this general approach I would like to (isonomía) in their total unity Hippocratic physician in the exercise make clear that I detect the figures of (kosmos), led the Hippocratic physi- of his profession to the suffering Hippocrates and the Good Samaritan cians to see infirmity as an imbal- patient and lead him to suffer with in the health care workers of today’s ance (monarchía, dyskrasía) and a him and for him? The answer which world. This certainly leads me, and disorder (chaos) and to consider is to be found on many occasions in indeed compels me, to pay atten- suffering as a painful consequence of the texts of the Corpus Hippo- tion—albeit in a superficial and this condition (pathos, lypé). They craticum seems clear: the physician selective way—to what historians thus believed that infirmity and was to do this as long as the and bible scholars have said about suffering were unnatural realities. inexorable laws of nature allowed these two important figures. For this reason the duty to combat the physician to reduce and eliminate 1. Three texts from the Hippo- suffering had an almost religious the suffering of the sick person cratic tradition should, I think, significance which was expressed by through the practical application of suffice to bring out the approach of a Latin maxim which clearly has the art of medicine. That is, that the the followers of that tradition to the Hippocratic origins: “Divinum opus Hippocratic physician could unite suffering of sick people. These three sedare dolorem.”5 What is natural, active compassion to treatment in his texts are as follows: “The physician therefore, is necessarily indifferent relationship with the patient only if transmutes the pain of others into his and apathetic (apathés), and in the he believed that his methods could own worry” (Escribonio Largo);1 divine order there is no suffering. It be effective. The above-mentioned “when faced with the pain of others should therefore be observed not text De Arte makes clear that “The the physician suffers his own pain” only that the form and kind of aim of medicine...is refrain from (De Flatibus, L. VI, 90);2 “The aim medicine which we now call Hippo- engaging in the treatment of those of medicine is to free sick people cratic was born and developed in who are overwhelmed by illness, in from suffering, alleviate the acute imperial Greece but also that it had situations, that is, when the science attacks of illness, and to refrain from this specific physiological religiosity and practice of that medicine in engaging in the treatment of those as its fundamental base and ideolog- practical terms can do nothing to who are overwhelmed by illness, in ical foundation. help the patient.” situations, that is, when it is known The chief orientation, course, and Hippocratic medicine thought that that the science and practice of direction which this form of certain illnesses overwhelmed the medicine can do nothing in practical medicine employed in its struggle patient because of nature itself terms to help the patient (De Arte).3 against pain involved the elaboration (kat’ananken tes physeos) and that The second quotation makes very of a technique (techné), a word the use of medical knowledge and clear that in a certain way the Hippo- which expresses the brilliant discov- skill in such circumstances was not cratic physician takes on the pain of ery of the Greeks about the impor- only useless but even wrong because his patient. In the second quotation tance of applying knowledge to it involved going contra naturam. we are struck by the fact that this nature. In opposition to the magical Such illnesses were held to be process leads the medical doctor to or merely “trial and error” style of technically, morally and religiously suffer. From the third quotation we medicine of previous ancient incurable. Other illnesses, on the can deduce that these two facts— cultures, Hippocratic medicine (and other hand, occurred by chance that is, the taking on of the pain of thus also that of Crotones, of (thyké) and together with the suffer- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 129 ing which they produced were the sensitive to the suffering of others. In is both clear and fundamental. b) true objects of the profession of relation to the wounded man, whom Love your neighbor as if he were treating and curing. The radical the parable presents as the typical Christ. This is the moral lesson to be naturalism of the Hippocratic school representative of those men to whom found in the eschatological passage extended the understanding and the we should show compassion, the from Matthew 25:39s: the least of my practice of philanthropia (love for Samaritan is the sign of a universal brethren are, in general, all those hu- one’s fellow man) of the physician in human approach towards suffering man beings who for one reason or an- relation to the suffering sick person which involves being moved and other need company and help. c) only to the point where it was possi- then deciding spontaneously to draw Love your neighbor as though you ble to re-establish the perfection of near to the person who suffers. In yourself were Christ. This is what the nature in that patient -by which was relation to the practical world of passage from John 15:12 (among meant the re-establishment of the treating and caring for the suffering, other passages) makes clear: love one sick individual himself. the Samaritan is the live expression another as I have loved you. The It should be stressed that the ethics of the fact that assisting a sick person Christian must love others in the and the religious beliefs of the Hip- (and here no attempt to achieve same way as Christ loved. 9 For the pocratic physician prevented the perfection is intended), whether followers of Jesus Christ, the contri- taking of steps beyond this point. bution of loving self-giving to those The human being was considered in who suffer is limited at the outset terms of nature alone and it was nec- solely by the prudence and the practi- essary to hold to this belief. The per- cal humility which human frailty nec- sonalist conception of the human be- essarily requires and involves. ing, and thus also of the suffering Christ is the purest incarnation of sick person as well, was foreign to the Good Samaritan when we come ancient Greek thought. This concep- to consider this initial approach of tion and approach emerged with placing oneself at the side of those Christianity which went beyond the who suffer. The gospels clearly limits of Hippocratic naturalism and show how Jesus could not be in the provided a new perspective on treat- presence of suffering without being ing and caring for the sick. Chris- deeply moved. On seeing that the tianity also supplied an imperative people who had come to him were and alternative forms of initiative “harassed and helpless” (cf. Mt which were both new, and from a 9:36) he “had compassion for them” certain point of view also limitless. (see also Lk 7:13) and was upset. 2. At the side of, and in front of, These sentiments and feelings were the figure of Hippocrates this inter- the emotional basis and the primary national conference has placed the impulse which set his work as a figure of the Good Samaritan. I healer in motion; and he was a healer believe that this is not only due to bearing a universal philanthropia the fact that he is Christian model which did not exclude anybody. For for concern for the sick but also the Samaritan-Christ, as St. Paul because, and here I use the expres- would later say, “there is neither Jew sion of John Paul II, he has “become effected by a medical doctor or by a nor Greek, there is neither slave nor one of the essential elements of non-professional figure, is an act of free” (Gal 3:28) when we draw near moral culture and universally love—of a love which comes before to those who suffer in order to be a human civilization.”6 Indeed the scientific and technological knowl- neighbor in the most fundamental Pope also observes that “not without edge and prior to the prescription of sense of the term, acting, that is, good reason in common language drugs.8 beyond the limits imposed by as well we term a work of the Good But what meaning—what kind of Judaism or by Hippocrates. “Who is Samaritan every action taken on appeal—does the word “love” have weak, and I am not weak? Who is behalf of men who suffer and of all in the strictly Christian context of the made to fall, and I am not indig- those who need help.” What is there parable of the Good Samaritan? Pe- nant?” (2 Co 11:29). in this figure which has made him dro Laín Entralgo, the eminent med- b) Pope John Paul II goes on to transcend his historical and literary ical doctor and a Christian by voca- say that the Good Samaritan “is he time and epoch and come down to tion, answers this question in way who offers help when there is suffer- us, and has led him to continue to be which in my opinion is so effective ing...whatever kind of help that may a symbol for those who today look that I have no alternative but to sum- be; effective help, wherever this is after the suffering? Pope John Paul marize it here: For Christians, love— possible.” This action is what makes II gives an answer to this question open love—has a religious and meta- the Good Samaritan the allegorical which is both direct and clear physical coherence which imposes symbol of health care workers— through the employment of three three commandments: a) love your whether they are professional or successive statements7 which illumi- neighbor as yourself (where the term volunteer—at all times.10 It is no nate the meaning and implications “neighbor” is understood in the exaggeration to say that the of the figure of the Good Samaritan: Christian sense of any human being ministries and the activities of the a) The Good Samaritan is every in a state of need to whom one draws Church in relation to those who man who unites himself to the suffer- near). This is the teaching of the para- suffer, throughout the whole of the ing of another man, whoever that ble of the Good Samaritan. The new Church’s history, have arisen from person may be...every man who is departure as regards Greek thought an approach based upon ideas of 130 DOLENTIUM HOMINUM voluntary service and inspired by the ries of new departures, beginning which is not merely narrow in model of Christ, the Good Samari- with the perspectives of the gospels, character. In other words, such an tan, the Shepherd who has come to namely: the overcoming of the con- action should not be a mere question offer his life (cf. Jn 10:17), who was trast between assistance and treat- of providing a diagnosis and of sent to “bind up the brokenhearted” ment, a contrast which, it might be following and prescribing a treat- (cf. Is 61:1). This is an example pointed out, is deeply rooted in mod- ment which is technically impecca- which has come down to our own ern and contemporary medicine16; the ble. days and which inspires all those practice of “a kind of verbal or psy- It should be, rather, a constant and who render service to their suffering chological psychotherapy of a moral interacting human relationship neighbor, and freely dedicate and religious character...aimed at which gives force and strength to the themselves to helping others as the the creation of a correct intellectual healer so that he can give of himself Good Samaritan did.11 and emotional framework by means and take on the suffering of the And the same may be said of of which the sick person can under- patient. He should give a larger or medical doctors and other Christian stand the painful trial which his infir- smaller part of himself, of his own health care workers.12 Ever since the mity represents"; the acceptance of inner self, according to the serious- moment when Christianity absorbed the idea that the Christian doctor ness of the case he has to deal with. Galenic-Hippocratic medicine into should take care of the incurably ill He should also take upon himself a its project of health care in definitive and the dying—something very dif- part of the suffering felt by the sick fashion, for medical doctors of the ferent from the moral and therapeutic person, whether that suffering is of a Christian faith the figure of Christ detachment of the ancient Greek organic, physical or mental charac- the Physician13 has continued to be physician and of many other kinds of ter. The healer and physician who the figure of the Good Samaritan doctors even today; and, finally, the wants to act in imitation of Christ, adapted to new circumstances and moral and therapeutic value of living the Good Samaritan and the Healer conditions. In this way one can see with pain. This new departure brings of souls and bodies, must be aware that Hippocratic philanthropia has me to the third observation made by of the fact that care for the suffering been united with Christian charitable Pope John Paul II. of others means that to a certain initiative, and technical capacity has c) The Good Samaritan is the man extent he also must fall ill in order to been linked to the contribution of who is able to give of himself. In this be the wounded healer of the suffer- voluntary work to the health care idea we find deeply embedded the ing of patients and thereby sphere. All this is expressed in the most profound aspect of what I have contribute what was lacking to the offer of help to those who suffer, in a sought to emphasize in this paper the passion of Christ, through (the shared attempt to convert compas- achievement of that personal in- consolation of) his body, which is the sion into an effective contribution to volvement in care for patients which Church. (cf. Col 1:24). the comforting of pain. Yet it should is required from the Christian volun- be pointed out that at the initial tary or professional health care moment of this fusion the newness worker. From the Hippocratic tradi- 2. The Suffering Which of Christian feeling and the radical tion it appears clear that such care in- is Involved in Caring nature of its imperatives were volves a certain “dolorido sentir” for for the Sick certainly more than evident. the physician, to employ the excellent Early Christianity itself was able phrase used by Garcilaso de la Vega y Unfortunately this subject attracts to create a more than valid system of Azorín. But how great should this in- very little attention on the part of pre- health care which was based upon volvement be? I believe, once again, sent-day health care institutions and voluntary action. This was more that in truth it is the really the Christ- in relation to the general pastoral than natural given that for the first ian tradition which brings out the true work of the Church. This is not true century and a half of its history depth and the requirements of this in- however when we come to consider Christianity could scarcely rely upon volvement. Let us now briefly turn the psychological and pastoral stud- the help of Hippocratic medicine.14 our attention to how this is so. ies which have appeared recently on The first Christian communities The Gospel according to St. the phenomenon of “burn out,” on showed how a lack of economic and Matthew, in its description of the the drying up of practical care when technological means and resources healing activity of Jesus, brings out people are faced with and have to deal were not an insurmountable obstacle the personal price that those who with the suffering of others. Nonethe- to giving suffering people a form of engage in health care assistance less, such “burn-out” is an incon- care which matched their needs. This (whether they are professionals or testable fact which any careful ob- lack of immediate resources was volunteers) must pay when that server is able to pick up on and which compensated for with human and assistance is completely and is encountered every day by those spiritual forms of care and treatment. profoundly human. According to the who practice pastoral work in the The infrastructure of such care was text to be found in Matthew 8:16 ff., field of health care. For this reason I based, above all, on those human Jesus fulfilled the prophecy of Isaiah have thought it opportune to pay at- resources which arose from, and when he engaged in healing: “He tention to the subject of pastoral care were provided by, the community took our infirmities and bore our and to leave to one side those other el- itself. From then until our days this diseases.” Reading this passage, and ements which go under the general has been the dominant feature of the that from Isaiah 53:4, where refer- heading of suffering and the meaning history of voluntary Christian health ence is made to health care, one of life. care and service.15 should observe that the technical I would like to produce observa- When we consider and examine element is certainly necessary but it tions derived from my own experi- the professional care provided by is not in itself sufficient in every ence of pastoral work which has Christians we should examine a se- action of healing and treatment been carried out in the name of the VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 131

Church. The correct practice of tiveness and efficiency; yet at times very enormity of the suffering which pastoral work in the health care field they also lead very deep mental and they have to deal with every day in does not only involve the carrying spiritual crises. the course of their work, those efforts out of actions which are central to Health care workers, and here I which involve an attempt to establish such work. It also provides a privi- also refer, of course, to Christian a distance between themselves and leged observatory of objective signs health care workers, often find them- their patients. They seek to justify this and subjective symptoms which are selves in the same situation.18 It is stance with reference to the need for manifested in those who receive widely believed that as a general rule balance and for scientific and techni- such pastoral care. These are signs they are immune to the suffering of cal objectivity but in so doing forget and symptoms which must receive the sick people they care for and treat, that anxiety is more infectious than the attention of all the disciplines and are also insulated against the suf- pathogenic micro-organisms. A great involved in health care—disciplines, fering of the relatives of these pa- many of these Samaritans need a di- for example, such as anthropology tients. Indeed, it is often believed that agnosis and forms of treatment which and theology.17 their profession gives these people a are both human and pastoral in char- I would like to begin by giving a kind of emotional armor-plating. In acter and which will lighten the in- brief and simple exposition of the actual fact health care workers often evitable suffering which they take semiology and the symptomatology upon themselves and which will com- which the pastoral observer detects pensate them for the energy they have in the health care workers who take lost through their great efforts! care of those who suffer.17 I will In reality anybody who has the begin with the voluntary workers. In least human or pastoral sensitivity the eyes of society and the Church and sensibility can very easily dis- such people seem to be the reincar- cover that health care workers need nation of a form of philanthropy help and substantial support which is which was thought to be almost usually not available in health care in- extinct. For this reason they are a stitutions and indeed is not even precious symbol which everybody forthcoming, when such workers are strives to the utmost to bring to the Christians, in the Church itself. We attention of the public. For very might give a list here of what the many institutions which have to deal needs of health care workers in this with the world of suffering, these field really are: people constitute a veritable army of The need to give expression to individuals who by their vocation what they feel, a need caused by the are ready and willing to carry out systematic repression of their tasks whose character clashes with feelings which arises from repeated the mentality of a society which is contact with the suffering of sick based upon superficiality and people and their relatives; and the hedonism. need to have suitable channels for On the whole, these people are the expression of such feelings. well qualified to perform this task The need to counter and compen- with skill and efficiency but the help sate for the many complaints and that they need goes well beyond their instill a feeling of security in sick criticisms which sick people and training. The price of pain that they people and their relatives: “by now their relatives often make, some of have to pay in order to be loyal to you are used to seeing illness and suf- which are caused by the negligence their vocation as Samaritans shows fering” is a sentiment which is com- or false steps of health care workers itself in the worried concern that they monly expressed. themselves but which are also often display about whether they are really There are three principal reasons the result of the defects in the health up to the tasks that they are entrusted behind this widespread attitude. First service itself, of which they with. They are troubled by the fact of all there is the image that society themselves are the victims. that at times they do not know where has of health care workers, people The need to secure satisfaction in or how to lighten the suffering that who are seen as the technicians of a demanding kind of job and form of they have to deal with and which is health and health care and whose ef- employment which usually does not thrown in their direction. They have fectiveness and efficiency seems to offer many rewards to those who the feeling that they do not receive be accompanied by a cold scientific perform it. sufficient attention and esteem from objectivity which renders them in- the institutions they work for. These sensitive to the suffering and emo- facts are often experienced with that tions of other people. The training 3. The Contribution that sensitivity which is natural to pas- and education of the health care the Hippocratic Individuals toral assistance in the health care workers is another factor. Indeed, and the Good Samaritans field, and many of these Samaritans their studies involve an emphasis on of Today’s World Make often display a distinctive constella- scientific disciplines and there is ten- to the Meaning of Life tion of symptoms: tiredness, instabil- dency to neglect the human dimen- ity, disappointment, and bitterness. sion of things (including spiritual The question of the contribution to And if these emotions are not per- care) in their training programs. Fi- the understanding of the meaning of ceived and dealt with in suitable nally, reference has to be made to the life when that life is in contact with fashion they can lead in the best of efforts many health care workers suffering, something of course which cases to a notable reduction of effec- make to defend themselves from the happens when the sick are looked af- 132 DOLENTIUM HOMINUM ter, can and must be answered with worker who is engaged in caring and like those of Christ himself, every- two other questions in order to make curing discover his fundamental body else and they themselves will sure that a full and complete—but at human character— understand, that be healed. (cf. 1 P 2:24). the same time short -answer can be is, that he is both a pauper and a given. donor, that he is at one and the same Rev. JESUS CONDE The first question is highly condi- time both in need and able to help Archdiocesan Delegate tioned by the fact that suffering is a those who are themselves in need. for Pastoral Care in Health, Madrid sign and relates to the meaning that The second question directly this sign has for those who see it as a involves the state of mind of those result of their contact with patients. working in the field of health. This The question is as follows: what question is the following: what kind Notes meaningful aspects of life, which of orientation does the experience of are not present in other forms of looking after the sick impart to the 1. Quoted by PEDRO LAIN ENTRALGO in experience, do health care workers life of health care workers? Because Historia de la Medicina (Salvat, Barcelona, 1987), p. 135. come into contact with when they of their contact with suffering, a 2. Quoted by the same author in La Relación care for the sick? The answer neces- suffering examined and felt through Médico-Enfermo (Alianza, Madrid, 1983), p. sarily involves a number of steps. their care for patients, Hippocratic 98. 3. Quoted by the same author in the same First of all, they encounter one of the people have secured a constant work, p. 99. most lacerating forms of the advance in medicine which has 4. The observation is made by DIEGO presence of evil in the world and continued until today and will GRACIA GUILLÉN in “El Dolor en la Cultura they thus come up against the sign progress even further into a future Occidental,” in Fe Cristiana y Sociedad Moderna, vol. 10 (SM, Madrid, 1982), p. 27. of the inherent infirmity which St. which will be even more extraordi- 5. D. GRACIA GUILLEN, l.c. Paul perceived in the whole of the nary. These are workers of a techni- 6. JOHN PAUL II, the apostolic letter Salvifici Creation.19 Indeed, it should be cal miracle, and for Christians they Doloris, Feb. 11, 1984, no. 29. pointed out that all human cultures express and bear the ordained power 7. JOHN PAUL II, Salvifici Doloris, no. 28. 8. P. LAIN ENTRALGO, La Relación, p. 105. have seen suffering as an evil which of God in their curative actions. 9. P. LAIN ENTRALGO, op. cit., pp. 107-108. should not really exist. The health care Samaritans, on the 10. “La concepción de la asistencia que But differently from those who other hand, encourage us to work for dimana de la doctrina y conducta de Jesús imprimiió una evolución decisiva a la cultura have argued and continue to argue an ever more overall form of care y la praxis sanitarias de Occidente y, a travs that we should distance ourselves and treatment which can provide an de ellas, a las de toda la humanidad” (J. from our own suffering and from the answer to the various aspects of CONDE HERRANZA, “La Aportacion de la suffering of other people20 people suffering which a patient undergoes, Iglesia a la Sanidad,” in “Evangelio y su Propria Tradición,” Labor Hospitalaria: like Hippocrates and the Samaritans whether of an organic, psychic, Organización y Pastoral de la Salud, no. 223, of each and every epoch have social or spiritual character, begin- 1992, p. 72. detected a form of human penury in ning with these very same dimen- 11. JOHN PAUL II, op. cit., no. 29. 12. This is recognized by the present Pope as suffering—a poverty which can be sions, which of course are also well in a paragraph of this apostolic letter: treated by anybody who helps those shared by the volunteer worker or “There is a great deal of the Good Samaritan who suffer from its effects. Suffer- the professional practitioner. Once in the profession of the medical doctor, of the ing, therefore, is a reason for human again the model and inspiring nurse, and of other health care workers.” 13. For a discussion of this title, its meaning progress, progress, that is, which is example for this integral process is and its implications see the magnificent study both physical and psychic, scientific Christ. As the New Man, he is, of of MANUEL GESTIERA GARZA, “Christus and spiritual. The Hippocratic tradi- course, the representative of total Medicus: Jesús ante el Problema del Mal,” in tion believed that suffering, and the synthesis which in the case under Revista Española de Teologia, 51, 1991, pp. 253-300. infirmity of which it was the sign and discussion involves a fusion of 14. See D. GRACIA GUILLÉN, “El Cristian- expression, involved a challenge to patient and healer; figures which are ismo y la Asistencia al Enfermo,” in Labor man’s ability to introduce order and present, become integrated, and also Hospitalaria: Organización y Pastoral de la Salud, no. 184, 1982, p. 67. harmony into chaos through the use become transformed in his person. 15. For a more detailed discussion of this of reason and through the employ- To conclude this paper it should point and the others that follow see J. CONDE ment of instruments invented by the be observed that Christ is that HERRANZ, op. cit., pp. 73-77. human mind. meaning to life which today and in 16. P. LAIN ENTRALGO, op. cit., p. 128 ff. 17. A more detailed and complete pastoral On the other hand, the Samaritan the future requires a grand alliance contribution to this subject can be found in the tradition, by which I mean the Christ- between Hippocrates and the Good various works published in the separate ian tradition, involves an invitation to Samaritan, between intelligence and monographic publication of Labor Hospita- ensure that not only natural and ratio- feeling, between reason and will, laria dedicated to “El Sufrimento en la Enfer- medad. Claves para Vivirlo Sanamente,” no. nal resources are mobilized against between science and faith, between 235, January-March 1995. suffering but the whole of the person technology and charity, and between 18. See J. CONDE HERRANZ, “Los and personality of the individual who treating and caring. In health care Cuidadores del Ser Humano Enfermo,” in “Introduccion a la Pastoral Sanitaria,” provides treatment and care. pastoral work we see matters from Delegation of Pastoral Care in Health to the This, in turn, involves drawing this point of view. And taking this Archbishopric of Madrid, September 1994, upon the resources of the redemption form of pastoral care as our point of pp. 22-24 (document for internal circulation of Christ, the Healer who made departure, we call upon the whole only). 19. In Rm 8:26 St. Paul calls this “our himself Servant and Patient and Church to give a strong and resolute weakness” and extends it to the whole of the through this triple capacity (which impulse to this alliance within her creation in verses 19-22. was expressed in unified form in his own life and structures, and to ensure 20. For example, and for different reasons, ancient stoicism, Buddhism at all times in its own Person) was able to cure, to that all Christians become ever more history, or the modern religion of “happi- lighten and to console. Only through concerned to assist those who assist ness,” which is still very widespread in the Christianity can the health care so that as a result of their wounds, West. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 133

STANISLAW GRYGIEL

The Civilization of Sadness and the Culture of Joy

“Supernatural remorse leads the religious dimension to life. moral obligations upon us—but were to an abiding and salutary The word “religion” comes from the guided by things to do and to have in change of heart, whereas Latin term relegere—that is, “bind,” Jericho. Thus it was that they passed the world’s remorse leads “collect into one,” “read,” and ‘walk.’ by that man who called (like Job) for to death.” Man reads the text which is he himself justice for his wounded dignity.2 In (2 Cor 7:10). and other people, he collects it into a their mentality—which is so similar to whole and reads it with He who has our scientistic way of thinking—there Man wishes to live more fully. He written it. At the same time the good of was and is no place for a sacrifice of knows what he must do to have abun- the truth which is given to man in this one’s own ideas for the sake of truth dance. It is not clear to him, however, text unites his love with He who has and for the good of man. what he must do to satisfy his wish to be loved man from the very beginning in The formalism of the priest and the more fully. To be to the full is some- the act of creating everything that Levite blinded them to what was really thing very distant and the paths along exists.1 It is precisely from this starting before them and meant that they failed which he treads during his miserable point that man walks towards God or, to create a story worthy of being told. present only lead him to another present in other terms, it is here that he loves The time of their going to down “from which is equally miserable and short- Him “in spirit and truth” (Jn 4:24). Jerusalem to Jericho” is a time of lived. Man not only wishes to be more Eternal life awaits all those who emptiness—nothing happens. They fully—he also feels himself called to be love God and their neighbors as remain within the Gospels as images in such a way and he is thus responsible themselves with all their hearts. When of people who in banal fashion go for his response to such a call. The task the lawyer asked “who is my neigh- nowhere and are convinced that it is of being to the utmost, therefore, is en- bor?,” Christ showed through the story precisely there that they will deal with trusted to his freedom. But where are of the compassionate Samaritan that the questions bound up with the the paths of this freedom? Without any the question had been asked in the meaning of their lives. They approach doubt they are reached “through faith” wrong terms—do not ask who your this meaning as if it were a “riddle” to (Heb 11:8-9) and hope. Indeed, they neighbor is but become the neighbor be solved with the help of powers of lead beyond time and space, dimen- of other people! Change the direction reasoning. In passing by another sions in which only things to be pos- of your existence! On the road which person in indifferent fashion they sessed exist. But where do these paths led from Jerusalem to Jericho the detach their minds from the truth and begin? Man becomes afflicted by great priest and the Levite were also to be the wish for that good which has been sadness and anxiety because he knows found. But they passed the wounded given to their freedom—that is to say that upon himself alone rests the re- man by without caring about him and to their faith, hope and charity. They sponsibility of whether this sadness without concern. They did not change think they know what the evil is that “will turn into joy” (Jn 16:20) or the direction of their existence. They consumes the man. They believe whether it will start to degenerate into were not “moved” by the injured man therefore that the truth and good of his “irrevocable” despair. and they remained unaffected. They being depends on them. As a result, “A man was going down from did not read what was written and did they give voice to mere empty gestures Jerusalem to Jericho” (Lk 10:25-37). not love the good which was revealed and refrains which are repeated in a By means of the parable of the Good in his injured condition. Their affairs sort of ritual fashion. Samaritan Christ answered the which they had to deal with in The “little prince” would call men of question posed by the learned man of Jerusalem meant that “their eyes were this kind mushrooms swollen up with law: “what shall I do to inherit eternal kept from recognizing him” (Lk their own pride.3 Thus it is that license life?” The lawyer knew that man can 24:16). Thus it was that their failure to produces pride and refuses to receive speak about eternal life only in the recognize the truth and the good in the gift of other people. The person who form of a question. He did not know, another person meant that they failed has already solved the riddle of man however, that the answer is not to be to do that person justice. They also comes to treat him as an object from found in a particular sentence but in a failed to do themselves justice. They which nothing can be expected. He change in the direction taken in life. allowed themselves to be guided not passes him by, therefore, and enters The wish for a fuller life which by what was revealed in the experi- “Jericho” with the same unthinking im- expresses the desire to be, and not to ence of the presence of another pudence with which Oedipus entered have something or other, opens man to individual—a presence which places Thebes after solving the riddle posed to 134 DOLENTIUM HOMINUM him by the sphinx. But although he ex- ical-economic nature has made the economy and an apparent culture pre- perienced power and pleasure in that presence of other people useless. As a vail, in which comfort and pleasure are place, both he and those dear to him result, he is not present even for him- the principles of thought, action, and were to meet a tragic fate. A civilization self. In line with equations which en- being. In not building a family home, which distances man from man directs able him to be something but not to be the human person loses his identity and the ecstatic existence or rather the spir- somebody, the time of jealous love for his dignity. He loses his paternal inher- itual life of individuals towards the Antigone—the time dedicated to other itance, as happened with the younger void. They go out from themselves but people—is time lost. In a world created son in the parable of the Gospels who go towards nothingness and fall into an by spiritually sick people, each and leaves father and brother and leaves unthinking revelry and desperate sad- every Antigone will be condemned to “for a faraway country” (cf. Lk 15, 13). ness. Their wish to live more abun- death. In the “faraway country” he falls into dantly puts roots not into what is, but Truth entrusts its mystery to man in a ideologies and searches in vain for his into a praxis which has been calculated way which is proportionate to the ex- identity within them, all this after re- in Promethean fashion. Their love and tent to which he exists in dialogue with ducing the evil which injures man to an their knowledge are deprived of good another man. It flees from those who in easily answered riddle and not stopping and of truth and fold in upon them- solitude, and thus in sterility, construct to stay at the side of someone, not even selves, losing themselves in a search for opinions which are “shadows” of himself. In the void which does not call effective means by which to produce truth—that doxa process of Plato’s for love there dies both thought and comfort and pleasure. Their spirit is cave of slaves, or the matters to be dealt will. In the void man perishes. The road sick. The falsehood of intelligently with in “Jericho.” Truth and good are to salvation from the appearances of constructed illusions devastates their unable to bear the work of truth and life and from mortal sadness passes minds and makes slaves of their wills. good. Illness of the spirit leads to sloth through the man wounded by evil. Job Where there are no meeting points (acedia). Man is then besieged by sad- calls on his friends to stop and to be a there is only that which does not ex- ness and worry (anxietas, augustia) gift to him—that is, to justify both his ist—the void.4. In the bible the void and about hidden evils and at times by the and their being. Those who stop to be sadness which spring from this absence good in others—as if this caused evil to beside him “will see” God with him and appear for the first time in Caine (cf. Gn himself (invidia)7—which paralyzes will experience a happiness different to 4:6). Caine believes that he knows the the mind and the will. Man becomes in- all those different kinds of happiness significance of the evil which torments ert not only in knowing truth and loving which they have previously experi- him—he sees its cause in the specific good (agere) but also in external activ- enced. What happens through the com- presence of his brother. He observes ity (facere).8 Sloth thus links up with passion which links the Samaritan to the latter’s happiness with envy and despair. the man wounded by evil creates the does not realize that Abel receives that The priest and the Levite certainly story which could save us if, as Plato happiness in an opening of himself with had houses but they did not have a would have said, “we gave faith” to that elevated realism to the divine dimen- home in which to be themselves. A very story.12 sions of his own existence. Caine home can only be built in communione The Samaritan was so open to pride, moves in sterile fashion in the void of personarum. The pusillanimity which and thus free as well, that when the equations of pure reason. Subordinat- prevents them from stopping next to presence of the wounded man caught ing himself to their mechanics he tries another man has made them become in- him unawares and surprised him he to be more abundantly through the pos- dividuals who are homeless. The put up “resistance,” stopped and session of things more abundantly. But homeless do not constitute a society but changed his plans. The Gospels say unfortunately this does not transform an appearance which is called a crowd. that the Samaritan was greatly moved the human being. As Plato would have The crowd is always full of sloth. Its ac- at the sight of the man afflicted by expressed it, Caine ceases to be a “de- tivism is none other than another form evil—“he was compassionate towards moniacal man”5—that is to say a spiri- of sloth. The inability of spiritually sick him.” The tears of emotion purified his tual man, an expert in questions which people to take creative decisions and to eyes and for this reason the Samaritan are of decisive importance for the perform creative works means that was able to perceive what neither the meaning of his life—and becomes a within society ars gubernandi, which is priest nor the Levite, and not even the “mere workman” who knows some an extension of ars creandi 9, becomes friends of Job, were able to see. “trade” or other. Closed within this replaced by what I would term ars ad- The truth revealed in the other man “trade,” he carries death for other peo- ministrandi. In an administrative, logi- placed the Samaritan in front of two ple within himself rather than becom- cal, empty and workless functioning, difficult challenges. In replying to ing their neighbor. The spirit decides ars dominandi becomes the logic of so- these the Samaritan gives priority to the character of the moral conscience of cial relationships. The struggle for the his neighbor over his affairs in Jericho. man. A sick spirit means a sick moral functions of administration is accom- This makes the other man almost a co- conscience. panied by servility. This latter gives owner of his property. The Samaritan “Nobody is as sad as I am.... I look rise to merely apparent politics whose is not in a hurry. He gives his time to into myself and see what I am...dead. purpose does not involve, as Aristotle the other person. He is able to give it Did I say I was sad? I lied. The desert, would have said, “promoting friend- because it is under his command. He the incalculable nothingness of the ship” (and thus also justice) because measures his freedom in terms of the sands beneath the lucid nothingness of “justice and injustice take place above greatest future of time. This generous the sky, is neither sad nor gay: it is sin- all else between friends.”10 In the crowd realism allows him to be master of ister. Ah! I would give my kingdom to men are not so much worried about the himself and therefore enables him to shed a tear.”6 For the King of Argos, building of a common home but about exist as a gift for other individuals. who utters these words in Jean-Paul their own interests in opposition to the In converting himself to the wounded Sartre’s work Flies, the “trade” of dom- laws which govern a shared home.11 In man the Samaritan comes to know the inating the mechanisms of social-polit- this way we observe that an apparent truth of what he is. Thinking in its deep- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 135 est sense has the character of a dia- God. It is the path of creative action the essence in the life of man. It is logue. For this reason it requires action which embraces man and the path of precisely for this reason that man can and an enlarging of hearts—or, to put it creative embrace which acts with man only ask questions about the truth of another way, love. This indeed begins for man. Within this creative action is his being. He asks about it with in the com-passio personarum. The gradually revealed the Action of the keenness and hope in com-passione16 tears he sheds enables man to perceive Love of God. Because of this, the ac- because only in com-passione does he the truth that he can only ask about. It is tion of man becomes the image of the cease calculating and thus stop fleeing precisely this question which is the Action of God, and this image is ever from what he is in the “faraway essence of the dialogue, and without more expressive of what it represents. countries” of his own inventions. In this dialogue, indeed, man cannot In the actions of man there is something com-passione we think and exist with think. of a divine character, something which responsibility and faith. Our creative What does the Samaritan think? The reveals itself in being present in such (creatio) actions have their outcome Samaritan is profoundly moved by the actions, it is something which cannot (gubernatio) in our thinking and exist- human being who is in danger of be seen or understood by man himself, ing with the other man and for the dying. He is moved by the contin- it is the moment of sacrifice. Is man, for other man. The Samaritan treated the gency of the being of the man with example, able to say why he goes to the wounds of the poor victim; took him to whom he has come into contact and aid of someone who is drowning an inn and “took care of him”; and who shows him a road to be taken notwithstanding the very great danger entrusted him to the inn keeper and which is different from that which to his own life? Here can be seen the promised to return. (Lk 10:34-5) The leads to Jericho. And it is this other “bet” of Pascal. Act as though there fact that the Samaritan is moved road which the Samaritan has asked were eternal Life—it will reveal itself creates a space for interpersonal for. He asked for it not with words but to you and will enter into you through relations: others enter into his work. In with a change in his own existence. He your actions. Where there is something the Gospel parable, society is born will indeed go to Jericho, but by a to be saved grace will flow forth. when the inn-keeper enters into the different route. com-passio which united the Samari- Through the contingency of the hu- “From close at hand tan with the injured man. Society is man being he has seen the fragile con- It is difficult to grasp born when a third man enters into the tingency of the world of things, their that God is there. act by which a man makes himself non-necessity. Previously the Samari- But where there is danger, there another man’s neighbor. tan had seen only changes in the world, also grows that which saves you. Only in a space which is social in changes which he could dominate, in In the shadows live this sense and in performing a creative much the same way as Oedipus an- the Eagles and without fear act which does justice to what happens swered the riddle of the sphinx which go the children of the Alps in order to express truth for the mind had man as its subject. But only when over the abyss and good for the heart, does man come he is face to face with death—that de- of weakly built bridges.” to understand that his being is directed scent of the being of the person into (Fr. Holderlin, Patmos) towards Another Being. In this way as non-being—does he enter into that well, by making himself a neighbor for context where he becomes a metaphys- In the being “moved” of the Samar- others, he becomes freed of every ical question about being.13 An in- itan there is that sadness which St. Jericho. The free man—that is to say creased sensitivity to the contingency Thomas of Aquinas called mercy.14 he who is true to the other man in of the human being and metaphysical Both heroic thought and in equal creative fashion—betrays humanity thought arise in the Samaritan thanks to fashion heroic existence, and therefore and the Divine when he distances his being “moved” by the presence of that which we call the metaphysical, himself from Him and goes to the the man who is threatened by nonbeing. spring from mercy in com-passione “faraway country” of his own private The Samaritan senses that the being of personarum. He who knows how to inventions. Where the word betrayal is the man asks for help in order to exist. live knows how to think, and he who an empty word, the word society is Who can give him that help? The an- knows how to suffer with others—that also empty. swer to this question does not solely lie is to say he who makes other people The “little prince” said of the in thinking about the condition of the his neighbor—knows how to live. society of individuals who made wounded man—something which the Thought is dialogue, but loneliness themselves neighbors of each other in priest and the Levite (or the friends of kills dialogue. King Oedipus begins to creative fashion: “you have golden Job) certainly did. The Samaritan does understand the truth about man—a colored hair. It will be wonderful when not search for help for the other person truth which has nothing in common you take me into your home. The corn in thoughts—on the contrary, he begins with the world of riddles—only when is gold and will make me think of you. to act. He performs actions which there his daughter Antigone, in analogous And I will love the sound of the wind at that very moment require his and not fashion to the Samaritan, leads him in the corn... Only those things which another person’s presence. Taking the into the lands from which one starts have a home can be known. Men no other man within himself, the Samari- out. longer have time to know anything. tan justifies both his own being and that Heroic thought and heroic existence They buy things already made from of the other person. He strengthens are the essence of creative work which merchants. But because merchants in both and defends both from nonbeing. opens man—and here one speaks in friends do not exist, men no longer St. Thomas of Aquinas would prob- religious terms—to resurrection15 We have friends. If you want a friend take ably have said that the fact of his being should not forget that Christ told the me into your home!”17 A society of “moved” led the Samaritan to take the story of the Samaritan as an answer to friends which “make a home” for each so-called third path ex contingentia. a question about what one should do to other, their mutual and shared This path leads him to the Being who inherit eternal life. presence which is so great that it exists by His own will—that is to say It is the greatness of God which is of reveals itself in all its splendor only 136 DOLENTIUM HOMINUM through their...absence such a thing them. They are apostles. Notes transforms the world. This presence is The joy of happiness is the fruit of 1. I am in no doubt that the so-called transcen- full of joy. It distinguishes itself from the mutual presence of people. “When dental elements of classical metaphysics— empty merriment because it is rooted you look at the sky, the night, and being, truth and good (ens, verum et bonum)—if in sadness com-passionis personarum. because I will live in one of those and I they are not reduced to a product of human It is the joy of contingency understood will laugh in one of those, for you it thought and thereby destroyed, direct the intel- and justified by mercy. He who is a will be as if all the stars were laugh- lect and the will of man towards God. 23 Metaphysics has no sense if in speaking about vehicle for the words volo quod sis (St. ing.” The joy of happiness is the fruit that which becomes in order to be able to be, Augustine)—I want you to be, to be of shared work. The cultivation of the reference is not made to God. better than you are—experiences joy. soil—a task which God gave to Adam 2. The parable of the compassionate Samari- If such becomes the situation of man, and Eve, to a community of love rather tan shows how searching to pass from so-called enunciative sentences to imperative sentences then we are dealing with society in the than to mere individuals (cf. Gen causes a distancing from the truth of God. Moral deepest sense of the term. In such a con- 1:28)—stops being a dimension of the engagement does not spring from the mecha- text eros-desire, which is conceived in creation of society and culture when it nisms of reasoning but from the presence of man human Misery, are filled with Divine becomes closed up in the interests of for the sake of man, and this is a presence which 18 calls men to perform acts of compassionate Abundance, by that ...... , and be- individuals. The person must enter into justice. comes a love which is given in divine the work of his neighbor in order to 3. ANTOINE DE SAINT-EXUPERY, Il Piccolo fashion. Eros-desire directs man to- participate in joy. This, indeed, has the Principe (Bompiani, Milan, 1993), p. 37. wards God19 and becomes ever more character of communion. (cf. Jn 4:38) 4. It should be remembered here that Aristotle had much to say on the subject and believed that the divine wish to be a gift for others. We cannot speak about work, friendship “is something which is very neces- Plato understood this truth when he de- culture and happiness unless we speak sary to life, Indeed, nobody would chose to live clared through the lips of Diotima that in religious terms and within a without friends, even if he has every other good” “divinity does not become mixed with religious framework.24 In this sense (Ethica Nicomachea, 1155a). 5. PLATO, Convitus, 203a. man. Through Eros is expressed every nothing need be added to the words of 6. JEAN-PAUL SARTRE, Flies, II, 3 and 4. relationship and every conversation be- Plato: “Whoever...has cultivated love 7. Cf. Summa Theologiae, I-IIae, 35, 8, c. tween the gods and men, both when for knowledge and truthful thoughts 8. Cf. ST THOMAS AQUINAS, Summa Theolo- these last are asleep and when they are seriously, and has engaged in these giae, I, 63,2, ad 2 (Acedia...est quedam tristitia 20 qua homo reditur tardus ad spirituales actus). awake.” The “demoniacal man” is dif- faculties above all others, is, I believe, 9. See the classical maxim creatio est continua ferent from the “mere workman"—he led to think on immortal and divine gubernatio. behaves like a pontifex, he builds questions, provided that he refers to 10. Ethica Eudemia, 1234b. bridges between men and God, he pro- the truth. There is no defective part 11. The word “economy” comes from the greek oikos (home) and nomos (custom, law). duces in unselfish fashion and creates within him in that long space which 12. LATO 21 Cf. P , The Republic, 621c. in Beauty. In building such bridges he reaches to the points where human 13. From the perspective of the experience of becomes a neighbor of the other per- nature is endowed with the ability to the danger of death, we should think in new son. He exists because he is a gift. The participate in immortality. To this man terms both about the materialistic vision of Permenides about being (of the One)—a vision Gospels do not tell us what happened to who always stewards the divine and has in which changes are apparent—and about the the learned man of law who asked scrupulous respect for the guiding pantheistic philosophy of change of Heraclitus. Christ about eternal life in order “to put genius who lives within him—the It seems to me that the fact that they do not him to the test” (Lk 10:25). It is cer- demon—is in special fashion guaran- consider the Samaritan’s experience of the tainly true that his attachment to the teed eudemonia, the happiness of mortal danger which hangs above the being of 25 man, means that they are unable to become a scholarship he possesses makes it more life.” question about the Other Reality. Non-being, difficult for him to become some- In the parable of the prodigal son the indeed, does not exist. Death, on the other hand, body’s neighbor. The capacity of Oedi- older brother did not make himself the cannot be reduced to the changes observed in the pus to solve riddles about acquired neighbor of his own wounded brother. world. 14. Cf. Summa Theologiae, I-II, 35, 8c (Miseri- functions enables man to enter Thebes In passing him by without pity in going cordia, quae est tristitia de alieno malo, inquan- or Jericho but it makes it more difficult down to his Jericho, he also wasted his tum aestimatur ut proprium). for him to enter eternal life (cf. Mk inheritance. Were it not for the pres- 15. It seems to me that in heroic thinking and 10:23-25). The young rich man “went ence of the Father—He who never equally heroic being, the so-called third way of St Thomas Aquinas begins and takes place. It is away sad at heart, for he had great pos- stops making himself a neighbor to all in the profound concern for man that the contin- sessions” (Mt 19:22). The surrogates of his children—in that song of our exis- gency of our being and existing is manifested. truth and good obstruct the way to hap- tence there would prevail a desperate 16. Cf STANISLAW GRYGIEL, “Il Senso della piness—that which is called sadness and an equally desperate rev- Sofferenza nel Mondo Secolarizzato,” in Il Nuovo Aeropago, no. 2/1995. beatitudo—because they weaken elry of men who draw away towards a 17. Cf Ibid., p. 93ff. within man that capacity of his to re- “faraway country” where a wild injus- 18. ARISTOTLE, Metaphysics, A, 1072b. ceive truth and good.22 tice reigns. In the story which takes 19. CF. PLATO, Convitus, 178c,d, Christ spoke about new life to place in the presence of the Father “in 20. Ibid., 203a. 21. Ibid., 206d,e. Nicodemus who did not want to put the end also that which is wild must 22. The Latin word beatitud comes from Jesus to the test but sought to know come to the sacred place of the faraway beatus which refers to a person who has what was in his heart. Christ spoke countries” (Fr. Holderlin, Friedens- received good, bonum. about new life to the Samaritan who fier); a place in which sunt lacrimae re- 23. Il Piccolo Principe, p. 116. 24. The words cultus and “culture” derive from asked for such a life by asking about rum and gaudium et spes; a place where the word colo, that is “cultivated.” Only by eternal life. The peace which flowed just mercy governs. working in a communal fashion can we “till the out from Nicodemus and the joy of the land.” The same is true of free individuals, that Samaritan expressed themselves to Professor STANISLAW GRYGIEL is to say individuals linked to the truth and the Professor of Philosophical Anthropology good which come from God. We work, there- other people. Men who are so happy at the John Paul II Pontifical Institute fore, for man, and worship God in the truth and carry to others the truth of God about for Marriage and Family Studies, in the good of what is. man, the truth which is present in at the Pontifical Lateran University, - Rome 25. PLATO, Timeus, 90b,c. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 137

WANDA POLTAWSKA

The Responsibility of the Medical Doctor and the Life of the Patient

Introduction tered any difficulty when taking the tion in professional ethics has created oath asked of them. Only actual a fundamental problem for Catholic The medical profession has been changes introduced into the text of doctors. Indeed, it rightly gives rise to the object of esteem and respect for the oath have caused conflict and rad- difficulties because there is a funda- many centuries. Some have called it ical friction. Under the totalitarian mental conflict between present-day a free profession, others have seen it regimes doctors were often the ex- medical practice and the principles of as a vocation. It has even been ecutors of a variety of political tasks Catholic ethics—those ethics which suggested that it is not a profession at and for this reason such regimes tried the Catholic doctor is called upon to all but an art—ars medica. to control and direct their profes- practice in the exercise of his profes- This “calling” is completely sional activities, a process which in- sion. In the same way, the patient who directed towards the good of other volved depriving medical doctors of is a believer also has the right to ex- people and has always involved a their professional independence. pect that the doctor behaves and gives special responsibility. This has been The activities of German doctors advice in line with the canons of the apparent in the creation of an at the time of Hitler was an example Hippocratic oath. Such a situation independent set of professional of such a state of affairs and culmi- creates an inevitable dichotomy ethics from the times of Hippocrates, nated in the infamous death penalties within the world’s medical profes- a code which has been accepted by imposed upon many doctors after the sion, as indeed is more than demon- doctors all over the world. This Nuremberg trials. Indeed, in 1947 strated by the frequent establishment medical code applied to the practice the Supreme Court of Nuremberg of specific separate organizations for of medicine justifies the trust which returned independence to medicine Catholic doctors. people place in medical doctors. by establishing in firm and decisive The traditional ethical code of This general esteem is a response to fashion that the medical doctor Hippocrates obliged doctors to the special character of this profes- should only follow his conscience as follow certain fundamental points sion—a profession which is indeed a doctor and the guidelines of tradi- which are binding upon every honest worthy of respect. tional professional ethics, and should doctor still today, and they are above In this way a special dependence not be forced to accept and follow and independent of his particular of the patient on the doctor has laws decreed by other institutions. way of seeing the world: arisen. This dependence still exists The medical doctor, therefore, is even if the general attitude towards authorized to go against requests a) Primum non nocere—Above all medical doctors is not always which are contrary to his profes- else, do no evil. infused with esteem and admiration. sional conscience. This principle requires constant In recent decades, indeed, the ethos It might appear that a statement of study and updating to ensure an exact of doctors has undergone such great this kind acted to save the ethos of diagnosis of the pathology which is changes that it has become necessary the profession from various dangers. present. Where doubt arises, it re- to define what the true characteris- It might seem, that is to say, that quires the doctor to call upon col- tics of this ethos really are. This, in from the Nuremberg trials onwards leagues who have greater expertise turn, has given rise to an urgent need the situation in the field of world and experience. It might be pointed to achieve a precise and renewed medicine has changed decisively. out that the traditional second opin- definition of the duties and the rights The opposite is the truth. Crimes ion is disappearing and each doctor of medical doctors. which were clearly judged at now sees himself as an “authority.” Nuremberg to be “crimes” have This principle also requires constant since acquired social acceptance. I study and research to find new and 1. The Traditional Ethics am referring here to killing sick more effective methods of treatment. of Medical Doctors people in order to shorten a useless But at the same time it requires pru- and Catholic Ethics life or the use of people to carry out dence and long-term reflection. That experiments. Indeed, at the present is to say it calls for prudence in the The traditional ethical code of Hip- time many doctors engage in activity hurried acceptance of what is new— pocrates did not in any way find itself which would have been condemned it can often happen that the forms of in opposition to Catholic ethics. For as criminal at the Nuremberg trials. treatment which are proposed have centuries Catholics have not encoun- This highly significant transforma- worse consequences for the patient 138 DOLENTIUM HOMINUM than the illness itself. The most im- soul in relation to the body and must placed in his hands...God himself. portant thing is to pay primary atten- take the destiny of that soul into These ethics call upon the doctor not tion to the immunity systems of the account. to dominate the patient but to serve body and if possible strengthen them. For this reason, if a newborn child him. They demand the respect due to Overall, this principle imposes a cer- has uncertain health or his life is in the simple fact that the patient is a tain humility on the physician. danger, the Catholic doctor must man—for a Christian, to be a “man” make sure that the child is baptized means to be a child of God, created b) Salus aegroti suprema lex est immediately. In the same way, if a in the image of God himself. The need to place the health of the patient is seriously ill he must have The Catholic doctor must accept patient first in the exercise of the the opportunity of having absolution the divine origins of man—each and profession of medicine has given rise and the last rites. every man—quite irrespective of the to the building of an ever larger All advice given by the doctor re- condition and development of his number of hospitals and rest homes garding both treatment and preven- body. In each person he must see that in order to be able to treat the sick tion must take an exact and overall vi- fundamental value which is the person in the ways and with the time sion of man into account. To this end, dignity of the human person. This which are required. the doctor must not only know but person is called to the life of the But for the medical doctor who is Spirit, and it is at this point that a believer the concept of health has Catholic ethics are totally and to include something more than the completely opposed to biologism mere health of the body. In the which sees in man a mere collection Christian mental framework, man is of cells derived from the mother and never a body alone: he is a person father and thus ignores the Spirit who has his origins in God; he has a which gives and maintains life. The soul; and thus within him he bears a doctor must accept the fact that the dimension of eternity to which he is true giver of life is not the parents— directed—he is thus called to eternal they merely transmit the life happiness. According to this concep- received from God the Creator. As a tion of man, the idea of salus must result, only the Creator can be seen also include reference to the overall as the Lord of life; to Him alone is to perspective of human destiny. be given the decision as to the Because of this neither therapy nor moment of birth and of death. its effects can be contrary to human Respect for the person must lead to dignity and its responsibilities. The respect for the human body and to Catholic doctor cannot practice a true canons of behavior. The right to form of treatment which involves, life is the primary right of every man for example, the need to deprive and the doctor must defend and another person of his life—as occurs promote every life—in particular in the case of surgical treatment for lives which are threatened, weak or Alzheimer’s disease and with other ill. It is obvious that the doctor does diseases which involve transplants. not have the right to kill an unborn Here we touch upon the funda- child or an elderly person whose life mental difference between the is about to finish. A Catholic can behavior of doctors who are believ- also accept the principles of Christian never, in any situation, take life ers and those who are not believers, anthropology and always be in line away from a human being. and this is a division which is and concordance with them. In dubio mitius—in doubt choose becoming ever deeper. A Catholic the most moderate solution. This cannot prescribe contraceptives or rule of behavior for the medical abortion-inducing drugs, and he 2. The Correct Conception doctor—and especially for the cannot consent to sterilization, of Man in Christian specialist—notwithstanding original genetic engineering, and so forth. Anthropology, Biologism, intentions, can end up by favoring a Sterility treatment cannot take place and Utilitarianism choice which is wrong—that is to through the use of artificial insemi- say an acceptance of the so-called nation—something which is not The doctor can treat the patient in lesser evil! But the Catholic doctor worthy of man—nor can the treat- the right way only when he accepts can never choose evil, whatever ment of sexual neurosis involve the fundamental conception of man form it may take. He cannot choose proposals to commit adultery, and all revealed by Christ himself who went either a greater evil or a lesser evil. the rest. “against the tide” as regards the The choice of evil is always a sin. If concern for the health of the conception of the world which The words of Jesus are very patient (which is the basic principle prevailed when he was alive. This significant here: “Woe to the world, of the doctor’s whole activity— approach also goes against the tide for the hurt done to consciences! It suprema lex) must consider not only when we consider the ideas which must needs be that such hurt should the earthly life but also the supernat- are ascendant in today’s world. come, but woe to the man who ural life of the patient, it naturally Before drawing near to a patient the through whom it comes!” (Mt 18:7). follows that the advice given by the doctor must know who he is. Christ- Now, given that correct decisions doctor cannot damage the soul. ian ethics, those ethics which are the depend upon the personal convic- Indeed, the advice of the doctor must most rigorous, require that the doctor tions of the doctor, who the doctor is accept the primary importance of the sees in the person who has been and how he lives his life is not of no VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 139 importance. Christian anthropology present at the moment of death. For thirteenth of December in Poland places human life within the context the believer death is an encounter when despite the fact that the repre- of eternity and imposes decisive with God “face to face,” and man sentatives of the Union of Doctors requirements. Man has not only must prepare himself for this were present, the Catholics voted received his life as a gift, he also has moment with the utmost seriousness. against the principles of true ethics. tasks which are linked to that As a result, the patient must not be The Catholic doctors are character- gift__that is, he must be perfect “as thrown in a corridor and hidden ized by weakness and a readiness to your Heavenly Father is perfect” (Mt behind a screen, left as though he compromise, and by their easy sub- 5:48). The doctor, therefore, must be were some useless thing. The jection to the pressures of the medical holy because this is the primary task Catholic doctor has the duty when world to obtain profits and popular- of the life of each and every person, present at the patient’s death to pray ity. One could cite endless examples and of this the Catholic must be fully for that patient; to prepare his family of moral degradation in the medical aware. In this way, apart from his for this moment with all delicacy field, not to allocate blame but to pro- duties towards the patient, the doctor possible; and even to ensure that the voke initiatives which will improve also has precise duties towards family is there so that the death of this situation. himself. One can thus state with the patient becomes truly human. One way of doing this is through confidence that the first element is pastoral work in the health sphere. conditioned by the second. Of This has been done by the Catholic relevance here is the advice given by Church, for example, in Krakow, a doctor on television about how to where there is a special tradition—a conduct one’s sexual life—he tradition promoted by the Holy himself had had four wives. Father who was responsible for such Finally, the fundamental principle pastoral work in that city. which governs the actions of a Chris- Indeed, the Church is concerned tian must always be love for his with the salvation of man and gives neighbor, and this must be a total precise indications. But a knowledge love. “Love your neighbor as of the publications and directives of yourselves,” declare the Gospels. It the Church in this area is very weak is not possible to think that such love amongst doctors, even though many can be achieved when it is condi- papal communications dwell upon tioned by the economic advantages questions that doctors deal with or which might be gained from it. with which they should be con- Indeed, an attitude of total indepen- cerned. dence must always be adopted For this reason the first task of a towards such material reward. In the Catholic doctor is to have a profound history of humanity there have been knowledge of the doctrine of the many exceptional doctors whose Church and to see how his own ideas actions have been rooted in a love for relate to the principles of Catholic their fellow-men—a love carried to ethics. He should not only be aware levels of heroism. One might refer of general rules but be informed as to here to the Polish doctors who how they should be applied in the decided to die with their patients at practical situations which actually the time of the Nazi persecution (Dr. The Catholic doctor must make arise. Zdzislaw Jaroszewski)1. sure that in the rooms of the sick At the present time there is an But love for one’s neighbor must people there is a cross on the wall enormous temptation to follow also be shown in the respect that one and a priest to help the patients. In progressive and liberal currents. This has for the body of each and every this way a hiatus will not be created is a temptation which derives from man, in the respect and delicacy with between the theory and the practice human vanity alone. But the medical which it is treated. Indeed, given that of his ethos. doctor should become the instrument the dignity of the human person also of divine grace rather than arrogate includes his body, the patient has the to himself those rights which in fact right to be treated in such a way that 3. Casuistry belong to the Creator. Thus it is not his dignity is neither wounded nor for the doctor to decide the moment humiliated. An example of this is the When one observes the actions of of birth or to decree who should have idea that it is always necessary for doctors who describe themselves as a child or when a grandmother the patient to undress in a way which being Catholic one can see a diver- should be killed. does not take his modesty into gence between the statement that Test-tube fertilization is another account. For example, in radiology it they belong to the Church and have temptation which afflicts the medical is not true that the patient must received the sacraments of baptism, world in the name of so-called “scien- undress. In American private clinics first communion and marriage on the tific progress.” This is certainly a de- such an idea is unthinkable. The one hand, and their actual behavior velopment with regard to technologi- radiological examination, in actual in the professional sphere on the cal possibilities, but in relation to hu- fact, is carried out with the patient other. man dignity this way of being born is covered by a cloak—the material of The medical world is simply cor- in opposition to the essence of that the garment does not cause shades rupt and of this all doctors are guilty, dignity. It is something fit for ani- on the X ray. including Catholic doctors. One need mals, creatures quite different from To conclude, the doctor is often only remember what happened on the man. Although one cannot deny that 140 DOLENTIUM HOMINUM one should treat infertility, it is neces- diseases, that a condom be used. contraceptives, and if he does not sary to place clear limits to what sci- This is because abstinence alone is a understand the reasons for this ence should do. safe and effective form of preven- policy he must seek the advice of a tion; moral expert or read the publications The Catholic doctor 6) must make clear in decisive on the subject issued by the Church; 1) must never, in any circum- fashion that virginity is not in contra- 12) in his own life must take stances, kill a child. There is no diction to nature and must promote advantage of the grace of the sacra- medical diagnosis in the world an authentic vision of human sexual- ments so that the advice he gives is which authorizes a doctor to kill. ity. There is no physiological mecha- illuminated by the Holy Spirit. The There can only be special forms of nism which forces an individual to Catholic doctor should be aware that treatment when the pregnancy engage in sexual activity; his actions should be in harmony involves complications, because in 7) must never advise divorce as a with those words addressed by the such a situation there is always the solution to a situation of conflict Holy Father to doctors when the question of saving two individuals; when there are contrasts within the Pope was in Krakow: “You are my 2) may never propose or carry out marriage relationship; hand stretched out to those who do artificial fertilization “in vivo” or “in 8) can never allow his profes- not come to me.” vetro,” quite apart from the fact of sional service to be influenced or whether such fertilization is homolo- conditioned by the economic advan- “Let your word be Yes for Yes, gous or heterologous; tages which he gains or might gain and No for No” (Mt 5:37)— without 3) may never invite the patient to from such service; ambiguity. secure artificial ejaculation for the 9) does not have the right to kill a purposes of examining the quantity seriously ill person, giving as an Professor WANDA POLTAWSKA of spermatazoa, not least because the excuse the motivation of so-called Member of the Pontifical results of such a test are never “mercy.” Nobody knows the extent Academy for Life, certain. Indeed, there are people who to which the difficult moments of the Director of the Institute have five children despite the fact illness may be necessary to salva- for the Theology of the Family that a sperm analysis demonstrates a tion; at the Pontifical Theological low count in both quantitative and 10) can never succumb to pressure Academy in Krakow, Poland, qualitative terms; of any kind whatsoever, but must Consultor to the Pontifical Council 4) does not have to carry out a always be guided by the Catholic for Pastoral Assistance to prenatal diagnosis in all cases, and ethical code, and this also applies to Health Care Workers such diagnoses, when carried out, cases where this involves economic must be used for possible treatment, loss or even loss of prestige for the never to kill; doctor; Notes 5) must never suggest to a person 11) must always give a clear and afflicted by AIDS, or to people with decisive opinion in relation to the 1. Sterminio dei Malati di Mente in Polonia other kinds of sexually transmitted ever controversial question of 1939-1945 (PWN, Warsaw, 1993). VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 141

ELIO SGRECCIA

The Embryo: A Sign of Contradiction

First of all, I would like to express une gave evidence. There have also periodic destruction ordered by my deep gratitude to His Eminence been a large number of legislative governments, and the removal of Cardinal Angelini for inviting me to proposals aimed at making abortion cells; open the debate of this round table. lawful in such Latin American coun- b) the question of new products, At the same time I would like to tries as Peru and Mexico. These pro- methods and vaccines which are express my admiration and good posals have necessarily involved the deemed contraceptive, interceptive wishes for the success which these question of the status of the embryo or anti-pregnancy but which are in re- international conferences have and the fetus, either directly or indi- ality techniques of abortion because always enjoyed and achieved— rectly, if only because the life of the they prevent the implanting or the conferences which are a point of process of implanting of an ovule reference, among many other things, which has already been fertilized. for ethical-medical reflection, Amongst these, reference should be thought, and written discussion. I made to the IUD, the day-after pill, greet the authorities and experts who the northplant, and vaccines. Evan- are present and I especially thank gelium Vitae deals with this whole those who will make a contribution area at n. 13. It is in relation to these to the debate which will be questions, and above all in relation to conducted by this round table. The in vitro procreation, that the highly subject which we are to discuss this sophisticated and groundless theories afternoon at this round table has of the pre-embryo (the early embryo become of central importance to the of the first fifteen days of life) or the present-day debate which revolves pro-embryo (the embryo of the first around two principal areas: bioethics eight days of life) have sprung up. and biolaw. The basic biological and philosophi- We need only look at the data cal dimensions of these ideas and the- bank of bioethical and medical ories will, I imagine, be examined by writing on the subject to see how this those who are to contribute to this is so. In the years 1970-1974 rather round table. more than five hundred works I would like here to draw attention dealing with the biomedical aspect to a quotation from one of the Fathers of the question existed, and there of the Church, Tertullian: “homo est were twenty-seven works of a philo- qui venturus est.” sophical-theological character. In the I would like to draw even greater years 1990-1994 there were nearly attention to a passage from the in- 4,200 works on the biomedical struction Donum Vitae which is in dimension of the subject and 242 on turn quoted by the encyclical Evan- the philosophical-theological aspect fetus and that of the mother have been gelium Vitae: “From the moment of the debate. The reasons for this considered in relation to each other. when the ovule is fertilized a life be- are more than evident, and we are But at the present day there are two gins which is not that of the father or not dealing here, as before, with the other great questions which have of the mother but of a new human be- mere question of abortion, however brought bioethics and biolaw to the ing which develops of its own accord. present, painful and controversial center of public attention: It can never be human if it is not hu- that topic may be. a) the question of in vitro procre- man from that moment... At the mo- The subject of abortion has indeed ation which involves the phenome- ment of fertilization is begun the ad- been of major public interest. There non of the surplus production of venture of human life, and each of the was, for example, the special com- embryos which come to be termed great capacities of this life needs time mission of the American Senate “supernumerary” (a new category of to find its balance and to prepare itself which met on 23 April 1981, a com- human being) and where a number to act.” (Donum Vitae, I,1; Evan- mission established by President of abuses take place: freezing, trans- gelium Vitae, no. 60). Reagan and to which Professor Leje- fers which cause death, experiments, The proof of this statement is to be 142 DOLENTIUM HOMINUM found above all else in biological whole question and then publish a this same question. I will now invite facts: work on the subject. the first speaker to address the 1. From the moment of fertilization It is in order to discuss this overall conference, and I offer my apologies we are in the presence of a new, inde- subject and to defend the position to everyone here present. pendent, individualized being which taken by the encyclical publication develops in continuous fashion. Evangelium Vitae that I must now Most Rev. ELIO SGRECCIA There is no moment which is less nec- (with little elegance) withdraw to Vice President of the Pontifical essary than another (and this is even take part in the special work group of Council for Life, recognized in the Warnock Report), the National Committee for Secretary of the Pontifical and each stage is strictly dependent Bioethics which is now discussing Council for the Family upon the stage which precedes it and which determines it. 2. Objections based upon the fact of gemination, upon the appearance of the primitive streak and of the nervous system bud, and upon the relevance of the implanting as a decisive event for the continuation of development, do not bear in the least upon the individuality of the embryo or the continuity of development: in the process of didymous separation the residual part does not lose the individuality of being human and the new part which separates off has its own new individuality; the appearance of the primitive streak and of the nervous system—like the whole process of organogenesis—are the outcome of this active and individualized development. The two moments of real disconti- nuity in the life of an individual are to be found in the acts of fertilization and of death. Leaving this reality apart, human and philosophical reason must go beyond functionalist or phenomenologist forms of mentality which approach facts in relation to their operative capacities and with reference to the demonstration of such capacities. Human reason—if, that is, it really seeks explanations and gives explanations for facts—cannot but affirm that authentic explanation which is given to us by the recognition of the existence of a special and specific energy which informs and animates the whole of the human being; which vitalizes it and individualizes it. This is none other than a self capable of spirituality, a personal self, which bears within itself all that active capacity which fulfills and realizes itself in the person. R. Colombo, a molecular biologist, observes: “None of the scientific knowledge available to us allows certain support for the objections raised to the rational nature of the human embryo and the human fetus and its individualization.” In order to investigate this subject the Academy for Life has set up a multidisciplinary task force which will study all the aspects of the VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 143

MARIE-ODILE RETHORÉ

Jérôme Lejeune: A Scientific and Christian Profile

When in 1952 Mr. Lejeune asked From that time we have acquired a what he had just written. When I me (having been advised to do so by large number of new and advanced found a play on words which was his wife) to work with him “on genet- machines which have become ever overdone I said to him simply: ics” I accepted immediately. How- more effective and sophisticated. I “What you have written here you ever, I had absolutely no idea about have not seen one which from an like but perhaps you could cut it what awaited me. At that time genet- early stage was not transformed, I out.” He then said to me “It would be ics was not taught in medical facul- would even say transfigured, with a pity, but no doubt you are right,” ties. jam or chocolate paper, or with and he conceded the point. Jérôme Lejeune at that time transparent tape. All the salesman When hurt by criticism which worked in the pediatrics section led and people who installed these came from all directions or he was by Professor Raymond Turpin. It machines went away amazed and worried about what would happen to was there that he discovered children astounded, but never convinced by the institution he used to say to me: which were called “mongoloid” and the effectiveness of the transforma- “Why worry, why lose time over to whom he would dedicate a great tion in the workings of these things over which one has no part of his existence. machines which we had achieved. control.” Perhaps he knew that his Professor Turpin was the only But let us return to the initial days were counted. When it was person at that time to have created a description of the laboratory and of necessary to separate him from his clinic for children suffering from a its microscope. “This wonderful lens work at times one had the sensation mental handicap. Mr. Lejeune often lay on a trolley for sick people which that one was doing something said that such a handicap was acted as a solid support. A high chair wrong. During his illness I heard just “undoubtedly the most dramatic was a part of the support, that kind of one complaint: “It’s so so stupid. because only man can suffer from it chair which is rather like those that There are so many things still to do.” and it is the most inhuman because it one still sees today behind an old He was not worried; he was not prevents the patient from being fully organ in a church. This was where afraid. A journalist asked him if he himself.” the trolley was so useful. Instead of was afraid of the capacity of technol- After becoming a researcher he moving the chair—a risky undertak- ogy to blow up our planet and he did everything in his power to set up ing given its age—one sat down replied: “I am in favor of absolute a research laboratory: “a sort of immediately with a complete sense trust, for the very simple reason that I machine with which to seize the of security. think man is immortal. I believe that opportunity presented to me, whose And just like Grok with his piano, man is made for eternity but I am not effectiveness depended upon a we found it was merely necessary to sure that humanity is made for eter- condition of permanent alertness.” draw the trolley forwards to see nity. The real question is to know if A little more than ten years later, everything with great ease. This was man is or is not made in the image of on 10 March 1965, during an inau- really a lucky find and it brought us God. If God has or has not loved man gural lesson, Professor Lejeune re- great advantages.” I would add: here so much as to give him his image. If called the establishment of that re- we see how easy it is to be a happy the answer is yes, then humanity ac- search laboratory with a certain nos- man—he needed nothing else! quires a clear and high dignity. But if talgia and a great deal of emotion: He loved his work. He believed in you think that man is a matter of mere “The place was very beautiful. It had it deeply and it was this, I chance, the product of accident in an two great sky-lights but there was I never saw bitterness, jealousy or indifferent universe, why should one neither water nor gas nor any kind of envy in him. Yes, indeed! He was not indeed continue to play fast and support plan. Our microscope, which happy in a simple fashion and knew loose with mankind?”2 had been the pride of the hospital dur- how to make other people happy. “My father was an admirable ing the twenties, was still of a certain He was ready with a joke at every guide, and to him I owe everything I use especially when the filed teeth of moment. He played with words and know which is of real importance. He its cogs were covered with a piece of could not do otherwise. This disori- taught me that the existence of a man chocolate paper carefully placed in its ented his detractors, even the most must be ruled by two imperatives: gears.”1 choreic! He often asked me to read rectitude in judgment and enthusiasm 144 DOLENTIUM HOMINUM for what is true. My mother taught me ical consequences, and above all else ence are not the products of evolution the greatness of devotion and the to tackle the need for a therapeutic in the automatic sense of the term: the power of goodness.” Here we can see solution which could be presented to intelligence of men exists because the roots of the guiding thread of this his patients, he became a researcher they are made in that way! It has been man of research, this doctor, and this in the field of biochemistry: “it is a given to them entirely and freely!”7 teacher. question of life or death” he often He compared the working of “Research should be carried out said to me, “if we do not cure them modern computers to human intelli- with one’s whole heart, for all of they will be killed.” He suggested a gence and made the following obser- one’s life, and all the time, otherwise variety of theoretical models which vations: “they resemble each other it is not research! Researchers do not would permit a representation of the merely because the calculators are know more than other people. They sensitive surface of cerebral cells made by men and it is not surprising are by no means wiser in the static and thus involve the prediction of the that we find in their highest sense of the term. They are only men types of molecules which could be examples a kind of mirror in which of learning whose passion for under- acted upon in this kind of metabo- we configure.” But he immediately standing has not obscured their went on to declare: “this means that faculty to admire. This enthusiasm computers are in precise terms for nature is the only real sign of the disembodied intelligence. It is for researcher.”3 this reason that at times their powers His propensity to imagine general seem so much to be feared. Men are theories never led him to forget the exactly the opposite. They are in a primary importance of experimental precise way an incarnation of intelli- steps: “During the course which I gence, and it is for this reason that will have the honor to present you each one of us is so valuable.”8 with,” he used to say to his students “A commonly held opinion at the inaugural lesson, “everything regards man as an anomaly without a which I will explain to you as being cause whose destiny is nowhere experimentally proved must be inscribed, an object which will be accepted by you as constituting forever incomprehensible, the fortu- building blocks of good quality. But itous product of an indifferent everything which I will suggest to universe. Either human intelligence you which is an explanatory hypoth- is the outcome of chance—the mere esis you will have to consider as expression of evolutionary mecha- being provisional scaffolding which nisms as some people would have perhaps masks the final architecture it—and thus according to the ancient of a building which is still at the aphorism of Democrates (expressed building site stage.”4 in new form by Monod) a question The medical doctor at the service of where “everything in nature is the of patients always came before the outcome of chance and necessity,” researcher. “You only need to know or our intelligence is (as Engels the terrible experience of a soul would have it) the mere consequence imprisoned within an imperfect of psycho-chemical laws. Matter and body, of an intelligence which feels energy, it is argued, generate the itself but which cannot express itself spirit so that this latter appears, one because of the lack of a finite lism so as to achieve a reduction in day, in some corner of the universe. substratum, to understand that the disturbance. “Men are not born Leaving aside this dilemma, there is medicine must not surrender to this equal before destiny. The only however an explanation which is sentence pronounced by destiny, that dignity which exists in our science is more convincing. we must not resign ourselves to the the search for means by which to This is that the spirit which leads irreparable. The whole history of restore to men by means which are the universe and its laws has created medicine teaches us that those who as different as they are necessary that in a most special way the only living have freed man from the plague and which nature has refused to them or creature which is able to discover the from rabies are not those who suffo- has taken from them.”6 marvels of that universe. In such a cated those afflicted with rabies Everything which affected man line of thought the fact that the between two cushions or who burnt and his intelligence was almost sa- universe is intelligible itself becomes the houses of those struck down by cred in the eyes of Lejeune: “The new intelligible! the plague. The morality of medicine moralists argue that man is made by The absolute superiority of man, can be expressed in a single phrase: society, that it is society which gives his complete newness, lies in his be- hatred for the illness, love for the him intelligence and that as a result ing the only creature able to experi- patient. If this is forgotten, we are society has the right to dispose of him ence a kind of link between the laws perhaps technicians but we are most with the laws it creates for itself. of nature and his sense of existence. certainly not medical doctors.”5 However, the knowledge which we The ability to admire is present only In order to have a better under- have accumulated over the centuries in man! standing of the connection between tells us that the opposite is true. Hu- The man who was the first to know genetic disturbance and its patholog- man intelligence and the whole of sci- how to die and to build tombs; the VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 145 man who helped his fellow man when born blind from birth: “In a similar cules are nothing but the progressive wounded, tended to him, fed him, and way we can say that when men are transformations of an idea which is defended his weakness; the man who able to overcome an illness, to save a always the same: an idea which discovered art rather than mere tech- child from death, when they ensure seems inevitable to us perhaps niques; that man is us, we are not the advance of science, in such cases because it is really inscribed in the more than one hundred thousand the work of God is also expressed.”13 deepest part of ourselves. An idea years old, and intelligent love is like a “In this materialistic age of ours,” which I could not express better than spark within us.”9 he said at Notre Dame in Paris on 10 by paraphrasing the beginning of an And this man, merely because he October 1982,14 “it might seem inap- old book: at the beginning was the is man, has the right to absolute propriate to reconcile the facts of rev- message. This message is in life and respect for his life from the very first elation with hypotheses based upon this message is life.” instant until his natural end. Here is scientific observation. These two one of the messages of Professor forms of knowledge are profoundly Professor MARIE-ODILE Lejeune which everybody remem- different. One is given freely and is RETHORÉ bers: “Some scientists express very Member of the National Academy nebulous opinions to make people of Medicine of France, believe that they—the scientists—no Associate Professor of Genetics, longer know what a human being is The University of Paris, France and that they do not know when that human being begins. But we know exactly what a human being is and we have an extremely simple definition: he is a member of our species. If the embryo were not a member of our species from the very first moments then he could never be a member of our species.”10 A journalist asked him what he thought of ethical committees which make decisions about respect for life and about embryos, and he answered: “When I hear people talking about ethics, I am immediately careful. The people who talk about ethics often want to put morality to one side. The person who speaks about morality understands that convention should conform to higher laws, but the person who speaks about ethics assumes Notes that laws should conform to convention.”11 1. Inaugural lesson, 10.3.1965, L’Expansion Scientifique Française (15, Rue Saint Benoît, He spoke very rarely about his Paris 75006). faith. He lived it, in simple fashion: 2. “I do not like Speaking about Ethics “I have been asked what I would be expressed in poetic language which When Morality is the Subject,” 1.03.1985, France Catholique, n. 1993. if I were not a Christian. I am forced the heart understands with joy. The 3. Inaugural lesson, 10.3.1965, L’Expansion to say that I do not know. In the same other is gained with hard work and is Scientifique Française, (15, Rue Saint Benoît, way I have been asked what I would a difficult matter which reason can Paris 75006). 4. Idem. be if a were not a medical doctor. only conquer with a great effort.” He 5. Idem. Here also I am forced to say that I do concluded: “Such is the decision of 6. “I do not like Speaking about Ethics not know. It is certainly true that we God, who made the sky and the earth When Morality is the Subject,” 1.03.1985, France Catholique, n. 1993. have different features, but in essen- and made all these things obscure to 7. “The Incarnation of Intelligence,” tial terms we are all hewn from the the wise and the knowing but re- 28.09.1978, Congress of the Association of same rock.”12 vealed them to children.” Saint Benoist, Avignon (France), Eaux Vive, n. 39, pp. 26-27. When he was asked if as a doctor At the end of his inaugural lesson 8. Idem. he in some way blamed God for all he expressed his deep conviction:15 9. Idem. the suffering he came into contact “Whatever the name it receives, 10. Idem. 11. “I do not like Speaking about Ethics with every day, he used to answer: whatever the characteristics and When Morality is the Subject,” 1.03.1985, “When faced with unbearable evil properties which it is attributed, or France Catholique, no. 1993. the doctor never accuses God.... The the structure which it is thought to 12. Idem. 13. Idem. temptation to accuse God.... No, that have, something must exist at the 14. “Biologie, Conscience et Foi,” really does not befall me.” boundaries of matter and form which 10.10.1982, Recherches et Expériences He found the answer to the transcends both but at the same time Spirituelles (Notre Dame de Paris, France). 15. Inaugural lesson, 10.3.1965, L’Expan- mystery of suffering in the explana- unites them. Formative virus, inner sion Scientifique Française (15, Rue Saint tion offered by Christ to the man form and the coding of macromole- Benoît, Paris 75006). 146 DOLENTIUM HOMINUM

ADRIANO BAUSOLA

The Cultural Anthropology of the Right to Life

The cultural-anthropological ap- thanasia centers first and foremost character. We should therefore proach to the whole question of life, on the direct question of its accept- analyze the characteristics of the its value, and its defense can take ability and whether it should be rec- doctrine of libertarian the abortion place at a number of levels. ognized and sanctioned by the law. phenomenon: the egalitarian- Cultural anthropology in the This debate involves arguments homosexual tendency which goes strictest sense of the term is a proposed by the critics of euthanasia with certain defenses of abortion, descriptive and comparative inquiry and abortion which should inspire especially in the feminist camp; anti- into the various systems (or subsys- general agreement because of their Catholicism, anarchism and other tems) of culture of the various ethnic intrinsic worth. And yet it is a elements. communities. This involves especial common feature of our days that When this has been done the attention being paid to the origins of these arguments are heard with diffi- question poses itself: how did we their forms and an interpretive, but culty: they are very often misunder- come to all this? To employ not an evaluative, system of analysis stood or even rejected out of hand. Freudian terminology, we can see (at least at the level of declared The dominant culture even derides how Christian ethics—ethics which, intention because in actual fact them. Any effective anti-abortion among other things, involve duty, things often turn out rather differ- initiative at the level of arguments sacrifice, the overcoming of mere ently). This generally leads to a and persuasion would have to take personal interest and thus are comparison of the various cultural notice of the weak hold that these capable of safeguarding every life systems which exist in the world. arguments have on our contempo- even when that life cannot make It is, however, clearly impossible raries (at least in Italy). We must ask itself felt—had far less difficulties in to effect a complete survey of all the ourselves, if we want to take effec- the pre-industrial scientific-social cultural systems in the world, tive action, what the reasons are for pre-modern age than in today’s whatever the particular elements the failure of this persuasion world. The “principle of reality” in within these systems may be that one however valid its principles may such a context called on people to wants to investigate. be—something, however, which is make sacrifices (given the fact that For this reason we have to choose. by no means difficult. the resources available at that time And I, following the orientations of A historical-cultural investigation were rather limited) and gave my own specific cultural into the origins of the abortion credence to the outlook of Christian background, will dwell upon the phenomenon—a movement which is ethics with their ideas about modera- subject which forms the subject of very widespread today especially tion and self-restraint. This made this important conference (the value within the mass media—is thus very people ready to accept rules which and the defense of life) with refer- clearly called for. required the sacrificing of personal ence to the Western cultural systems I will begin my attempt at a interests in order to defend the rights of our time. I will compare and general path of inquiry by citing an of others, including the rights of contrast them and engage in a incisive observation made by Luigi those who were not yet born. discussion about their various princi- Lombardi Vallauri. For this author- With the emergence of industrial pal features. ity, the form of the abortion phenom- society, and the triumph of technol- An analysis of the subject of the enon which prevails today is of a ogy, it appeared that the availability right to life with reference to the “libertarian” (abortion is legitimate of goods had become so extensive threat to life provided by abortion is because the foetus is the property of that the idea of self-sacrifice which very difficult. The same may be said the woman, something which is hers, was characteristic of previous ages of the question of euthanasia as it and anyway the woman has the right was no longer necessary. Not so long arises within our Western societies. to deal with her body as she sees fit ago the idea became widely accepted If there is enough time I will thus without reference to the action of the in industrialized societies that also try to engage in a brief discus- state or other authorities) rather than poverty was by now a thing of the sion of this second question. a “humanitarian” (abortion is a past and that “the principle of reality” I will begin with a matter of fact. “lesser evil” to be prevented where no longer required traditional inhibi- The debate about abortion and eu- possible but tolerated otherwise) tions. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 147

As Augusto del Noce has written, fied in theoretical terms), pornogra- once it is assumed that transcendent “The total dominion of man over phy, and the abortion mentality. ethical norms have no basis, it is no nature seems to have coincided with But within this general framework longer worthwhile to defend lives the disappearance of ethics, at least the abortion phenomenon has its which compromise the well-being of in relation to sacrifice, self-restraint own special connotation which those already in this world; lives and asceticism. The disappearance springs from the particular social which are seen—if they are even of religion and morality seems to phenomenon of which it is the allowed to begin—to be destined for have been a part of the victory of expression. The abortion attitude is a a world perceived in dark and technology. Technological progress synthesis of hedonism and despera- pessimistic colors. thus appears to have made a tion. In addition to the selfish calcula- complete naturalism possible.” The hundreds of millions of pos- tion of “Let’s remain few in number Here we can see that what was sessive hedonistic individualists gen- and thus go on living well in this previously only argued by certain erated by the emancipated bourgeois world,” great emphasis should be philosophers became widespread at culture transferred to the masses by placed on the existential pessimism a mass level: “the principle of plea- which is present in our crisis-locked sure” became the criterion for hu- societies, something which leads the man action, and ethical libertarian- fact of being born today to be consid- ism became the formula which most ered as a negative fact. suitably expressed it. I would ob- “I enter an integrated planning of serve that at the root of this process the economy and of society/nature,” was the historical crisis (not a real observes Lombardi Vallauri, “and crisis given that in truth things are the libertarian element is losing, is very different) of the metaphysical provisional; one can only go towards (and Christian) belief which held integrated socialization. I enter the that the world was full of objective physicalistic world of `nothing- meaning, and that this was because other-than’ (from the nothing other it was given a purpose by God. In than the world of quantity and such a way the world was in itself quality), and man is lacking in oriented and oriented man accord- ontological essence. He is a process ing to certain objective moral which can be calculated and molded, norms. The atheism and materialism his human essence becomes distrib- of certain modern philosophies have uted in sovereign and historical given theoretical expression to, and terms by society. And it is society universalized, the mechanistic con- which confers the right to exist on ception of the universe which has people.” been characteristic of modern sci- In the libertarian project this ence from its birth onwards. It ontological right of the unborn child should be remembered here that sci- is confiscated by the mother. Will it ence itself, during the course of this not pass on in the future to the trade century, has often greatly changed union, the party, or the planning its own principles and has raised office? I enter materialistic new questions about the real exis- immanence and totalitarian abortion tence of this mechanism. Socialism and by the trade union has at least the same chances as Materialist philosophy joined movement do not now find them- libertarian abortion. Indeed, collec- hands with the mass movement of selves face to face with the overcom- tivism will probably prevail at the industrialization, and this movement ing of poverty. On the contrary, they final reckoning over individualism.” provided the false assumption that have before them evident limits to de- It should be observed here that in man has an unlimited ability to velopment, ecological disaster, popu- many environments there has been dominate matter and to be a com- lation presure, and new forms of falling off in educating people to plete master of himself. This crime—in short, the partial failure of approach reality with their rational process produced mass libertarian materialism, a failure which is both faculties. This is because attachment ethics in both the West and the East, material and spiritual. It seems that to sense impressions prevails (or at in both capitalism and socialism. In one cannot but be bourgeois. But to- the most a more sophisticated this way, and in this mass culture, day there is a risk that one can no version of it, namely ethical senti- the principle of pleasure came to longer manage to be so. This means mentalism) and according to this prevail over the principle of reality, that we have before us both the ideo- creed only the person who manages and traditional sexual and family logical triumph of industrial culture to provoke feelings is of impor- morality found itself supported by a and its human and de facto crisis. tance—that is, feelings of sympathy Christianity which was much weak- Libertarian abortion is, therefore, or pity: the child who already laughs ened. Thus it was, inter alia, that a phenomenon of moral dissolute- or cries, but not the baby who has not sexual libertarianism gained wide- ness and of despair. Its dissoluteness yet made his appearance. (The adult, spread currency in the form of di- is promoted by this triumph; its it may be observed, is respected vorce advocacy, the anti-family despair is encouraged by the crisis of because he has strength in his arms mentality, homosexuality (also justi- materialism. During an age of crisis, or in his mind.) 148 DOLENTIUM HOMINUM

At base, materialism is still justification is a universal right. One reasons, and various reasons, given metaphysically present but with a could add that a perspective which that the theoretical approaches of the psychological application which gives hope of immortality can confer secular humanists themselves take should be investigated separately: effective and practical force to various forms. one needs to identify in practical injunctions not to search for the Similar (but not, obviously terms, within the realm of psycho- unlimited satisfaction of the needs of enough, identical) things may be sociological root systems, what the the men of today. In this case, true said in relation to the roots of the reasons are for the fall of reason. For enough, the secular humanitarian defense of euthanasia. At base here without reason, without the concept would not be personally put into as well there is a radical hedonism beyond the senses, it is difficult to crisis. Only his trust in the possibility according to which life should only understand the truth that even a life of the widespread diffusion of his be lived in happiness and unhappi- which is not fully life is in essential ideas would be put into a state of ness should be excluded. terms life and that there exists a duty crisis, a possibility based upon the As Caludio Magris writes, “It to respect life in a universal sense. simple structure of his principles seems that there is an ever greater Libertarianism, it should be diffusion of the mentality which added, has its matrix not only in the holds that to have the right to life one civilization of (assumed) abundance should be in possession of happi- but also in the belief that without the ness. The religion of happiness is “Hellenic” metaphysical construc- becoming ever more accepted, a tion of the world (there is an order to process which implies the falsehood being wanted by God) order is given that we can need to live with pain to the world by man by his own from our individual and social decree. lives.” Either happiness, or nothing. Today there are indeed some the- In support of an attitude which is ologians, both Protestant and favorable to euthanasia there is also Catholic, who say that God wants a another factor which is very world in which man himself gives widespread in contemporary culture. meaning to things and to life. In this “The emphasis on the need to case there is a need, without in any achieve subjective self-fulfillment way ignoring the difficulties of find- leads to an exaggerated search for ing an audience in today’s world, to ways of being and of living which refine the ancient metaphysical tend to exclude any perspective truths, as well as those of an ethical which involves limiting desire.” (G. character. It is certainly true that in to- Piana) day’s world there are forms of non- To live as old people and to live as nihilistic secular humanism which seriously ill people certainly are open in a positive sense to inter- means—it should be pointed out—to personal values and to respect for the live in the acceptance of not embrac- life of others. ing certain values. Let us suppose In the past there was a bourgeois that we should accept a spontaneous ethic of sobriety and discipline. vision of life which does not accept Today, there are humanists, Social- the disciplining of immediate ists and non-Socialists, yesterday which are, from the point of view of impulse, a vision which does not and today there were and there are an effective base, clearly inadequate. tolerate sacrifices for the sake of philosophers like Rousseau, Kant But this is not enough. It is not future superior goods. If such were (who, to tell the truth, were not enough to invite people to opt for the case it would be logical to atheists), Croce, and yet others who Christianity because this is the most conclude—it may be observed—that did not agree with destructive and solid point of departure for a univer- if the need and the positive character nihilistic libertarianism. In their sal diffusion of humanitarian ideals. of the sacrifice cannot be seen where works there is often to be found the Only if objective arguments can it is most clearly seen as being neces- implicit influence and presence of be presented can one go forward to a sary precisely because it will lead to the Christian inheritance. Christian proposal of universal a future good, the acceptability of the Secular humanists often do not cogency. And in such a context the sacrifice itself will not be perceived defend their values by choice but by problem becomes one of studying a fortiori where the positive aspect is feeling (we are dealing here with an the arguments in favor of deism (and less evident (even though it is emotion, a passion which does not of Christianity) which can strike a real)—an aspect which must and can have theoretical bases). One can see chord with secular humanists. And be looked for in the privations of old here that one needs not so much to this means that we must investigate age or painful illness. see that this emotion is invalid but the specific reasons for their refusal The cultural orientations which that the basis of its validity lies in its of deism (and of Christianity). These we have referred to act powerfully to deism. Where it is not said that reasons will not be the same as those produce an ethical climate in today’s everybody feels the emotions that which led to hedonistic libertarian- world which is incapable of recog- we ourselves feel, a revealed (or ism (not, therefore, those of industri- nizing the positive nature of life in philosophical-theoretical, deistic) alism, etc.) but there must be every situation and in every state. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 149

There is also a third factor at different attitude towards the genera- should be understood with reference work: the modern world—quite tion of human beings, towards birth, to the specific importance of its state. apart from the contrasts between and thus towards abortion. This is especially important today, at capitalism and socialism—lives in This value of generosity in giving a moment when sexual frustration is the dimension of the transformations life can also be recognized at the seen as an iatrogenic cause but when of the world, and thus in the dimen- level of psychological reflexes generative frustration is not seen in sion of the future. It is quite natural, which can be experienced directly. the same way, and this because it is therefore, that youth is prized, that A recent book by the great subject to the dominant technologi- there are spasmodic attempts to psychologist Erik Erikson makes the cal ethos of birth control.” always be young, that the idea of old following observation: “When But here the argument becomes age is rejected, that efficiency, the generative enrichment in its various too wide-ranging, and I must here capacity to work and to produce, in a forms fails completely, it is easy to conclude what has already been a word utility, are seen as the most come across regressive moves long paper. important values that there are. towards previous states both in the We need to ensure the widespread form of an obsessive need for false rediscovery of the value of generos- intimacy and in that of an excessive ity, of giving. This is also a decisive and exclusive concern with one’s Professor ADRIANO BAUSOLA value—if a brief digression is own image. In both cases there is a Chancellor of the Catholic University allowed—in the achievement of a widespread sense of stagnation. This of the Sacred Heart, Milan, Italy 150 DOLENTIUM HOMINUM

TADEUS STYCZEN

The Origins of the Concept of the Person: Four Variations on the Suggested Theme

Introduction very center of philosophy. The sage world for, is to bear witness to the of Athens believes that the mission of truth” (Jn 18:37-38). I will begin with a confession. the philosopher is to make his disci- The “Ecce homo!” of Pilate links When I received the invitation to ples aware of the need to “generate the question of the ideal of man with discuss the subject of “the origins of themselves” through self-knowledge the question posed by Socrates. It the concept of the person” my (“Know yourself!”) and he himself of illuminates itself with the light of the thoughts were drawn to the First Man course became a martyr to this cause Gospel. Nothing which is authenti- of the Book of Genesis and to the through the adoption of such a course cally human is alien to God who, for moment of his impact on the fact of of action. the sake of man, appears on his path. the world.1 Adam looks at the world However, this question finds its Thus was it that St. Thomas Aquinas of objects, wants to identify them, zenith and its full enlightenment only observed: “Gratia non tollit naturam and thus defines them and gives them in the New Covenant. It already sed eam supponit et perficit.” Thus suitable names. But he soon realizes appears at the very beginning of the also do we understand the reason why that there is not one which is mission of Jesus Christ when he “the question posed by Socrates” has surprised at the world, as he is. With engages in a conversation with always been present in the history of increasing amazement he observes Nicodemus. During this conversation the philosophical and theological that he is different from the rest of the the Master of Nazareth wins over a thought and debate of Christians in world. And even if the world is his “pharisee” who is fully convinced of relation to the question of the spiritual home, he feels uncomfortable in this the need “to be born again” (cf. Jn 3). birth of man. home -foreign and strangely alone. And thus it is that the question of the We do not know the name of the The amazement created by looking at birth of man as a liberation of man Christian who in enthusiastic fashion himself in the light of this difference from man through knowledge of truth wrote the text of the Hippocratic oath generates within him a need to ask and a decision in favor of that truth in the form of a cross on a parchment. himself a question about himself: in “know the truth and the truth will But we do know the name of another practical terms, who am I? make you free” (Jn 8:32)—is placed Christian who after centuries had I suppose that for the organizers of at the very center of the message of passed did almost the same thing with this international conference on the the gospels. Around it revolves the Socrates by bestowing the title Scito theme: “Vade et Tu Fac Similiter— entire oral message in an almost Te Ipsum on his own work of moral From Hippocrates to the Good monothematic composition, a theology and suggesting that the Samaritan,” who have asked me to message crowned by the death on the litanies of all the saints should end discuss the subject of “the origins of cross of Him who communicates it. with the invocation: “St. Socrates! the concept of the person,” it is Jesus Christ is the new Adam who Pray for us!” And this because of a precisely this question to which I expresses within himself the ideal perceived “baptism of blood.” That should devote myself. In the paper man, who creates him “in the suffer- Christian was Abelard! This is a that follows I would like therefore to ing of the passion” and in the fullness parallel which is very striking. E. propose to those who are listening to of the freedom of the truth until the Gilson even speaks about the “Chris- me that we accompany the First Man victorious “everything has been tian Socratism” of the Fathers of the on his path towards self-genesis and achieved” of Golgotha. In this context Church of the East and the West, and that together with Adam we thereby the “Ecce homo!” of Pilate (Jn 19: 5) goes on to draw attention to the discover a self-portrait of our own is a deeply important comment on the exceptional contribution of B. Pascal personal and spiritual physionomy. question of Jesus of Nazareth, a to the crystallizing of the personalist The question of the “self-genesis” comment which has proved highly approach to the discipline of philoso- of man which is dealt with in the first instructive to this day. Indeed, that phy.2 pages of the Book of Genesis by the comment came from the mouth of a inspired author of the Old Covenant man who a little time previously “had has, one might say, a “secular” equiv- liquidated” the solemn declaration of 1. The Subject and the World alent in ancient Greece. This equiva- the Accused with the ironical obser- lent is to be found in the introduction vation of a skeptic: “What is truth?.” I have already mentioned that “the by Socrates to the problem of the The Accused had declared: “What I origins of the concept of the person” “anthropological turning point” at the was born for, and what I came into the are to be found in the contact between VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 151 man and the world. It comes through do we not perhaps present a “partial himself that he is the only being in the an act—and at the same time a fact— definition”? That is to say a definition world who sees `from within’, that he of knowledge. In this contact man be- which, by perceiving the first person is bound to known truth, bound and comes struck by the contrast between in the question of the essence of the thus also `obliged’ to recognize truth, the world and himself. Man feels a person, actually pronounces the last if needs be, also through free choice, shock at the discovery of his own di- word on such a question. through acts of witness in favor of the versity in relation to the world and truth. This is the capacity to rise lives out his loneliness at the very cen- above oneself in truth.... Man merely ter of that world. He feels his separate- 2. A Subject of Knowledge observes that he is a personal subject, ness within it. And it is precisely this and A Subject of Freedom that is to say a person. He is placed contact of knowledge with the world face to face with his own dignity.”9 which initiates, together with the his- By now we can understand that we It is precisely here that man reveals tory of self-knowledge, the history of are next to Adam (and ourselves) like to himself the question of his own the birth of the concept of the person. a subject in front of a subject of moral identity through the recogni- And this—the act of knowledge— freedom—that is to say in front of tion that he is an actor burdened by frees within man the beginning of the someone who is himself thanks to the the exclusive responsibility of finding history of the whole of his great ad- the solution to this problem, a venture with the world and with him- question which is a supreme personal self on the stage of his own interior— drama, a question relating to whether something which for him becomes at he should or should not be himself. the same time the central stage of his What does this actually mean in world. Man sees that he is the only ac- more precise terms? tor on this stage and at the same time First of all I would like to say that the only spectator of his own perfor- the man-person is somebody who mance: the dramatis persona. continues to be unable to see himself In searching in the world for as long as he does not see within him- someone who can share his amaze- self someone to whom, through a free ment at the world, Adam finds that act of choice, it is not absolutely legit- person only in himself. And he then imate to deny the truth of he himself concentrates his amazement upon recognized through a cognitive act. himself when he discovers that what Secondly, this means that man can makes him different from the world is nonetheless deny that which he should what at the same time distinguishes absolutely not deny: man is an actor him from the world.3 The depth of the who can use the power of his own spell which accompanies this self- freedom to deny the truth which he discovery is paralleled by the death of himself recognizes. Thirdly, this the fear which grows within Adam at means, indeed, that the man-person— the discovery of his own loneliness who in fact decides to deny a truth amidst the world. “The eternal which he himself perceives—in- silence of infinite space frightens evitably works for the decomposition me...through space the universe of the compactness of his personal surrounds me and swallows me up structure as a union of the subject of like a dot; through thought I under- knowledge and freedom: that is to say stand it...I must not seek my dignity fact that in knowing truth he does not the union of a rationally free “self.” from space but from the correct use of cease to continue to depend upon Indeed we need only consider the my thought.”4 himself. Does not man, however, in following: what happens then to the Thus does Pascal see the interior of knowing truth commit himself to actor, and more precisely what does Adam in himself—the person and his knowing it also through acts of the actor do to himself, when through dignity. With a spiritual gaze Adam choice in order to remain loyal to the an act of freedom he denies the truth directly touches his own “self” as a end to truth and to himself—that is to which he himself as a person recog- subject in contrast with the “this” of say to his own identity?7 Indeed, nizes through his own cognitive act? the objects of the world.5 He discov- thanks to the personal perception of The truth remains the same. But does ers within himself the person as a this truth he can but observe that he the subject who as a subject denies subject of knowledge. guides and governs himself only the truth and at the same time recog- Is man, however, a person only when he allows himself to be guided nizes it, as the subject of knowledge, because of the fact that he is the and governed by truth. With the as truth, go on being that which he subject of knowledge? If such were power of his own liberty would he was—that is to say himself? Indeed the case the dramatic confession condemn himself to the tragedy of by lowering himself as a subject of made for us all by Ovid—”Video loneliness, that loneliness which gave freedom to something which he meliora proboque deteriora rise to the cry of St. Paul: “Pitiable himself does not approve as a subject sequor.”6—would not be possible in creature that I am!”?8 of knowledge, he freely falsifies his the biography of any man. St. Paul John Paul II has observed: “In truth own “self” through introducing by would make the same confession with is contained the spring of the the same act (within the sphere of his the words: “what I do is something I transcendence of man in relation to ontic “self”) that “self” which he has have not the will to do.” (Cf Rm the cosmos in which he lives. It is denied—that is, a “nonself.” And he 7:19). In characterizing the person, precisely through reflection on his always does this when he yields, therefore, as a subject of knowledge own knowledge that man reveals to whether freely or unfreely, to 152 DOLENTIUM HOMINUM something which he himself does nor to refuse it? Then I would condemn declaration: Hello sadness! approve—that is, to something which myself to a tragic loneliness in Per opposita cognoscitur. overwhelms him. He thus gives in relation to myself, loneliness being The question of choosing whether personal fashion his own self-depen- the close relative of despair. Indeed, to be or not to be ourselves is a “yes” dence, his own independence, which the person as a rationally free subject or a “no” to truth. It is not right for me is in the grip of some external power, cannot but on the one hand condemn to deny the truth of which I am to heteronomy. And he thus renders himself for the schism caused by cognizant! I govern myself when I himself and his own independence himself within his own structure, and allow myself to be governed by the slaves through the power of his own on the other observe that he does not truth. I make myself dependent upon freedom. Can we imagine a greater possess within himself the least myself when I make myself depen- slavery than the self-slavery which is power by which to annul the effects dent upon the truth. When I despise caused by this self-hypocrisy?10 Can of the rupture caused within his inner the truth I despise myself. I remain we think of a deeper fracture within being. He does not have the power to myself, and affirm myself within oneself which is deeper than this?11 make an act which he has performed myself, only when I rise above Thus we find the method of per nonexistent, and make that which is myself through an act of free choice opposita cognoscitur which enables its inevitable consequence null and in the direction of the truth of which I us to achieve a clearer completion of void. From now on he must always am aware. Only truth, therefore, the definition of the lines of our self- remain a witness and a judge of makes us free... portrait as persons. The person is the I understand the conclusion to the self-dependence of a subject (“self” reflection undertaken hitherto in the from “self”) which comes about in following terms: I see myself within one’s own act of making oneself myself as a person and I define my dependent upon the only power conceptual features when I observe which does not make a slave of the how I am someone for whom it is subject—the normative force of truth absolutely wrong to deny the truth known by the subject.12 I am myself which I have recognized. Or to put it always and only when of my own another way: when I myself place the accord I render myself dependent on sign of equality between myself and myself, but I make myself dependent the placer of truth.14 on myself always and only when Obviously enough, nobody can through acts of free choice I render take the place of somebody else in myself dependent on the truth which I performing the act of personally affirm and recognize as being seeing this truth, an act which consti- independent of myself. The truth tutes the beginning of self-genesis as goes beyond myself.13 For this reason a person. Each person must person- I remain myself and I assert myself in ally know the truth which makes him my own compactness and integrity free, and each person must personally always and only when I go beyond choose it so that it frees him in real myself towards known truth— and effective terms. Another person, affirming it until the end through acts however, can help him (as Socrates of free choice. In my personal perfectly observed) to see the truth essence as a union of subject of and that person can thereby become knowledge and freedom, I unify the midwife of his birth, and thus, myself always and only as a witness necessarily, the midwife of the of truth in its highest expression genesis of his vision of himself as a when I am its guardian and steward. himself as the creator of the tragic person. In truth, the man-person is a priest at victim of his own suicide. The Thus it is that even the author of the service of truth at two inseparable person, indeed, must look for ever the words: “Know the truth and the levels of such service: at the level of upon the work of his own self- truth will set you free” (Jn 8:32) halts the steward of the truth and at the destruction and condemn himself for full of respect before the threshold of level of the steward of the steward of having carried it out. He is the the freedom of man, the threshold of truth—in himself... creator, the victim and the judge—all the freedom of the person. Christ For this reason woe to the person, in one person—of his own tragedy. leaves Nicodemus with the task of not to truth, if the person betrays In The Divine Comedy Dante giving himself rebirth but he does truth. Thus it was that St. Paul did not expresses the tragic quality of this everything to engender within him say: woe to the Gospel if it is not situation with the words: “Abandon the work of self-genesis. From this preached but, rather: woe to me if I do hope all ye who enter here.” And he point of view Christ, the New Adam, not preach the Gospel. Vae mihi! places these words above the gates of goes infinitely beyond what the Karol Wojtyla, on the other hand, hell. Sartre defines the same internal author of the famous Psalm 8 had expresses the essence of the personal state of the person with the title of a been able to understand.15 God the structure of man with the words of a play—Huis Clos (“Behind Closed creator throws the whole world at the poem which bears the significant and Doors”)—a sentence which the feet of Adam and now throws himself meaningful title: “birth of the confes- English render well with two words: at his feet as God-Man, the Redemp- sors”: “But if truth is within me then I “No Exit.” Françoise Sagan on the tor Hominis, in order to fascinate and must explode. I cannot reject it, if I other hand, the author who comes touch man with truth about his great- did I would reject myself.” from the land of the cock-crow, ness and thus help him to choose his And what would happen if I were greets this despair with the following own greatness and uphold it until the VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 153 end. Deus homo ut homo Deus! as a person through his own action. philosopher, Augusto del Noce, who died only recently. Cf R. BUTTIGLIONE, Augusto del Gregory Nazianzen would proclaim “Through the act the person becomes Noce.Biografia di un Pensiero, (Piemme, when astounded by the offer of the “someone” and also manifests himself Casale Monferrato, 1991). In the same spirit is crucified God-Man.16 But St. Augus- as “someone” (K. Wojtyla). The birth to be understood the contemporary Italian tine would rightly add to this: “Who of the person is in this sense also the philosopher of law, SERGIO COTTA. See his “Etica e Diritto. Dall’Unità al Completa- created you without you, will not birth of the concept of person. mento,” in Studi in Onore di Manlio Mazziotti save you without you.”17 Man must Nobody can take the place of an- di Celso, (Cedem, 1995), pp. 287-294. Cf also be born of his own accord. However other person in this birth. Each person JOSEF SEIFERT: Essere e Persona. Verso una God is constantly waiting for man to must be born alone. Even God, for Fondazione Fenomenologica di una Metafisica Classica e Personalistica, (trans- allow him to help him in this birth. He “God cannot save man without man” lated with an introduction by R. Buttiglione, waits and constantly enjoins him— (St. Augustine). But because man Milan, 1989). and this because of the fact of the nonetheless can actually be born he 3. In a section with the meaningful title (in Incarnation—to ask himself that has an indispensable need for God. the Polish version) of “Man in search of his own entity” JOHN PAUL II characterized the great question of Anselm of Aosta: God wants to concede this new birth to condition of the “first man” in the following Cur Deus Homo?18 him and to do this God made himself way: “Thus the created man, from the very first For this reason once man asks this man, and he did this in order to be con- moment of his existence, finds himself face to face with God and is almost in search of his question he will have made a good stantly available to man like the Good own entity—one could say in search of a defin- beginning. Indeed, man thereby Samaritan. Man, however, continues ition of himself. A man of our times would say places himself in the visual field of “in search of his own ‘identity’.” The aware- God-Man.19 “The trials and tribula- ness that man is “alone” in the visible world and in particular amidst living beings has a tions of birth” (Rv 12:2) of man in negative meaning in this search because it himself—together with every possi- expresses that which he “is not.” Nonetheless ble temptation to surrender and to fall the awareness that he cannot in essential terms identify with the visible world of other living into the abyss of despair—from now beings (animalia) has at the same time a on will always be shared by man with positive aspect in relation to this primary the “trials and tribulations” of the search—even if such an awareness is not yet a God-Man, the Good Samaritan who complete definition it nonetheless constitutes 20 one of its elements. If we accepted the kneels before him. Aristotelian tradition in relation to tradition Let us allow Pascal to speak once and anthropology, we would have to define again: “Knowledge of God without this element as a “near kind” (genus proxi- knowledge of one’s own lowness gen- mum). Uomo e Donna, op. cit. Because of the importance of the text of this erates pride. Knowledge of God with- passage it should be quoted in full. But because out knowledge of one’s own lowness that is not possible here the reader who is inter- generates despair. The knowledge of ested in a closer analysis of this line of thought should make his own way to the passage. Jesus Christ is to be found between 4. B. Pascal, Pensieri e Altri Scritti su two extremes because in that knowl- Pascal, (Edizioni Paoline, 1987), an integral edge we find both God and our own version from the French taken from the lowness.”21 Brunschvicg edition (1897/1904), nos. 206, 347, 348. The text cited shows that “the thought” of Pascal is synonymous with knowledge or science and is opposed to the Cartesian Summary and Conclusion way of understanding the phrase “I think” (“cogito”). For this reason the “anthropological turning point” of Pascal is also radically differ- There is a birth which occurs and ent from the Cartesian “anthropological turning there is an end to it. And there is a birth point” and from the position of the German which must be the work of our own idealists, thinkers who belong to the same school of thought. hands. In both cases man is the subject to remain free. He is not obliged to ac- 5. In relation to these he is “different” from but in both cases he is a subject in sub- cept the offer of God-Man. Indeed, he and “higher” than everybody. stantially different ways. In the first can reject it. 6. OVID, Metamorphosis. case man is the subject and becomes 7. Cf. A. SZOSTEK MIC, “Wolnosc— Prawda—Sumenie” (Freedom -Truth— himself with he “to whom something Professor TADEUSZ STYCZEN Conscience), in Ethos, n. 15/16 (1991), p. 27. happens” (personal suppositum)— Member of the Pontifical 8. Cf Rm 7, 24. 9. that is, he who becomes and is himself Academy for Life, Cf. JOHN PAUL II, “Responsibility for the Known and Communicated Truth,” address because of his own nature. In the sec- Professor of Ethics at the University given to the world of Polish science and learn- ond case, on the other hand, man him- of Lublin, Poland ing at the great hall of the Catholic University self becomes and is the subject, him- of Lublin, 9 June 1987, published in La self, because of his own act of knowl- Traccia, no. 6, year VIII, July 1987, p. 724. Notes 10. It it worthwhile here to observe the context edge of truth and the free choice in fa- in which the words of Christ (“You will come vor of truth (personal subiectum). This 1. Cf Gn 2:18. Cf. John Paul II, Uomo e to know the truth, and the truth will set you birth is the personal work of each man Donna lo Creò. Catechesi sull’Amore Umano, free”) are spoken in the Gospel according to St. on his own. The man as the subject of (Libreria Editrice Vaticana, 1986), chapter one, John. The words which follow shortly after- this kind of act at the same time “Il Principio,” chapter five “Il Significato wards—”Every man who acts sinfully is the dell’Originaria Solitudine dell’Uomo,” pp. slave of sin”—go to make up the answer of demonstrates himself to himself and 44ss. Jesus to the declaration of those taking part in to others: by imprinting himself in a 2. Cf ETIENNE GILSON, L’Esprit de la Philoso- the dialogue who strongly deny that they have certain sense in such acts as their cre- phie Medievale, (Paris, 1943), chapter IX, ever been in a condition of slavery. “We are of “Knowledge of Oneself and Christian Abraham’s breed, nobody ever enslaved us yet; ator he at the same time through such ‘Socratism’.” This point is also underlined by what do you mean by saying, ‘You shall acts expresses himself to himself and the eminent contemporary historian of the become free’?” (cf. Jn 8:30-34). to others, he expresses himself in them history of philosophy, and equally eminent 11. It is clear that the caricature of freedom is 154 DOLENTIUM HOMINUM

also a form of freedom. But what distinguishes (With Solidarity: Free Through Truth), in 17. St. AUGUSTINE, Confessions. freedom and by its own act rises above Ethos, 3 (1990), n. 3/4, (11/12), pp. 5-9. 18. Pascal answers in abstract form: (transcends) itself “towards truth” and allows 13. Cf. KAROL CARDINAL WOJTYLA, “The 1) in order to show man the great scale of itself to be orientated and guided by truth is Self-Theology of Man and the Transcendence of his fall, if such a major act is necessary to save precisely the fact that such freedom remains in the Person in the Act,” contribution sent to the VI him; harmony with its original impulse, that it International Congress of Philosophy organized 2) in order to show man how great his accompanies the cognitive act of the subject by the Faculty of Letters of the University of Si- dignity is in the eyes of God notwithstanding from that very moment at which the subject, enna and the Faculty of Magistero of the Univer- the fall, if God believes that man continues to through this act, effects an assertion of truth. If sity of Arezzo, Arezzo 1-5 June 1976. For a ver- deserve his intervening action; John Paul II called his encyclical Veritatis sion in Polish, see KAROL WOJTYLA, “Osoba i 3) in order to show man how great God’s Splendor an ode in honour of freedom, this Czyn Oraz inne Studia Antropologiczne,” the love for man is if God is prepared to intervene means that he wanted first and foremost to Catholic University of Lublin WTN, 1994, pp. in such a way. distinguish the freedom which is in truth from a 478-490, especially p. 489. 19. “You would not have looked for me if freedom which reflects its own dynamism onto 14. Only then do I see myself as a person, that you had not already found me,” cf. Pascal, itself. He also wanted to give a warning about is to say as someone whom I must generate Thoughts. the tragic possibility that this deviation could within myself unendingly. Unendingly. This 20. “God so loved the world that he gave up become a mere self-deviation. I think that it is parent is not ipso facto, it becomes so when the his only begotten son, so that those who precisely at this point that we must engage acts are taken to rise above oneself (open believe in him may not perish, but have eternal again in a clarifying dialogue about the essence oneself) as a subject of freedom towards the life. When God sent his son into the world, it of freedom with thinkers such as L. truth which is already affirmed in the act of was not to reject the world, but so that the Kolakowski, thinkers who state that true knowledge of truth. This amounts to “not world might find salvation through him.” (Jn freedom (bound to truth) is not freedom. See, hardening the heart” to the voice of truth which 3:16-17). It is significant that Christ had for example, Kolakowski’s critical reflections is already known and by that very process already uttered these words during his conver- and observations on the Catechism of the recognized as such. sation during the night with Nicodemus. Cf. Catholic Church. 15. See Psalm 8. similar passages in Jn 5:22; 12:47; Lk 19:10; 12. Cf. T. STYCZEN SDS, Wolnosc w Prawdzie, 16. See ST. GREGORY NAZIANZEN, Sermon 7, and Acts 17:31. (Freedom in Truth), (Rome, 1988). See by the delivered after the death of his brother Caesar, 21. Pascal, Thoughts, ibid. no. 527. same author: “Solidarni: Wolni Przez Prawde” 23-24. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 155

EMMANUEL SAPIN

The Horizons of Fetal Medicine and its Ethical Consequences

The ethical consequences of the women (and which couples) run an 1. Prenatal Diagnosis development of prenatal diagnostics especial risk of having a child af- and Fetal Medicine and the new prospects for fetal medi- flicted by a hereditary illness or by a cine have been analyzed in depth and deformation. Obviously enough, fe- At the present time we have all the in an especially perceptive way in the tal medicine exists to avoid such a instruments we need to effect treat- Encyclical Evangelium Vitae. Rather risk and in a general sense it provides, ment and therapy. This is because than laying emphasis on the dangers as it were, genetic advice. fetal medicine has been made more which presently threaten and will in Whatever may be thought about precise and effective by being able to the future threaten man, I would like the way in which prenatal diagnosis engage in more effective examina- in this paper to dwell upon the present is carried out, at the present time tions of the fetus through the use of state of, and future prospects for, fetal such a diagnosis has become a biology, echography, the Doppler, medicine. My paper will be of a reality. We must therefore give a amniocentesis, and the taking of rather technical character, and this is meaning to prenatal diagnosis which fetal blood from the umbilical something for which I apologize at is not merely that of identifying cord—to name just some of the the outset. But this approach will, I anomalies which could lead to the modern techniques available. After hope, enable you to gain a realistic interruption of the pregnancy. Here, the diagnosis, decisions have to be idea of the present practical applica- then, is what the horizon of fetal taken about the forms of treatment tion of fetal medicine and the future medicine should be: the fetus is a which should be employed, and in prospects of this form of medicine. human being and if he is ill he must this process reference is made to the On the basis of this information be treated; if there is a risk that he knowledge that we have about the which I will offer to you, it will be might fall ill then such an eventuality spontaneous development of certain easier to understand and evaluate the must be avoided; and if nothing can anomalies, the technical, medical or dangers which the encyclical on life be done then a welcome must be surgical instruments and methods we has drawn attention to, and it will also given to him and the parents must be have to hand, and the risks these be easier to make sure that fetal med- accompanied during this difficult forms of treatment could have for the icine is directed towards its real aim trial and be helped as much as possi- well-being of the fetus and the and purpose, namely the defense of ble. pregnant woman. life at the service of man. At the present time the horizon Employing a simple analytical Prenatal medicine was for a long which is actually at work does not approach, we can detect two princi- time a matter of identifying anom- correspond in the least to this ideal pal situations: the discovery of an alies which might produce a miscar- horizon. Indeed, very great dangers anomaly which is already present riage. But in recent years this form of threaten to deviate fetal medicine and the identification of a risk. medicine has made great strides be- from its true goals, and these dangers The discovery of an anomaly leads cause of advances in prenatal diagno- are: to the carrying out of tests to sis—something which is now more —abortion, which is called the discover the cause of that anomaly precise and achievable in diagnostic medical interruption of a and to assess the seriousness of the terms and which also allows a far bet- pregnancy, when an anomaly has condition. There is than an attempt to ter assessment of the prognoses of been identified; analyze the viability of treatment and certain illnesses. Prenatal diagnosis —genetic counseling involving the to evaluate its feasibility, its possible now enables us to identify the correct selection of individuals; and beneficial effects, and the risks that fetal therapy which should be em- —the use of tissues from embryos or are involved. When such tests have ployed but at the same time it also in- fetuses. been carried out, and their results volves the danger that individuals are Behind all these realities is have been reflected upon, a form of selected from a medical point of view concealed that most difficult treatment can be decided upon before they are born. Like conven- problem of the definition of man, of whose aim will be the removal of the tional medicine, fetal medicine must respect for human life whose value, cause of the difficulty or the reduc- be seen as being a treatment for a pa- according to the dominant ethics of tion or elimination of its conse- tient, in this case a patient who has not today’s world, is dependent upon quences, and all this to achieve the yet been born; at the level of preven- and conditioned by the quality of survival of the fetus. When such a tion it must be used to identify which life. form of treatment can no longer be 156 DOLENTIUM HOMINUM applied, or when the anomaly of the has an illness which could have been removed from the fetus affected fetus places its survival at greater serious consequences for the child by the anomaly. The grafted cells are risk or at immediate risk, the role of she carries within her (for example, then reintroduced into the original fetal medicine should involve a hypertension or diabetes); host organism. When germinal cells gradual preparation of the parents for — the treatment of the fetus are grafted in this way one should al- the trial which awaits them and the through the giving of drugs and ways be fully aware of the danger that creation of conditions by which the medicines to the mother (as can take the human genome might be manipu- newly-born person can be welcomed place with certain conditions such as lated or interfered with. To conclude into this world. In a certain sense we toxoplasmosis, listeriosis, syphilis, this section, reference should also be are talking here about a palliative disturbance of the fetal heart-beat, made to the grafting of fetal tissue. form of treatment. hypothyroidism, or certain sexual This involves the use of fetal tissue to When we are faced with the identi- ambiguities); treat an individual in a fetus state af- fication of a high possibility of fore- — the direct treatment of the flicted by an anomaly. When this seeable anomaly, as for example hap- fetus: treatment is applied to man it is em- pens when there is an incompatibility a) both through the injection of ployed with people who are already between the blood of the mother and elements into: born. The marked capacity of this tis- the blood of the fetus or when there is sue to develop and the low risk that a couple who have already had a child the tissue will be rejected have led afflicted by inherited illness but who some practitioners to propose and want to have another child, fetal med- employ this technique. icine must weigh up the risks which A couple has a child whose immu- are present and try to avoid them. nity system is severely compromised This is what we term “preventive and who can only survive if he is kept treatment.” This should be the task in a sterile environment. A grafting of and goal of genetic advice in the fetal tissue is then proposed to this broad sense of that term. couple in order to ensure that their The present-day purpose of ge- child acquires the immunity defense netic advice is to enable a couple with mechanisms which it does not have, special precedents to make a decision the absence of which, naturally about whether to have a child in the enough, constantly threatens its life. full knowledge of the real risk that This treatment will allow them to they run and with the opportunity to save the child that they see, know and take advantage, if they so wish, of love, and which causes them to suffer prenatal diagnosis. An example of as parents. The fetal tissue which is this might be when parents have al- used is taken from a fetus which has ready had a child who suffers from been aborted. Should this answer to cystic fibrosis of the pancreas or from Ð the amniotic liquid, their problems be accepted or re- myopathy. If the couple decides to Ð the fetal blood through the jected—what a terrible responsibility have another child, prenatal diagno- umbilical cord, for these parents! Must they accept sis (when this is possible) enables the Ð or direct injection into the fetus the idea that a fetus can used as an in- probability of another anomaly to be itself; strument of medicine, that it is only a replaced by certainty about whether b) and through means of fetal product and not a complete human the child will or will not be struck by drainage; being which has been sacrificed? I an anomaly. If the child does fall foul c) fetal catheterism involving the will leave the judgment to the con- of an anomaly, the possible decision dilation of a blockage; sciences of those present here today. to effect an abortion comes into play. d) or action effected through the The information available to the cou- use of fetoscopic methods; ple, therefore, enables that couple to e) or, to conclude, extra-uterine 3. Fetal Medicine: resort to abortion when that diagnosis fetal surgery. A Real and Authentic confirms that the fetus is affected by Form of Medicine an anomaly. We can thus see that in As for the question of gene ther- the logic of genetic advice, coupled apy, we can observe that its employ- Rather than offering a complete with the actual ability to destroy those ment in the field of fetal medicine still survey of fetal medicine, I would unborn humans who are struck by an belongs to the realm of research and like to give various key examples of anomaly, there is an evident eugenic experiment. Its guiding principle is the component parts of this form of philosophy. the idea of remedying the gene anom- medicine. aly which is directly responsible for the anomalous condition or the actual 3.1 Preventive Fetal Medicine 2. Therapeutic Methods substitution of the defective gene. Some parents have had the misfor- in Fetal Medicine The first practice is still not techni- tune to have had a child which has an cally possible. The second is anomaly of the neural sulcus—spina There are a whole variety of ways achieved through the transfer of a biphida or anencephalia (the absence of treating the fetus, and they are as gene through the viral vectors and the of a brain). Certain studies have follows: replacement of the viral gene with the shown that this can be the outcome of Ð the treatment of the mother gene which is to be introduced. This a lack of folic acid in the woman. A begun before, and continued during, grafting is carried out ex vivo in live preventive therapy can be effected the pregnancy, if the mother herself cell cultures where such cells have when a new pregnancy is envisaged VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 157 through the treatment of the woman treatment and therapy. Such is the ter his birth. with folic acid before conception and case with fetal blood transfusion ef- In other cases the prenatal detec- during the first three months of preg- fected by means of a puncturing of tion of a fetal deformation enables nancy. One study has demonstrated the maternal wall when there is an in- the birth to be organized in a special that the risks that such an anomaly compatibility between the blood of center where the newly-born child can recur falls from 4.6% when there the fetus and the blood of the mother. can be looked after. This will avoid is no such treatment to 0.7% when In the same way, a fetal drainage sys- mistakes being made in the form of such treatment is applied. The identi- tem under echographic control can treatment which is chosen and can fication of this lack and its subse- be placed between a large lung cyst prevent treatment being applied too quent treatment also allow the risks of and the amniotic cavity. In very ex- late or in the wrong way. It can also having an under weight child to be re- ceptional circumstances ex-uterine allow a weak newly-born child to be duced by a half. fetal surgery can be proposed. This transferred to another location more Maternal diabetes can have very form of fetal treatment seeks to en- easily later on. serious consequences indeed for the sure the survival of the fetus, to avoid unborn child. The mortality rate in serious consequences caused by the 3.3 Palliative Fetal Medicine cases of maternal diabetes was 13% operation so that the organs of the fe- In other situations prenatal diagno- in 1960, 5% in 1970 and 2% in 1990. sis does not lead to the possibility of The congenital deformation rate in applying preventive or curative cases of uncorrected maternal forms of therapy. When such situa- diabetes is three to four times higher tions arise there is the problem of in- than for the rest of the population. If forming the parents about the condi- the treatment of diabetes is begun tion of the fetus and we have to deal before the pregnancy the deforma- with the responsibility of the medical tion rate falls to 0.8%. If the treat- doctor who is faced with the anxiety ment is begun only after the eighth of the parents who know before the week of pregnancy the deformation birth of the child that an anomaly is rate is 7.5%. A treatment which present which cannot be treated. In ensures a correction of the glycemia such cases abortion is often sug- to the highest possible extent often gested as a solution to these desperate leads to an avoidance of these very parents. When faced with this deci- serious consequences of maternal sion we often encounter a flight from diabetes. For this reason there must handicap and from illness, and a re- be an identification of the presence jection of what is both predictable of diabetes before the pregnancy and unavoidable grounded in a fear of begins but also during the suffering and death. But at the same pregnancy. The same applies in time the search for the perfect child— cases, for example, of maternal arter- tus develop well, and to avoid a birth a search which is part and parcel of ial hypertension. which is premature. the law of supply and demand, where, In cases where there are fears of a Let us take the case of a woman it may be observed, the supply is the very premature birth a treatment can who is expecting twins, one of which outcome of medical advance and the be applied to the mother which will is able to develop normally but one of pride of doctors and their science, and stimulate the development of the which is not. The healthy twin devel- the demand is a demand by the par- lungs of the fetus and avoid neonatal ops at the expense of the well-being ents for effectiveness in producing a intracerebral bleeding. and health of its brother. This is what child which conforms to their wishes is termed the syndrome of transfused- and aspirations—can even lead to le- 3.2 Curative Fetal Medicine transfusor which can lead to the death gal action when an anomaly is not de- At times prenatal examination will of one of the twins and to the other tected or when doctors are unsuccess- not only allow a diagnosis of a fetal twin having his life endangered. ful in the actions and treatment they anomaly but will also reveal that the Thanks to the techniques of fe- promote. fetus is reacting very badly to this toscopy and the use of miniaturized anomaly. The situation can be so optic fibers we can now use a laser to critical that the life of the fetus is remedy the intraplacental communi- Some Reflections endangered even before actual birth. cations between the twins and thus In the same way the normal develop- achieve a harmonious growth of them In order to render my paper lighter ment of the fetus can be so compro- both. in tone and content, I have not mised that very serious complica- In certain cases at the end of a preg- sought to deal with questions raised tions can take place if nothing is nancy an anomaly can emerge and by the discipline of bioethics. These done before the moment of birth. In develop very rapidly and this can in- questions require separate analysis other cases the life of both the volve great difficulty for the fetus—if and consideration. mother and the fetus can be placed in action is not taken speedily the life of Although the means and instru- serious danger if nothing is done the fetus can be endangered. A pre- ments of prenatal investigation and before the moment of birth. mature birth can be programmed us- analysis become ever more effective Certain very serious situations can ing a Caesarian operation after a ther- and act to show that the life of a child be detected before birth through the apy has been begun which promotes begins well before his birth, it is also use of an echographic scan and in cer- the cerebral and lung development of true that at the same time these new tain cases these can be remedied the fetus. In this way the newly-born opportunities, this new field of action through the application of prenatal child will be less weak and fragile af- for the power of man, lead to old 158 DOLENTIUM HOMINUM demons being brought back to life. tectable anomaly before the birth of a examples, fetal medicine can be seen The respect due to a human being child inevitably leads to the proposal as a form of medicine in the noblest becomes dependent upon his quality to abort. In the case of a chromosome sense of the term. But the practice of life: some lives, it is argued, are anomaly, as for example with the tri- and the directions taken by this form not worthy of being lived! The somy 21 syndrome, we are dealing of medicine raise very important evaluation and assessment of the with nothing less than the conscious ethical questions indeed. value of life has become dominated selection of individuals, and this We must engage in an enlightened by the affective aspect and dimen- amounts to eugenics. In the case of an system of custody and stewardship to sion which takes the place of any inherited illness such as mucovisci- always bear in mind that a human be- kind of deep reflection or considera- dosis or myopathy this is part of the ing exists from the very first days of tion about the respect due to a human philosophy of euthanasia, and more conception and that each and every being. This leads to decisions which particularly of prenatal euthanasia. anomaly which afflicts that human are guided by a sort of humanitarian Questions relating to economics, to being is not a mere idea or concept compassion. The human being, it is the financial funding of policies of but something which affects a living believed, is, as it were, only a real social protection, can encourage the being who commands our absolute human being when he is wanted. identification and the destruction of respect. How can we accept this eu- the embryo or fetus which is afflicted phemism of “embryo reduction” in by anomaly rather than the removal Love is not learnt through science! the case of selective abortion carried of the handicap or the reduction of its Where is Man in all this? out when a medically produced preg- consequences. No! The Embryo and the Fetus nancy involves a multiple pregnancy The absolute reference point of are not the only beings and when that pregnancy will not modern man is science. What to be in danger! produce a live child unless some em- science does not understand does not We must be his Good Samaritans. bryos or fetuses are not destroyed or exist. Where science cannot act and may actually put the life of the mother be effective there is a failure and this in danger? Here we are faced with re- failure, even if a human being is Professor EMMANUEL SAPIN alities which go beyond the most sin- involved, must be eliminated. Specialist in Pediatric, ister of deceits. In conclusion, as has been shown Visceral, and Urological Surgery The lack of an ability to treat a de- through the examination of certain at St. Vincent de Paul Hospital, Paris VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 159

BRUNO SILVESTRINI

Respect for Life and Biomedical Research

Introduction which are even more worrying. In embryos in scientific research, of the such circumstances the eternal ques- very many instances of conflict Scientific and technological re- tions about the meaning of progress between personal and collective search is an activity which is written and the principles upon which interests, and between the life of one into man’s nature; it satisfies one of progress should be based are raised individual and another. The bioethi- his inescapable needs. At times, how- once again and with renewed force. cal debate thus moves from special ever, it works against him. This is a In the past it was the discipline of and particular questions to basic very old problem but perhaps it is felt physics which did this, moving as it philosophical issues. Answers to more keenly today because our abil- did from being an experimental sci- these issues could be looked for in ity to act upon nature has grown out ence to being a philosophy. Now bi- other spheres of thought where they of all previous proportion. This was ology must do this, and in this en- have been debated for centuries, but seen when all the benefits created by deavour this discipline enters onto biology now feels itself mature the theoretical and practical advances what is, for it, an unusual terrain. Re- enough to make its own independent achieved in the sphere of physics spect for life in biomedical research contribution, not least with reference were called into question by the ex- will be discussed in this paper with to an astounding quantity of infor- plosion of the atomic bomb and by reference to this reality. mation which the discipline itself has the subsequent emergence of such been able to accumulate. other very serious dangers as those involved in the peaceful use of nu- 1. The Bioethical Debate clear energy. At the present time biol- 2. The Centrality of Life ogy presents the greatest threat be- In the above-outlined context, the cause after centuries of torpor it is discipline of bioethics has emerged What is life? This is the first ques- now rapidly closing the gap which into the light of day. “Ethics” tion to which the biologist seeks to had previously opened up between committees are asked to perform two give an answer. For him, life is the this discipline and the other sciences. tasks, which are treated in various light which illuminates the universe Through the use of modern medi- ways, with differing levels of and gives it form, thereby bringing it cines and drugs—which are exoge- responsibility, and involve change- out of the darkness. The reality which nous substances capable of changing able degrees of investigation. These surrounds us does not correspond to the functional mechanisms of living tasks were described by the Council an objective fact but is the outcome of organisms—biology has defeated of Europe in 1989 in the following the perception which living creatures many fatal or incapacitating diseases. ways: have of it. In some of these creatures It has also greatly reduced the impact a) “inform society and public sight is the primary sense, in others it of others and has so advanced in the powers about scientific and techno- is taste, touch, hearing, smell or other sphere of agricultural production that logical advances achieved in embry- systems which are not present within millions and millions of people have ology, in research, and in biological man or which have become atro- been saved from starvation. Biology experiments;” phied. Reality changes completely has also impinged upon the molecu- b) “orient and monitor their possi- according to which sense is domi- lar bases of life and has shown that it bilities of application, evaluate their nant. One type of food can be pleas- can directly act upon genetic errors results, and assess their advantages ant or unpleasant, an object can be and can also correct them. and disadvantages, with reference dull or full of colors, an event can be a At the same time, however, many inter alia to the rights and dignity of source of joy or of desperation, and dramatic events have occurred such man and other moral values.” what is invisible for one creature can as the thalidomide tragedy, the eco- However, when we pass from the have major consequences for an- logical disasters caused by pesticides, declaration of principles to individ- other. the massacres produced by devastat- ual questions and problems we come There is also a reality which is ing biological weapons whose devel- up against conflicts and differences constructed by instruments created opment is closely linked to advances of opinion which appear irresolv- by man, and this goes well beyond in the world of medicines, and the able. We need only think here of the domain of the senses—towards wild and uncontrolled manipulation abortion, artificial and assisted fertil- the ever smaller world of cells, mol- of DNA. This last opens up prospects ization, euthanasia, the use of ecules, atoms and particles, or to- 160 DOLENTIUM HOMINUM wards the ever greater world of stel- thing towards the loss of organization mentary to man himself. lar space. Time also changes ac- and order,and towards an increasing DNA has been called the project cording to the individual or, in the level of entropy. It is like a glowing of life (Dulbecco) but this term is not same individual, in relation to his ember which is becoming burnt out adapt—a project on its own remains biological age. There is the time of and turning into ash. Life is a part of a dead letter if their is no external childhood which is so shaped by the this universe but it goes in an opposite action on the part of its formulator. experiences the individual under- direction and towards configurations The project of life, on the other hand, goes as to seem eternal, but there is which are characterized by an in- “contains within itself everything also the time of the old person creasing degree of order and organi- which it needs to come to fruition, which flows away with ever greater zation. It is like a sailing boat which except,naturally enough,the basic speed as the events which interest follows a precise course and in the matter and the energy which it gains him become rarer and further and face of a violent wind gradually man- from the environment. It knows how fewer between. ages to go in a direction which is a di- to construct of its own will the pieces There is the reality which is ametrically opposed to that taken by which it needs and the instruments limited by the speed of light. Yet other things which, for their part, are which are required to put these today we can already imagine that blown onto the rocks. Life can do this pieces together. It knows how to one day when we will enter that adapt to the environment. It knows reality through an instrument which how to create sub-projects which can detect the superforce which become ever more detailed in sustains and invests the universe, not character and are required as the travelling in space and time like light project progresses. In addition, the but linking them together completely project of the living being and the like an elastic band which is always living being which springs from that tight. There is also the universe of project are not separate but strictly the microbes which extends for a identified with each other. Rather few millimeters and lasts for a few than “project,” therefore, it would be minutes but which is as real and as better to use the term “Sacred book lasting as the universe of man. What of life,”for this enables us to express gives us the right to consider one of that feeling of bewilderment which these realities as being more real and we feel when we try to turn over its tangible than another? pages.” (Silvestrini, 1995). These ideas have been the object This project is the essence of life of sustained debate by philosophers, throughout its journey, from simple who have always oscillated between duplicative procreation to sexual pro- relativism and objectivity in their creation and then on to cultural pro- search for a fixed point of meaning. creation. It happens before our very Thinkers have also been concerned eyes every day when a single fertlized with the theories of physics regard- cell divides into two, into four, into ing relativity and indetermination, eight, into sixteen, and so forth, and theories which seem to be more from this myriad of components there advanced because they are proved emerges in distinct form the embryo, by experimental methods but which because, and only because, is it dif- the foetus, the newly born child, the are not able, however, to include life ferent from the rest of the known infant and then the adult. The adult or man in their equations. These world. has already begun the downward path ideas are now the objects of discus- Life bears the knowledge of its but not before giving his particular sion in biology, a discipline which own identity and defends it against contribution to life. The project also places life at the centre of the everything which seeks to destroy it; carries within itself future develop- universe. it also constantly develops that ments, those developments which The sacredness of life thus be- identity. Knowledge—that is to say will lead it to spread out even further comes not only a religious idea but an organized and organic complex of through scientific and technological also an idea beyond the religious information—is not, therefore, progress. sphere, and the biologist feels like a merely that which through life gives We do not need to be Einsteins to climber who reaches the top of the origin to surrounding reality: it is understand that at the helm of the sail mountain after a great effort only to also the core of life itself. boat which tacks against the wind discover that somebody else has got Rather than explaining this mys- there is something which is different there before him, and by another tery, the discovery of DNA acted to from the sea in the midst of a storm. route. increase it. This discovery showed For the nonbeliever this quid either that the project of life is present in remains a matter of mystery or is every living thing in addition to be- seen as the mere outcome of chance, 3. The Essence of Life ing present in each of the billions of the fortuitous combination of cells which go to make up multicel- billions and billions of events which How does life function? This is an- lular organisms. In an infinitely are constantly taking place in the other fundamental question for the small space which is invisible to the universe. For the believer, on the biologist and it is strictly linked to the naked eye, is to be found the other hand, there is the idea that first. According to the laws of essence of life itself: its past, its pre- transcendental action is at work. physics, the universe is upheld by a sent and its future, in all their forms Once again, however, the diver- force which pushes each and every of expression, from the most ele- gence between religious thought and VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 161 nonreligious thought loses impor- ments to adapt to bad weather, or for also becomes frightened when he tance because life exists anyway and fins and wings to appear on his body, considers the risks and the dangers constitutes everything that we have. with his own hands he builds which accompany that progress. Both schools of thought, therefore, clothes, shelter, boats and planes. can but agree on the basic principle He also creates instruments and of the defence of life. To quote a tools which help him to extend and 5. A Lesson of Life document of the National Commit- enlarge his knowledge and thus to do tee for Bioethics: “the defense of life the same to that universe which The answer to these questions is to is not rooted in an abstract form of exists beyond the domain of his be found in those same intellectual philanthropy but in the recognition senses. This change springs from his capacities which have made progress that man exists because he is a living manual and intellectual capacities possible. Differently from other being and that he is at the same time which enable him to draw informa- living creatures who defend life endowed with his own specific tion about life from its natural instinctively merely because they individuality which renders him substratum and then transfer it to exist, man is able to understand the unique and means that he is closely another substratum made up of fundamental principles of life, to interconnected with the society to spoken and written language and of achieve wisdom in relation to life, which he belongs” (National and thus to respect it not merely Committee for Bioethics, 1995). instinctively but also consciously. Thus it is that culture stops being a theoretical lucubration and gives 4. Life Is Progress practical answers to the questions with which man is bombarded both Every other living being adapts to in the details of his daily life and in the fundamental principle of the the more general political sphere. defence of life because of the very Some achieve this advance through fact that it exists, and this thanks to the gift of faith—the quickest path the information present in its but also the most difficult. Some functioning and its organic structure, others advance through studying life this latter being composed of differ- with humility. I firmly believe that ent kinds of apparatus, organs and both these paths can converge. minor organs. In contrary fashion to Indeed, life communicates the same what happens with the books of man, teachings as those imparted by this information is present in the religion. Respect for the rules of form and the functioning of life, and civic co-existence derives primarily it is the same thing. This concept is from what is convenient rather than partially expressed in the springing from an ethical imperative. chemosmotic theory of the interde- There is an opportunity to be at the pendence of form and function, a same time both egalitarian and theory which gained for Mitchell the aristocratic because life entrusts a Nobel Prize in 1979 but which specific and complete project to each clearly has a far wider value. living being from the microbe to It is to be found in the whole of collective and individual culture. He man, and gives each living being an the evolutionary process and was translates it, therefore, into practical equal point of departure. described in the bible for those who means. It seems, but such is not the At the same time, however, it know how to read it. During the case, that he takes on the ideas which gives a prize to the being which evolutionary process life gradually Plato attributed to the divine. emerges because of its quality or passes through single cell organisms This is the starting point of a new commitment. It does both these to multicell organisms which place type of evolution which comes to be things because the individual is cer- themselves in the hands of survival called progress. It is a part of life tainly appreciated for his quality but instinct and give their bodies special and it promotes its development but this is only because he belongs to a forms of apparatus—integuments it also concentrates in the hands of community. which protect them against harmful man an enormous power which This is why the Church could radiation or bad weather, fins or makes him proud of himself yet also never be left-wing or right-wing, gills to move and live in the water, frightens him at the same time. If he Liberal or Socialist, but always wings to fly in the air, and so forth. is religious he feels the bearer of a both. Life does not pursue pleasure The information concerning these divine mission but at the same time or fight pain in themselves as man changes is not written and kept to he is afraid of breaking its rules. If might be tempted to do. It uses both one side in a library, but is con- he is a philosopher or a scientist he these phenomena to give an indica- tained within life itself. pursues knowledge, but paradoxi- tion as to what is harmful and what Man has these characteristics as cally the more he advances the more is useful. well but with him something new he feels incapable of giving an an- For life everything which exists happens. Rather than allowing swer to these fundamental ques- has a meaning where it forms a part himself to be guided instinctively by tions. of its project. In this sense every au- the fundamental law of life, he If he is an ordinary man he gains thentic culture, whether based on re- analyzes it and tries to find a rational from the benefits of progress, bene- ligious belief or not, stops being an explanation for his own existence. fits which prolong his life and make abstract fact and transforms itself Rather than waiting for his integu- it increasingly comfortable. But he into a lesson for life. 162 DOLENTIUM HOMINUM

6. Respect for Life words of all those great scientists opinions, even when very strong and in Biomedical Research who have contributed to the opposing feelings are involved. For advances and successes of medicine, this teaching, as for others, I am in- I am not a philosopher. I thus leave including my teacher and guide debted to Cardinal Fiorenzo An- to others the task of developing these Daniele Bovet (Bignami, 1993). But gelini, in the same way as I am in- ideas in a way which is suitable. It going back even further in time it is debted to other Princes of the Church falls to me merely to emphasize that an idea which is powerfully present who bear witness to this teaching in these ideas can be applied in ex- in the teachings of Hippocrates. And their works before they give expres- tremely practical terms in the realm it for this reason that I feel I should sion to it in their words. of biomedical research as well, and express my gratitude to, and admira- let us not forget that biomedical re- tion for, Cardinal Fiorenzo Angelini, Professor BRUNO SILVESTRINI search has become one of the most who, in dedicating this conference to Director of the Institute of Phamacology important elements in promoting Hippocrates, has given us a very and Pharmacognosy progress. valuable opportunity to meet each at La Sapienza University, Rome I will not dwell here upon the areas other and to engage in shared reflec- Consultor to the Pontifical council for where biomedical research has in- tion. Pastoral Assistance to volved degeneration and degradation I have tried to develop this concept Health Care Workers by offending life rather than respect- from a philosophical approach, and ing it. I will concentrate instead upon because such a point of view is rather those two paths which it has always unusual for me I will have undoubt- Bibliography taken in the achievement of positive edly fallen into error, and for this I ask G. BIGNAMI, Ann. Ist. sup. San., 1993, 29 results. The first path has led it to fight forgiveness. I have also adopted this (Suppl. 1), pp. 1-104. suffering and illness from the outside. approach because I am firmly con- Comitato Nazionale per la Biomedica, Here biomedical research has vinced that fundamental religious “Documento sui Vaccini” (Istituto Poligrafico achieved very great successes which principles have a universal value and e Zecca dello Stato, Rome, 1995), in preparation. have improved the quality and length can be reached through paths which Council of Europe, Proposal of the Parlia- of human life. do not involve faith. This is a way of mentary Assembly of 2 February 1989. But these successes have turned understanding the motto non prevale- R. DULBECCO, Il Progetto della Vita out to be ephemeral. One need only bunt and it is also the element which (Mondadori, Milan, 1989). P. MITCHELL, Science, 1979, 206, pp. think here of antibiotics. They repre- leads the believer never to fear debate 1148-1159. sented one of the most significant and the exchange of opinions with B.SILVESTRINI, Malati di Droga (Sperling e stages in the advance of modern med- those who do not share his religious Kupfer, Milan, 1995). ical treatment. But perhaps precisely for this reason it was forgotten that during evolution the defensive mechanism of antibiosis was diminished in importance and greater emphasis was placed upon the role of the immunity system which was, indeed, much more effective. We were thus unprepared for difficulties which arose in the use of antibiotics, difficulties which could have been easily foreseen: bacterial resistance and thus the constant employment of new antibiotics; side effects which constantly take on new forms; and the great problem of those millions of children in Third World countries who were saved but then abandoned to inhuman conditions in which to live. The other path involves studying illnesses before fighting them and examining not only their causes but also their biological significance, their in- terrelation with other processes, and the defensive mechanisms produced by nature herself to combat them. This path offers more long-lasting and secure solutions: vaccines, health education, the development of health structures and services, action to defend the environment, and social organization. Respect for life, therefore, means first and foremost a thirst for knowledge. This idea shines forth from the VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 163

CARLA GIULIANA BOLIS

The Human Brain: from Hippocrates to the Present Development of Neurosciences

The search for a coordinating tion of the events that lead to dis- was left aside for at least two thou- system and localization of functions eases. No more divine intervention sand years when the electric com- in the nervous system and in the was described. munication was discovered along body was always given prime im- The vision of Hippocrates and of the nerve. portance in anatomical studies and the philosopher Plato (429.347 Specific concentration of studies in the philosophical approach over B.C.) concerning the localization of the brain has been given by the centuries. of coordination was somewhat Emeso, Bishop of Emesa, and St Sometimes information, even cerebrocentric, but later Aristotele Augustin in the fourth century AD, linked only to macroscopic events, (384-322 B.C.) imposed his cardio- concerning the localization of func- was not interpreted as particularly centric view of coordination of the tion to the three ventricles de- fundamental as it was later consid- human body. Aristotele described scribed by Galeno: in the anterior ered. But we have to note that the the heart as responsible for all the ventricle is localized imagination; understanding of the brain’s func- functions, including perception and in the median, reasoning; and in the tions is only nowadays considered thinking; the brain was the coldest posterior, memory. This is the first correctly. part of the body and its function approach to localization of func- The study of the brain has re- was to temper the heat generated tion, and for almost a thousand quired a lot of scientific achieve- by the heart. years this approach has given rise ments and technical skills and we Herophilus and Erasistrato in the only to drawings and prints. can say that only now we are in a third century B.C. had been able to At the time of the Renaissance position to understand the basic study human bodies and they had anatomical studies continued and at mechanisms of most of the physio- been in a position to distinguish the Hospital of Santa Maria Nuova logical and biochemical functions cerebellum, brain and medulla. in Florence around 1505 Leonardo linked to the nervous system. They also demonstrated that the da Vinci took wax mouldings of A clear example of the difficulty brain has ventricles and that its sur- cerebral ventricles and made draw- of interpretation is given by the dis- face has circumvolutions. In addi- ings of the brain’s circumvolutions. covery of an Egyptian papyrus, tion, they clearly understood that Around the same time again in Italy dated 3000 years BC, in which blood vessels are very different Vesalio, and in France Fresnel, there was a sequence of observa- from nerves and the origin of nerve gave more and accurate morpholog- tions of head injuries correlated to is brain or medulla. Nerves are dis- ical descriptions. specific somatic manifestations. In tinguished between motor and sen- Willis (1667) tried to find a more principle, the observation were cor- sorial. accurate anatomic description and rect, but it took almost 50 centuries In the second century A.C. he distinguished the brain matter, to prove the basic mechanisms of Galeno (129-199) disputed Aristo- i.e., gray and white. Willis, taking the correlation between head injury tle’s view and, through direct ob- into account the work of William and peripheral lesion. servations, he proposed the distinc- Harvey (1578-1637) on the heart We have today to begin consider- tion of motor and sensory nerves at- and circulation, conducted brilliant ing the work of Hippocrates. there tributing importance to the percep- studies on brain circulation, for the is no doubt that Hippocrates (460- tions, thus anticipating the concept identification of the rete mirabilis 370 BC) was a great physician and Nil est in intellectu quod prius non or Willis circle. also had a very clear understanding fuerit in sensu. But during this period brain re- of some neurological conditions Galeno considered not only search, considering the relation be- like stroke and epilepsy, which are anatomy but also was the first to tween brain, mind and soul, took a mentioned in the Aphorismi and the look at physiology. He gave great philosophical approach. Praesagia Hippocratis, liber II, De importance to the ventricles, which In 1665 Malpighi described, in convulsione. he divided into anterior, medial and De Cerebro Cortice, the brain sur- Hippocrates and his school, in posterior. Galeno also predicted face with a primitive enlargement the publication Corpus Hippo- that along the nerves travels an system. In 1666 in the Cerebro he craticum introduced the rationaliza- agent, the pneuma. His intuition described two observations on the 164 DOLENTIUM HOMINUM distribution of the gray matter in ter system of staining (silver stain- It was only in 1786 that Luigi the brain. He stressed the structure ing) nervous tissues was discovered Galvani, making experiments on of the brain being particularly diffi- by the Italian, Camillo Golgi, and frogs, proposed the existence of a cult to dissect; the manipulations also applied by the Spaniard, Santi- kind of animal electricity. Later, in that he had to make naturally gave ago Ramón y Cajal; together with 1838, Matteucci registered for the rise to a series of artifacts. better techniques of microscopy, first time the electric current pro- Around 1718 van Leuwenhoeck these led to formulation of the neu- duced by a muscle. In 1898 Dubois produced the first appropriate imag- ronal versus the reticular theory. Of Reymond described the existence ing of the microscopic organization course, the neuronal theory consid- of a current that travelled along the of the nervous system, when he ered the neuron as an individual nerves. In addition, in 1875 Caton considered the structure of the cell, already distinct in space from demonstrated, in experiments on nerve as composed of little vessels its target cell and affirmed the indi- rabbits, that the cerebral cortex also reassembled together, sometimes viduality of the neuron. However, produces electricity. envelopped by a structure later upon this dispute, in which the neu- The magnificent publication of identified as myelin. ronal theory won, followed another “De viribus electricitatis in motu Microscopic anatomy did not musculari commentarius” by Gal- make progress until 1824 when vani in 1791 opens an important Dutrochet identified, in invertebrate and fascinating approach to animal ganglia, the presence of “little electricity. cells” of spherical form. This is the Until 1950, there was no evi- first description of a nervous cell. A dence on how stimuli could pro- few years later, Valentin described duce nerve excitation. Today we the presence in the cerebellum of know, thanks to the studies of tails around these spherical cells Hodgkin and Huxley (Hodgkin, and we know now that these tails 1964; Hodgkin and Huxley, 1952; were later identified as dendrites. Hodgkin and Keynes, 1955) that Finally, Deiters (1865) proposed the execitable membrane exists in the structure of the nerves as we two states: one polarized (with the know it today, thanks to the intro- maintenance of different ionic duction of electronmiscroscopy changes on two sides of the mem- (1950). brane) and one depolarized, which In the framework of these obser- results from the former following vations and Deiter’s proposal there drastic changes in permeability, an was, in the scientific community, order of milliseconds, after stimu- active thinking about the possible lus. communications and interactions The rapid changes in ions perme- between the nervous cells. Today ability give rise to the electrical im- we know that interactions are re- debate: How the signal given by the pulses transmitted along the nerve stricted to specialized systems neurons was transmitted: “chemical axon, where ion exchange is regu- called synapses. This word comes transmission,” according to which lated by the plasma membrane from Greek, meaning “clasp”, and neurons were supposed to release through which the cell communi- was coined by Charles Sherrington molecules acting on specific cells, cated with its environment. The (1897), and in one of his scientific or “electrical transmission,” accord- axon offers a unique pathway not contributions he wrote: “So far as ing to which the signal was of an only for the conduction of ion im- our present knowledge goes, we are electrical nature. pulses but also for the circulation of led to think that the tip of a twig of It is really interesting to note that macromolecules between the cen- the arborescence is not continuous in 1884 Thudicum published The tral nervous system and the periph- with, but merely in contact with the Chemical Composition of the Brain. eral organs. Any interruption or substance of the dendrite or cell At that time, biochemistry was pathological alteration of nerve body on which it impinges. Such a starting to emerge, but no valid fibers impedes the axonal transport special connection of a nerve cell techniques for correct identification of molecules and thereby deprives with another might be called of substances were available. We the central and peripheral parts of synapse.” Already, 50 years before have to wait until the turn of this the nervous system of molecular (1850), Claude Bernard had main- century, and only in the 1950s the exchanges. tained the possibility that the con- chemical composition of substances This axonal anterograde transport tact between nerve and target cells was identified. is one of the central issues that fa- was specialized and some change The research work of Sir Henry cilitate the understanding of physio- had to occur during the transmis- Dale and Otto Loewi finally estab- logical mechanisms responsible for sion of the signal. lished in 1920 that the chemical axonal degeneration and regenera- At the end of the nineteenth cen- transmission was the most valid the- tion. Vice versa the retrograde ax- tury and beginning of the twentieth ory. But at that time all the sequence onal transport represents the means century there was an interesting de- of events involved in the generation by which chemical information is bate on how neuron connection is and propagation of the electrical conveyed from the axonal periph- established. The provision of a bet- signal were not yet known. ery and possibly from the target VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 165 cells to the cell body. Such mecha- is released under an electrical sig- of the concept of the receptor inter- nisms may play an important role in nal at the pre-synapsis and recog- action with other membrane pro- the regenerative response and in the nized by post-synaptic receptors, teins, such as the G-proteins, that development of stable synaptic con- leading to the modification of the allow the activation of a final effec- nections between neurons and their biological activity of the receiving tor system. It is a cascade of cat- target cells. (post-synaptic) cell. alytic events allowing the amplifi- At that time the structure of the The receptor is a protein bearing cation of the signal. biological membrane mechanism specialized regions (sequences of The interest on G-proteins has was well defined, and the studies amino acids) able to specifically been growing, as witnessed by the on transport systems were very ac- recognize the chemical message. recent Noble prize given to Gilman tive. The synapse is an important site of and Rodbell for their discovery. In view of the ability of CNS and signal modulation and of homeosta- The G-protein is the protein con- PNS to repair after exposure to dif- tic regulation. The release mecha- necting the receptor to the effector. ferent environmental conditions, nisms and the recognition processes Several G-proteins are known to and to establish new adaptive are regulated events. The special- depend on the cell type and trans- connections, or recover function duction system involved. We through involvement of surviving should note the existence of both neurons, neuronal recognition is stimulatory and inhibitory G-pro- now a very promising field of re- teins that converge on the same ef- search, especially for its impact on fector system, leading to the strict nervous lesions and repair. control of the amount of informa- Today we know that the human tion to be transmitted. brain is composed of about 10.1111 Finally, we should recall the im- neurons, a number very similar to portance of the phosphorylation the stars in our galaxy. These cells systems, which are either built into are subdivided in 100 different cell some receptors (e.g., receptors for types, whereas in all other organs of growth factors) or linked through the body the subdivision is rather the already described cascade of modest. events to the activation of several In this cellular complexity, func- receptors (e.g., receptors for bio- tional effectiveness is reached genic amines). through harmonius cooperation. To all this information should be Cooperation is maintained by the added the recent notion that specific genetic code, neurotrasmitters, neu- neurotransmitter systems, such as romodulators, and neurohormones those containing VIP and NE, as and is expressed by neuronal func- shown by P.J. Magistretti, may reg- tioning and behavior; inefficiency ulate metabolism in glial cells and of these related activities is ex- ized contact point - the synapse - in endothelial cells of intra- pressed by pathological conditions. should therefore be considered as a parenchymal vessels of the brain, Even if nervous system cells are “plastic” site that can be modified adding a previously unforeseen linked to the same genetic coding by brain activity and physiological function for neurotransmitters. as other cells and have a general events. The search for the localization of cellular organization, they differ Quite a number of neurotrans- functions in the brain was always at from other cells in some character- mitters belonging to several unre- the forefront. To this end, Franz istics, especially because these neu- lated chemical classes are known Joseph Gall produced the following ronal cells interconnect and func- today. experimental data at the end of the tion with other cell types making Among classic neurotransmitters nineteenth century. He made abla- specific contacts with other neu- catecholamines and acetylcholine tions of well-defined anatomical, rons, gland, or muscle cells. were first described and are the centers and observed animal behav- The communication is by electri- most studied chemical messengers. iour. cal and chemical signal via These two classes of neurotransmit- For instance, he demonstrated synapses. Chemical signals are re- ters represent in several physiologi- that the abation of cerebellum dis- lated to neurotransmitters: first, cal activities an example of func- turbed coordination of movement. T.R. Elliot, on 21 May 1904 at the tional antagonism. In addition, in agreement with meeting of the Physiological Soci- Finally, we should stress the rec- Galen he demonstrated that bulbar ety of London, stated that “adrena- ognized possibility of the coexis- lesions (at the posterior ventricle) line might be a chemical stimulant tence (and functional cooperation) induce modifications in respira- liberated on each occasion when of more than one neurotransmitter tion. the impulse arrives at the periph- in a nerve terminal. Later, Gall considered that verbal ery....” The receptor proteins are divided memory or language was located in The chemical and the electrical into two main categories, the recep- the frontal lobe of the cortex. The transmission is that at the contact tors that constitute an ion channel French neurologist Bouillard, over wone between two nerve cells; the and those that are linked to G-pro- 40 years of study of 100 cases, put chemical signal (neurotransmitter) teins. This leads to the introduction in evidence that there was a linkage 166 DOLENTIUM HOMINUM between brain damage in the frontal environmental toxins, metabolic Suggested readings lobe and loss of speech (1825). causes, and infectious agents. ARISTOTELE, De partibus animalium. But it was only in 1860 that the Today we know that glial cells, ARISTOTELE, De memoria et reminiscen- neuroanatomist and anthropologist, the non-nervous cells in the nervous tia. Broca, presented his clinical and system, are fundamental for the BINDMAN L., LIPPOLD O. (1981), The neu- rophysiology of the cerebral cortex, London, anatomo-pathological evidence that maintenance of the functional activ- Arnold. language loss is related to unilateral ity of neurons and axons. The inte- BIRNBAUMER L. (1990), Transduction of damage of the left frontal lobe. He gration activity of neurons and glial receptor signal into modulation of effector activity by G-proteins: the first 20 years or demostrated at the same time the cells regulates many of the neuronal so... FASEB J. 4:3178-3188. asymmetry between the hemi- activities and, according to new ex- BODIAN D. (1952), Introductory survey of spheres. Also very interesting were perimental studies, participates in neurons, “Cold Spring Harbor Symp. Quant. the studies of Carl Wernicke in his the regulation of cerebral metabo- Biol”, 17, pp. 1-13. BOLIS, C.L. (1984), Acetylcholine recep- monograph of 1874 on “Der Apha- lism. tors: Introductory remarks. Information and sische Symptomencomplex.” But basic research transcends the energy transduction in biological mem- In 1909 Brodman assembled all laboratory and extends into all areas branes. Alan R. Liss, Inc. NY, 251-253. BROCA, P. (1865), Du siege de la faculte available data on men and monkeys du langage articule. Bulletin de la Societe and divided the cerebral cortex into d’Antropologie, VI, pp. 377-393. 50 areas: areas of association, of BRODMANN K. (1909), Vergleichende Lokalisationslehre des Groshirnrinde, motor or sensorial perception. Leipzig, Borth. It is only in the last two decades CAJAL S. RAMON y. (1911), Histologie du that tools have been developed to systeme nerveux de l’homme et de vertebres. Paris: Maloine. accurately localize brain function. CATON R. (1875), The electric currents of These tools include CT scan, PET, the brain. Brit. Med. J., ii, p. 278. SPECT, magnetic resonance, and DAREMBERG C. (1841), Exposition des connaissance de Galen sur l’anatomie et la others. physiologie du systeme nerveux. Paris. Today we understand many ac- DEITERS O. 81865), Untersuchungen uber tivities of the brain, including en- Gehim and Ruckenmark des Menschen und der Saugetiere, Braunschweig, Vieweg und ergy utilization and function. Of Sohn. course, these techniques have been DUBOIS-REYMOND E. (1848-1884), Unter- conceived for the diagnosis and un- suchungen uber tierische elektrizitat, Berlin, Reimer (2 vol.) derstanding of basic mechanisms DUTROCHET H. (1824), Recherches underlying neurological and psychi- anatomiques et physiologiques sur la struc- atric disorders. ture intime des animaux et des vegetaux, et All approaches and applications sur leur mobilite’, Paris, Bailliere. ECCLES J. (1964), The Physiology of of new techniques since the early synapses. Berlin, Springer Verlag. stages of man’s interest in the brain, ELLIOT T. (1904), On the action of adren- as a site of control of body func- alin, J. Physiol. (London), 31:20. FELDBERG W. (1943), Synthesis of acetyl- tions and of the mind, have been choline in sympathetic ganglia and choliner- crucial for today’s understanding. gic nerves. J. Physiol. 101:432:445. The success of neuroscience de- FREUD S. (1953), On aphasia. New York. GALL F.J. (1822-1825), Sur les fonctions pends on a multidisciplinary ap- du cerveau et sur celles de chacune de ses proach: biology, anatomy, physics, of human behavior. What com- parties, Paris, Bailliere (6 voll.). chemistry, and medicine. menced as an anthropological study GALVANI (1791), De viribus electricitatis in motu musculari commentarius. Bologna The use of drugs (neuropharma- of an isolated tribe in New Guinea, Ex Typographia Instituti Scientiarum. cology and psychopharmacology) afflicted by a progressive degenera- GOLGI C. (1883-1884), Ricerche sull’is- has also been fundamental in the tive disorder of the nervous system, tologia dei centri nervosi, “Arch. Ital. Biol.”, 3, pp. 285-3177; pp. 92-123. understanding of specific function- opened up a whole field of investi- GOLGI C. (1908), La doctrine du neurone. affecting neurotransmitters, second gation demonstrating that some Les prix Nobel en 1906, Stockholm, messengers, plasticity of synapses chronic neurological disorders are Norstedt & Soner. HIPPOCRATES, Aphorismi. and neuronal circuitry. Through caused by persistent viral infec- HIPPOCRATES, Praesagia Hippocratis, molecular biology it has been possi- tions. liber II, De convulsione. ble to define the structure of some Anyway, today, using the ratio- HODGKIN A.L. (1964), The conduction of the nervous impulse. Liverpool, Liverpool of the receptors, especially the nal approach to disease indicated by University Press. complex protein receptors and ion Hippocrates, we are able to prevent HODGKIN A., HUXLEY A. (1952), A quan- channels. and control a series of neurological titative description of membrane current and its application to conduction and excitation The application of molecular bi- disorders, and this list is likely to in nerve. J. Physiol., London, 117, pp. 500- ology has been crucial for the iden- increase in the near future. 544. tification of several genetic diseases HODGKIN A.L. AND HUXLEY A., F. (1952), CARLA GIULIANA BOLIS, A quantitative description of membrane cur- in neurology and psychiatry. The rents and its applications to conduction and information available in basic neu- M.D., Ph.D. excitation in nerve. J. Physiol., London, rosciences has been essential for the Professor of General 117:500-544. identification of basic mechanisms and Comparative Biology, HODGKIN A.L. and KATZ B. (1949), The University of Milan (Italy) effect of sodium ions on the electrical activ- for the prevention and treatment of and Consultant, WHO ity of the giant axon of the squid. J. Physiol., nerve degenerative disorders due to Unit on Neuroscience London, 108:37-77. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 167

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CETTINA MILITELLO

The Overcoming of Emphasis on Pain in the Christian Conception of Suffering

1. Pain and Suffering death have their roots in personal re- self as an ever more complicated re- as Anthropological Aporias sponsibility. In our century Marxist ality and does so no longer in the culture has condemned social condi- partial perspectives of the sciences Pain and suffering have always tions and their impact, while psycho- of nature but in the global perspec- accompanied the individual and he analysis has referred to the influence tive of the human sciences and their has often not been able to respond in and impact of the subconscious. organic correlation. At the heart of adequate fashion to the dramatic re- Whatever the response or the spe- their outlook these latter place the ality of the questions they pose. cific approach may be, in our culture human phenomenon in all its global This, in the ultimate analysis, is be- the drama of pain still remains com- predictability, in its psychological cause the problem they present is the pletely open.3 This is all the more se- complexity, in the grid of its self-un- same as that of the meaning of man, rious in its implications because we derstanding, in its shared interaction his limits and the reason and the are now face to face with a sort of with other human subjects, and in its meaning of these limits. Whether as collective removal of everything historical location within the many- appeals to nature or appeals to a which might disturb the general faceted story of the world of created transcendent divine force, man ex- mind. This reality is rooted in the es- beings with which its existence and periences suffering and illness, and tablishment of a model of life which the existence of others is bound up. above else death, as an “evil.” Keen is hedonistic and consumeristic to However the paradox of the delir- to rise above himself, in search of the extreme. ium of omnipotence which exor- immortality and lasting happiness, Perhaps our culture has ended up cizes pain and death lies in the anxi- he seems unequal to the experience by succumbing to all the conse- ety which afflicts the man of today of pain, to which, however, he quences of that removal of myths without giving him rest. A fleeing strives to give an answer. and the sacred from our approach to from the ultimate question of mean- “In the cultural repertory of every nature which according to Max We- ing does not remove “existential human group there exist theories ber had its point of departure in bib- frustration,”6 the inadequacy or the about illness, whether of a scientific lical religion and the reality of “dis- senselessness of being in the world or religious character.... They are as enchantment,” something which in- without an answer which reveals variable and as various as the cul- volved an approach to nature which man to man (cf. Gs 22). The prob- tures to which they belong. No the- contained an operative intention, lem, therefore, is anthropological in ory can be fully understood outside which in its turn was an essential nature, and for believers it is also, the cultural context to which it be- preliminary condition to the devel- and of necessity, theological. We longs and the social structure of opment of the scientific mentality.4 have, therefore, to return to the an- groups which share certain opinions Whatever the case, within our swers that the Holy Scriptures7—both and strategies in relation to adapta- culture and its collective processes the Old Testament and the New Tes- tion and survival.”1 of removal there is the perverse and tament—give to the problem of Pain, suffering, illness and death, titanic wish to defeat illness, pain pain. What we have to do, is (and in therefore, involve the anthropologi- and death, and this is something all honesty) return to the interpreta- cal subject, whether the individual which is almost equivalent to a tive paradigms which have been of- person or the collective personality. delirium of omnipotence. There is fered by Christianity during the They interact, that is to say, with the the tendency to interpret pain and course of its history. specific characteristics of the sub- illness as alien phenomena which jects and with the social group as arrive from outside and remain ex- such in the latter’s understanding of traneous. This idea is almost cer- 2. Paradigms of Theological itself as a cultural entity.2 tainly further encouraged by the Solutions For the so-called “primitive” peo- practical expression of the methods ples and cultures, at the origin of of medicine.5 2.1. The Old Testament and the every form of suffering, and of every In our culture, therefore, pain is New Testament calamity or catastrophe, there is a seen less and less as a “human” ex- transcendental power of which man perience. This is particularly dis- The etiology of Genesis responds is the victim. For Greek culture as for turbing when one considers that the to the meaning of suffering, pain Jewish culture, pain, suffering and anthropological subject presents it- and death by making humans re- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 169 sponsible for them. The God who punishment invites his people to any other human creature. in the called the universe into existence, change their ways, to turn to Him, to solitude of Gethsemane (cf. Lk the God who created male and fe- return to loyalty, to his love and to 22:39-44) and on the cross (cf. Mk male man, is a wise and just God. his law. Suffering and trial thus be- 15,34) pain and death seem to him to Neither death nor pain are his work, come a “crisis,” a test, a perception, be without meaning. But it is in this and at the same time there is no an opportunity offered anew to re- participation in the meaninglessness other God than He. Suffering and turn to his love and his covenant. and scandal of pain, which afflict death are, therefore, the work of The “pathetic” aspect of the God him because he has made himself man and of his sin. of Israel becomes emphasized and “sin” (cf. 2 Co 5:21), that the pas- Despite this guilt, man is not where possible more explicit and sion of God for man reaches its cul- abandoned by God. The Creator is definitive in the New Testament. minating point. In this passion is re- also the “redeemer.” Indeed, it is Here the Word made flesh shares vealed the final redemptive plan: from the experience of redemption and takes upon itself everything, in- “Christ has risen from the dead, the that biblical man moves in relation cluding suffering, which belongs to first fruits of all those who have to the intelligence of the plan of the the human experience. The “keno- fallen asleep” (1 Co 15:20). Creator. The optimal horizon of bib- sis” of the Son of God (cf. Ph 2:7) The event of Christ does not exor- lical man is always “shalom,” that cize pain, it does not remove it from blessing of God which is expressed the human horizon. But for the be- in security, well-being, and immedi- liever the reference to Him is para- ate and practical happiness. digmatic. Victory over death and In contrary fashion illness and pain takes place through participa- pain are a punishment in proportion tion in his “kenosis.” But it is pre- to guilt. But as the Book of Job—an cisely in this horizon of participa- authentic summa on the mystery of tion, in this imitation of the Christus suffering—reminds us, not every- patiens and of the “suffering ser- thing is always so simple and obvi- vant” that Christianity sets out two ous. But whatever the case may be, ways of understanding pain which in the victory of faith over trial and are different and antithetical. tribulation Job is returned to that condition of happiness and well-be- 2.2. Christian Culture and the Ex- ing which should characterize the perience of Pain existence of the righteous man. Although it is true that according On the one hand Christians have to the revelation of the Old Testa- laid stress upon the mysterious rela- ment the God of Abraham, Isaac and tionship which exists between faith Job is a God of life, we should not, and the cross. They believe that the however, minimize his capacity to price of suffering is infinite when it be moved. The God of the Covenant is associated with redemption. Spir- suffers because of the sin of his peo- itual authorities, and above all the ple. He speaks to it in dramatic “moderns,” have concluded from terms. He complains about its infi- this that suffering is absolutely nec- delity, its adultery. He expresses his includes being born to a woman essary to inner progress. It has even passion for the people he has chosen (Gal 4,4); being subject to the laws been argued that only suffering with expressions which bear the hu- of growing up (cf. Lk 2:52); having brings the impress of authentic per- man experience of betrayal, aban- to draw away from his natural fam- fection and that because of this we donment and faithlessness. This ily (cf. Lk 8:19); the experience of should want to experience suffering emerges above all else in prophetic being rejected by those who are and love suffering. It is certainly revelation,8 in the dialogue which nearest to him (cf. Lk 4:28 ff); by his true that nobody has ever argued He sustains with those members of people in both a wide and a narrow that suffering is a good in itself, a this people whom are called by him, sense (cf. Jn. 6:60 ff; 12:37 ff); and good unrelated to the love of God. almost with violence, to act as chan- by his disciples, those who he per- But a great many works of devotion nels for his impassioned love. sonally called to him and who en- have over the centuries implied such Thus it is that beyond the interpre- dure the scandal of his passion and a doctrine. tative framework which attributes death (cf. Mt 26:69-75; Mk 14:50). There is, however, another and death and pain to the sin of individ- Jesus suffers and is moved in indi- opposing school of thought, which uals or the whole of Israel, beyond vidual terms. He is wounded in is more moderate and more plausi- the disturbing paradox (and indeed friendship (cf. Mk 14:10-11), and in ble, and certainly more rooted in the notwithstanding) the prosperity and love for his city which is destined to tradition of the Gospels and the Fa- happiness of wicked men and the be ruined (Lk 19:41). But above all thers. The idea proposed by this unhappiness of the righteous, the else he bows before the suffering of school is that suffering derives from God of Israel is a God who suffers, others and uses healing as a call to evil. God, it is suggested, wants us who feels anger, who is moved, who the values of the kingdom of God, to struggle to extirpate suffering is able to take part in, and to take the path to faith and conversion (cf., from this world to the greatest extent upon himself, the suffering of his for example, Jn 9). possible. The establishment of the people. The Son of God experiences vio- joy and the peace of the Lord, the The God of Israel is also a merci- lence and death through his own promotion of the kingdom of God ful God who through suffering and flesh. He is frightened of them like on earth—this undertaking is more 170 DOLENTIUM HOMINUM in tune with humanism which at an- His taking of death upon himself on struggle of the ascetic, the stylite for other level strives to promote devel- the cross (when faced with other pos- example. The drawing near to the opment and natural good. The defeat sibilities involving continuing his re- Christus patiens by the martyr is of sadness through the illuminating demption of man) remains written based upon an extreme faith which effect of a love which consoles us is into the sin of the world. Christ made triumphs over and defeats pain. But a heroic and courageous undertak- himself share in the pain of man and the voluntary martyrdom of the as- ing. However this ideal, like that took it upon himself, but he did not cetic, which is often akin to en- ideal outlined above, can lead to er- seek it out for himself. This is cratism, is something quite differ- roneous doctrinal emphases which demonstrated by his existential tra- ent, and was rightly rebuked by the can provoke, even though indirectly, vail. Nowhere in the gospels can we Fathers of the Church.13 a diminution in the value attributed find an authentic disciple who is in- The conception of pain during the to the spirit of sacrifice.9 vited to seek out pain for his own Medieval period was equally dualis- benefit. On the contrary, the message tic. A man who is really a man dis- 2.2.1. Praise of Suffering of Jesus is a message joyful with lib- plays indifference and disdain. Pain eration (cf. Lk 4:18 ff). is a matter for women, as is demon- The first approach, obviously The stress on pain in the history of strated by the condemnation of Eve enough, is based upon the example (Gn 3:16).14 Nonetheless, physical of Christ’s taking of suffering upon suffering has a medical value, both as himself, and that only through a per- regards the living body and in rela- sonal association with this action tion to the soul in purgatory, and for does the mystery of pain acquire this reason the Medieval imagination meaning. This is an idea which is al- produced various forms of correction ready present in Col 1:24 where based on physical endurance. Paul declares that he completes The almost Stoic attitude towards within his own flesh what was ab- pain—typical of the feudal aristoc- sent from the sufferings of Christ to racy—breaks up at around the end the benefit of his body which is the of the twelfth century.15 This is con- Church. Here there is no suggestion nected with a process of declerical- that there was something lacking in ization and the popularization of the experience of the cross. Indeed, culture which comes to fruition in the idea rather is that there is a gain- the fourteenth and fifteenth cen- ing of individual access to it, a per- turies. Now the piety of the believer sonal entering into the vital dy- is concentrated upon the “Man of namic of that body which Christ ob- Pain,” on his passion.16 He is se- tained through dying on the cross duced by this idea and is led to imi- (cf. Eph 5:23-26). tate him through physical suffering However, this principle is full of too, and to make himself responsible debatable elements. It has informed for those brethren in whose poor and what could be termed “pain-cen- suffering body the suffering Christ teredness,” that forte of a great deal is incarnated.17 of spiritual literature, but first and At times this involves imitation foremost something which is the ex- Christianity is also accompanied by spilling over into the realms of sado- pression of a specific set of cultural another emphasis, namely that masochism. One need only think of circumstances. which attributes the “gift” of suffer- the exaggeration with which the In replying to the question of ing to God’s initiative. It is to non- body was attacked, disfigured, and whether suffering is always a good believers that God appears first and forced to do without food and sleep.18 thing, or at the very least if it can be- foremost in this form—as the by no In all sincerity, one cannot believe come such, it is not difficult to affirm means paternal guise of a torturer, that the mere imitation of the cruci- that pain is not always tolerable10 and something which is in radical an- fied Christ could justify these forms that faith is powerless to discern its tithesis to the teachings of Christ of behavior, phenomena which in meaning.11 The only forms of suffer- outlined in Matthew 7:9-11.12 It may more moderate form would remain ing which can help us are those and well be that such suffering leads to within the spirituality of the follow- only those which can be borne. Un- conversion, that it is a unique oppor- ing centuries.19 One need only cite connected to love and faith, suffering tunity for maturation and growth. here the inverse tendency of the produces only evil. The force and the But an a priori exaltation of suffer- Baroque age and the return of the charity which enable us to face up to ing and the propensity to trace it practice of penitence during the sev- suffering are the only elements back at all times to God is without enteenth century, at the margins of which are good in themselves. The meaning. the Jansenist movement, the rigors of superiority of the man who has suf- The paradox of a Christianity which developed rather than became fered springs from the fact that he which has made these arguments its arrested within by no means few reli- was able to prevail over the trial own appears in clear fashion if we gious communities, especially for which they imposed upon him. try to place them in their historical women. The identification of perfection context. We are familiar with the “Pain-centeredness” in the real with suffering to the point of seeing Romantic dimension to “pain-cen- and authentic sense is a phenomenon the first in the search for the second teredness.” But this element was which belongs above all else to the does not appear to be rooted in the certainly present in previous epochs. last century and in large part to this paradox of the “suffering servant.” One thinks here of the titanic century, something which becomes VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 171 incredible when one considers that it in it a salvific value within the con- a man amongst other men within the had become extraneous to Occiden- text of the suffering of Christ. It is existential limitedness of a practical tal culture. Its fatalistic and supine not for us to undergo such suffering being entrusted to a psychophysical acquiescence in the presence of pain, again. We are to realize that suffer- complexity, written within time and its propensity to ascribe it in passive ing involves neither disengagement space, is the horizon, the very terms to the divine will, the search nor surrender. The understanding of modality of the reality of the human for it as a value in itself, all these ele- suffering, its mystery, which also re- phenomenon. ments go beyond the recognition and mains as such from the perspective There is a feature of pain which imitation of the “Man of Pain” as a of faith, does not involve acquies- perhaps should not even be termed spiritual paradigm. Indeed, they may cence in its pathologies, whether as such and which is a perception of even obscure its liberating and re- physical or moral. Indeed, it invokes oneself which is equivalent to an demptive transparency.20 This is a the sick person—and here we en- awareness of being limited. But this cultural path belonging to a certain counter the paradigm of the Good rather than other realities is man in date, and written according to a Stoic Samaritan—who in bearing pain his psychophysical complexity. or Manichean conception which is takes on a decisive and active com- According to the Christian faith, not at all close to Christian hope and mitment. God draws near to this man from the salvation whose eschatological con- very outset. The Christian God is a tent blames neither the present and God who is aware of the ontic limits the past nor the experience of the of the creature which he has body.21 nonetheless created in his image. He draws near to this limit, and even 2.2.2. The Struggle Against Suf- undergoes the experience of death fering on the cross. It is certainly true that the Christ- The early Christians certainly ig- ian faith lays stress upon the con- nored the “Romanticism of pain.” science, the weight of limitation be- “Pain-centeredness” was totally ab- ginning with the mortgage of guilt. sent from their way of thinking and But whatever its alienating and dis- acting. Their struggle in favor of rupting character may be, the limita- God included every evil, including tion borne by the created being is suffering. This remains the position written into the pre-Fall experience. of all those who fight strenuously The problem, then, is to refer to our- against illness and death and make selves, in a creative and active fash- this struggle a part of their human ion, with reference to a God who mission and a duty of their Christian “suffers” and whose “history”24 is at witness. I am thinking here for ex- the same time the key by which to ample of Dr. Gianna Beretta Molla interpret the “suffering” of man. who refused to take analgesics in or- Pain in terms of its acceptance as der to remain “compos sui.” a pathology—which is always and In the same way the early Christ- in every way contingent with the ian community had nothing to do subject (illness is not an alien entity with notions of the providence of The individual, therefore, is at but derives and springs from the in- pain. The words of the Lord’s stake, the human person, created in dividual who is afflicted by it)25— Prayer “Thy will be done” does not the image of God (cf. Gn 1:26). The must be seen in the terms of this envisage the removal of active indi- character of this image, which is not original reference point. viduality, of personal action, in fa- canceled by sin (cf. Gn 5:1b-2), re- In this sense the Christian concep- vor of the creation of the kingdom of veals the mystery itself of God in the tion of pain, now that we have re- heaven. What should have been a mystery of man. The mystery of moved every uncertainty and “pain- program of liberation all too often pain can now but find a meaning centered” impress, invites the hu- becomes sterile acquiescence, mere within that relational impress which man subject to see pathological pain blameworthy eschatological flight. manifests the mystery itself of the within the context of ontic limita- The struggle against suffering love of the Trinity in man when he is tion. And therefore to live it as a does not seek, however, to dull or called to communion. fully human experience and thus dim Christian sensitivity and sensi- Man is a “pathetic” being.23 The commit himself to fighting every- bility. It seeks, rather, to tackle the perception and awareness which he thing that is a threat to the quality of question of illness in coherent fash- has of himself are necessarily en- his life and the lives of other people. ion by turning its attention to the in- trusted to the sphere of dialogue, to This does not mean fleeing from the dividual. Suffering and illness are the request for otherness and tran- scandal of the cross but professing considered with reference to the per- scendence which in revealing him to the globality of the Christian mys- sonal and community sphere. himself, reveal him for what he is, tery. This is certainly a mystery of but always within his ontic limits. kenosis but it is also a mystery of re- 3. Towards a Christian Concep- Pain, not in its pathological form demption and glory. As has often tion of Suffering but as an awareness and perception been observed, Easter Friday with- of the individual’s limits, is an expe- out the Resurrection would involve The publication “Salvifici Do- rience which is of the essence of be- merely the celebration of evil. loris”22 paid attention to the subject ing human. This understanding of It is here and now that we must of human suffering, and perceived oneself and perception of oneself as advance the kingdom of God. It is 172 DOLENTIUM HOMINUM here and now that we must return p. 82 ss. The idea of the “pathos” of God is a within the flesh of marks of the passion. If this notion which Neher takes from A.J. HESCHEL, makes him belong to the imagery of the “Alter the creation to God, in praise of his Il Messagio dei Profeti (Rome, 1982). Christus” in quintessential fashion, the pre- glory. It is here and now that we 9 This is almost a literal quotation from M. Humanistic inspiration of Francesco prevents must fight our own limitation, thick- NEDONCELLE, La Soufference. Essai de Rflex- us from placing him within a context which is ened by what we have become used ion Chrtienne (Paris, 1950), pp. 12-13. furtively “pain-centered.” 10 For the present-day debate on the use of 17 Cf. G. DUBY, “Reflexion sur la Douleur to terming the collective structures analgesics see, e.g., I. SCHINELLA, “Il Cris- au Moyen age,” in AA. VV. La Douleur. of sin. tiano, il Dolore e gli Analgesici” in Vivarium, “Au-Del des Maux,” op. cit., pp. 71.79. In his Between pain as the contextual 3, 1993, pp. 519-531. opinion, and because of this cultural mutation, 11 The brief apologue of L. SANTUCCI is em- the different attention of science and medicine nature of created beings who exist blematic: “Pain knocked at the door, it came which gradually commit themselves to the art and pain as evil, as collective and to open him to faith, but nobody was there.” of healing, reject the redemptive function of personal disorder, the Christian has 12 “Or what man of you, if his son asks him pain and dedicate themselves to defeating it no choice but to oppose the second for bread, will give him a stone? Or if he asks with all means available. for a fish will give him a serpent? If you, then, 18 A striking example is offered by S. Eu- and to see his own limitation as a who are evil, know how to give good gifts to stochia, the founder in the fourteenth century challenge and an exordial paradigm. your children, how much more will your Fa- of a monastery of Minoresses at Messina. We must match up to the merciful ther who is in heaven give good things to Folk history has it that she engaged in an ob- synkatabasis of God (cf. Dv 8), to those who ask him!.” sessive search for suffering, and that the mor- 13 See my volume Donna e Chiesa. La Tes- tification of her body led her, after her death, represent it as a paradigm for salva- timonianza di Giovanni Crisostomo (Palermo, to be a spring of scented oil, a phenomenon tion and life and as a conditio sine 1985), pp. 74 ff. which was also present, it appears, in the fol- qua non of final access to the Mys- 14 It would be interesting to approach the lowing century. Cf. F. TERRIZZI, La Beata Eu- subject of pain from the “female” point of stochia. 1434-1485 (Messina, 1982). 19. Cf. tery and to glory. view. It is certainly true that the experience S. SPINSANTI, L”Etica Cristiana della Malat- of pregnancy and above all childbirth seem tia (Alba, 1971). Professor CETTINA MILITELLO to link women to pain in indissoluble fash- 20 This does not mean in the least that we ion. But today, given that we have removed should deny the possibility that such mystical Professor of Theological Anthropology at the idea the women are by their nature weak, exaltation, inspired by supernatural charity, the Teresianum and Marianum Pontifical the link between women and pain seems an can involve the expression of authentic holi- Theological Faculties, Rome existential paradigm of that “merciful plia- ness and perfection. However there are good bility” which enables the woman to rise reasons for thinking that there is a certain ha- above herself with a more lucid psyhco- giographic tendency to trace holiness to the Notes physical lucidity. It should also be observed required stylistic features of “pain-centered- that the paradigm of the bearer of children as ness.” Obviously enough, another reading 1 S. SPINSANTI, Salute, Malattia, Morte, a person able to go beyond suffering was al- could finally enable us to discover the deep (NDTM, Cinisello, B., 1990), p. 1136. ready to be found in the New Testament (cf. values which have informed the lives of by no 2 Cf. e.g., M. Aug and C. Herzlich, Il Senso Jn 16:21). For a female reflection upon the means few saints, in addition to and beyond del Male. Antropologia, Storia e Sociologia subject of pain see D. SOELLE, Sofferenza this presumed option in favour of suffering. della Malattia, (Milan, 1986). (Brescia, 1976) and G. P. DI NICOLA Il Lin- 21 On this subject see C. ROCCHETTA, Per 3 An example of this is La Douleur. “Au de guaggio della Madre, (Rome, 1994). Of una Teologia della Corporeià (Rome, 1990) l des Maux, (Paris, 1992). This is a brief bibli- equal interest, and rich in literary and icono- and S. SPINSANTI, Il Corpo nella Cultura con- ography on neurology and pain; behaviour graphic background, is the subject of “mater temporanea (Brescia, 1983). and pain; medicine and pain; pharmacology dolerosa,” and this also is a cultural topos 22 AAS (1984)... and pain; anthropology and pain; literature prior to being a theological question. (Cf. M. 23 On the semantic character of terms con- and pain. It was an accompanying text for the LE BOT, “Une Femme en Pleurs,” in nected to pain (pathos/pascho, thlipsis, thlibo) Paris exhibition of the same title. AA.VV, La Douleur. “Au-Del des Maux, op. cf S. NATOLI, L”Esperienza del Dolore. Le 4 Cf. ibid., p. 140 ff. cit. pp. 81-94). Forme del Patire nella Cultura Occidentale 5 Cf. in addition to the above mentioned 15 The anonymous work “Le dodici utilit (Milan, 1987), p. 19 ss. work by Spinsanti, e.g., B. HAERING, Procla- della tribolazione,” PL 207, 989-1006, is an 24 Without entering into the validity of the mare la Salvezza a Guarire i Malati example of this. Amongst these are listed: the points raised by A.N. WHITEHEAD, Process (Ospedale Mulli, Rassegna Trimestrale, help which God gives to the person in tribula- and Reality (Cambridge, 1929) and by C. 1982/692). tion; the purgative dimension; the payment of Hartshorne, The Divine Relativity (New 6 The expression is that of V. FRANKL. See the debt incurred through sin; being forced to Haven, 1948), a legitimate use of this lan- his work Homo Patiens. L”interpretazione look for heavenly things; the stewarding of the guage can take place above all else within an Umanistica della Sofferenza (Varese, 1972). heart; the assurance that God loves those he “economic” context, that is to say the history 7 The time available here rules out an punishes...At a poetic level, on the other hand, of salvation as an exordial history of God. analysis of the extrabiblical, intercultural or reference should be made to Jacopone da From this point of view, the Trintarian God interreligious analysis of the paradigms by Todi: “Lord, please,” for example.... suffers with us, but above all suffers in the which to solve the problem and suffering. 16 The experience of Francesco is emblem- Word made man. 8. Reference is necessary here to A. NEHER, atic here. His loving identification with the 25 Cf. AGAIN S. SPINSANTI, Salute..., op. cit., L”Essenza del Profestismo (Casale M., 1984), “Christus patiens” even implies the presence p. 1138 ff. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 173

CORRADO MANNI

Palliative Medicine and Christian Eschatology

In recent years palliative forms of volve his family, both as an object of culties and problems which a mere treatment have rightly acquired a treatment and as an active force “technical” approach—directed, that fundamental role in the sphere of so- which takes part in the care and treat- is, towards the clinical aspects alone cial-health care. They have become ment of one of its members; of the illness—cannot really solve. the subject of great debate, and in- At the present time the number of Above all else, physical pain and volve not only medical questions but patients who need palliative forms of the other disturbances linked to the ethical and social problems and treatment is constantly increasing, pathology of which he is the carrier dilemmas as well. especially in the Western World.3 take on an especially serious charac- Furthermore, only very recently This is caused by two primary fac- ter. This is because they do not go has palliative medicine begun to actors: away but actually increase in inten- quire the recognition of bearing the The first is the increase in the inci- sity. Secondly, the direct effects of status of a new discipline of medi- dence of pathologies which develop the illness—the mutilations caused cine—a discipline which merits the rapidly and lead to death such as can- by any surgical intervention which very greatest attention and should cer, AIDS, Alzheimer’s disease, might take place and the general have devoted to it clear programs Kreuzfeld-Jacob’s disease and vari- compromised condition of the pa- dedicated to its suitable development ous forms of multiple sclerosis. This tient—greatly reduce his indepen- and diffusion. phenomenon is partly linked to the dence and autonomy and force him First and foremost, I would like to increase in the average age of the to be dependent on other people. refer briefly to the definition of “pal- population, which in turn is caused Thirdly, the knowledge of the seri- liative treatments” which is offered by improvements in health and social ousness of his state of health and a di- by the World Health Organization: conditions and by a decrease in infant agnosis which offers no hope— “palliative treatments consist of the and youth mortality rates. which sooner or later grow in impor- overall care given to a person af- The second cause is to be found in tance in the mind of the patient—pre- flicted by illness who is no longer re- the increase in the length of time that sent him with the anxiety of being sponsive to therapies which aim at a these patients go on living. This deprived of his earthly life in the im- cure. Their aim is to obtain the high- arises because of the greater effec- minent future. est level of quality of life possible for tiveness of medico-surgical sympto- The combined pressure of these the patient and his relatives through matic therapies and because of much difficulties and problems cause deep the control of pain, other symptoms, earlier diagnoses of the patient’s con- spiritual and psychological concern and the psychological, social and dition. There is no doubt, therefore, and worry which give rise to the most spiritual difficulties which arise that although advances in medicine desperate forms of reactions: in- within the suffering group made up on the one hand have involved a credulity, rebellion, disorientation, of the patient and those members of drastic reduction in death rates, on anxiety or depression. This further his family who share in his suffer- the other hand they have also con- aggravates the physical suffering of ing.”1 The special characteristics of tributed to an increase in the length the patient and worsens the course palliative treatments, therefore, are of survival, and to the numbers of that the illness takes. as follows: those surviving, of patients afflicted Unfortunately, in such conditions 1) they are used with incurably ill by illnesses which at the present time the relationship between the doctor people; are still incurable. and patient is not really suitable for a 2) as such, they are not primarily We are therefore face to face with correct and sound management of aimed at the achievement of a cure new kinds of ill people who need such a complicated reality. Indeed, but seek to improve quality of life; very intense forms of care and treat- we can assert that over the last few 3) they are not directed towards ment in the widest possible sense. In years medical culture has become the mere biophysical and pharmaco- other words, attention must be di- impoverished in relation to its “hu- logical aspects of the illness but are rected towards the whole spiritual manist” component and has evolved conceived for the benefit of the suf- and psychosomatic complex reality increasingly into a kind of “exact sci- fering man, in all his physical, moral of an incurable patient. ence”—something which is effective and spiritual aspects;2 Indeed, there is no doubt that the but impersonal and ever more distant 4) they are not directed towards patient afflicted by an illness which from the transcendent nature of the the individual patient alone but in- leads to death presents special diffi- great mystery of life, that very ele- 174 DOLENTIUM HOMINUM ment which always constitutes the whole patient and preventing the er- other, the ordinary person has be- purpose of its knowledge. The use of ror known as “reductionism.” It is come ever more unprepared to deal ever more sophisticated diagnostic precisely for this reason that we must with it, the dying patient has had his and therapeutic procedures, an at always remember that it is our duty is suffering intensified and has to en- times excessive employment of hos- to treat the sick person and not the ill- dure the moral and material conse- pitalization, and the rationalization ness. quences of an isolation of which all and formalizing of the approach to The medicalization of the ap- too often he is made the subject. the patient—all these factors increas- proach to the sick person is a major In each and every one of us the ingly tend on the one hand to dis- obstacle in the way of understanding sight of the death of another person tance the patient himself from his his difficult human and spiritual ex- provokes discomfort because it re- own social and human environment, perience (not to speak of the painful minds us of our own destiny. In the and on the other to create a gulf be- expression of the physical and moral case of the medical doctor there is in tween the doctor and the sick person suffering of his existence). But in the addition a personal feeling of defeat he is treating. incurable patient other factors, in this in relation to his own abilities and ca- Of course, we do not want in any instance of a social and moral nature, pacities. The above mentioned re- way to deny the evident benefits that act to place other obstacles in his ductionism also serves to promote technology has given to us. Nor do this erroneous vision of things be- we wish to neglect the scientific rigor cause it leads to a loss of the identity of our discipline. But we would do of the patient who becomes identi- well to remember that technology fied and confused with the disease he has a value as long as it is used to the is suffering from. From this point of advantage of the patient. When, on view death is wrongly seen as the fi- the other hand, technology is em- nal outcome of a pathology rather the ployed merely for the benefit of sci- natural end of a life. ence it ends up by promoting a “de- We thus see how the above men- humanization of medicine,” and this tioned factors are closely intercon- causes very great damage both to the nected: “technologism” and reduc- patient and to the doctor who is look- tionism may at first sight be consid- ing after him. Another risk for the ered as mere “professional deforma- well-being of the delicate relation- tions” promoted by the medical class. ship between the doctor and the pa- In reality a closer and more accurate tient lies in the fragmentation of analysis shows how they are both the medical knowledge into a whole host instrument and the justification of a of specialized disciplines which are more generalized cultural rejection principally directed towards the path. Indeed, in an opulent and proof death which involves not only the study of just one organ or internal ap- duction-oriented society as is present medical doctor but society as a paratus—nephrology, pneumology, in the West (where material prosper- whole. This stance of rejection and gastroenterology, cardiology or he- ity is all too often held up as the only detachment from incurable illness patology, to name just a few on the possible good to be aimed at and and its inevitable outcome can have list. It cannot be doubted that the very where the mass means of communi- two consequences which are only ap- considerable advances which have cation tend to construct an image of parently in contradiction: been achieved by modern science existence which consists only of 1) on the one hand, it can lead the would not have been possible with- beauty, wealth and success) the dark medical doctor to persist, in obstinate out moves towards a very high level sides of life such as suffering, old age fashion, with forms of treatment of specialization on the part of those and death are ever more marginal- which have become useless and inap- who have promoted such progress. ized, almost as if there was an at- propriate and which cause further But in actual fact many doctors have tempt to remove them altogether suffering without actually benefiting greatly altered their learning and from the common consciousness. In the patient. This error, as is well ways of doing things with the result a perspective which only includes known, is designated “therapeutic that there is a danger that they end up worldly goods, the painful dimension obstinacy.” Numerous factors give treaters of organs rather than of the to existence can only appear as an rise to this practice. Indeed, in addi- body as a whole—something which unthinkable and inexplicable void— tion to the doctor’s inability to admit should be their real task. something to be exorcised. In- his inability to cure the sick person The increase in the number of dis- evitably, the loss of a transcendental there is the fear that not “everything ciplines implies a corresponding in- meaning to live deprives its natural possible” has been done for the good crease in the number of people prac- conclusion—death itself—of mean- of the patient, not to speak of an un- ticing medical care. Indeed, it is not ing as well. derestimation of the suffering which rare to come across patients in very Behind the tendency to hospitalize prolonged hospitalization and ag- serious conditions entrusted to the the illness we often find an attempt to gressive forms of treatment can care of four or five different special- hide this painful dimension from the cause to a sick person who is already ists, each of whom has the tendency eyes of society. However the lack of under the full burden of a debilitating to focus his attention on his own spe- acceptance of such a reality, its mar- illness. cific area of professional compe- ginalization or the fact that it is con- It is wise to make clear in order to tence. And the presence of a doctor cealed behind “technologism” and avoid any possible uncertainty that who oversees this diagnostic and medicalization has a dual impact. On by therapeutic overkill is meant the therapeutic activity is often not suffi- the one hand this reality is not pre- use of forms of treatment which are cient to avoid losing sight of the vented from being present. On the of proven uselessness in relation to VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 175 the overall goal. To this is added the of patients whose condition is very serious in its character and impact presence of a high risk and/or a spe- serious, where life expectancy is than therapeutic overkill—I am re- cial danger for the patient, in addition clearly low, such forms of treatment ferring here to a real and authentic to further suffering in a context as pain killing, nutrition and hydra- “therapeutic abandonment.” This where the exceptional character of tion, dealing with bedsores, and help- abandonment can lead to a complete the means and methods used is ing with daily needs, do not, it must dismissal of the patient because he is clearly disproportionate to the reali- be observed, amount to therapeutic deemed incurable and no prospect of ties of the specific condition of the overkill—they are merely indispens- care is offered to him. To the moral patient.4 able elements in maintaining the dig- isolation of the patient which is al- The first criterion, therefore, is the nity of the life of the patient. ready present is added real and au- proven ineffectiveness and thus use- 2) It should also be stressed that a thentic material and social loneliness lessness of the treatment. This is doctor’s knowledge that the patient which afflicts both the sick person based upon the evident contradiction entrusted to him has been diagnosed himself and his family. We need not to be found in the approach of the as being incurable can lead him to add that this can but increase the medical doctor—”overkill.” By this commit an equally serious mistake— number of serious difficulties which is meant the obstinate and senseless to surrender, to turn his back not only afflict both parties. use of a treatment which does the pa- In reality the feeling of profes- tient no good at all and which, in- sional defeat provoked by the incur- deed, cancels any “therapeutic” able patient—whose rejection is the value. This, in turn, goes against the basis of both the therapeutic overkill very nature of treatment which and the therapeutic abandonment— should in fact have the goal of im- essentially derives from a misunder- proving the well-being of the patient standing of the real purpose of the and improving his quality of life. doctor’s mission which is seen solely Furthermore, it is more than obvi- in terms of achieving a healing of the ous that, however involved, intricate, patient. Once again care and concern and complex a therapy may be, if it is for the sick person are forgotten and suitable to the illness, it could never the illness alone is concentrated be defined as being an example of upon. In reality, whilst it is not al- therapeutic overkill. The employ- ways possible to achieve an end to ment of advanced diagnostic and the illness one can always and one therapeutic resources which express should always offer care and con- a high level of technological exper- cern. For example, diabetes is an in- tise is fully justified only when the curable illness yet nobody would goal of such treatment is the well-be- on useless forms of treatment but ever dream of defining it as being un- ing of the patient alone. also on methods which would greatly treatable. What distinguishes it from The second criterion lies in the in- reduce the suffering of the patient if conventional incurable illnesses such tensity of the treatment—the extent, employed in the right way. One is re- as cancer of AIDS is the different life that is to say, of the risks it involves ferring here, naturally enough, to pal- expectancy of the patient. Yet the of causing new and additional physi- liative forms of treatment. need for care and concern to be de- cal and moral suffering. When such From this point of view the sick voted to the patient is certainly not risks are high we can speak of a pol- person who has no possibility of get- proportionate to the length of life icy of “therapeutic violence.” ting better comes to be considered a which is still to be lived. Indeed, it is The third criterion involves the ex- “lost” patient who is no longer wor- really the opposite which is the case. ceptional nature of the therapeutic thy of real and authentic care, In fundamental terms—and even means and methods which are em- whether in a strict health sense or in when there is no longer any room left ployed. These should never be dis- terms of moral support. When the for the use of therapies which aim at proportionate to the aims and objec- medical doctor who is in charge of destroying an illness (that is to say tives that the medical doctor has in the case has lost all hope of healing those which seek to strike at the mind. the patient, detachment takes the cause of the malady)—it is the doc- It is evident that this last criterion place of professional and scientific tor’s strict duty to do everything pos- is the subject of constant develop- attention. In this way the patient is sible to remove the suffering con- ment within the world of medical sci- denied trust and spiritual support at nected to the illness itself, whether ence. Means and methods which at precisely the moment when he has that suffering is of a physical or of a one time were considered dispropor- most need of such things. Informa- moral nature. tionate are today commonly and or- tion on the condition of his health be- At this point it should be pointed dinarily employed. One need only come vague and evasive and in basic out that clause 32 of the Italian code think here of mechanical ventilation terms he is ignored. This is because of medical ethics makes clear that and of hemodialysis which are now the medical doctor is made to feel “the doctor cannot abandon a sick practiced in the patient’s home as embarrassment at his lack of power person who is deemed incurable. He well as in a hospital setting. Judg- to do something effective and experi- must continue to care for him even ments as to the suitability of a treat- ences bitterness at his professional when a mere reduction of psychic ment must be based upon a suitable failure. Moved by pity, he may deal and physical pain is envisaged, and knowledge of the clinical conditions with the matter by giving a false pic- he must help him and comfort him.”5 of the sick person and on the practi- ture of the situation to the patient. In even more specific terms the Na- cal benefits to be obtained from the In this way an error is committed tional Committee for Bioethics dur- therapeutic intervention. In the case which may be considered even more ing its press conference of 19 July 176 DOLENTIUM HOMINUM

1994 to launch its publication worker must be the first to make such level. Today more than ever before “Bioethical Questions Relating to the values his own. He must not become social-health care has to deal with a End of Human Life”6 stressed the a victim of discouragement or self- lack of legislative and economic in- very high bioethical value of pallia- ishness. He must know how to under- struments at its command. We are tive forms of treatment. These find stand the transcendent and human di- constantly faced on the one hand their justification not in the false hope mension of the physical suffering of with great success stories involving of being able to save a patient from the sick person and the spiritual and treatment in highly specialized cen- death but in a firm determination not psychological drama of the detach- ters. On the other, there are equally to leave the patient alone—to help ment which dying means and in- high-profile failings in the health ser- him, therefore, to live out his last rad- volves. These are by no means easy vices, even in relation to essential ical experience of life in the most hu- tasks. needs. The causes of these imbal- man way possible, from both a physi- We cannot deny that “when faced ances can only in part be attributed to cal and a spiritual point of view. with the mystery of death we are medical doctors. They are first and Principally directed towards re- powerless. Human certainties trem- foremost a reflection of a more gen- ducing pain in general and the pain ble. But it is precisely when faced eral lack of interest on the part of so- of terminally ill patients in particular, with such a situation that Christian ciety towards its weakest members— palliative forms of treatment have faith...presents itself as a spring of the elderly, the sick, and the poor. expanded and continue to expand serenity and peace...What seemed Many incurable patients in need of their horizons and their sphere of ac- without meaning acquires meaning palliative forms of treatment belong tion. They now constitute one of the and value.”8 In carrying out this task, to more than one of these cate- fields in which modern medicine the bearing witness to faith and to gories—the elderly, for example, or demonstrates its deeply rooted voca- hope in Christ on the part of the AIDS sufferers, both of whom suffer tion to care for the patient in an over- health care worker acquires a deter- from poverty and social marginaliza- all sense, directing attention and con- mining role. “The demonstration of a tion, either prior to illness or (unfor- cern not only towards the physical di- presence of faith and hope on the part tunately) because of it. mension of the sick person, but to- of a health care worker is the highest From such a deformed point of wards his psychological and existen- form of by which to humanize dying. view, the abandonment of the incur- tial aspects as well. It involves more than the alleviating ably sick person can appear to many Furthermore, it should be stressed of suffering. It means facilitating the as a necessary solution to reducing that care for the incurable patient ac- sick person’s drawing near to God health costs and thereby helping pa- quires an even higher spiritual mean- through the employment of care and tients who have a better prognosis. ing in Christian ethics. For the Chris- concern.”9,10 And this choice is often justified with tian medical doctor, the first moral At a practical level, therefore, the the notion of “allowing the patient to imperative is that of serving life, and imperatives of the health care worker die in peace at home” in order to save this means looking after life until its in relation to the incurable patient are him the stress of hospitalization. In natural end. Health care for the dying as follows: reality such a prospect is completely person is an especially important and 1) avoid a “medicalization” of the erroneous. The discharge of the in- delicate task because it involves illness; curable patient without providing for making sure that the dying person 2) keep his treatment within the any program of palliative treatment sees himself and values himself as a right limits of what is proportionate, or home support is not only ethically living person. To quote the words of with a consequent avoidance of ther- unacceptable but has very high social the Holy Father: “in nearness to apeutic overkill or abandonment; and economic costs which can be death and in death itself it is neces- 3) be a constant and caring source calculated in terms of the lost work- sary to celebrate and uphold life of hope and moral support for the pa- ing days of the members of the pa- more than in any other context.... The tient and his family through a bearing tient’s family. approach to the terminally ill person of witness to the faith; This is caused not only by the need is often the litmus test of a sense of 4) effect and promote by every to look after the sick person but also justice and charity, nobility of the means possible those forms of pallia- by higher levels of physical and psy- spirit, the responsibility and profes- tive treatment which reduce the suf- chological illness caused by the sional ability of health care workers, fering of the patient and thereby help stress of dealing with the illness and beginning with medical doctors”7. To to humanize death and make it more then with mourning. To this should help a person die means helping him acceptable to the dying person. be added the waste caused by an er- to live out the last experience of life This last consideration leads us to roneous use of medicines, and above intensely. This is achieved through a the need to emphasize that the em- all pain killing medicines, because of loving presence at the side of the dy- ployment of palliative forms of treat- a discontinuous or inadequate system ing person. This presence makes him ment involves programs which en- of prescription.12 feel alive without giving him false sure the continuity of such treatment Even more worrying is the attitude hope. He feels a person amongst peo- both inside and outside the hospital of those who come to propose eu- ple because he receives, like any and guarantee a strong circle of care thanasia as the only real solution other person, but more than any other around the sick person. This cannot when faced with the suffering of ter- person, in this special context, care, be achieved without a program minally ill people. This approach is concern and attention. This caring which involves the relatives of the justified with reference to the fact that and careful presence must inspire patient, the family’s doctor, social in general it is the patient himself who trust and hope in the sick person and and religious workers, and public asks for such an extreme solution. reconcile him with death. structures.11 In replying to those who propose It is evident that to be really able to Unfortunately, this is still not very such an extreme policy I do not pro- inspire trust and hope the health care recognized at a political and social pose here to dwell upon the intricate VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 177 set of arguments which go to make makes euthanasia unacceptable and ontologia Medica,” Il Medico d”Italia, 44(3), up the debate over euthanasia. I will demonstrates that it is a policy which Suppl. 1990. 6 Comitato Nazionale per la Bioetica, limit myself to quoting the words of cannot be proposed. This is the “Questioni Bioetiche Relative alla Fine della the Pope: “the pleas of very sick peo- strongest answer we can give to the Vita Umana,” in preparation. ple, who at times ask for death, must “culture of death and abandonment.” 7 JOHN PAUL II, to the participants of the international conference of the Omnia Hominis not be understood as a real wish for Association, August 25, 1990, in Insegna- euthanasia. They are in fact nearly al- Prof. CORRADO MANNI menti, XIII/2, p. 328. ways worried and concerned calls for Director of the Institute help and affection.”13 The sick person for Anesthesia and Intensive Care, 8 JOHN PAUL II, to the participants of the in- who feels surrounded by a friendly The Catholic University ternational conference of caring for the dying, of the Sacred Heart, Rome Osservatore Romano, March 18, 1992, no. 5. presence and who perceives that his 9 Pontifical Council for Health Care Work- suffering is reduced does not fall into ers, Carta degli Operatori Sanitari, (Vatican the depression experienced by those City, 1994). Bibliography 10 JOHN PAUL II, to two work groups pro- who feel abandoned to a destiny de- moted by the Pontifical Council of Sciences, prived of all hope.”9 1 World Health Organization, “Dolore da October 21, 1985, in Insegnamenti VII/2, no. In conclusion I would like to ob- Cancro a Cure Paliative,” (Geneva), collana 6, p. 1083. rapporti tecnici, no. 804, 1990. 11 A. ROMANINI and M.R. SPEDICATO, serve that medicine today has many 2 A. VENTAFRIDDA, “Continuing Care: A “Unità di Cura Continuativa, Nuova means available by which to control Major Issue in Cancer Pain Management,” Soluzione Terapeutica e Assistenziale nella pain and confer upon the terminally- Pain, 36: 137-143, 1989. Malattia Terminale” in Progressi Clinici: ill patient a dignified quality of life 3 WORLD HEALTH ORGANISATION, World Medicina, III, 3, Padua, 1988. Health Statistics Annual 1988, (Geneva, 1988). 12 J.CAMERON and C.M.PARKES, “Terminal until that life comes to its natural end. 4 C. MANNI, “Accanimento terapeutico: Care: Evaluation of Effects on Surviving Fam- There can be no excuses for igno- definizione e aspetti scientifici,” Acts of the ily Members of Care before and after Bereave- rance or omission of their employ- AMCI-ACOS conference “Accanimento ter- ment,” Postgrad. Med. J., 59:73-78, 1983. ment by health care workers whose apeutico: un concetto da precisare,” Rome, 13 PAUL VI, to the participants of the third 1990. world congress of the “International College very professional goal is the well-be- 5 Federazione Nazionale dei Medici of Psychosomatic Medicine,” September 18, ing of the patient. Palliative medicine Chirurghi e degli Odontoiatri, “Codice di De- 1975, in AAS, 67, 1975, p. 545. 178 DOLENTIUM HOMINUM

AN VERLINDE

Women in the History of Care for the Sick

1. Introduction that of these 15%, about 60%, if not sick, devotion and self-sacrifice indeed 75%, have managerial and could only be achieved by belong- In all countries, in all societies, directive roles in the sphere of social ing to a religious order and that this and in all epochs, it has been assistance and this area of caring for also required the taking of eternal women, above all, who have taken the sick, and this development has vows and a permanent commitment care of children, women and men. been especially marked over the last to celibacy on the part of those Women have always been, and they fifteen years. Taking Michelle Per- women who wanted to dedicate are still, those who chiefly care for rot (1990) as a reference point I themselves to care for the sick. the sick, both at a professional level would even venture to talk about the It is, however, a matter of fact that and in the private sphere—for ex- “power of men and the force of it has been first of all women in the ample, home care and family care. women.” In the history of men there West who have been given the task From an inquiry conducted in are however a number of well of caring for the sick, and it is also Holland in 1994—and it is reason- known exceptions where women true that they have often been in- able to suppose that the results can have ruled. Often these are dramatic spired by religious faith. be applied to the other industrialized exceptions involving women who During the history of the Church, countries of Europe — it appears have been heads of state or the com- Christian women have always per- that of every five hours dedicated to manders of armies, figures such as ceived, recognized and understood care outside the hospital world four Catherine the Great or Joan of Arc. fundamental contemporary needs are the work of women. Further- There have also been many exam- and have answered this call in prac- more, over 60% of personal care is ples of powerful and influential tical fashion. In doing this they have the work of wives, daughters, women who have played an impor- always taken the gospels as their daughters-in-law and female rela- tant backstage and behind-the- point of departure. They have done tives. In absolute terms were are scenes political role and have thus this with the total commitment of talking about an important impact of wielded great political influence. their persons and their lives and the use of female work time. We should not however be sur- have used the specific instruments One person in six of all people prised at the fact that it is women and methods of each epoch to over the age of fifty-five receives who have largely engaged in profes- achieve their ends. care at hospital or at home. Further- sional and personal care for the sick. Always inspired by the Holy more, one in three women between Many factors lie behind this reality, Spirit, they have responded to the the age of thirty and sixty are en- and the principal such factors are: needs of their time, to the needs of gaged in the provision of personal a) The natural predisposition of the Church, and to the needs of the care. In short, therefore, the provi- women. The natural disposition of society in which they lived. sion of care is the predominant re- women—that is,, to engage in such The Holy Spirit does not only illu- sponsibility of women. The results activity, a predisposition based upon minate the Almighty but also the of an inquiry and a special investiga- the maternal care and concern of deepest parts of man. It knows the tion carried out for the fifteenth women which, in turn, comes to be needs of man and his most keenly world congress of CICIAMS indi- extended naturally to all those who felt wishes. And by illuminating the cate that nursing and obstetrics are should be protected, comforted or Word of God the Holy Spirit guides largely in the hands of women. helped. history. Man finds answers in the In industrialized countries about b) The role of women within soci- Word of God as well. What has 85% of care for the sick and social ety. The sacred mission—that is, of marked Christian women is the fact assistance is carried out by women. devotion and altruism which come that they have always come, and still Men entered the world of this kind to be expressed in effective coopera- come, towards man, as the example of health care in the 1960s and since tion with the medical profession and of Mother Theresa well demon- that date their proportionate role has in a technical science which needs strates. They have also seen, and al- remained more at less at the level of excellent personal and manual abili- ways see, man through the vision of 15%. Statistics about the future sug- ties. God. In addition, they have been gest that this percentage will remain c) The impact of history. For moved by the Holy Spirit and detect more at less stable over the next ten many generations Western public its presence in all men. years. It should however be noted opinion believed that care for the When Jesus had his feet washed VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 179 with spikenard ointment at Bethany This is true of a branch which has and consecrated their lives to the he said: “You have the poor among achieved its own independence such practical implementation of these you always.” Down the centuries as that represented by chemists, or principles. Some lived in communi- there have always been poor people of categories which have always ties which gradually organized and today there are more poor than been more or less independent such themselves under the authority of ever before. Jesus Christ identified as nurses or the practitioners of ki- bishops. These communities had with all poor people on saying, nesiotherapy. clear duties within society, and one “When you did it to one of the least Medicine and the whole of the of the most important of these duties of my brethren here, you did it to professional health care world are was to care for the poor and the sick. me” (Mt 25:40) defined within society in relation to With the passing of the centuries It is clear that a great many the common interpretation of the the Church became a stable institu- women have moved towards others origins of illness. tion which enjoyed a recognized and taking the apostolic impulse as their At one time—and this is often at organized authority and which could point of departure. At the present times true today—the causes of each draw upon wealth and people conse- time many male and female nurses illness had a moral connotation. It crated to service within her ranks. In and obstetricians who are members was thought that illness was the re- France, between the fifth and nine- of CICIAMS perform their duties sult of a wrong which had been teenth centuries, the Church created from an apostolic point of view and committed or of evil wished by oth- numerous important institutions of are thus to be placed in the tradition ers, both alive and dead. Thus it was various kinds to deal with the great and historical trajectory of the that witches, seers and priests failings of the social order. These in- Christian members of the nursing sought to identify the cause, to fight stitutions were refuges for pilgrims, profession. This emerges from the that cause, and to rehabilitate people orphans, the elderly, and beggars, answers of CICIAMS associations who had been cured through the use and also performed the role of hos- to the questionnaire published at the of purifying rituals. pitals. time of the fifteenth world congress However despite this background The administration of these insti- of CICIAMS which was held at medicine was able to develop instru- tutions was usually entrusted to fe- Louvain in Belgium in 1994. ments and methods which were of- male orders, with the exception of Many people serve the mortal ten effective in their impact. The the Hospitallers of St. John of body of the Lord and this despite the history of the nursing profession can Jerusalem, a male order founded in fact that Mary had chosen the best be associated with the history of 1102 during the period of the cru- part of all: “Martha, how many cares people entrusted by society with the sades. and troubles you have! But only one provision of support and care for the In addition to these kinds of insti- thing is necessary; and Mary has sick. tutions the Church also dedicated chosen for herself the best part of A healer or practical man of med- herself to direct and personal care all, that which shall never be taken icine could at the same time engage for the poor and the sick. One of the away from her” (Lk 10:41-42). in the medical diagnosis of the cause most important creations in this area What does this mean? Should we of the affliction, provide treatment, was the order of the Daughters of think that Jesus rebuked Martha for and act as a nurse, but such was not Charity which was founded by St. her domesticity? How could he have always the case. Indeed, in archaic Vincent De Paul. The first school criticized her for something? After societies where the division of refor nurses was established in Paris all, she was completely taken up sponsibilities was not always clear November 1633 by St. Vincent De with caring for her Guest and of- the role of the physician often Paul. fered hospitality to the Lord himself. amounted to removing the evil In the countries of the Reforma- Here were are not dealing with a re- which had been identified through tion the religious orders were buke because if such were the case the imposition of very painful prac- thrown out of the hospitals. In nobody would care for those in need tices which were made such in order France their departure gradually and everybody would choose “the to drive the evil—the unwanted took place between 1798 and the best part” for themselves. guest so to speak out of the patient’s separation between Church and state Nobody would give food to the body. The role of nurse was often in 1902. hungry anymore; nobody would performed by a woman of the family But who took the place of these care for the sick; nobody would visit or of the tribe. religious orders engaged in care for those in prison, and so forth. Our But we can trace the origins of the the sick? Down the centuries those care and concern remain of the ut- professional figure of the nurse, and of a religious vocation were helped most importance and indeed are thus a specific social group present by a staff which was illiterate and necessary to those who must be within Western countries, to the rise had not taken vows but merely nourished. Martha and we our- of religious orders connected with worked in order to earn a living. selves, male and female nurses, and the emergence of Christianity. In- Many observers of the time attested obstetricians, and all those who pro- deed, Christianity introduced revo- to the fact that the hospitals then vide care, are dedicated to serving lutionary principles: human life is went into a phase of decline. the mortal body of the Lord. sacred, the poor and the sick are rep- In England another factor worked resentatives of Christ and our love in favor of secularization. Industrial- of God should lead us to come to ization favored the emergence of a 2. The Historical Evolution their aid, without any distinction of middle class, led to the development of Nursing race or religion. This, indeed, is the of scientific medicine, and brought message of the parable of the Good about the creation of the Red Cross. Every health care profession can Samaritan. The faithful gave their The great protagonist of this be defined in relation to medicine. property and wealth to the Church change was Florence Nightingale. 180 DOLENTIUM HOMINUM

This reform was based upon three Ð I am thinking here of St. Vincent based on little formal training. It main elements: De Paul and his Daughters of Char- was not an activity which met with Ð the professional recruitment of ity, of Pastor Fliedner and his wife, financial reward but was the fruit of nurses; and of Florence Nightingale. It maternal and devoted care. Ð formal training in schools which should be observed that Florence The female nurse was not had an independent budget and a Nightingale herself received her equipped with medical knowledge competent teaching staff; training as a nurse from Fliedner and and always had to refer to the med- Ð and work in institutions where the his wife and spent some time in the ical doctor, a paternal figure who nurses were responsible for the or- hospital established by St. Vincent dealt directly with the problems and ganization and administration of De Paul in Paris. difficulties of the hospital and the nursing and cooperated with the patients. It is therefore clear that the management of the hospital and the female nurse followed what the doc- doctors. 3. The Modern Female Nurse: tor said and obeyed his instructions Florence Nightingale work ed in From Hippocrates much as occurred at the time in a pa- favor of the adoption of a profes- to the Good Samaritan triarchal family. sional approach on the part of nurses Nightingale to a certain extent de- which was based upon a medical The Hippocratic oath has deter- tached nursing from the family con- code of professional practice and mined the character of medical text because in her opinion nursing upon Christian values. She herself ethics for over twenty-five cen- was a professional activity which used to say that “we must not only turies. A new departure lies in the should be based upon religious ideas care for and heal the illness, we also application of these general ethical and carried out by qualified nurses. have to care for and heal the sick principles to biomedical ethics. An- For upper-class women this was an person, and this on the basis of other new element lies in the fact excellent opportunity to escape from Christian values.” that ethical questions now require a the passive role of women which From the beginning of the twenti- interdisciplinary scientific ap- had been imposed upon them by so- eth century onwards three profes- proach. Medical doctors, members ciety. sional groups emerged in Europe of the nursing profession, psycholo- The religious beliefs of Florence and the industrialized world: those gists, the practitioners of kinesis, le- Nightingale were expressed in her belonging to religious orders, those gal experts and others must reflect severe criticism of certain develop- working in the public sector, and together upon the implications ments in the nursing profession such those working in the private sector. which technology now has for hu- as the creation of professional asso- These three groups were very differ- man dignity. ciations for nurses, better financial ent. The first category was moved We all agree that biomedical rewards and improved social condi- by personal commitment and en- ethics leads us to address ourselves tions of work. trance to it was based upon the tak- to such controversial questions as In the opinion of Florence ing of vows. The second sought a abortion, AIDS, euthanasia, experi- Nightingale such aspirations did not livelihood and entrance to it was menting on embryos, and the trans- reflect the idea that the provision of achieved through a contract of work planting of organs. care should be a religious vocation. with an institution. The third cate- The members of the nursing pro- Her ideas and approach, and in par- gory was animated by the wish to fession are also led to think about ticular her religious convictions and exercise a profession, which be- the care that they provide every day. her military discipline, have left a stowed honor and prestige, prior to There is a distinction between the major mark on nearly all members getting married. ethics of nurses and biomedical of the modern Western nursing pro- These three groups also had cer- ethics first of all because the first are fession. tain aspects in common: specifically concerned with profes- When she was asked what made Ð There was no significant financial sional activity in terms of the forms for a good nurse she replied: “born reward for the services rendered. of care which are provided, and in the church and raised in the This was because the female mem- upon the role and the position of army.” This statement remained bers of religious orders had taken those who engage in such care. The valid until after the Second World the vow of poverty, the nurses in the present-day activity and actions of War. It was probably because of this public hospitals did work which was the members of the nursing profes- that male and female nurses, obste- not very skilled, and the nurses in sion, and the values and rules which tricians and social-medical assis- the private sector were engaged in govern such activity and actions, are tants waited for a long time before voluntary work and disdained to re- the outcome of the tradition of cen- establishing an international profes- ceive a payment for what they did. turies of institutional care. sional union. Under pressure from Ð Service was based upon religious, We cannot forget the influence Belgian and French members of the bureaucratic or military obedience. here of Florence Nightingale. We nursing profession, CICIAMS was Ð Little emphasis was placed upon should however understand her in created only in 1936! professional training except in the the historical context of the time and Florence Nightingale believed case of service in the private sector. with reference to the condition of that the ideal nurse was a nurse who Ð To sum up, therefore, it is possible women during the nineteenth cen- corresponded to the traditional fig- to say that the dark period of caring tury. Before the appearance of Flo- ure of the “very upright and good for the sick finished when men and rence Nightingale the nursing pro- lady” of the Victorian period. As a women inspired by religious senti- fession simply did not exist. Care result emphasis was placed upon pu- ment became personally involved in for the sick was considered the spe- rity and upon devotion, obedience this impoverished area of social as- cific duty of the woman at home. It and loyalty towards the doctor. sistance. was thus an activity which was These values were expressed in the VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 181

“Florence Nightingale promise”, service is being rendered. and a veritable explosion in the the oldest statement of nursing 4) Access to the profession number of professional codes of ethics we have which is also very through monitored and regulated conduct. In other words, it is reason- close in form and content to the Hip- procedures of training. able to suppose that the members of pocratic Oath. 5) Exercise of the profession by the nursing profession want to ex- In the move from the nineteenth members of professional associa- press themselves more fully in rela- century to the twentieth century, and tions protected by law, and by these tion to their role and on the subjects until the Second World War, numer- members alone. of a more “human” approach and the ous professional associations came 6) The belief that professional as- achievement of “good care”. It into being for nurses and midwives. sociations have their own profes- should be observed that the parable There was also a veritable explosion sional culture and formation which of the Good Samaritan is often taken in textbooks and articles published should be promoted by trade unions. as a point of departure and as an ex- by nurses and written specifically The process of the professional- ample to be followed. for nurses. It is important to notice ization of nursing has involved a that often great attention was paid to tendency to create a certain indepen- rules and regulations, and especially dence in the definition and exercise Conclusion to those concerning the need for per- of what should be done—that is, au- fect obedience. There was also a tonomy and independence in the de- In conclusion I would like to specific set of norms of both a moral scription and practice of the profes- quote the words of my predecessor, and civil character relating to de- sion. Miss Gh. Van Massenhove, the Na- cency and to how to behave—in a In recent times there has been an tional President of the NVKVV and word, “ethics.” attempt not only to ensure an exact general secretary of CICIAMS. The The articles published by Isabel application of technical knowledge difference between a profession and Hampton Robb of the United States and methods but also to guarantee a vocation is to be found in the dis- of America were an example of this the application of the quality and the tance which exists between acting and are commonly seen as the first capacities of processes of communi- out of faith and charity and acting step towards the construction of cation. Furthermore, there is a out of obligation and necessity. Be- nursing ethics. At the same time a keenly-felt need to devote mature tween vocation and profession is to great many books and articles were thought to the activity and to the role be found that enthusiasm which is published on the character forma- and position of nursing staff. expressed every day in caring for the tion of female nurses. The kinds of We have witnessed the publica- less privileged and the most vulner- virtues which were invoked were: tion of a large number of studies able. patience, love for one’s neighbor, about ethical questions and options, loyalty, purity, wisdom, honest, jus- AN VERLINDE tice, and, above all, devotion. General Secretary of the Catholic Although medicine had under- International Committee for Nurses gone major development and ad- and Social/Health Workers (CICIAMS), vance for technological reasons, Belgium nursing remained loyal to these Consultor to the Pontifical Council for above-mentioned norms and con- Pastoral Assistance to ventions more or less until the Health Care Workers 1960s. However, after examining these rules and regulations the les- Bibliography son to be drawn is very clear—it was necessary to behave like the M. BIHEt, Histoire du Nursing (De Soer, Good Samaritan. Liège, Belgium, 1947). C. MORDACQ, Pourquoi des Infirmières? After the 1960s great emphasis (Du Centurion, Paris, 1972). was laid upon the professional char- M. PERROT, “Les Femmes, le Pouvoir de acter of nursing and this involved l’Histoire,” in Annales, Paris, March-April, the exact technical application of the 1986. H. PHILIPSEN, Da Naaste en Haar Patiënt knowledge and the methods which (Negentiende Dies Natalis, Rijksuniversiteit, were available. In imitation of med- Limburg, Hanauri, 1995). icine, nursing had to correspond to A. VAN DEN BERGH-BRAAM, “Verpleging op het Kruispunt,” in Verpleegkunde op het the following ideal model. It in- Kruispunt (Acco, Leuven/Amersfoort, 1987). volved the following elements. A. VAN DER AREND and C. GASTMANS, Ethisch Zorg Verlenen, Handboek voor Ver- 1) A theoretical and systematic pleegkundige Beroepen (Imro, Nijkerk, 1993). knowledge on the part of the nurse G. VAN LAERE, Spiritualiteit en Kristelijke which would ensure the practical Spiritualiteit: Studiedag Bio-Ehiek (Leuven, application of the directives of the 1992). profession; K. VAN WONBERGEN and E. VERMEULEN, “Wij Zijn Allen tot Dienst Geroepen,” in Au- 2) A recognition by the patient of gustinus Over het Apostolaat (Augustinus- the authority and the experience of dag, 1991, Uitg. Augustijns Historisch Insti- members of the nursing profession. tuut, Leuven, 1992). A. VERLINDE, “Synthèse des Réponse au 3) An ethical code to regulate the Questionnaire du CICIAMS,” Fifteenth associations to which nurses be- World Congress of CICIAMS, Louvain, longed and to express the idea that a 1994. 182 DOLENTIUM HOMINUM

BERNARDIN GANTIN

The Primacy of Life Under All Conditions, with Special Reference to Africa

In this paper I would like to: tation in which life itself occupies ciety and in particular in village life. 1) talk to you first of all about the primary position of importance. Nobody wants to speed up the death Africa, a continent which, despite all It should also be observed that this of an elderly person or hasten the end the suffering it has to endure, contin- attempt to make sure that death does of a person who is very ill because ues to love life; not prevail partly explains the im- that person is no longer able to pro- 2) outline to you the moral, physi- pulse to have a great many children. duce. However it is often difficult to cal and psychological areas where This practice aims at ensuring that find the means by which to take care life, unfortunately, is still wounded; notwithstanding everything, the high of such elderly people. 3) and describe what the Church is death rate will not destroy every- This traditional African concern trying to do and the reasons we have body. with the defense and promotion of for believing in the future. This is borne out by the surprising life partly explains the population peace of mind that Africans display explosion which has taken place in when they are subject to great trial the continent. There were 640 mil- 1. Africa, a Land with and difficulty. Indeed, they give the lion inhabitants in 1994 and there a Great Yearning for Life impression of playing, as it were, will probably be 1,200 million in with death even when death never 2015—that is, 19% of the world In one of the languages which is ceases to beat a path to their door. population. It also explains the sur- spoken in the south of my country It is without doubt this attachment prising youthfulness of the popula- (Bénin), man is termed “the father of to life, like the invention of a thou- tion. Indeed, without this new life” and the fertility of God is termed sand methods by which to lessen the growth perhaps the continent would “the mother of life.” I believe that in traumatizing effects of ill-fortune, have met with a very serious fate. many other African languages there which explains the survival of so Africa survives thanks to its young must certainly be similar expressions many Africans who have been people and it has the youngest popu- which exalt and praise life and ex- wrenched from their land down the lation in the world (50% of Africans press its importance in the same way. centuries and have been taken far are less than sixteen years old). Indeed, Africa has a great hunger from their continent by methods of There is no attempt to stop life at its for life and strives to eat it to such an which we are all too well aware. dusk, and in the same way there is no extent that in the eyes of many peo- African native medicine, which we wish to strangle it after conception. ple this seems to involve a base plea- are still very far from knowing fully, On the other hand there is no wish sure. All those who have drawn near has virtues which cannot be played that such realities should blind us to or have been in contact with this con- down, despite the fact that modern the complicated and intricate charac- tinent have grasped and understood science holds that its own therapeutic ter of conditions and realities in that life and its promotion are at the methods are best and goes on to im- Africa and to the various hardships center of all African concerns and on pose these methods in order to ensure and trials which impede the advance the horizons of its philosophy about their success and diminish their fail- and development of our continent. things and its ideas about man. ures. International organizations and We are reminded of the words of The “Bantu Philosophy”—as in- associations should help us to explore the Holy Father spoken during the deed was once observed by Father this whole area in order to rationalize special synod of the bishops of Tempels in a way which had a great native African medicine and spread Africa which was held at the begin- impact—well demonstrates how its use. ning of the tragedy of Rwanda, a African realities are moved and ani- Despite the seduction of modern tragedy which presented us with a mated by a kind of “vitalism”—that life and uncontrolled forms of urban- whole host of questions and acted, so is, by the belief that life is of primary ization which often take the form of to speak, to obscure the face of importance. a kind of free-for-all, Africa still re- African Christianity. Those words Subsequently, after Tempels, tains, at least in essential respects, were as follows: “This continent many works by African philosophers great respect for life and for elderly loves life and cultivates death; be- and young theologians have stressed people. Indeed, elderly people are lieves in brotherhood but, alas, so of- how the trilogy of Life-Death-Life seen as the bearers of wisdom and ten loves fratricide.” It is our duty to expresses the overall African inter- their presence, although it is weak, analyze the causes of this paradox. It pretation of existence—an interpre- ensures a certain balance within so- would certainly be useful for us to VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 183 ask and help the Africans to find the the medical and health care services through vaccination ensured sub- best and most lasting means by which are available. stantial advances which contributed which to abolish the diseases and the The situation of the continent of to demographic growth and gave rise tragedies which are placed in the Africa in relation to the problems to grounds for hope. Africa gained way of the full development of the and difficulties of life thus impinges from the advances in health care daily life of their continent. in painful fashion upon the con- throughout the world. Even though science of Africa and calls upon advances in health were at their low- Africans to deal with the whole est in Saharan Africa, average life- 2. Africa, A Continent Where question with greater determination. expectancy was raised from 39 to 52. Life is Fragile The various ills which torment the But over the last ten years or so the continent should be faced up to with return of poverty and abject poverty Health as everybody knows—al- greater lucidity and their causes have caused the reappearance of though the point should be re- should be analyzed with far-sighted such great endemic diseases as lep- peated—is a precious attribute for responsibility. This situation also rosy, malaria, tuberculosis, meningi- every individual and for society more touches upon the conscience of the tis, typhus and dysentery. At the pre- generally. It is an essential element of world which should express strong sent time Africa has the highest rate well-being but as reports of the World of incidence of infectious diseases, Bank often stress: “there are also and is much worse afflicted in this good economic reasons to justify ex- sense than Asia or Latin America. penditure on health services.” This is The reappearance of such diseases is because improvements in health lev- to be explained with reference to the els contribute to economic growth poor quality and ineffectiveness of and are an important factor in the our health care and economic poli- fight against under-development. cies. Questions and problems concerning To this long list of diseases we health and health care, therefore, should add AIDS whose devastating should receive major attention. effects cannot always be fully moni- We are very happy and pleased tored. This plague is present in areas that health standards have improved where there is great permissiveness in the continent of Africa, as indeed or a high level of destabilizing con- they have around the world. But we flict, factors which cause the migra- cannot deny there are still many tion of people and dangerous levels things which we have to do! of promiscuity. Malnutrition has re- The difficulties of our economic emerged on a grand scale. What we systems have worked against the have to do is to be aware of the fact spread of the economic advantages that delay in acting will greatly which have been gained during these worsen the situation. As a result of last fifty years. In particular, it is all these factors the continent of known that public hospitals and clin- Africa has the lowest rates of life ex- ics—which represent most of the pectancy and longevity on the whole care and assistance offered by mod- of our planet. ern medicine—are often inefficient solidarity and engage in a logic of and the funds which they are given shared international responsibility 2.2 High Mortality Rates vary greatly from year to year. The which does not stop but at mere pal- and Their Causes recent appearance of the Ebola virus liatives but which works for some- in Zaire and the deaths which fol- thing which is more long-lasting. Africa seems therefore to be the lowed that outbreak are a good ex- From this point of view it is de- land most afflicted by death in the ample of this worrying state of af- plorable that the industrialized coun- world, and appears to be prey to a fairs. tries do not hesitate to offload their kind of trivialization and dehuman- The poor are the first victims of toxic waste and other junk onto this ization of death itself. It is against these shortcomings in the public hos- already fragile and besieged conti- these realities that we are seeking to pital system. The poor do not have nent. The international conscience mobilize all men of good will and in access to basic health care and the should rebel against such behavior particular the governing elite of our treatment and help that they receive which endangers the very survival of continent. The trivialization of death, are very poor. But when we talk many populations in Africa. it cannot be doubted, is one of the about the poor we are of course talk- The African continent is the conti- causes of the general regression of ing about the vast majority of the nent which is, unfortunately, most Africa, a continent which is, how- population of the continent. A great afflicted by death and by illness, ever, full of natural riches. doctor who has dedicated forty years those two great enemies of life. What we have to do is to engage in of his life to health care in an impor- a far-sighted analysis of the various tant African country has rightly re- 2.1 Deterioration of the historical, psychological, political, ferred to: “the great misery of hospi- Health Care Systems economic and religious causes of the tals in Africa.” It is certainly true that wars which have devastated and dev- much has already been done, may Let us consider first of all the case astate our continent, spread death, God be thanked. But there is still a of the sick. Illness, we say in Africa, and severely impeded advances in the great deal to be done in the way of is the enemy of life. For fifty years realm of health and health care, pre- increasing the quantity and quality of basic health care and prevention venting thereby general and overall 184 DOLENTIUM HOMINUM progress. We have to engage in this question of respect for the dignity of to provide effective health care and analysis if we want to remove these the human person and his rights— protection, and this is another major causes. rights which are often violated on factor in the spread of disease in and From Liberia to the Sudan, and false pretexts: reasons of state, anar- from the urban areas. from Sierra Leone to Angola and So- chic self-defense caused by the fail- What we have to do, therefore, is malia, the number of our dead sisters ure of legal authorities to provide to start thinking about public health and brothers killed in recent times suitable protection, torture by the po- in the cities and this is because the cannot be counted. We can find no lice, the alarming increase in crime great urban centers are major gener- relief for our grief because we are caused by abject poverty, unemploy- ators of infectious diseases. dealing here with a real and authen- ment and a wild process of urbaniza- Given the recent expansion of the tic tragedy. We should pay especial tion which is causing a massive exo- cities, the success of preventive mea- attention to the cases of Rwanda and dus from the countryside (at the rate sures could have a rapid and positive Burundi because their classic exam- of 3% of the population each year). influence on the rural areas where ples of fratricidal violence both This process of urbanization is even the inhabitants are in permanent con- cause us great pain and also consti- more disturbing and worrying given tact with their city-dwelling rela- tute something which it is very diffi- the fact that it is accompanied by a tives. The movements and behavior cult to explain. The fratricidal vio- of these relatives often cause the lence which has taken place in these transmission of disease to the coun- areas which have a high concentra- tryside. tion of Christians—has assumed The Church cannot do everything, very disturbing levels and leads us to but she wants to make her own con- reflection and to the examination of tribution to this important and valu- our Christian consciences, which able attempt to protect and promote naturally enough are very troubled the dignity of man. This endeavor is by what has happened. absolutely necessary and has a vital How is it possible that in Africa importance. We should not therefore where there is so much talk about be discouraged by the difficulties solidarity, ties of blood can prevail which we often find on our path. over ties created by the holy water of baptism? What we have to do is to 3. The Christian Contribution, ensure that the conscience of Africa A Source of Hope demonstrates the limits which must exist in relation to the implications of The Church gives great impor- ethnic loyalties, although this is not tance to this concern for human dig- to deny that there are of course quite nity because she believes in man, in proper and legitimate feelings of eth- every man, created in the image of nic identity. The life of a man cannot God and saved by Christ, whatever become of no consequence merely his race, his origins or his human because he is a member of a different condition. This is a fundamental gift ethnic group. Nothing can justify of the gospel message and a forceful genocide. Each man who dies as a expression of its spirit of universal result of the violence which exists in relative absence of urban planning. love. this continent is a loss for Africa and This reality gives rise to whole host Together with education, which for mankind. of problems and difficulties: a lack has always occupied a primary posi- In this meeting of hope where we of health care structures, an increase tion in her pastoral work, health has are examining the questions con- in the number of shanty-towns, dan- always been one of the principal nected with life we can declare: gerously high levels of promiscuity, concerns of the missionary activity “help us to overcome the forces of and insecurity and uncertainty of all of the Church. From the moment death; sell us more ploughs and agri- kinds and forms. when they took on this responsibil- cultural machines and less arms, ri- It seems to us important to under- ity, the churches of Africa have fles and bombs.” War is devastating line that the whole phenomenon of sought to do everything to continue the continent of Africa and need- the city and city life should be re-ex- and adapt this apostolate in relation lessly leaving death in its wake. War amined in the light of the problems to the most disinherited populations is often caused by the irrational ap- of development which afflict the of the cities and the countryside. Nu- petites of a few men crazed by a de- countries of Africa. If we could solve merous wells have been dug within sire to conquer or keep power at any these problems we could then go on the framework of NGO programs cost. But it is also often caused by to solve other difficulties. Diseases and the initiatives of charity organi- the covert role of non-Africa powers are often propagated by the cities zations in order to solve the problem which make war on each other by precisely because they have become of water. Hospitals, clinics, and ma- proxy, through the use of groups to the pole of attraction for the move- ternity wards have been created in an found in Africa itself. ment of large numbers of people. At attempt to improve health care. the same time, as has been observed Africans themselves have always 2.3 The Need to Respect above, the vast and sprawling cities been connected and associated with the Human Person which are becoming ever greater in these initiatives and their practical number in Africa (as in other third realization, and this in order to en- The promotion and the protection world countries) do not have the fi- sure that they assume responsibility of life in the continent involves the nancial and material means by which for the maintenance and upkeep of VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 185 these various amenities and struc- the role of the Good Samaritan ity-inspired process of mutual help tures. People only really protect that should be seen. The Church must which will prove very effective. which they have built with their own follow his example and thereby give The international community can hands. Africans should be helped great credibility to her actions do a great deal in relation to the re- even more in this overall endeavor. through taking to heart the defense form of health policy in Africa. It How many human lives have been of the life of men who are wounded can help the Africans to deal with saved thanks to this charitable work by nature or by their neighbor. the problem themselves and thereby of the Church which is part and par- Let us take advantage of this occa- defeat the evils which afflict them. cel of her evangelical mission! This sion to thank all those who have There seems an ever greater need for effort and this reality of financial aid taken part in the efforts which have external support for research in the should be continued and expanded, been made in Africa to improve mat- medical field which should be especially because government-pro- ters. But we do not believe that the chiefly concerned with the great vided services have become ever solution to the problems of Africa health and health care problems of more ineffective or absent. lies in easy answers which in reality the continent. The various sects which are con- could merely lead to new difficul- At the same time we should do all stantly increasing in number at- ties. It seems to us of the utmost im- we can to eliminate the various tribute great importance to the heal- portance that international organiza- glowing embers of war, many of ing ministry of Christ. The estab- tions keep this fact very much in which seem to be artificially kept lished churches should realize how mind. Attempts to protect life must burning. important they really are in the not take place at the expense of true The Christians of Africa do want African context. In our continent the morality. As Christians, we must to be and cannot be absent from such various populations have a great stress this point to ensure that Africa, endeavors. The encouraging in- yearning for healing, for a healing of which from many points of view is a crease in the number of African both the body and the spirit. We very fragile continent, does not end Christians and the astounding dy- therefore should not lose sight of the up by having to pay the bill. namism of their churches are factors fact that we are dealing with popula- which push in this direction. The tions which are poor and fragile. We Christians of Africa must be the sun must be aware of the psychological Conclusion and the light of this land, a land dimension of things. After all, many which was the first to offer hospital- evils have psychosomatic origins. Much has to be done in Africa to ity to the child Jesus, the Emmanuel, Education and the removal of ig- protect life and ensure that every- threatened by violence. norance are the right antidotes to the body and every individual has the It is our most heartfelt wish that increase in illness and violence. best possible chances of survival. the continent of Africa will once Without giving the impression of We know that the means we have again become the land of respect for wanting to take the place of the state available are limited and that we life, and in very real terms the land of in relation to ensuring health for all, should not divide our forces. Clear welcome and of peace. the Christian institutions of the con- and open cooperation between the tinent should fight on all fronts to Christian churches on the one hand protect the integrity of the human and the state on the other can help to BERNARDIN Cardinal GANTIN person. ensure that resources and efforts are Prefect of the Congregation for Bishops It is in this overall perspective that united in order to achieve a solidar- The Holy See 186 DOLENTIUM HOMINUM

YAW-TANG SHIH

Health Care and Quality of Life: Taiwan’s Experience

I am honored to be given this op- ated health stations for instance, municable diseases have either portunity to present to you Tai- particularly at the grass-roots level been completely eradicated or wan’s efforts in the past decades in in remote areas with fewer medical brought under effective control. promoting respect for human lives care resources, to care for the ill Malaria, which at one time was a through various health care pro- and to prevent the transmission of threat to the lives of many, was of- grams. diseases. This focus has, in the last ficially declared eradicated by the Taiwan has made tremendous 15 years, been shifted to health pro- World Health Organization in 1965. progress in improving the health of motion and health maintenance, Taiwan has been fortunate in hav- its people in the last 50 years. Life that is, to remain healthy and be ing contained the dreadful AIDS expectancy, for instance, has been healthier, through education, pre- epidemic to only 900 HIV positive prolonged from 53 years in 1951 to ventive health services, develop- thus far for a population of 21 mil- 72 years in 1993 for men; and from ment of positive health behavior, lion. The infant mortality rate has 56 years to 78 years for women in and, above all, by making health dropped to a low of 5 per 1,000 live the same period. This progress has care available and accessible to all births; maternal mortality to only 9 been made possible through various through the implementation of a na- per 100,000 live births, or only 27 well-organized health care pro- tional health insurance program deaths in 1994. However, deaths grams along with rapid socioeco- since March 1, 1995, with a view to due to accidents and injuries, par- nomic development. attaining the goal of health for all ticularly among young people in Taiwan’s health care programs and to improving further the quality traffic accidents, are becoming a are organized around the following of life. major concern. Life expectancy is belief and principles: To cure the illness of an individ- now 72 years for men and 78 years Ð that human life above all is to ual and thus to protect life, although for women and is expected to ad- be respected and valued; it is an important task of the health vance further. The newly imple- Ð that health is a basic human care professionals, is only sec- mented National Health Insurance right; ondary. What is primary is not Program, though only in its 9th Ð that each human being is enti- merely to preserve life but to im- month, has 96 percent coverage of tled to living in good health and in prove and promote the health con- the total population. Adequate dignity; ditions of individuals, communities, health care is now available and Ð that access to adequate health and human beings as a whole, to al- accessible to each of the 21 million care with equality and equity re- low peoples of the world to have a people. gardless of sex, age, and socioeco- higher quality of life. After all, Yet, we are not content. We are nomic status is essential; in particu- health is defined by the World determined to see to it that every lar, the lack of financial resources Health Organization as: “not person on Taiwan, the Republic of should in no way be a reason for merely the absence of illness, but a China, will live longer, in good denial of adequate health care; state of physical, social, and mental health and in dignity. To this end, Ð and that, less privileged indi- well-beings.” Taiwan has launched several ambi- viduals of the society should be Quality of life is a rather vague tious projects as presented in the given priority care. concept. From the point of view of Health White Paper, a copy of Around these beliefs and princi- health care, however, I believe it which is enclosed herewith, to fur- ples, Taiwan’s health care programs can be measured in terms of: 1) ther improve the health of the peo- have been organized, in the early freedom from the fear of being in- ple and the quality of life. days, focusing more on the protec- fected with communicable diseases; tion of lives through programs to 2) lower mortality rates of all kinds; eradicate and control communica- 3) longer life expectancy; and 4) 1. Insurance Program, Attaining ble diseases, such as the successful easy access to adequate health care. the Goal of Health for All eradication of malaria in 1965, and By these criteria, Taiwan is a rel- through establishing more medical atively healthy place, of relatively Health is a basic human right. care institutions, government-oper- high quality of life. Almost all com- For health promotion and mainte- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 187 nance, easy and equal access to ad- some specific groups, the elderly, gretfully, are young adults. Eco- equate health care is essential. Be- the mentally disordered, and people nomic loss, particularly the tragic fore the inception of the National in the remote areas for instance, loss of young lives due to accidents, Health Insurance Program on with a view to reducing the differ- is beyond calculation. By age March 1, 1995, there had already ences in health care between groups groups, motor vehicle traffic acci- been in Taiwan several govern- and between urban and rural areas. dents and injuries are the first lead- ment-operated health insurance pro- Some of these programs are illus- ing cause of all accidental deaths grams for the laborers, government trated as follows: for all age groups above one year of employees, and farmers, covering age; drowning is the second leading around 60% of the total population. a) Hospice Care cause of all accidental deaths for The other 40% of the population One is entitled to live in dignity; age group 1 to 24 years; accidental not insured were primarily depen- he or she is equally entitled to die in fallings are the second leading dents such as the elderly and young dignity. Medical care comes in both cause of all accidental deaths for children, who in general were more positive care and hospice care. For age groups 45 years and above. vulnerable to illness and hence instance, one-third of cancer pa- Though safety education is most would require more health care. tients would require positive care; important in the prevention of acci- The main objectives of the Na- dents, adequate emergency care im- tional Health Insurance Program mediately after accidents is as im- are: 1) to provide each citizen of the portant. To save lives and to reduce country with adequate health care; disabilities, an emergency care net- 2) to effectively utilize the available work has been established in Tai- health care resources; 3) to reduce wan. financial barriers to access to health Local health authorities have care; and 4) to promote the health been instructed to work in collabo- of the population. With the imple- ration with police and fire depart- mentation of the National Health ments to plan for regional emer- Insurance Program, this vulnerable gency care programs, to set up an group of people, who otherwise emergency care liaison center and a would have been denied access to radio communication system to ex- health care, are now properly cov- pedite emergency care. With the re- ered in this state-operated manda- cent legislation of the Emergency tory health insurance program. Fur- Care Act, a mass training program ther, in regard to human life, spe- will begin soon to train, in addition cific provisions are made in the Na- to medical personnel, fire rescue tional Health Insurance Program to members and ambulance workers care for the elderly and individuals for them to provide first aid care to of the less privileged groups, such the other two-thirds are beyond any the victims on the spot and in the as the handicapped, the mentally remedy. To allow them to share ambulance before they reach the disordered, and the indigent. These with others the last moment of their hospitals. provisions include: waiving of co- lives in peace and dignity and with- payments for the continuing care of out fear of death, plans have been c) Psychiatric Care chronic diseases, for care of serious formulated to develop in Taiwan To respect the rights of psychi- illnesses, for the indigent and for hospice care on a pilot basis in atric patients and to provide ade- residents of mountain areas and off- some hospitals. Currently, there are quate care to them, the current pol- shore islands with fewer medical 18 beds in the McKay Memorial icy in the prevention and treatment care resources; subsidies on premi- Hospital, 20 beds in the Cardinal of mental illnesses in Taiwan is to ums to the low-income families; re- Ticn Hospital and 17 beds in the promote positive care and rehabili- imbursement for home care ser- National Taiwan University Hospi- tation and to reduce negative con- vices; and free physical examina- tal. Physical, emotional, and social finement and segregation. Taiwan tions for the elderly. With the im- care and religious consultation for is divided into several regions to plementation of the National Health patients at a terminal stage and to form a comprehensive regional Insurance Program, the population members of the family as well are mental health service network. Pa- as a whole and the less privileged offered. tients are encouraged to receive ad- individuals of the population in par- equate treatment, including treat- ticular are now well attended to b) Emergency Care ment, and follow-up at both out-pa- medically. With the rapid increase in motor tient and day care clinics, and reha- vehicles, including motorcycles, ac- bilitation therapy in the community 2. Development of Special cidents and adverse effects, particu- with a view to prepare them to Health Care Services larly traffic accidents and accidents eventually rejoin the community. In due to occupational hazards, have December 1990, a Mental Health In addition to general health care been the third leading cause of Law was promulgated. programs, special programs have death in Taiwan for many years. also been promoted to attend to the Each year, around 13,000 persons d) Long-Term Care special needs of individuals of die of this cause, most of them, re- With the aging of the population, 188 DOLENTIUM HOMINUM around 7.1%, or 1.5 million, of the fied with the cure of one patient elderly in Taiwan smoked, one-fifth total 21 million population of Tai- alone; they began to explore the of them drank, 40% of them did not wan are above the age of 65 years feasibility of preventing diseases in exercise regularly, 32% of them at present, and the increase in advance; several vaccines were took high salt foods, and 27% of chronic and degenerative diseases, then been developed as a conse- them took high cholesterol foods. the need for long-term care has be- quence. Today, although disease Only some changes in these come more imperative. prevention is still considered im- lifestyles and some control over The elderly have been tradition- portant by many, a new concept of these risk factors could bring about ally cared for, medically and in positive health promotion has considerably better health condi- their daily life, by members of their evolved. The mere absence of dis- tions to the elderly in Taiwan. families and/or relatives. With the ease alone no longer satisfies peo- To reduce, if not to remove en- changes in family structure, as re- ple. People now look forward to tirely, risk factors hawardous to vealed by a national survey in 1988, living longer and in good health. health, such as smoking, drinking, 14% (from 12% in 1986) of the el- Poor health is very much behav- poor diet, lack of adequate exercise derly in Taiwan lived alone, 15% ior-oriented. Factors that may affect and, in the case of Taiwan, betel- (14% in 1986) of them lived with the health of an individual are: 1) nut chewing, and at the same time, spouses, and 68% of them lived biological factors, 2) environmental to develop positive health behavior with children; it seems that a more factors, 3) health care service and are keys to good health. In this re- organized form of care for the el- facilities, and 4) health behaviors gard, several projects are ongoing; derly, if not to replace, at least to and lifestyles. Among them, the For health promotion: anti-smok- supplement the loosely organized health behaviors and lifestyles of an ing, promotion of health fitness, nu- traditional way of care, is called for. individual are the most important. trition and balanced diet, mental Currently, the long-term care of the The causal relation between smok- health; elderly take the forms of home care ing and health has been well estab- For health maintenance: preven- (65 institutions providing this ser- lished. Drunken driving is always a tion of accidents and injuries, vi- vice), day care (around 240 beds), major cause of traffic accidents. sion promotion, oral health; and and care in nursing homes (11 insi- Yet, in a survey of 1988, it was For preventive health services: tutions with 450 beds for 24-hour found that around one-third of the maternal and child health, genetic service). The number of institutions providing long-term care is not sufficient; more will be done in the future. c) Health Care in Remote Areas The mountain areas and the off- shore islands, where transportation and living conditions are often inadequate, are deficient in health care resources. To protect the health of residents of these areas, action has been taken: to train on government scholarships young students from these areas in medical and nursing education; to improve health care facilities; to promote telecommunication medical care; and to encourage private sectors through subsidies to establish medical care institutions in these areas. Provision is also made in the Na- tional Health Insurance Program to waive the co-payment of the medical care fees for residents of these areas.

3. Reducing Risk Factors to Health

In the ancient days in China and elsewhere in the world, people would have been overjoyed by the cure of a patient. Some decades ago however, people became unsatis- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 189 health, prevention and control of smoking campaign was estimated 2) the effects of alternative in- chronic diseases and cancers, long- to increase from 1.6% in 1990 to vestment strategies focusing on the term care, and primary health care. 9.8% in 1992. determinants of health; Take anti-smoking, for instance; 3) the social, economic, ethical, Taiwan initiated an anti-smoking 4. Conclusion and political costs and benefits of program in 1987, when domestic the first two points in various com- markets were made open to foreign Taiwan is moving fast toward binations; cigarettes. A survey in 1992 showed modernization and industrialization, 4) other social needs competing that the smoking rate for men above and health is locked into the for available resources; and the age of 16 years was 55.3%, and process, resulting in a decline in the 5) our social and ethical con- for women, 3.2%. To fight against overall death rate, which, however, cerns, both short and long-term, the hazards of tobacco to health, a can be expected to cease its decline about the availability of life-saving, Tobacco Hazards Act was drafted: and even to go up as the proportion life-prolonging, and life-enhancing to restrict or ban the advertisement of the elderly in the population con- services. and sales promotion of cigarettes, to tinues to grow. Infant mortality We are unlikely to achieve these place a warning label on each pack rates may level off as the full goals at one time. Resources are, as of cigarettes, to indicate nicotine weight of modernization is brought always, limited. Yet, we believe and tar contents, to restrict smoking to bear on the health of mothers and that while we are developing our areas, and to prohibit selling ciga- children. However, there is little economy, we shall also strive to rettes to minors. doubt that there still is substantial reach the goal of health for all, and The Act is currently being re- potential for further improvement the eventual goal of a happy and viewed by the legislature. Mean- to reduce differences from one area prosperous society. while, intensive educational activi- to another. This can be achieved if ties are going on to educate the we as a society view: Dr. YAW-TANG SHIH, public, and the school children who 1) the likehood that increased or M.D., D.R.P.H. have not yet started smoking in par- sustained investments in basic bio- ticular, against the hazards of to- medical research will yield new or Deputy Director-General bacco. In a survey, smoke cessation improved technologies for the con- Department of Health, Yuan Executive attributable to the effect of the anti- trol of the major health problems; Taiwan 190 DOLENTIUM HOMINUM

GEORGE ALLEYNE

The Primacy of Life

The very words included in this and “no one ought to harm another sexual activity, which besides be- title give a sense of issues of really in this life.” The liberal state of ing morally unacceptable, also in- great importance and anyone at- Locke’s thinking sought to protect volve grave risks to life? tempting to do it justice must first those rights seen as basic and all Our many judicial systems go to explore the various interpretation those who followed in this tradition great lengths to protect this right to that are buried in the manner in such as Paine and Jefferson, reaf- life and punish those who, when they which it is phrased. My treatment of firmed the “self-evident” nature of take it, deprive another of that which it must of necessity also be the re- the right of man to life, property, no person can replace. sult of my own disciplinary orienta- and liberty. Life was seen as a right Pope John Paul II goes on to decry tion in the social sciences—particu- or entitlement that must be ensured the emergence of a culture which larly medicine or rather health and should not be infringed upon by denies solidarity and in many and—my responsibilities as Direc- anyone. cases takes the form of a veritable tor of the Pan American Health Or- The ultimate negation or depriva- culture of death—a conspiracy ganization. tion of this right is death, which in against life. One possible interpretation is that its most violent forms is a brutal It may be difficult to establish in every corner of this earth there manifestation of the abrogation of some hierarchy or primacy among should be concern with the primacy the right to life. Human beings over basic rights, but I would venture that of life under all human conditions— the years have naturally been con- life indeed merits a very high posi- a position that seems almost trite. I cerned that this right be protected tion is any such hierarchy, if not in- must also avoid the tautology that is and this anxiety is shown clearly in deed the highest place. The primacy implicit in the interpretation that all the Encyclical Evangelium Vitae of life among the other rights might human conditions imply everywhere (The Gospel of Life), in which His rest on its non renewability in com- on earth. I will address the topic as Holiness Pope John Paul II calls at- parison with other rights. almost an affirmation that life of hu- tention to Property can be restored and the man kind is of prime concern and the extraordinary increase and individual once compensated may must take pride of place in our con- gravity of threats to the life of in- be almost whole again. Liberty, or sideration of those matters that im- dividuals and peoples, especially the struggle for liberty, has been the pinge on or determine the human where life is weak and defenseless. battle cry of famous movements condition. This concern for the hu- He is equally compelling when he that through the years have changed man condition has to be at the center says nations. Although individuals can- of all legitimate social endeavor and - How can we fail to consider the not be adequately compensated for is the focus of all those like myself violence against life done to mil- the period for which liberty is lost, who practice the social disciplines. lions of human beings, especially yet liberty can be restored. The pri- I cannot enter the lists with the children, who are forced into macy of life might rest on the fact eminent philosophers who over the poverty; malnutrition and hunger that the deprivation of it is ab- ages have debated and agonized over because of an unjust distribution solutely and irrevocably finite. Life the meaning of life, or with the vari- of resources among peoples and as we know it can never be restored ous groups of biologists who argue social classes? and it is obvious that the person de- about the origins of human life, as - What of the violence inherent not prived of life can never be compen- we know it, or even with those who only in wars as such, but in the sated for the loss of it. Nothing that would question the existence of life scandalous arms trade, which the poets have written about the glo- forms outside the earth. I stress that it spawns the many armed conflicts riousness of the manner of leaving is human life that concerns us. which stain our world with blood? life or the possible fruits of that loss The preservation of life has been - What of the spreading of death can alter the stark immutability of accepted as one of the fundamental caused by reckless tampering with the change. rights. The liberalism advocated by the world’s ecological balance, by The sharpness of the definition of John Locke argued that all human the criminal spread of drugs or by the deprivation of life in death is beings are equal and independent the promotion of certain kinds of ever present in the mind of the VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 191 physician, whose pristine function cal conflict between the deontologi- The best concept of the healthy is to preserve life and avert death. cal approach that gives primacy to life is one in which there is no dis- The standards of ethical and moral the individual and the consequential ease in the pristine sense of the term. behavior that are explicit in the Hip- dogma that focusses on the good of It implies one in which there is in- pocratic oath enjoin physicians to the many. deed mental, spiritual, and physical do no harm, and in spite of the The sharpness of the divide is ease. It is not only the culture of growth of the respect for autonomy, even more marked when resources death that must be counteracted, but the traditional bedrock of medical are scarce and nothing has occurred it is the culture of quality of life that ethical practice has been to make re- to satisfy the modern Benthamites must be promoted. spect for life operational. who do not often have to face the ag- Death is easily recognized and The physician of today often be- onizing choice in the presence of in- disease easily measured but the comes embroiled in the intensive dividual human suffering and pain. healthy state, for all its importance, discussions about the preservation of There are numerous biblical refer- is relatively invisible and it is some- life at different stages of the life cy- ences to the importance and value of times this invisibility that leads to cle, and it is not unusual for some to life and I always bear with me the false perceptions. Health, like many feel slightly affronted when the of the other essential qualities that moral concerns for the protection of make humankind whole, is difficult life are crossed with the economic to grasp and hold. It is when matters considerations. become visible, when the invisible The value of life in economic state is lost, that we recognize the terms has been a subject of continu- importance of what we no longer ing interest and sparked some of the have. As I heard as a youth, “one political arithmetic that preceded the never misses the water until the well discipline of modern economics. But runs dry.” A part of our work is con- it is inevitable that we should think vincing our fellows that this invisible of the economic value of life and add state called health is an essential re- these arguments to the moral ones source for living, perhaps one of the for the preservation or amelioration only really and genuinely non-re- of that life. To the extent that the newable resources. If we are going to wealth of a nation depends on pro- engage others in the struggle to duction by its human resources, then maintain that resource, we must clar- life and the length of productive life ify what its main determinants are. will always be an economic concern. This approach is often bedeviled by Much of the argument for improving the unfortunate fact that our best and or preserving life turns around possi- most widely accepted measures of ble productivity or loss thereof. health are indeed measures of loss of This debate about the absoluteness health—measures of disease and ill- of preservation of life itself has eco- ness. nomic ramifications and although a In spite of the difficulties with ap- right implies that there should be a statement (John 15:13) propriate measurement there is now measure or protection, and I would Greater love hath no man than general agreement on the determi- add preservation, in the world of to- this, that a man lay down his life for nants of that healthy state that indeed day this cannot be viewed only in the his friends. gives primacy and quality to life. It is absolute. In spite of the affirmations This concept of life as the ultimate important to understand these deter- about the primacy of life, because of gift is in some ways more pleasing to minants, if individually or societally the reality of limited resources, the me than the concept inherent in the we are going to press for measures to view is often put forth and argued Hegelian construct which portrays preserve or restore health. The social very vigorously that scarce resources death or the loss of life as the ulti- and physical environments are dom- should be applied where they should mate chip in the serious struggle for inant in this context. It has always do best for the society as a whole. recognition. Both views, however, been easy to grasp the impact of the Thus we find government having to are very compatible with assigning physical environment on human make decisions about the incorpora- life a primacy beyond all human health, and the appreciation of such tion and use of technology which is conditions. an interaction reaches back to the known to prolong or preserve life but But to most of us who work in writings and teachings of Hip- whose cost is prohibitive. The ethics health, there is another dimension pocrates. It is true, however, that es- of the allocation of resources of this which I will now explore. The pri- pecially recently we have grown to nature go beyond the simple eco- macy of life entails for us not only its understand this interaction some- nomic dicta that guide the applica- preservation in an absolute sense, what better. The changes in the mition of such resources in times of not only survival, but also some con- croenvironmental can easily be asso- scarcity. cern for the quality of that life. The ciated with disease and there is stark The regard for the primacy of life right to life in some way implies the evidence all over the world of poor and the perception that each life is right to those states that make for a environmental conditions such as precious and deserves special atten- decent life, and high on the list of lack of water, poor waste disposal, tion often leads to unnecessary ethi- those states is health. contamination of the air and soil pro- 192 DOLENTIUM HOMINUM ducing disease, often of epidemic are other determinants of health. of the budget allocated to health in proportions. The lessons of John There is evidence all around us of any system. This is because of the Snow, who showed us how cholera health damaging behavior that leads origins of the healing profession, the was related to fecal contamination of to disease. Smoking, unhealthy sex- public power of the most vocal of its drinking water, have been repeated ual practices, and eating habits are members individually and in groups, several times over. The tragedy is only a few examples of those bepat- and the normal anxiety of the indi- that, having learnt the lesson, we terns that impair health. One of the vidual that everything possible have been unable to apply the obvi- tragedies of our time is the insistence should be done to preserve life and ous remedy on a global scale. on autonomy and the right of self-de- avoid death. There is rarely any en- Cholera is still with us and children termination to the detriment of both thusiasm for prematurely “shuffling still die of diarrhea. the individual as well as the collec- off this mortal coil.” What is perhaps new is the appre- tive good. However, when one examines the ciation that changes in the macroen- Genetic endowment is yet another relative importance of these various vironment that have been induced by determinant of our health, and until determinants of health, it is clear that human action also lead to disease. recently there was little that could be although the social and physical en- The climatic changes induced by vironments are the most important in global warming and the changes in promoting and maintaining the the protective ozone layer lead to healthy state, most of the health re- both immediate and distant effects sources go to the care services. No on health. one would wish there to be such The impact of the social environ- stringency that no or few resources ment also has its history and the rela- are allocated to care, but concern for tionship of poverty to health was health as the expression of the pri- well recognized by Virchow in Ger- macy of life might be appropriately many, Villerme in France and Alison translated into having additional re- in Scotland. Chadwick and Shattuck sources go to those other determi- are household names in public health nants that are shown to play such an because of what they did to amelio- important role. rate the social conditions and im- Our concern for health goes be- prove the health of populations. It is yond the individual and is also facile to say that poverty relates to framed in the context of a wider disease and ill health solely through good. The presence or absence of effects on the microenvironment and health or the uneven states of health the possibility of nutritional depriva- in a society are often manifestations tion. of inequity in that society. The refer- But there is now a considerable ence by the Pope in Evangelium Vi- body of literature relating health to tae to poverty, malnutrition and social conditions, and the most hunger, as a result of an unjust distri- striking findings relate not only to bution of resources among peoples the influence of social class on done to alter this. It is often not the and social classes, is a clear indica- health, but to the fact that this so- presence or absence of some genetic tion of the concern for the health cially determined gradient in health trait per se that leads to ill health, but manifestations of social inequity. Al- is rather resistant to change. The fa- because it predisposes to some other most 20 years ago the nations of the mous Black report of 1988 analyzed harm or injury. The ethics of genetic world, in a remarkable show of una- the relationship between social manipulation for correction of such nimity and solidarity, raised the cry class and health in Great Britain and defects are beyond the scope of this of Health for All. They did this with showed that although health status discussion. the full knowledge that there would improved absolutely over time, the In modern times, however, it is the never be some utopia in which there gradient still persisted. The socially care for the individual that consumes would be no ill health. They did it as well off continue to have better most of our attention. The injunction a demonstration of the commitment health indicators than those at the to care for one another and espe- to seek the kind of social equity that bottom of the pile. cially the admonition to the physi- manifests itself in better Health for There is no doubt about this asso- cian to care and cure are bedded All. Like many noble and lofty aspi- ciation, but the more fascinating re- deeply in our cultures and practices. rations, Health for All is impossible search is directed towards elucidat- Much of the expression of the pri- in the pragmatic programmatic ing its mechanism. The explanations macy of life is through attention to sense. are varied, but I have always been at- individual care, and the sacerdotal Over the course of these last two tracted to the thesis that the wealthy origins of the healing profession decades there has been improve- have access to more and better in- speak to the importance of this care. ment, but there is a feeling abroad formation and in addition are better The importance of care is clearly that much of the original enthusiasm able to internalize and utilize this in- demonstrated in the attention paid to has waned although there is still a formation to create their own culture the care services and the institutions great deal to be done. Our attention of health. that deliver such care. The care sys- is being struck by pictures of large Individual and collective behavior tem consumes by far the largest part populations suffering and new dis- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 193 eases emerging. Indeed, the concept a flowering of the human spirit and Mr. Chairman, by training and of new, emerging and re-emerging the possibility for humans to achieve conviction, we who work in and for infectious diseases in now high on more of their potential. health believe in the primacy in life, the agenda of the world’s public I would hope to persuade you that and see that primacy expressed most health. Human Immunodeficiency at this time we need to see health not beautifully in the promotion and Virus Infection/Acquired Immunod- only in sectorial terms and as an is- preservation of that most precious of eficiency Syndrome (HIV/AIDS) sue of concern to the health profes- resources—our health. But it would may be the best known example of a sionals. Health touches all sectors, be a semi-tragedy if this vision re- newly emerging disease. But poor and one of the elements of this remained only with those in health, sanitation, ecological changes, and newal of Health for All is to give and I would wish to see all human rapid transportation are all contribut- more emphasis and meaning to the beings share it. Perhaps when that ing to new threats, and there is no interaction of health and other as- day comes, we will indeed see not doubt that their impact is and will be pects of social endeavor. We need to only improvement of human condi- global. These diseases are problems see health so located in the public tions everywhere on earth, but there of the developed and developing agenda that all actors in society ap- will truly be recognition that this pri- world alike, and the efforts to warn preciate their roles in promoting the macy of the life that we hold so sa- us of them and hopefully counter concept of health as a resource for cred will indeed be acknowledged to them will need a global effort. our full being and something to be be important under all human condi- Our countries are seeking to re- bemoaned for its absence. tions. new the call for Health for All, be- Health is essential for living, but cause they appreciate the timeless- health is also a powerful force for se- Sir GEORGE ALLEYNE ness of the goal. But now there is the curing conciliation and reconcilia- Regional Director for the Americas of the World Health Organization, added dimension that there is a more tion. Our experience is that it repre- Barbados Islands conceptual clarity about the role of sents one of the noble areas around health in relation to those other activ- which there is little conflict and for ities and attributes that combine to- which it is relatively easy to secure I wish to acknowledge the help of gether to make for human develop- the dialogue that can lead to under- Dr. J.R. Ferreira in preparing this ment as a state in which there is truly standing and peace. manuscript. 194 DOLENTIUM HOMINUM

FRANCIS ARINZE

The Pedagogy of Pain in Other Religions

1. A Phenomenon 2. Hinduism on Pain d) Response to Pain That Imposes Itself: Hinduism teaches that the re- Man and Pain a) The Law of Karma sponse to pain and suffering is to Basic to an understanding of the be found in virtues like renuncia- Pain is a reality which faces hu- Hindu approach to the mystery of tion, austerity, study of scriptures, man beings during their earthly pil- pain or suffering is the Hindu belief non-violence, truth-force or Satya- grimage. It comes in many forms. of the law or theory of Karma. The graha (i.e. when filled with truth, a Physical pain can come as bodily word Karma means action, work or person has inexhaustible power to aches, physical hurts and wounds, deed. Hindus believe that the im- do good), help of a guru, etc. The weakness, hunger, sickness, old age, mortal self (or soul) is the substra- three classical means or paths for or death. tum of knowledge, action and enjoy- liberation in Hinduism are the path Mental, spiritual and moral pain ment. Every action of the self, of knowledge, the path of loe of can take the form of disappointment, whether good or evil, produces a God and the path of disinterested failures, ingratitude, false accusa- corresponding unseen result. This action. tion, insult, or marginalization. It result is to be enjoyed or suffered by can also be caused by the death of the doer in this life or in the life to e) God’s Role dear ones. come. The nature of the embodied How does Hinduism see the role Unpleasant weather conditions, existence in the next life (because of God in human suffering? God is accidents, fires, and natural disaster Hindus believe in re-incarnation) is regarded as impartial. He allows also make people suffer. Pain con- determined by the actions of this life people to assume bodies destined cerns man in his entirety, in his and of previous lives. Therefore the for them by their own past Karmas. sometic-spiritual unity. body and the spatiotemporal cir- But He gives them free will, and Pain accompanies man and practi- cumstances which a person has here they can, by strenous practice of cally demands his attention. It im- and now are not accidental. They are spiritual means, destroy all the re- poses itself on man as a subject for the sum total of all the results of all sults of Karma, and thus break the reflection and meditation. the Karmas of the previous births. chain of births, deaths and rebirths, Man throughout history has asked and obtain eternal liberation. In questions about pain, about suffer- b) Pain is Merited classical systems of spirituality like ing, and about evil. He has sought If, therefore, we ask why a right- Samkhya and Yoga, God is not re- their meaning and the answer to eous man undergoes sufferings and garded as concerned with the salva- them. miseries and has to face problems in tion of man. The seeker wins liber- The Second Vatican Council life, Hinduism answers that he has ation by his own efforts. But in the wisely notes that “men look to the been an evildoer in his previous life theistic Vedanta systems and in the various religions for answers to the or lives. One is born blind because Bhakti literature, God is coinceived profound mysteries of the human he has sinned with his eyes in his as a person and His help is re- condition which, today even as in past life or lives. Suffering, mis- garded as essential for the salvation olden times, deeply stir the human eries, evils, and problems in life, in of man. heart” (Nostra Aetate, 1). all their shades, are thus explained Pain is one of those profound by means of the eternal karmic law. f) Value of Pain and Suffering mysteries. How do Hinduism, Bud- On the whole, Hinduism sees no dhism, Judaism, Islam, and African c) Other Causes of Suffering positive value in pain or in suffer- Traditional Religion offer to their Particular interpretation or ing. Suffering is regarded as a result followers an answer to this unavoid- schools of hinduism suggest other of Karma. However, the holy people able enigma? What reflections can causes of pain and suffering, such as and mystic of the Bhakti movement we make on these answers in the the gods, or the material world, sor- willingly accepted sufferings to ex- light of the Gospel of Our Lord and row and ignorance, a fragmented vi- press their intense love of God. For Savior Jesus Christ and the Christ- sion of reality, egosim, hunger and Hinduism, there is positive value in ian faith? thirst, old age and death. self imposed suffering, such as VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 195 freely undertaken renunciations and suffering in it, is called Ineffable ment or suffering: “The fathers have the practice of rigorous ascetism. Peace, Perfect Calm, Supreme Beat- eaten unripe grapes; the children’s These are regarded as means to sal- itude or Full Happiness. teeth are set on edge” (Jer 31:29; cf vation. In the fourth truth, Buddha indi- also Ezk 18:2). But soon Jeremiah cates the way that leads to the Nir- (Jer 31:30), and more definitively vana. The octuple Way to Right- Ezekiel (Ezk 18), asserted the prin- 3. Buddhism and Pain eousness is as follows: right vision, ciple of individual rather than col- right thought, right word, right ac- lective retribution. a) Liberation from Pain tion, right life, right effort, right at- and Suffering tention and right meditation. b) Explanations of Pain Suffering is the point of departure and Suffering and indeed the foundation of all c) A Moral and Soteriological Way The book of Job and Ecclesiastes Buddhist teaching. Buddhism can Buddhism responds with silence show how the Jewish mind was indeed be said to be a doctrine that to all questions on God, man and the puzzled and disturbed by suffering, preaches the liberation of humanity universe. Buddhism is not a meta- to which no answer was found. from suggering. The teaching of There appears to be no final solu- Buddha is summarized inf our No- tion to the problem of the suffering ble Truths, all with reference to suf- of the innocent person apart from fering, regarding its truth, its cause, faith. A person must see God, en- its end and how to be free from it counter God, and bow in adoration and reach the Nirvana. before God, if he is to live with The first truth, the Truth on Suf- pain and suffering. fering, says that everything is suffer- In Alexandria, Egypt, the Wisdom ing: birth, sickness, old age, union of Solomon, a book which appeared with an unloved person, separation about the year 90 B.C., stressed from a loved one, not getting what clearly a definite faith in future re- one wants; in short, the five material wards after death, and the conse- and spiritual elements together with quent reduction of attention on suf- attachment are suffering. Every hap- ferings that exist at present. Retribu- piness or joy in this world, marked tion takes place for each individual as it is by instability and transience, after death. The Pharisees believed is already suffering. Buddha says strongly in the resurrection of each that during our existence we have person. shed more tears than the water con- Maimonides believed that the par- tained in the four oceans (cf Samyut- ticular evils which befall a person tanikaya II, 180). are for the good of the universe as a Buddha says that the cause of suf- whole and that all suffering is pun- fering is attachment. This can take ishment for previously committed the form of longing or thirst for sins. things, or an egoistical clinging to physical system. It is solely occu- Buber held that evil is really only them. It can lead to the fear of loss. pied and preoccupied with the salva- a “turning away” from the good to- This is the second truth about suffer- tion of all beings from the evil that is wards “nothingness.” ing. suffering. Buddha did not deny the Judaism in its nonphilosophic existence of metaphysical problems form acknowledges the utter reality b) Nirvana but he denied their usefulness. Bud- of evil and suffering. Indeed, God The third truth about suffering dhism is summarized in the saying: Himself is often described as suffer- refers to its end or conclusion, the “Avoid evil, practise good, purify ing with man. Man is challenged to annihilation of attachment-thirst, of the heart, that is the teaching of Bud- remedy suffering whenever it can be hatred and of error is Nirvana, the dha” (Dhammapada 183, Majjhi- remedied, and to endure it without state of holiness. Nirvana (exit, es- manikaya II, 49). The octuple Way complaining whenever it is irreme- cape) is the suppression of the fire of to Righteousness names eight diable. attachment-thirst and of the pas- virtues, all moral, and none refers to Another explanation of the exis- sions. Buddhist ascetism aims at God. tence of suffering is that it is a reaching the nirvana (extinction) of process of purification. The Talmud self and the purification of self. The terms such suffering “afflictions of Buddhist saint is the one who has re- 4. Judaism and Pain love.” Suffering was thought to be alized on emptying and denial of the ultimate form of divine purifica- self and passions. a) Punishment and Responsibility tion leading to mystical union. Nirvana can be reached in this The Bible is from the beginning In the 20th century the terrible world by destroying selfish attach- aware of suggering as a characteris- calamity of the Shoah (Holocaust) ment which is the root of all sugger- tic of human existence (cf Gen 3:19; has brought up the question of suf- ing, but it is obtained in a definitive Job 5:7). The Jews had a strong fering in its most acute form. How way only after death. The Nirvana, sense of community. This included could so many innocent people un- because of the absolute absence of the expectation of collective punish- dergo such terrible tortures and ig- 196 DOLENTIUM HOMINUM nominious death? Where was God cestors, in the form of sickness, epi- Son to save all men. “God loved the in all this? Jews have been com- demics, road accidents, drought, world so much that He sent His only pelled to seek a meaning for this flood, childlessness and death (espe- Son, so that everyone who believes mystery of evil, often through one or cially death by lightning). The in Him may not be lost butmay have more of the explanation given breaking of taboos is also believed eternal life” (Jn 3:16). above. But at times they prefer just to provoke evil and punishment. Jesus Christ saved all humankind to remain silent before this mystery. Pain can also come, it is believed, by His suffering, death and resurrec- from the caprices of evil spirits, tion. He did this out of love for His blind forces and witchcraft. God is Father and to save all men. Thus Je- 5. Islam and Pain generally not regarded in this reli- sus gives meaning to pain and suf- gion as responsible for any of the fering. And He invites all His disci- a) Suffering Will Be Redressed suffering which people undergo. ples to take up their cross and follow The Qur’ân and Islam see the life Him. By mystical union with Christ of God’s prophets as going through b) Attitude towards Suffering through suffering, the Christian dis- the stages of proclamation of the di- To remove suffering, the devotees covers the salvific value of suffering vine message, human opposition, and is able to beat it with love. persistance by the prophet in suffering and ultimately vindication by b) In Response to the Various Reli- God. In times of suffering, the good gions Muslim does not despair of God’s To Hinduism, the Christian faith goodness nor become self-destruc- proclaims that death is the end of tively bitter or destructively angry. man’s earthly pilgrimage and that He or she strives to wait patiently there is no reincarnation (cf. Cate- with full faith that God will eventu- chism of the Catholic Church, no. ally redress the wrong and make 1013), but rather life after death in things right. The Qur’an denies the heaven (directly or through purga- crucifixion of Christ and His death tory) or hell. While suffering can because that would have meant fail- sometimes be the fault of the one ure or that God abandoned Him. who suffers, it need not always be so. Efforts at asceticism and detach- b) Other Islamic Traditions ment from creatures are praisewor- The Shi’ite segment of the house thy, but Christianity teaches that we of Islam has a different tradition. It depend absolutely on God’s initia- believes in the vicarious efficacy of tive for our salvation. Without suffering. For the Shi’ites, the God’s grace we cannot achieve per- Imams (especially Hussain, grand- fection or salvation, although our son of Muhammad) took upon cooperation is required. themselves the sinfulness of human- While Christianity shows appre- ity, and by their faithful patience in ciation for the sincere efforts which tribulation and persecution, they of African Traditional Religion take Buddhists make at asceticism, there atoned for all the evil that humans some of the following measures: are major differences . Christianity do to one another. consultation of the fortune-teller to proclaims the essential good of exis- Worthy of mention is a high-rank- find out which spirit is angry with tence and the good of that which ex- ing Sunni mystic, al-Hallaj, who them, placatory sacrifices to the in- ists. Above all, Christianity pro- considered that the perfection of Is- dicated spirit or ancestor, and resort claims the existence of a transcen- lam (total abandonment to God) lies to real medical doctors who are ex- dent God Who is goodness itself and in “total abasement,” that is, in pert especially in herbal cures. Who lovingly created human beings “death on a gibbet.” Indeed, he was There is also the belief in fatalism, and wants their happiness. Man suf- crucified in Baghdad in 922. in suffering which is neither merited fers on account of evil, which is a nor preventable. certain lack, limitation, or distortion 6. African Traditional of good. Man is not able to procure Religion and Pain 7. A Christian response for himself eternal beatitude. He has an absolute need of the assistance of a) Causes of Pain To conclude these reflections, it is God’s grace for this. For Christian- The religion prevalent in most now necessary to ask ourselves what ity, salvation is the liberation of hu- parts of Africa before the arrival of comments can be made in the light manity from sin by the suffering, Christianity and Islam believes in of the Gospel of Our Lord and Sav- death and resurrection of Jesus God, in spirits and in the ancestors. ior Jesus Christ, on the answers pro- Christ. The Passion of Christ is part Its followers see pain and suffering posed by these religions to the mys- of His Paschal Mystery; for Chris- as having many possible causes. tery of pain and suffering. tians, suffering is not a negative fac- Moral faults—such as stealing, slav- tor from which man strives to liber- ery, adultery, incest, abortion and a) Salvific Value of Suffering ate himself, but is a way to carry our murder, are believed to provoke God loves humankind. Because cross and follow Christ, Who saved punishment from the spirit and an- of this great love, He sent His Only us by His Cross. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 197

Jews and Christians share that vicarious suffering. A major differ- Gospel frees man from fear of blind revelation of God to humanity ence is that Christianity stresses that and malevolent forces, and intro- which is preserved in the Sacred love is the richest source of the duces him into the loving plan of a Scriptures regarded by Christians as meaning of suffering,—that is, it saving God Who sent His only Son the Old Testament. Those Scriptures was out of love for His Eternal Fa- to redeem humankind by His suffer- present the figure of the Suffering ther and for all men that Jesus Christ ing and crucifixion. Christianity is Servant of Yahweh. Christians see suffered the ignominy of crucifixion an offer of God’s love in Christ to all in these texts (Is.42:1-9; 49:1-6; and that the crucifixion was not de- humanity. Man’s response to this 50,4-11; 52:13-53:12) a foreshad- feat for Christ but His victory, be- call includes willingness to undergo owing of Jesus Christ, Who suffered cause He rose again the third day. the suffering that comes one’s way. for us. “Ours were the sufferings He The glorious Resurrection of Christ Thus, one carries one’s cross and bore, ours the sorrows he carried..., is central to faith in His mysteries. follows Christ in loving union. and through His wounds we are Christ has thus given suffering a As can be seen, the Gospel is not healed” (Is 53:4-5). Jesus Christ is salvific value, and the Cross is a sign a higher edition of other religions. It the full and final manifestation of of His triumph. As followers of is a supernatural and totally novel ir- God’s glory and of His saving love Christ, we do not abandon ourselves ruption of God in human history. It for humankind. In Christ, suffering to fatalism when suffering comes is a call to a life of union with God to is given meaning. The Cross be- our way, but rather we feel called to which man could never by his own comes a source of salvation, peace, carry our cross and follow Christ, unaided powers aspire. The Gospel and joy and a call to discipleship of the Conqueror of sin and death. And gives meaning and a sense of direc- Christ and to love of our fellow hu- we do not always expect that God tion to pain and suffering. It gives a man beings who are suffering. will visibly manifest the victory of completely new and otherwise unat- Towards Muslims, Christians the person who is faithful to Him. tainable dimension to human exis- show appreciation of the virtue of Followers of African Traditional tence. Blessed be God! obedience to God and patient carry- Religion will be gladdened by the FRANCIS Cardinal ARINZE ing out of His will, as well as the liberating influence of the religion President of the Pontificial Council Shi’ite perception of the value of established by Jesus Christ. The for Interreligious Dialogue, Holy See 198 DOLENTIUM HOMINUM

ALBERT VANHOYE

The Good Samaritan (Lk 10:29-37) Biblical Hermeneutics of the Parable

The parable of the Good Samari- helpful to observe that the verses tion would be asked some chapters tan—which is the point of departure which follow it immediately speak afterwards by a very rich notable to for this tenth international confer- about the Samaritans in order to whom Jesus replies by citing the ence—from the point of view of show that this orientation provoked Ten Commandments (Lk 18:18-23). biblical exegesis raises a large num- their hostility. “Jesus,” relates Jesus does not give this particular ber of questions and displays highly Luke, “sent messengers before him, answer to the learned man of law indicative characteristics. In this who came into a Samaritan village, but makes reference instead to his short paper not all of these aspects to make all readiness. But the personal field of expertise. “Jesus can be examined but I will at least Samaritans refused to receive him, asked him, What is it that is written strive to ensure that nothing essen- because his journey was in the di- in the law?” (Lk 10:26). The lawyer tial is omitted from my talk and rection of Jerusalem.” (Luke 9:52- immediately found the right answer, analysis. 53). an answer which Jesus himself gave The text is only to be found in the One knows that the relationship in a passage to be found in the other Gospel according to St. Luke (10:19- between the Samaritan and the Jews two synoptic Gospels (Mt 22:36-40; 37). It is in harmony with the special were not of the best. The fourth Mk 12:28-31). This answer links to- emphasis of this Gospel on the sub- Gospel describes this reality at the gether the precept of love of God ject of compassion, and this empha- beginning of the meeting between expounded in Deuteronomy 6:5 and sis is also to be discerned in the para- Jesus and the Samaritan woman (cf. that of love for one’s neighbor ex- ble of the prodigal son (Lk 15:11-32) Jn 4:9). pounded in Leviticus 19:18. and in other episodes which are par- In addition various passages from Jesus confirms the correctness of ticular to Luke (7:11-17, 36-50). the Old Testament reveal the con- the answer and invites the learned Thus it is that a special source, “L,” tempt that the Jews felt for the man of law to put this answer into is invoked, a source perhaps used by Samaritans who were considered practice: “Thou hast answered right, Luke in addition to the sources bastards from every point of view, in he told him; do this and thou shalt which he shares with Matthew. both religious and racial terms (cf. 2 find life.” (Lk 10:28). The episode R 17:24-41; Si 50:25-26). The hos- now seems at an end. Its conclusion tility was mutual. Thus it was that corresponds exactly to its beginning 1. The Context in the Gospel the Jewish historian Josephus writes and conforms to the Semitic literary According to St. Luke about how the Samaritans used to procedure known as “inclusion.” trouble and disturb the Jewish pil- The doctor of law asked what he had The parable of the Good Samari- grims while they were on their way “to do” to receive “life.” Jesus said tan is placed by the evangelist to Jerusalem. (Ant. 20, 6, 1) to him: “do this and thou shalt find shortly after the beginning of a It is helpful to bring to mind the life.” But at this moment, and in un- lengthy section in the Gospel which refusal of hospitality which was en- expected fashion, the narrative goes is designated “the journey towards countered by Jesus at a village in off in a new direction. The learned Jerusalem.” This is a section in- Samaria if we want to fully appreci- man of law “to prove himself blame- serted by Luke between the second ate the generosity that Jesus demon- less” after asking the first question and third announcements of the strates towards the Samaritans in this then goes on to ask another: “And passion of Christ (Lk 9:43-44 and parable. This generosity is expressed who is my neighbor?.” And it is the 18:31-34; Mt 17:22-23 and 20:17- by the fact that he presents one of answer to this second question 19; Mk 9:30-31 and 10:32-34). It them as a model of love towards which provides Jesus with the op- goes from Luke 9:51 to Luke 18:14 one’s neighbor. Indeed, the parable portunity to tell the story of the Good and begins in the following fashion: is to be read in the next chapter of the Samaritan. “And now the time was drawing Gospel and belongs to the same gen- near for his taking away from the eral section. earth, and he turned his eyes stead- Jesus narrates the parable in order 2. A Change in Perspective fastly towards the way that led to to answer a question posed to him Jerusalem.” (Lk 9:51) This begin- by a “lawyer”: “Master,” he said, Biblical scholars and experts have ning clearly expresses the orienta- “what must I do to inherit eternal observed that in reality Jesus does tion towards the holy city. It is life?” (Lk 10:26). The same ques- not actually answer the question VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 199 which is posed by the learned man of chatological events he has foretold clear by the context. The term law. He does not really tell him who he does not give a precise chronol- “neighbor” is defined by a parallel his neighbor is. Jesus does not make ogy but offers warnings instead. To phrase—”the sons of the people.” clear which people qualify for this the question of the disciples: “Mas- Love for one’s neighbor is thus un- category and fails to specify which ter, when will this be?” (Lk 21:7), Je- derstood as an attitude of solidarity other categories are not covered by sus answers: “Take care that you do with one’s fellow-countrymen, and this definition. not allow anyone to deceive you. thus is very narrow in character. It is Rather than answering the ques- Many will come making use of my to be observed however that a few tion which has been posed to him, name; they will say, Here I am, the verses later Leviticus extends the Jesus implicitly substitutes it with time is close a hand; do not turn concept to include foreigners (in He- another, and that question is: what aside after them.” (Lk 21:8). Jesus brew the word is gèr): “When a forms of behavior make you the never presented himself as a thinker stranger sojourns with you in your neighbor of another person? The or a theoretician—he always strove land, you shall not do him wrong. learned man of law adopts a static to communicate and achieve a dy- The stranger who sojourns with you point of view which attempts to fix namism of conversion and of love. shall be to you as the native among limits to the precept of love for you, and you shall love him as your- one’s neighbor. Jesus, instead, sug- self; for you were strangers in the gests a dynamic perspective to him, land of Egypt.” (Lv 19:34). This and this is a perspective which in- broadening of perspective deserves volves the creation of new relation- attention. It is in opposition to the ships. practice of every form of racial or Diachronic exegesis has sought to national discrimination within the discern an evident fusion of different borders of Israel. sources in the Gospel text and has In the passage from Leviticus love perceived in this change of perspec- for one’s neighbor is defined with tive a reason for supposing that the negative precepts: “You shall not op- parable of the Good Samaritan es- press your neighbor or rob him.” (Lv sentially exists independently of the 19:13) “You shall not go up and account of the encounter with the down as a slanderer amongst your learned man of law and that “it was people, and you shall not stand forth only subsequently added to the pre- against the life of your neighbor.” vious context because it does not re- (Lv 19:16) “You shall not hate your ally answer the question posed by brother in your heart” (Lv 19:17). the lawyer” (J.A. Fitzmyer, The “You shall not take vengeance or Gospel According to Luke, Anchor bear any grudge against the sons of Bible, 1985, p. 883). your own people” (Lv 19:18) . But a synchronic analysis of Other passages from the Penta- the text shows that the link between teuch, however, go beyond these the parable and the second question negative rules and regulations. They of the learned man of law is essential enjoin an attitude of positive gen- to a correct interpretation of the erosity towards one’s neighbor. Gospel story. The absence of an im- Deuteronomy requires above all else mediate correspondence between the that every ten years the debts con- answer and the question which has tracted by one’s “neighbor” should been asked is in very precise terms be written off (Dt 15:2). Here an important aspect of the teaching “neighbor” means fellow-country- of the “Master” (Lk 10:25). What Je- men, as is evident from the text: “Of sus asks us to do is to abandon the a foreigner (in Hebrew the word is static perspective of separations and nokri) you may exact it; but what- segregations and enter instead into The learned man of law poses a the- ever of your is with your brother the dynamism of communication oretical question to Jesus: “who is your hand shall release.” (Dt 15:3). and communion. my neighbor?” (Lk 10:29) Jesus an- The law of Deuteronomy then dedi- We can observe that on other oc- swers his question by offering him a cates itself to the condition of the casions as well Jesus provides us model for action and says to him, poor: “If there is among you a poor with answers which do not corre- “Go on your way, and do likewise.” man...you shall open your hand to spond to the question which has been (Lk 10:37) him, and led him sufficient for his posed to him. On the contrary, they need” (Dt 15:7-8, 10). In addition, involve passing from a theoretical the freeing of the slaves of Israel is question to what is an existential re- 3. The Answer prescribed after a period of six years quirement. When one person asks of the Old Testament (Dt 15:12-18; cf. Jr 34:14). him: “Lord, is it only a few who are The prophets themselves were to be saved?” Jesus does not reply by The learned man of law could much concerned with vigorous ex- citing figures but chooses rather to have found numerous elements by hortations in favor of an approach in- make an exhortation: “Fight your which to answer his question by volving generous solidarity. We way in at the narrow door...” (Lk looking in the Law of Moses. The need only here remember the elo- 13:23-24). In the same way when Je- meaning of the precept of Leviticus quent appeal to be found in Isaiah, sus is asked about the date of the es- 19:18 which he himself cited is made chapter 58, where God defines the 200 DOLENTIUM HOMINUM kind of fasting he wants. He is not in 5. The Contrast Between word splanchnizomai which in turn favor of formalistic mortifications the Two Approaches comes from the word splanchna but declares instead: “Let the op- meaning “guts”). This reaction, pressed go free, and to break every The parable goes on to express a which involves pity, sets everything yoke” and “share your bread with the strong contrast between the ap- else in motion: rather than avoiding hungry and bring the homeless poor proach of the different people who the wounded man as the priest and into your house; when you see the go along the same road. Their iden- the Levite had done, the Samaritan naked, to cover him, and not to hide tity, this time, is more clearly de- draws near to him, he dresses his yourself from your own flesh? Then fined: we are dealing first and fore- wounds, takes him to an inn and shall your light break forth like the most with a Jewish priest and a takes care of him. He then entrusts dawn.” (Is 58:6-8; cf. Jr 34:8-9: Job Levite, and then a Samaritan. The him to an inn-keeper whom he pays. 31:16-20, 32). first two figures see the wounded He also promises that he will pay for man but pass by on the other side of any further expenses. One is amazed the street in order to avoid going near at such generosity, a generosity dis- 4. The Answer of Christ: him. No explanation is given for this played towards somebody whom the “A man....” Samaritan does not even know. The contrast between the two ap- The reply of Jesus to the learned proaches which are adopted in rela- man of law is to be understood along tion to the wounded man is extreme. similar lines, but it goes much further. This is also expressed in quantitative In truth one can asset that from more terms—only one word for the ap- than one point of view it is provoca- proach of the Jewish priest and the tive. The first phrase “a man” does Levite but more than fifty words for not say anything. We find it at the be- that of the Samaritan. It is also ex- ginning of other parables—that of the pressed particularly in qualitative prodigal son (“A man had two sons,” terms through the detailed descrip- Lk 15:11), that of the dishonest stew- tion of the extraordinary devotion of ard (Lk 16:1), and that of the rich bad the Samaritan. It might be thought man (Lk 16:11). that such generosity is difficult to be- It does not deserve special atten- lieve but in actual fact it is in line tion in these passages. But in our with the literary character of the bib- parable this phrase is very significant lical parables. These often have un- because of its indeterminate element. likely features precisely because In answer to the learned man of law they seek to question received ideas who asks him to give a definition of and strive to open new and divine who his neighbor is, Jesus does not perspectives (cf. Is 55:8-9). define anything at all and expresses This parable clashes with the men- himself in very vague terms. tality of the doctor of law first of all The Greek word used in the because there is nothing legalistic Gospel—anthropos—does not even about it and because, above all, it give an idea of gender. What comes condemns the role played by such afterwards indicates that we are talk- figures as the Jewish priest and the ing about a male but nothing at all is Levite, who, according to the Law of said about race, religion or social Moses are very respectable and rank. Is he a Jew? An immigrant? A made holy by their privileged rela- foreigner? Is he a religious man or a tionship with the temple of God. non-believer? We do not know at the And, secondly, because the parable beginning and we do not know at the invites the Jewish man of law to ac- end. This shows us that in order to cept the Samaritan as an example to define who our neighbor is Jesus re- attitude which is described very be followed, and the Samaritan, it jects any consideration of these cate- briefly with a single Greek word— should be stressed, is a figure whom gories, whatever the importance antiparelthen. Luke here uses a word the Bible had taught him to despise. given to them by the Old Testament with a double suffix (anti—in front Jesus wants the learned man of may be. of, on the other side; para—over law to undergo a radical change of The only facts which are supplied there) which is never found in the mentality along the lines of Simon to identify the person are those relat- New Testament and is only once to the Pharisee of a previous episode, ing to what had happened to him and be found in the Old Testament, and it that of the forgiven sinful woman the painful situation in which he is then employed with a different (Lk 7:36-50). Jesus offers this found himself. This man who went meaning (Wisdom 16:10). woman who Simon despised as a down from Jericho to Jerusalem The third person, the Samaritan, model of generosity and contrasts passed through an area of desert and adopts a completely different atti- her with the cold welcome which the fell into the hands of brigands who tude and approach. The first thing Pharisee had given him. Other took his clothes, wounded him and which is said about him, and this is Gospel episodes are directed to the left him for dead. He was a wounded when he sees the wounded man, re- same end, episodes such as those man, a man half dead—this was his lates to his emotional reaction—”he when Jesus praises the faith of a pa- identity. It is not even known if he took pity at the sight” (literally—”he gan centurion (Mt 8:5-13; Lk 7:1- was able to cry out or to moan. was struck in the guts” from the 10) or when he says to the scribes VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 201 and elders: “the publicans and the feature of Gospel teaching. By his portance in the eyes of God than the harlots are further on the road to words and even more by his exam- observation of the sabbath rest day. God’s kingdom than you.” (Mt ple, Jesus made clear that God In all these cases it is to be ob- 21:31). Like the Old Testament prefers a generous attitude towards served that Jesus ceaselessly calls for prophets (cf. Is 1:3; Ezk 16:48-51; one’s neighbor to ritual worship. In a change of perspective. This 22:4; 23:11), Jesus in this way the first Gospel Jesus interprets the change, he stresses, had been pre- mounts telling and incisive chal- words of the prophet Hosea where pared for by the teachings of the lenges to his people in order to foster God says: “For I desire steadfast prophets (Is 1:10-17; Jr 7:1-7; Am and promote authentic spiritual de- love (the Jewish word is hèsèd) and 5:21-24). It involves substituting the velopment within them. not sacrifice” (Hos 6:6; Mt 9:13; search for holiness through segrega- 12:7) along these lines. In the same tional observation with holiness ob- way a polemic sustained by Jesus tained through generous solidarity. 6. Two Different Concepts against exaggerated concern with rit- Ritual purity is not enough to of Holiness ual purity is dwelt upon at length by achieve an authentic relationship Mark and Matthew (Mk 7:1-23; Mt with God. What is needed is to place No explanation, we have ob- oneself at the service of God through served, is given in the parable for the service to one’s neighbor and to al- attitude and approach of the Jewish low oneself to be moved by the force priest and the Levite. Why do they of divine mercy which seeks to reach not draw near to the wounded man? people who suffer and are in need of Why do they pass by on the other care—the wounded, the sick, the side of the road? Why does Jesus handicapped, and the despised. The cast these respectable figures in a parable of the Good Samaritan ex- very bad light? presses this movement in two ways. In trying to solve these problems On the one hand it describes the gen- bible scholars have suggested that erous attitude and approach of the the most plausible explanation is to Good Samaritan to the wounded be found in concern over ritual pu- traveler and on the other it provokes rity. The Law of Moses required rit- admiration for the Samaritan him- ual purity for every act of participa- self, a member of a population which tion in ceremonial worship. The is traditionally the object of con- smallest contact with a dead person tempt. could lead to this purity being lost. The Law declares: “He who touches the dead body of any person shall be 7. A Model to Follow unclean seven days” (Num 19:11). To have participated in ceremonial In conclusion we can observe that worship would have amounted to a our parable belongs to a very special profanation of the House of the Lord category of parables which Adolf and would have involved the punish- Jülicher has termed “example-tales” ment of being “cut off from Israel” (Beispielerzählungen). Rather than (Num 19:13). For the priests the law describing the Kingdom of God of purity was especially strict. It through analogy, as is the case with should be pointed out that the Book the parable of the sower or of the of Leviticus devotes an entire chap- hidden treasure, the example-tales ter to the subject (Lv 21). describe a fact which illustrates a There are thus good reasons for teaching in direct and immediate supposing that the attitude of the fashion. Such is the case with the priest and the Levite described in “parables” (Lk 12:16) of the foolish the parable was the result of concern 15:1-20). The same is done, albeit in wise man, of Lazarus and of the bad over ritual purity. If they had at- more moderate form, in Luke (Lk rich man (Lk 16:19-31), and of the tended to the unfortunate traveler 11:38-41). pharisee and the publican (Lk 18:9- who had been left “half dead” at the All three of the synoptic Gospels 14). In this category of parables the side of the road, they would have (but more emphatically in Luke) in- Gospel of the Good Samaritan occu- risked holding him in their arms volve a relativization of the precept pies a special position because it is whilst he died, an event which about the sabbath day. To the the only parable which has a direct would have led them to have con- episodes which are described involv- invitation to follow the example tracted a very serious impurity ing the ears of corn (Mt 12:1-8; Mk which has been held up by the teller. which was incompatible with their 2:23-28; Lk 6:1-5) and the healing of Evidently enough, the foolish rich priestly “holiness.” the hand on the sabbath day (Mt man, the bad rich man or the prayer The implicit lesson offered by 12:9-14; Mk 3:1-6; Lk 6:6-11), Luke of the Pharisee are not examples to the parable, therefore, might be that adds the story of the healing of the be followed. The prayer of the publi- “mercy” towards the victims of mis- woman bent double (Lk 13:10-17) can is such an example but the fortune must take precedence over and the healing of the man with Gospel does not say this explicitly concerns about ritual purity. This dropsy (Lk 14:1-6). The lesson is al- and merely allows it to be under- lesson corresponds in effective terms ways the same: the urgent need to stood. to a constant orientation and central help one’s neighbor has greater im- The Gospel of the Good Samari- 202 DOLENTIUM HOMINUM tan on the other hand concludes with ment but was effectively translated 8. Conclusion these words of Jesus: “Go on your into action. The Good Samaritan is way, and do likewise” (Lk 10:37). In he “who had pity” and it is in these This, then, is how Jesus answered many other parables the term “bear a terms that he is described in the an- the learned man of law according to likeness to” (from the Greek ho- swer to the question of the learned the Gospel of Luke. He refused to moios) comes at the beginning in or- man of law (Lk 10:37). enter into a legal discussion about der to introduce the comparison: The same Greek expression the definition of the word “neighbor” “What is there that bears a likeness (poiein eleos) is to be found on only and thereby gave a strong impulse to to the kingdom of heaven; what one other occasion in the New Tes- the lawyer to become the neighbor of comparison shall I find for it? It is tament, and more precisely in an- each and every human person. For like a grain of mustard seed, that a other passage from the same over nineteen centuries the Gospel of man has taken and planted in his gar- Gospel. It is applied to God himself the Good Samaritan has not failed to den” (Lk 13:18; see also Mt 13:31; (Lk 1:72) and forms a literary “in- communicate the same impulse to Lk 13:21; Mt 13:33, etc.). In the clusion” with the expression “the those who have reflected upon it. Gospel of the Good Samaritan, merciful kindness of our God” (Lk The Good Samaritan also wants to which is unique in its kind, the ex- 1:78). By being moved (cf. Lk communicate this impulse to us, pression “likewise” comes at the 10:33) and practicing mercy (Cf Lk here, in this international conference, end. It is the last word. By accompa- 10:37) the Samaritan thus made which defines its orientation and di- nying a command it defines a rule of himself resemble God (Cf Lk 6:36; rection by reproposing the final action and shows that the tale which Eph 5:1-2; Col 3:12). He did not ask words of Jesus: “Vade et tu fac has just been narrated offers a model the question: “Is this man my neigh- similiter,” “Go on your way, and do to be followed. bor? Am I obliged to love him?.” likewise.” This model is the Samaritan who On the contrary, he took the initia- was moved by the sight of the half- tive of drawing near to him (cf. Lk Rev. ALBERT VANHOYE, SJ dead man and expressed his compas- 10:34), of caring about him, and he Secretary of the Pontifical Biblical Commission, sion through a generous action. His thereby became his neighbor in un- Professor of the Pontifical “mercy” was not a mere sterile senti- equivocal fashion (cf. Lk 10:36-37). Biblical Institute, Rome VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 203

IGNACIO CARRASCO DE PAULA

The Good Samaritan as an Anthropological Category

Because the title of this paper is From what has been said over the term meaning ‘declare,’ ‘demon- open to a large number of interpreta- last few days, I believe that a unani- strate.’ Categories are a way of ex- tions and because it would be impos- mous answer has already been given: pressing being in the irreducible pe- sible to do justice to them all, it would the Gospel model cannot be reduced culiarity and variety in which being be helpful to begin with a premise to a mere optional element even manifests itself. Categories underline which sets out the parameters of the though it may well be possible to ig- diversity at a primordial level, and in analysis which I will present in this nore it or degrade it to a merely sec- doing this they are set against tran- paper. This year’s international con- ondary role. I myself also propose to scendental realities, which, in oppos- ference has chosen to discuss the re- maintain this second thesis because I ing and contrary fashion, indicate lationship between the Good Samari- believe that it conforms more to truth ways of being which are common to tan and Hippocrates from the point of than does its counterpart.1 The sec- everybody: each existing being, by view of a historical and doctrinal in- ond question, to continue on with the the very fact of existing, is good, is heritance which has been able to per- image borrowed from Maritain, is true, and so forth. Let us here leave ceive complementary elements in the that it seems reasonable to suppose aside the hermeneutic problem raised Hippocratic ethos and in the Gospel that when the medical doctor has fin- by two opposing schools led by Aris- model, elements humanizing and ished his work in the hospital or in his totle and Kant. Here we need only af- completing each other. Whoever fol- private office, he goes back to being firm that an anthropological category lows in the footsteps of the pilgrim of an ordinary citizen and takes off those is nothing but the enunciation of a Samaria does not draw away from clothes which tell the outside world way of being man. proximity to Hippocrates. On the what his profession actually is. Now, An example can be given of this. contrary, that pilgrim comes to un- is it right and possible to carry out the The figure of the father is a classic derstand his meaning and brings Hip- same operation in relation to what model of an anthropological cate- pocrates to his highest point of per- those clothes represent? This ques- gory. The idea of the parent, in fact, fection. Having outlined these con- tion leads directly to another: To what evokes a particular way of being and siderations I would now like to pose extent does the medical ethos affect behaving. Parenthood arises and two questions. the personality and influence the be- manifests itself in opposition to an- havior of the health care worker? other anthropological category, that At first glance common sense of the child. Neither the parent nor 1. Two Preliminary Questions would seem to require a simple an- the child is to be traced back to answer: when the medical doctor, other event or a previous experience. The first question is, How can we whether man or woman, returns And for this reason they are charcter- define the relationship between the home, the intimate concerns of wives, istic elements distinguishing who a two approaches represented by Hip- husbands, and children cannot be lis- parent is and who a child is, as op- pocrates and the Good Samaritan in tened to in the same way as patients posed to somebody who is not a par- rigorous rational terms? Does the im- are listened to; the actions of close ent or a child.2 plicit complementary character of the relatives cannot be observed with the Although the relational dimension two figures correspond merely to a same analytical attention with which provides clear and precise contours of simple –albeit by no means casual— a sick person is examined. At home the categories of parent and child, agreement on ends which must be the hat and the shirt have to be hung mere rationality is not enough to give achieved? Are we dealing here with up when the threshold is crossed. these figures validity. The relation- an extrinsic relationship which arises And yet things are not so simple as ships involved are manifold. A per- from contingent circumstances? Or that. And here we have to introduce son who buys a newspaper estab- do we have before us a convergence the anthropological category. lishes a relationship with the newspa- which rests upon solid and lasting per seller, but it is rather unlikely that bases? To employ an image dear to he will consider the newspaper seller Maritain, could the Good Samaritan 2. Categories as Expressions as belonging to a specific anthropo- be seen as a cap which decks out the of Being logical category. In this case the rela- Hippocratic shirt or a hat which can tionships are confined to the provi- be left behind if circumstances or The concept of category in its orig- sion of a service, something which is convenience so require? inal meaning comes from a Greek thus contingent. An anthropological 204 DOLENTIUM HOMINUM category, to be such, requires, more- Samaritan was. It is certain that he loves does: he can become a “neigh- over, stability, a stability which is at did not go to Jerusalem for religious bor” or an “alien.” In order to illus- the same time required and guaran- or sightseeing reasons. He was proba- trate this antinomy, society provides teed by its being rooted in being. In a bly a merchant or trader. He is able, a number of examples—a judge, a certain sense the parent is in this con- however, to supply a kind of first aid. wealthy benefactor, a master or a dition before the existence of the Indeed, he applies a treatment and or- guide, and so forth. However, the child and will continue to be so even ders the rest and recovery in an inn of Lord chooses a traveler who found if illness were to carry off the child. a man who is seriously wounded. himself in the unusual situation of One is a parent not only through ac- The practice of medicine requires a having to provide first aid to a dying tion—that is, when one behaves as a specific training, but each one of us man. Without forcing our interpreta- parent, but because of the ontological knows that in the must unexpected tion of the parable, there are good rea- structure of one’s own being. moment we could find ourselves in a sons for thinking that the Lord found One final observation to complete situation where we have to improvise a particularly effective meaning in and clarify what I am proposing. Par- the role of health care worker to help the action of taking care of someone enthood can be preached to every our neighbor. In all of us there is a in danger of dying by which to illus- person. Every man and every woman radical readiness to serve life and trate how relationships between men has a connatural disposition towards health. One could say that each one of should really be. The Good Samari- fatherhood or motherhood. Obvi- us carries a little doctor within him- tan engages in a medical action and at ously enough, I am not referring here self. Whether this presence is opera- the same time furnishes an indicative to the essential procreative power of tive or not is quite another question. sign of humanity—care for the sick, the physical structure, and even less The role of the medical doctor, there- for the suffering, for the abandoned. to effective fertility. I am referring, fore, fulfills all the requisites neces- The Good Samaritan represents a rather, to an anthropological dimen- sary to belong to an anthropological specific model for behavior. The sion, to a true constituted being who category. But is the model of the parable speaks about a priest and a can only be neglected at a very heavy Good Samaritan a good way by Levite precisely in order to compare price. This also holds good for those which to define this category?4 these two figures to the traveler who who decide not to generate other indi- comes after them. The impression viduals out of a higher motive. In- which we gain is that the list could be deed, such people can only translate 4. The Anthropological even longer—a politician, a soldier, a the anthropological character of fa- Structure of the Model merchant, a scribe, and so on. But this ther/mother into spiritual fatherhood of the Good Samaritan would be at the cost of making the or motherhood. story unnecessarily heavy. The two The first indications which emerge individuals devoted to worship are from a reading of the parable of the enough. The Gospel does not explain 3. The Medical Doctor as an Good Samaritan lead to a negative re- the reasons for their behavior even Anthropological Category sponse. The question asked of our though we could give some very Lord does not concern the approach good guesses.5 However, what is im- I have dwelt upon this model, which should be adopted towards a portant here is not the ethical judg- which is well known to everybody, sick person. It is not a question about ment which excuses or condemns the not so much because the figure of the how the sufferings of a patient should act of omission on the part of the father and the figure of the doctor be alleviated. Moreover, it does not priest or the Levite, but the fact that have many elements in common,3 ask for advice in relation to matters of men can be divided into two cate- but, rather, in order to give a clearer professional ethics. The question gories: those that are prepared to be- idea of the path I propose to follow to deals, rather, with the following prob- come “neighbors” and those that are evaluate and assess the relevance of lem: Who are the individuals that I not. Obviously enough, to become a the Good Samaritan as an anthropo- must love as myself? Who is my “neighbor” we do not have to pour logical category. However, before di- neighbor? It is taken for granted that out wine or oil or spend money. And recting our attention to the parable not all men are worthy of my love, yet by acting in this way the Good narrated by Christ, we must examine and for this reason Jesus is asked to Samaritan makes himself a “neigh- whether a disciple of Hippocrates re- indicate and describe the signs or the bor” and at the same time demon- ally has valid grounds for aspiring to conditions which would enable us to strates a way of being and living such a status. recognize those people who are de- which is human in the fullest sense of It seems incontestable that the fig- serving of such an elevated form of the term. ure of the medical doctor cannot be love. In order to complete these reflec- traced back to a previous model. He Furthermore, the answer of the tions I would once again draw atten- has his own specific characteristics: a Master is not evasive, it does not tion to a key feature of this anthropo- way of being a man at the service of dodge the question which has been logical category: the ability to per- other men based upon a relationship posed. Indeed, it seeks to give full ceive the unfortunate person and the of opposition to the illness which satisfaction to the questioner. Christ situation he is in. What did the trav- threatens their humanity and places does not want to direct the argument eler from Samaria see which the oth- the subject in another category—that into the subject of doctors or medi- ers had not seen? The man? The of the patient or sick person. But we cine. He wants to show that “special” wounds? The need...? All these ele- still have to discover the anchorage of conditions which act to render people ments were more than obvious, and this in the being of the person. In sur- worthy of love do not exist. The fact to such an extent that the priest and prising fashion the parable of the of existing and of being met is the Levite avoided being involved in Good Samaritan comes to our aid. enough. Now, although love does not the affair. The Good Samaritan per- We do not know who the Good know categories, the individual who ceived something more—that is, a VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 205 man who should be loved as we love essarily mean that the indispensable ical doctor would do that which a ourselves, and without any condi- role of justice is denied. Whether or school teacher or a hotel keeper (and tions: he felt himself called upon by a not his observations are relevant (and the list does not end here) would do. person who was worthy of infinite I would say that they are not), we The question is meaningful only if love. should indeed seek to understand the posed to a military man. substance of these objections, quite The anthropological category rep- apart from the literal approach em- resented by the Good Samaritan does 5. A Response to Some Critical ployed by Childress. not constitute an instrument by which Observations It seems to me that his reading of to analyze medical reality in order to the parable does not help us in our obtain practical results. It is a means We cannot conclude these research for its anthropological mean- by which to achieve a suitable de- flections without referring to some ing. His reading is of use in the for- scription of the way in which human- critical observations which have been mulation of rules and the provision of ity—or the program of humanity made. In practical terms I am think- solutions in relation to the very many which is present in each and every ing here of the observations made by dilemmas which now present them- person—is achieved in those who Childress,6 one of the most significant selves both inside and outside the commit themselves professionally to experts on bioethics in the United world of medical ethics. What should that area of extraordinary richness States of America. This writer be- the Samaritan have done if the rob- and complexity which is the life and lieves that the model of the Good bers had returned to the site of the health of man. Considered overall, Samaritan is an inadequate model be- crime? What should a doctor do at the Good Samaritan behaves very cause it does not give answers to all Sarajevo when bombs are raining well, both as a medical doctor and as the possible situations which involve down? These questions do not be- a man. By practicing medicine by a doctor and his patient. It is sug- long to the specific category of the pure chance he becomes a neighbor gested that the charity which can lead profession. In basic terms, the med- to someone and in so doing he loves him to treat the victim would not others as unconditionally as he loves leave room for justice. Indeed, one himself. could even doubt the ethical validity We have before us an anthropolog- of his behavior because he takes im- ical category which never ceases to mediate action without informing amaze us. himself beforehand about the wishes, the preferences, or will of the individ- Monsignor IGNACIO CARRASCO ual concerned. The approach of the DE PAULA Good Samaritan is said to be disre- Member of the Pontifical spectful in relation to the indepen- Academy for Life, dence of that poor man. I think that Professor of Moral Theology at the Roman Atheneum of the Holy Cross, this criticism gives some idea of the Consultor to the Pontifical Council for narrowness of mind with which Chil- Pastoral Assistance to dress—who in his other writings is a Health Care Workers careful and rigorous author—approaches the parable of the Good Notes Samaritan. Furthermore, the author wonders 1 As Evangelium Vitae implicitly reveals, what the Good Samaritan would have Hippocrates, although pagan, has not been able to obtain the respect of a culture which denies done if he had encountered a number the existence of any relationship between the of men rather than just one individ- divine and the human. Indeed, the Hippocratic ual. How would he have allocated his Oath has been eliminated from most codes of medical ethics. resources, the wine and oil he had 2 Parenthood necessarily implies the exis- available, the money to pay for the tence of a specific role—that of having gener- inn as long, that is, as it was possible ated another human being and of having taken to find a bed for each person? This on oneself the task and the responsibility of providing for, and taking care of, the growth also, it is suggested, would have con- and upbringing of that human being. stituted a limitation on his actions, or 3 This nearness conceals a danger observed at least a problem which would have by modern criticism—the transfer tout court of remained unsolved. the parental model to the role of the medical doctor, something which gives rise to the much Our critic concludes by arguing deprecated (perhaps overly deprecated) phe- that we do not know what the Good nomenon of paternalism. Samaritan would have done if the 4 The motives which lie behind this behavior of the Good robbers had returned while he was at- Samaritans do not of themselves allow us to tending to the wounds of the man left create a category. Charity is the substance of for dead. Would he have attacked the parable. But charity is not an anthropologi- them to defend his own life and that cal category it is a virtue. Charity penetrates the whole of man and not an aspect or a particular of his neighbor? Or would he have area of his being and his acting. treated the thieves as his neighbors? 5 The priest ran the risk of rendering himself Let us leave aside the fact—ig- unable to take part in ceremonial worship. 6 SEE J.F. CHILDRESS, “Amore e Giustizia nored by Childress—that when em- nell”Etica Biomedica Cristiana”, in E. E. phasis is placed on the primary im- Shelp (ed.), Teologia e Bioetica (Edizioni De- portance of charity, this does not nec- honiane, Bologna, 1989), pp. 355-382. 206 DOLENTIUM HOMINUM

ANGELO BRUSCO

The Model of the Good Samaritan in the History of Hospital Care

Jesus Christ is the fulfilled model 1. The Pre-Christian Period (the asclepiei, the iatreia, the valetu- of the Good Samaritan, and this dinari, the medicatrine) there were model is offered to us not only in the We can detect the presence of nu- moving expressions of love towards parable in the Gospel according to merous features of the model of the one’s suffering neighbor. We know St. Luke but also in the texts of the Good Samaritan which has been out- of many examples of altruism in- Holy Scriptures taken as a whole. lined above in the history of care fused with an attempt to combine ef- The principal features of this model provided by health care institutions ficiency with compassion. There can be summarized as follows: during the period which preceded were also evident efforts to over- Ð He is a wounded healer, that is to the birth of Christ. come the barriers of social class. The say a person who can turn his own use of religion in the process of heal- suffering into a source of healing for The Wounded Healer ing was also often present. The influ- other people. As the prophet Isaiah The metaphor of the “wounded ence of such great figures as Hip- declares: “Surely he has borne our healer” arose in ancient Greece and pocrates and Galenus, and of the griefs and carried our sorrows; yet served to indicate that those who Greek schools, helped to create a we esteemed him stricken, smitten care for the sick should first look to medical and health care culture in by God, and afflicted. But he was their own wounds and understand which major emphasis was placed wounded for our transgressions, he them within the context of their own upon the idea of complete health and was bruised form our iniquities; experience. The freedom to draw upon such important moral values as upon him was the chastisement that near to sick people with compassion respect for the individual and his made us whole, and with his stripes for their suffering, and with partici- life.2 we are healed” (Is 53:4-5). pation in their suffering, springs In the general context of Greek Ð He takes the initiative, that is to from this process of self-healing. and Roman health care, however, say he goes towards those who suf- The myth of Aesculapius is very there were certainly negative ele- fer. illustrative here. The son of Apollo ments which worked against the Ð He is capable of compassion and and Coronis, he was wounded even model of the Good Samaritan. giving welcome. before he was born. What had hap- Ð He is not influenced by preju- pened was that his mother had been The Unhealthy Use of Religion dices about the race, the culture, or unfaithful to Apollo and had been Because of its close connections the social class of the sick person. wounded by an arrow fired by with religion and because of the in- Ð In his approach to things, health Artemides while she was still preg- adequacy of existing medical scien- and salvation are closely correlated. nant with Aesculapius. She had also tific and technological knowledge, Ð Commitment to serving the sick been condemned to die by fire. health care was often influenced in a person can also involve the giving of When Coronis was on the pyre, negative fashion by superstition, by his own life. Apollo took Aesculapius from his witchcraft, and by charlatanry. Down through the centuries how mother’s womb and thus saved him Those responsible for religion could has this model—which was incar- from the flames. The upbringing of easily become manipulators of the nated in the person and the actions of the baby was then entrusted to the sick and could exploit the suffering Jesus Christ—been put into prac- centaur Chiron who practiced the art of the sick to their own material ad- tice? of healing. Chiron suffered from an vantage. Each of the features outlined incurable wound which Hercules “The healers gained a great deal above has found concrete expres- had inflicted upon him. A healer in from their art both in terms of money sion, or at least partially, during each need of healing thus taught Aescu- and gifts. There was even a real and period of history. This is not to deny, lapius the art of healing, that is to say authentic commercial association of however, that different historical the ability to find himself ‘at home’ these healers who joined together in moments have witnessed the expres- in the darkness of suffering and to organized form. The sick customer sion of these features in very special find in that darkness the seeds of of a rather gullible character was informs. light and of healing1. vited to one temple after another and This is what I will try to demon- was expected to leave a large gift of strate during the course of this brief A Sense of Humanity money or goods in each. The way in paper. In the Greek and Roman hospitals which these astute healers worked VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 207 their treatment was the object of term “hospital” and has bestowed spirit and soul—is rooted in the min- satirical criticism by Lucian in his honor upon health care institutions. istry itself of Christ. The attitude of Shop of the Gods and by Aristo- Such great physicians as St. John the Good Samaritan has never been phanes in the comedy Pluto.”3 Chrysostomus, St. Gregory of forgotten as a way of life. However Nyssa, St. Basil, St. Clement of there have been people who have Alexandria (in the East), and St. Am- used this as the basis for a program 2. The Christian Period brose, St. Augustine, St. Cesarius of in such an intense fashion they have Arles, St. Gregory the Great (in the become veritable founding fathers in In a document of the third century West), dedicated great importance to this area. One of these figures was after Christ we can detect certain the value of hospitality. The term St. Camillus De Lellis. When pro- characteristics of the transition from Hotel-Dieu given to hospitals in claiming his canonization, Benedict pagan to Christian culture. This doc- France and its colonies in Canada XIV declared that he was the ument is made up of a number of clearly expressed the evangelical founder of a “new school of charity.” verses from a poem on the duties of character of the welcome given by One of the aspects of the newness of the physician. The disciple of Aescu- the Lord to the poor and the sick. his approach lay in the importance lapius, it is asserted, “should be sim- The monasteries also gave a no- he gave within the health care pro- ilar to God: the savior equally of ject to all the needs of the sick per- slaves, poor people, the rich, son, whether physical, emotional, princes...and he should help them all, social or spiritual. being brother to them all. He should Does this not lead us to reflect on not hate anybody, nor nurse envy the fact that today great effort is de- within his heart, nor inordinately voted to promoting a “holistic” or raise his fees.” How can one fail to overall approach to health care both find in these words an echo of the in relation to medicine and with re- Gospels?4 gard to nursing? In the Apostolic Exhortation Christifedeles Laici one reads the Emotional Involvement following lines: Given that the sick person must be “The Christian community has cared for in his entirety, the health written anew, down the centuries, care worker must commit himself the evangelical parable of the Good completely and must add “heart” to Samaritan, and has revealed and scientific knowledge and action. communicated the love for healing “More heart in those hands!” was and consolation of Jesus Christ. This one of the injunctions that St. Camil- has taken place through the witness lus De Lellis gave to health care of religious life consecrated to ser- workers. He also wrote down the fol- vice to the sick and through the un- lowing rule: tiring commitment of all health care “First of all each person should workers” (no. 35). ask the Lord to give him the grace of We can detect various periods in maternal affection to his neighbor so this writing anew of the gospel para- that he can serve him in all charity, ble and the consequent imitation of both in soul and body. This is be- the Good Samaritan, and we can per- table impulse to this hospitality, and cause we want, through the grace of ceive elements which have emerged were also major centers of learning God, to care for all sick people with especial prominence. and charity. We can not fail to see in with that affection which a loving this fact a convergence of Christian mother gives towards her sick only a) Before the French Revolution mission—practiced by bishops, child.”6 It has been historically demon- members of religious orders and the And who can ignore the immense strated that until the French Revolu- lay faithful—with attendance to the contribution given to health care by tion, and even beyond, care for the needs of the poor and the dispos- the foundation of the Daughters of sick took place under the impulse of sessed.5 Charity by St. Vincent De Paul? Christian doctrine. Even when gov- One saint, and more particularly They were “some of the first to con- ernment and other non-religious St. John of God, received and prac- secrate themselves to God outside bodies took on the responsibility of ticed the value of hospitality and the convent walls.” These nuns have building and managing hospitals, made it an instrument of the redemp- given greater prominence to the fe- they were guided by gospel princi- tive love of Christ towards those male face in the corridors of hospi- ples which found their most com- who live the difficult season of tals, a face made up of tenderness plete expression in the figure of the poverty or suffering. The Hospitaller and of compassion. Good Samaritan. Order which was established by St. The aspects of the model of the John of God added the vow of hospi- The Giving of Oneself, Even Good Samaritan which emerged tality to the three traditional and con- to the Point of Martyrdom most prominently during this long ventional religious vows. This is as aspect of the model of period were as follows. the Good Samaritan which has shone The Overall Approach with great light during the history of Hospitality to the Sick Person health care. The history of the This aspect of the Gospel text is The approach to the sick person in Church contains a large number of expressed in the meaning itself of the the entirety of his being—his body, men and women who have sacrificed 208 DOLENTIUM HOMINUM their lives caring for people who backs. As one historian from the sev- process created great hopes but also were afflicted with infectious dis- enteenth century puts it: “The hospi- provoked dramatic disappointments. eases. They thereby showed that tals were so hated and looked down What happened to the model of “devotion to the point of martyrdom upon by men of a certain position the Good Samaritan during this pe- is one of the principal aspects of the that priests did not want to go there riod? The salient features of the story prophetic character of Christian life whatever was offered them. It often can be outlined as follows: and in particular of the life of those happened that the bishops and other who belong to religious orders.”7 gentlemen of the hospitals were Technology as an Instrument The plague of 251 AD, when St. forced to use the scum of the earth, of Charity Cyprian displayed great holiness; that is to say ignorant, outlawed or There can be no doubt that the the plague which devastated half of prosecuted ministers, and placed overt aim of technology is to human- Medieval Europe; the pestilence of them in these places under penitence ize. One need only think here of the the sixteenth century which wit- or punishment.”8 Similar things are ability to prolong lifespan, to reduce nessed the actions of St. Charles said by authors writing during subse- suffering, and to improve the quality Borromeo; and the numerous out- quent centuries.9 of the social role of individuals. The breaks of infectious diseases have all use of ever more sophisticated ma- had a great impact upon thousands chines and instruments offers pa- and thousands of believers. They tients new chances of being cured, an have seen how the performance of expanded number of alternative service even at the risk to one’s own ways of being treated, and greater life can involve the fulfillment of an opportunities of communication. individual’s Christian and human From this point of view, technology vocation through the following of can be seen as a modern and effec- the example of Christ, the divine tive instrument for the expression of Samaritan, the physician of souls humanism and charity, as is evident and bodies. from the founding charter of the Sis- At the same time certain deforma- ters of Charity of St. Vincent De tions of the model of the Good Paul. It is clear, therefore, that the Samaritan are easily detected during Good Samaritan of modern times this period. also dwells in the new temples of medical technology, cooperating The Decline of Hospital Facilities thereby in the creative and redemp- The causes of this phenomenon tive action of the Lord. are to be attributed to maladminis- tration, corruption, and failure to The Rationalization live up to the ideals which had in- of Administration spired the foundation of the hospi- The rational organization of work tals. Indeed, the cultural shift from has favored real human progress and the Medieval period to the Renais- the sound administration of a health sance was not without a certain neg- care institution is the expression of ative influence upon the systems of genuine charity. The great hospital values which governed health care, saints provide a good example of as can be understood from certain b) From the French Revolution this. St. John of God was discharged descriptions of what happened to to the Present Day from a hospital where he had been Roman hospitals during the six- The Enlightenment led to great re- treated and then proceeded “to found teenth century. forms in the health care field. In another which was alternative to the large part these sprang from the tak- public service but not in competition Lack of Respect for the Religious ing of hospitals out of the hands of with it in order to demonstrate at a and Moral Beliefs of Sick People the religious orders, a process which practical level that it was possible to Sick people were forced to receive although not unknown in the past provide everybody with health care the sacraments as a pre-condition to during this period took on an irre- which was worthy of the human per- their being treated. There were few versible force. The state was encour- son, a health care based upon com- examples of opposition to this prac- aged to become responsible for the petence, solidarity, and upon solidar- tice (St. Camillus was a rather lone health care structures. Differently to ity at the service of love. His direc- voice) which, unfortunately, contin- what had happened previously, the tion followed new and up-to-date ued to exist until the nineteenth cen- Enlightenment and above all else the criteria some of which were well be- tury in the hospitals run by the French Revolution involved the fore their time”10. The same impres- Church. placing of health care institutions in sion is gained from a reading of the non-religious hands in a way that “Orders and methods to be followed The Crisis of Spiritual Care was linked to a departure from the in hospitals to serve the sick poor” This crisis took place during the Christian vision of man. The En- composed by St. Camillus.11 sixteenth, seventeenth, eighteenth, lightenment’s dream that illness and The modern administrator is a and nineteenth centuries, and is also death could be weakened penetrated Good Samaritan when amid the “pa- to be found in the health care institu- the culture of the modern health care pers, tasks, and ever more compli- tions managed by the hospitaller or- world and was promoted by the cated machines” of his office he ders. The hospital became a place enormous advances achieved by sci- knows how to keep the spirit of giv- upon which priests turned their ence and medical technology. This ing within his heart and he has the VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 209 strong conviction that at the center of tant in character. ministrator are very relevant here: his work is to be found Christ present In relation to administration in the “For a long time now the need has within a sick person. Who has not health sphere, we need only think of been proclaimed, and quite rightly, been led, in a state of constant spiri- the bureaucratization of the systems for a humanization of hospital health tual tension, to ask himself the fol- of service, a process which easily en- care, but we might ask if the debate lowing questions: genders apathy, routine, resistance to has also involved reference to the “Does this work really respond to change, and errors at the level of humanization of hospital administra- present-day needs? What should be communication. Specialization and tion. Those who work in constant the relationship between the human standardization in work and behav- contact with those who suffer are criteria of profit and prestige and the ior are often useful in creating generally helped in finding out what healthy criteria of realism not devoid greater efficiency but when they are the inhuman aspects of their behav- of an element of trust in providence? carried to an extreme, which indeed ior really are. But those who work in How can we give practical expres- often happens (not least because of the administrative sphere are more sion to the Church’s choice in favor the demands of trade unions), it be- subject to the risk of quantifying the of the poor and the marginalized comes difficult to respond in a per- sick, of thinking more in terms of without falling into acts of discrimi- sonal way to the problems of the sick bed space and meals available than nation? Is the administrative dimen- in terms of suffering people, and of sion of what is done both right and giving an absolute character to their open to compassion as an essential role and thereby closing themselves part of the complex human condi- to renewal, to dialogue, and to co- tion? Does it set a good and con- operation.”14 structive example for the present When administration is human- and the future? Is it integrated into ized it can itself become a source of the Church community? Does it humanization: have sound relationships with paral- “The support of an input of hu- lel initiatives taken as a whole? Is manity which should animate all there a clear sense of the transient those who work together is a part, in character of everything which is hu- fact, of healthy and humanizing ad- man?12 ministration. This is especially true in situations where it is necessary to Humanization create a climate of cooperation, re- The Good Samaritan of modern spect differences of opinion, and times carries out his mission through work together in a group. Humanity a humanization of the world of creates humanity and from the ad- health and suffering.13 Although sci- ministration in the hands of a mem- entific and technological progress in ber of religious orders there should the sphere of medicine and in rela- flow out that humanity and affection to administration has brought tion which are aimed at reaching the great advantages, it has also given patient and his environment.” rise to, and still gives rise to, serious How can we forget that refrain disadvantages. sung by the Genoese on the death of The difficult side of the applica- St. Catherine of Genoa? “But look: tion of technology to health care and person which are of a very individual in Genoa—a saint amongst the ad- treatment is to be found in the fact character because of their specific ministrators. So we also have a that this can involve neglect of man nature and their emotional dimen- chance, don’t we.” The saint lived at the very moment when an attempt sion. during the second part of the fif- is made to heal him. We could think The bureaucratization of services, teenth century and spent most of her here, for example, of everything con- for example, has contributed to a years serving the poor, thereby be- nected with ‘therapeutic overkill’. move from the predominance of pri- coming poor herself. On the one hand, there is the em- mary and family relationships to the ployment of very advanced techno- preponderance of functional rela- The Defense of Life and of the logical methods to keep the patient tionships which have become ever Individual alive, and, on the other, there is a more impersonal. In the functional In the Encyclical Evangelium Vi- lack of attention paid to the value of relationship the other person is not tae this aspect of the Good Samari- the dignity of the individual and to seen as an individual but merely as a tan of modern times is well brought respect for the individual. unit which furnishes or receives ser- out. He strives to ensure that within Another example is to be found in vices. Attachment, interest and love the health care world the logic of cases where suffering is treated in a tend to be substituted by the cold technology does not triumph over merely technological fashion, that is laws of a contract of work. It seems the logic of ethics, and that the dig- to say without any consideration of the case that compassion, identifica- nity of human fragility is respected, the fact that suffering is experienced tion with those who suffer, and per- as is necessary when man is afflicted by a person who feels its repercus- sonal involvement, are not encour- by physical or mental woes. Pain, ill- sions at all levels of his being. The aged by the health service system. ness and death are a part of life. illness is treated but the man is not We are led to ask ourselves about the There cannot be growth without suf- and for this reason the health ap- extent to which the administrative fering, and suffering can be trans- proach is often merely a clinical ap- apparatus can really be animated by formed into an opportunity to proach which is ascetic, cold and dis- human values. The words of one ad- achieve growth. 210 DOLENTIUM HOMINUM

The ethical dimension to service health. There is an ever increasing ple—doctors, nurses, other health- to life and the sick is not confined to number of marginalized people, vic- care workers, volunteers—that the the field of research but also includes tims of selfishness, violence and in- call becomes the living sign of Je- care at both a medical and an admin- justice to be found in the way of sus Christ and his Church in showing istrative level. Administration, in- progress. They go under a variety of love towards the sick and suffering” deed, should be based upon the names—lepers, AIDS victims, drug- (no. 53). moral values of justice, equity, re- addicts, the dying, the chronically ill. spect for the sick and those who are A great many Good Samaritans, Rev. ANGELO BRUSCO, MI dependent upon them, the invest- whether professionals or volunteers, Superior General of the Ministers ment and distribution of resources, come to the aid of this suffering hu- of the Sick (Camillians), Italy Member of the Pontifical and so forth. manity. Mother Theresa of Calcutta Council for Pastoral Assistance is a name which symbolizes many of to Health Care Workers Evangelization: these Good Samaritans. Health and Salvation The move from a society which is cohesively Christian to a society Conclusion Notes which is culturally, ethically, and re- 1 Cf. A. BRUSCO, “Vulnerabilità Personale ligiously pluralistic has given new What will be the dominant fea- e Servizio agli Infermi,” in Camillianum, 8, importance to the need to link health tures of the Good Samaritan during 1993, pp. 223-242. and salvation together in an effective the post-modern era? This is an era 2 Cf. D. CASERA, Chiesa e Salute (Ancora, Milan, 1991), pp. 9- 14. fashion, taking the work of Christ as characterized by weak thought, an 3 A. CASERA, L’Ospedale e l’Assistenza ai a point of departure. The Christian era which trivializes reality and Malati nel Corso dei Secoli (Salcom, Varese, health care institutions and the pro- events such as death and birth. It is 1990), p. 21. fessional health associations seek to resistant to the idea of accepting pain 4 G. BOTTURA, Il Giuramento di Ippocrate. I Doveri del Medico nella Storia (Riuniti, promote overall health which even as a component part of human expe- Rome), p. 29. touches upon the transcendental di- rience, but it is also rich in positive 5 Cf. D. CASERA, op. cit., p. 63. mension. Who could underestimate resources such as solidarity and the 6 M. VANTI, Gli Scritti di San Camillo the importance of this aspect of the thirst for a better world.15 (Rome, 1952). 7 Letter of Cardinal A. Sodano to the Supe- Good Samaritan? The answer lies in the essential rior General, Rev. Angelo Brusco, on the oc- component element of the model of casion of the establishment of the Day of On the Side of the Poor the Good Samaritan—love. All of us Camillian Religious, Martyrs of Charity, L’Osservatore Romano, May 26, 1995. and the Least are called to this approach of the 8 S. CICATELLI, Vita di San Camillo de Lel- This aspect of the Good Samaritan mind and the heart, as indeed is well lis (Viterbo, 1615), p. 86. has always been present down the pointed out by the already men- 9 A. BRUSCO, P. Camillo Cesare Bresciani ages. It is a part of the mission of tioned Apostolic Exhortation Chris- (Il Pio Samaritano, Milan, 1972), p. 62. 10 D. CASERA, op. cit., p. 89. man, not only of the Church. For be- 11 tifideles Laici: M. VANTI, op. cit., pp. 52-77. lievers it is an inescapable impera- “Today there is an increase in the 12 A. BRUSCO (ed.), Religiose nel Mondo tive and an integral part of faith. In presence of lay women and men in della Salute (Turin, 1993), p. 183. modern times it has taken on an es- 13 Cf on this subject: A. BRUSCO, Umanità Catholic hospital and healthcare in- per gli Ospedali (Salcom, Varese, 1983). pecial importance because of the stitutions. At times the lay faithful’s 14 A. BRUSCO, (ed.), Religiose, p. 184. great injustices which prevent a just presence in these institutions is total 15 Cf. various authors, Coscienza Etica e distribution of obtaining good and exclusive. It is to just such peo- Mondo della Salute (Rome, 1991). VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 211

J. AUGUSTINE DI NOIA

The Virtues of the Good Samaritan: Health Care Ethics in the Perspective of a Renewed Moral Theology

The formulation of my assigned ut to take up the challenge posed by formation in which we become good topic is significant: it is not just the the question, “why be moral at all?” by seeking the good. conduct of the Good Samaritan that and at least to sketch how our an- The good we seek is thus a com- concerns us here but the virtues un- swer here might shape our approach plex personal good. It is the good of derlying that conduct. to the other question, “what must I personal union with the Father, This formulation signals a shift in do to act morally in this or that through the Son, and in the Holy prevailing conceptions of moral the- health care situation?” Spirit. With Christ as the pattern and ology and thus of health care ethics The encyclical Veritatis Splendor principle of this transformation, as well. In its simplest terms, it is a is unique among the recent docu- moral life is a matter of growing fit- shift from a precept-centered to a ments of the Magisterium in taking ness for the life of trinitarian com- virtue-centered ethics. In part, this up the more radical question, “why munion, already initiated in Baptism shift reflects developments in philo- be moral at all?” In adressing the and to be consummated in the life to sophical ethics and, in Catholic question, the encyclical marks a crit- come.4 moral theology itself, a recovery of ical turning point in the renewal of The Catechism of the Catholic the riches of the biblical, patristic and moral theology initiated by the Sec- Church follows the encyclical in high scholastic sources of tradition.1 ond Vatican Council.2 Sweeping teaching us that moral life is nothing But an even more important im- aside both the legalism of past less than life in Christ. The Cate- petus for this shift has come from Catholic moral theology and the chism’s discussion of the ten com- the renewed moral theology pro- patchy remedies for it advanced by mandments is prefaced and perme- pounded by the Church’s Magis- some recent moral theories, our ated by its account of the principles terium in the encyclical Veritatis Holy Rather invites us to think of of the moral life which, in effect, Splendor and in the Catechism of the the moral life in a new, and perhaps constitutes a highly elaborated an- Catholic Church. Catholic moral even unfamiliar, way. Veritatis swer to the question, “why be moral theologians and bioethicists are be- Splendor argues that, in authentic at all?” Both the Catechism and Ver- ing invited to locate discussion of Catholic moral teaching, obedience itatis Splendor frame their answer to the rightness or wrongness of partic- to the moral law has its proper this question in terms of communion ular actions within the broader con- meaning only within the context of with the triune God and transforma- text of the moral good and its pur- the divine invitation to trinitarian tion in Christ. Together, they place suit. In this brief paper, I shall at- communion and, directed to that obedience to the divine law in its tempt to identify the nature of this communion, our own transforma- properly personalistic context. shift and indicate something of its tion in the image of Christ. If not a Moral life as such can never be re- impact on health care etichs. revolution, the encyclical certainly duced to the observance of law but In the field of health care ethics as signals a critical turning point in must be seen as the pursuit of the in other areas of life, we are familiar Catholic moral thinking—and, as good that the divine law insures and with the question, “what must I do to we shall see, one with crucial conse- undergirds. act morally in this or that situation?” quences for Catholic health care The fault of moral theology in a But the more radical question, “why ethics.3 more legalistic vein has been to lose be moral at all?” is one that we pose The question, “What must I do to sight of this profound truth of the rarely if at all. Perhaps we think that act morally in this or that situation?” authentic Catholic moral tradition, the answer to this more radical ques- is transposed in the encyclical to the recovered and forcefully pro- tion is self-evident, or that the ques- plane defined by another question, pounded by Veritatis Splendor and tion itself is too abstract. But it is a “what good must I do to have eternal the Catechism of the Catholic mistake to avoid the radical ques- life?” Eternal life is nothing less Church. tion, “why be moral at all?” By than a participation in the highest A simple analogy will help us to framing the issues of health care Good, the good of the divine com- see the contrast between the legalis- ethics precisely in terms of the munion shared by the Father, Son tic and personalistic conceptions of virtues of the Good Samaritan, the and Holy Spirit. The moral life—life the moral life that are at issue here. organizers of this conference impel in Christ—involves a gradual trans- Suppose that, while you are in the 212 DOLENTIUM HOMINUM process of preparing dinner, one of fitness for the communion of trini- pone rather than inspire action: “Is your children comes into the kitchen tarian love.5 she my neighbor?” “What about that eating a fistful of cookies, and you We can begin to see, then, that to fellow over there: Is he my neigh- say, “Stop eating those cookies!” discuss the virtues of the Good bor?” and so on. But Christ will al- When the child asks with “why, Samaritan is to locate the central low none of that. “Which of these mother?” at least two replies are agenda of Catholic health care seems to have been neighbor?” he available to you. On the one hand, ethics precisely within the frame- asks. In doing so, he challenges the you might respond: “I am your work of the renewed moral theology lawyer - and us - to look, not around mother, and I make the rules in this advanced by the Magisterium. us at others, but at ourselves, in or- household. Here, we do not eat The parable of the Good Samari- der to determine whether we under- cookies before dinner!” On the other tan itself encourages us to think stand and possess the personal traits hand, you might say: “If you eat along these lines (Luke 10:29-37). that would enable us to act in a those cookies, you will ruin your ap- Consider a feature of the parable neighborly manner towards another petite and be unable to enjoy your that is sometimes overlooked. The whatever the circumstances.6 favorite dinner.” The first answer lawyer asks, “Who is my neighbor?” The Samaritan’s actions in the appeals to your authority as a law- and in response. Christ tells a story. story tell us something about his giver and to the precepts you enjoin, character, and thus something about while the second appeals to the good the virtues that constitute neighbor- of the child. Attending only to the liness. What does it mean not only to logic of moral argument here (and act as a neightbor, but to be one? not to the principles of child-rear- The Samaritan’s conduct in caring ing!), in the first reply what is at is- for the man who fell among robbers sue is the observance or transgres- is correct and even, as bioethicists sion of a precept, while in the sec- have noted, supererogatory.7 But the ond it is the embrace or rejection of spontaneity and thoroughness of this a moral good. conduct suggest something deeper. Together, Veritatis Splendor and They exhibit a developed or settled the Catechism propound a renewed disposition to act with courage, moral theology in which the central compassion and justice in situations categories of the moral life are not like the one he faces in this instance. the permitted and the forbidden, but The parable thus exemplifies the the good and the bad. The divine law principal characteristics which, ac- forbids what is always harmful to us cording to classical moral theology, (viz., intrinsically evil acts) and mark virtuous action: readiness to commends what makes us good. In do the good, ease in accomplishing each action, and in some more than it, and satisfaction in its perfor- others, we seek the good or fail to. mance.8 And through each action, and in It follows that Christ’s concluding some more than others, we become words, “Go and do likewise,”— good or fail to. Virtue grows in us, which give this conference its theme or, in its absence, vice. In this per- —must be understood as a prescrip- spective, our actions are right or But, by the story’s end, it is clear tion not just for action but for the wrong, and they incur praise or that our Lord has in mind a question personal conversion and transfor- blame, because they are good or quite different from the one posed mation that would enable us to do bad, and not the other way around. It by the lawyer. Christ’s question is limewise. We must become like the is not the fulfillment of duty or of not, “Who is my neighbor?” but, Good Samaritan in order consis- obligation as such that make us “Which of these three seems to you tently to act as he did in the circum- good-for then the only virtue would to have been neighbor to the man stances he encountered in the para- be obedience - but the pursuit of the who fell into the hands of the rob- ble. It is not just his conduct that we moral good enjoined by duty and bers?” or, in other words, “What must imitate, but his virtues. obligation. The moral life is a trans- does it mean to be a neighbor?” To Perhaps no passage of the Scrip- formed or transfigured life in which be sure, there is every reason to sup- tures has served as a more potent the theological and moral virtues pose (as the tradition has) that our source of inspiration for health care play a central role. Lord means us to understand that than the parable of the Good Samar- According to the image of Christ every needy person is our neighbor. itan - so much so that, as our Holy and through the grace of his incarna- But the parable itself offers a de- Father wrote in Salvifici Doloris, “it tion, passion, death and resurrection, scription of what it means to be a has become one of the essential ele- we are changed in our very being neighbor and to act in a neighborly ments of moral culture and univer- and empowered to live and act in the manner towards another. The sally human civilization.”9 Still, as manner of adopted sons and daugh- lawyer’s question, “Who is my our Holy Father also noted there, be- ters who share the life of the triune neighbor?” has a theoretical—in- cause of its specifically evangelical God. The good that we must seek deed, as St. Luke suggests, a self- content, the parable makes us think and become is thus a radically per- justifying—air about it, and invites of the profession of health care sonal good, that of a grace-enabled the sort of reflection that can post- workers as a true vocation. It has al- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 213

ways been clear, throughout the his- thorough knowledge of the relevant duct of the Good Samaritan.12 Both tory of this great profession among biological and technical information the patient and the professional are Catholics and Christians generally, and of the pertinent ethical norms, embraced by the invitation to the that the possibility of embracing the but also the interior disposition to destiny of ultimate communion, and vocation of the Good Samaritan de- apply them for the good of the pa- ethical decisions in the health care pends in large part upon a personal tient as well as for the good of the field have their deepest meaning transformation.”10 professional. Indeed, as the tradition within the context of the pursuit of Perhaps presupposing this under- of Catholic health care has insisted, this ultimate good. lying Christian conception of the the good of the patient depends on But even a brief discussions of the vocation of health care, modern the goodness of the professional. significance of the parable of the bioethics has given it little explicit The virtues of fidelity to trust, com- Good Samaritan for health care treatment and has concentrated in- passion, prudence, justice, fortitude, ethics would remain seriously defi- stead on the ethics of decision-mak- temperance, integrity, and self-ef- cient if it failed to take account of ing in the particular, and admittedly facement are crucial to the forma- the allegorical reading of this para- difficult, situations that confront the tion of the dispositions necessary for ble, favored by many patristic and health care professional daily. But a health care professional to conduct scholastic commentators and re- the light of a renewed moral theol- himself or herself in a manner that is vived by some recent theologians.13 ogy must be made to shine on consistent with the full vision of the According to this reading, the Good bioethics.11 Moral action in the moral life that is ingredient in the Samaritan is Christ, and we are like health care field requires not just a Gospel and exemplified in the con- the man who fell among robbers. Construed in this way, the parable teaches us that, because of the salvation Christ accomplished for us when we were lost, the cultivation and practice of the virtues of the Good Samaritan in us depend radically on Christ’s grace. This understanding of the parable of the Good Samaritan is consistent with the renewed moral theology commended to us by Veritatis Splendor and the Catechism. It completes our endeavor to show that, in the field of health care ethics as in all areas of moral theology, we must be able to answer the question, “why be moral at all?” if we are to have a fully Christian answer to the question, “what must I do to act morally in this or that situation?” For, if the moral life is a transfigured life, then its pattern and principle is none other than the crucified, risen and glorified Christ. The freedom to embrace the good in every occasion of action and over the course of many occasions of action depends on the transformation of our nature and the conquest of our sins that are the work of Christ in us. Our participation in the ultimate good of the communion of trinitarian love depends finally on our conformation to the only Son, so that, when the Fa- ther recognizes the virtues of the Good Samaritan in us, he “will see and love in us what he sees and loves in Christ” (Preface VII, Sun- days of Ordinary Time). Rev. J.A. DI NOIA, O.P. Executive Director of the Secretariat for Doctrine and Pastoral Practices, Editor of The Thomist, Washington, D.C. (USA) 214 DOLENTIUM HOMINUM

Bibliography 1991), chap. 6. For its potential impact on the Ethics Journal 5 (1995), 253-77. See also health care debate, see RONALD F. THIEMANN, EDMUND D. PELLEGRINO & DAVID C. RELIGION IN AMERICAN PUBLIC LIFE (Cam- THOMASMA, For the Patient’s Good (New bridge, Mass.: Harvard University Press, York: Oxford University Press, 1988), esp. 1 For a profound analysis of this recovery, 1995), chap. 7. chap. 9, and The Virtues in Medical Practice see SERVAIS PINCKAERS, O.P., The Sources of 10 For the persistence of this theme, even (New York: Oxford University Press, 1991). Christian Ethics (Washington, D.C.: Catholic when the parable is not explicity invoked, see For complementary but distinctive treat- University of America Press, 1995). especially the essays by DARREL W. AMUND- ments of this issue, see JAMES F. CHILDRESS, 2 According to Vatican Council II, Decree SEN and MARVIN O’CONNELL in Caring and “Love and Justice in Christian Biomedical Optatum Totius, n. 16: “Special care should Curing: Health and Medicine in the Western Ethics”, in Theology and Bioethics, ed. Earl be given to the perfecting of moral theology. Religious Traditions, eds. Ronald L. Num- E. Shelp (Dordrecht: Reidel, 1985), 225-43), Its scientific presentation should draw more bers & D.W. Amundsen (New York: and GILBERT MEILAENDER, “Are There fully on the teaching of holy Scripture and Macmillan, 1986), 40-145; and also, Virtues Inherent in a Professions?” in should throw light on the exalted vocation of CHRISTOPHER J. KAUFFMAN, Ministry and Ethics, Trust and the Professions, eds. Ed- the faithful in Christ and their obligation to Meaning: A Religious History of Catholic mund D. Pellegrino , et al. (Washington, bring forth fruit in charity for the life of the Health care in the United States (New York: DC: Georgetown University Press, 1991), world.” Crossroad, 1995), passim. 139-55. On the distinctiveness of Chrstian 3 For the importance of Veritatis Splendor 11 See BENEDICT ASHLEY, O.P. “Does ‘The compassion, see EDMUND PELLEGRINO, “The for the renewal of Catholic moral theology, Splendor of Truth’ Shine on Bioethics?” Moral Status of Compassion in Bioethics,” see ROMANUS CESSARIO, O.P., “Moral Ab- Ethics and Medics (January, 1994), 3-4; RO- Ethics and Medics (October, 1995), 3-4. solutes in the Civilization of Love”, Crisis, MANUS CESSARIO, O.P., “From Casuistry to 13 Among the latter, see, for example, May 1995, 18-23. For an overall reading that Virtue-Ethics,” Ethics and Medics (October, KARL BARTH, Church Dogmatics, Vol. 1/2 relates the encyclical to developments in 1994), 1-2. (Edinburgh: T. & T. Clark, 1956), esp. 416- ethics, see ALASDAIR MACINTYRE, “How 12 See EDMUND D. PELLEGRINO, “Toward 21, and HANS URS VON BALTHASAR, The Can We Learn What Veritatis Splendor Has a Virtue-Based Normative Ethics for the Glory of the Lord, Vol. VII (San Francisco: to Teach?” The Thomist 58 (1994), 171-95. Health Professions,” Kennedy Institute of Ignatius Press, 1989), 352. For elucidation of crucial themes in the encyclical, see RUSSELL HITTINGER, “Natural Law as ‘Law’: Reflections on the Occasion of Veritatis Splendor”, The American Jour- nal of Jurisprudence 39 (1994), 1-32; MAR- TIN RHONHEIMER, “‘Instrinsically Evil Acts’ and the Moral Viewpoint: Clarifying a Cen- tral Teaching of Veritatis Splendor,” The Thomist 58 (1994), 1-39. For an analysis of moral theories criticized by the encyclical, see WILLIAM E. MAY, “Theologians and Theologies in the Encyclical”, Anthropotes 10 (1994), 39-59. For debate about the encyclical, see, for example, RICHARD A. MC- CORMICK, “Some Early Reactions to Veri- tatis Splendor,” Theological Studies 55 (1994), 481-506, and the response by MAR- TIN RHONHEIMER, “Intentional Actions and the Meaning of Object: A Reply to Richard McCormick,” The Thomist 59 (1995), 279- 311. For reliable anthologies, see the collection of essays in Communio, Summer 1994, and RAMON LUCAS LUCAS, ed., Veritatis Splendor: Testo Integrale Commento Filosofico-Teologico (Milan: Edizioni San Paolo, 1994). 4 For a fuller discussion of what follows, see J. A. DI NOIA, O.P., “Veritatis Splendor: Moral Life as Transfigured Life,” in RUSSELL E. SMITH, ed., Faith and Challenges to the Family (Braintree, Mass.: Pope John Center, 1994), 251-61. 5 For a luminous discussion of moral theology in this renewed perspective, see RO- MANUS CESSARIO, O.P., The Moral Virtues and Theological Ethics (Notre Dame: Uni- versity of Notre Dames Press, 1991). 6 See CESLAUS SPICQ, O.P. “The Charity of the Good Samaritan,” in Contemporary New Testament Studies, ed. M.R. Ryan, (Col- legeville: Liturgical Press, 1965), 218-24. For a standard commentary on the parable, see JOSEPH A. FITZMYER, S.J., The Gospel Ac- cording to Luke (X-XXIV) (Garden City, New York: Doubleday, 1985), 882-90. 7 For a typical discussion, see DAVID HEYD “Obligation and Supererogation,” in Ency- clopedia of Bioethics (New York: Macmil- lan, 1995), IV: 1833-38. 8 For a discussion of these characteristics, see YVES R. SIMON, The Definition of Moral Virtue (New York: Fordham University Press, 1986), esp. chaps. 2-4. 9 POPE JOHN PAUL II, “On the Christian Meaning of Human Suffering” (Washington, DC: United States Catholic Conference, 1984), 29 (p. 36). For an excellent discussion of the pervasive influence of the parable, see ROBERT WUTHNOW, Acts of Compassion (Princeton: Princeton University Press, VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 215

FERNANDO ANTEZANA

A Free Gift and an Act of Solidarity

The Hippocratic oath codifies a fragmentation of the human body as people too often content themselves professional practice, transforming an object of research and interven- with managing emergencies, attach- individual attitudes and virtues into tion—the risk of depersonalizing ing most importance to short-lived obbligations that physicians and relations between health workers moments of compassion. There is a health professionals have since and patients has increased. tendency to act on emergencies striven to comply with and defend, The number of tasks, the work- without following through, and passing them on in their teaching to load on health personnel, institu- without planning for and investing succeeding generations. The Hippo- tional pressures and the need to in the long term. And yet we cannot cratic oath goes beyond profes- make time pay, militate against conceive of health protection and sional technical commitment, since good quality relationship. And yet, promotion as nothing more than an it affirms a spiritual and social re- though it is too often forgotten, a ambulance and first-aid service, sponsibility before the gods and good relationship with patients is an with no support services or ongoing man, and before all generation, integral and decisive part of high activities. Nor could that ever be a past, present and future. Imbued quality, effective care. way to offer equitable access to with ethical values, the Hippocratic In health and social policy, and in health care. Here again, as the ex- oath also lays down the law. international cooperation itself, ample of the Good Samaritan sug- The figure of the Good Samari- gests, one must not only be there tan takes up and builds on the tradi- and respond to need, but also one tion which care implies, of giving must return to the patient, and de- and benevolence, without asking vote time and energy to continually for reciprocity. The suffering of the provoding for the patient until the other, recognized and accepted by task is accomplished. the passer-by as his own responsi- If they are to succeed, disease pre- bility, is enough to establish per- vention and control policies need sonal commitment. It is a total com- sustained development of infrastruc- mitment, which goes beyond the ture, education and training of hu- technical actions of washing, treat- man resources, systems for the fi- ing and bandaging wounds. Be- nancing of care, guarantees of the cause the Good Samaritan chooses quality and availability of care and to interrupt his journey, upset his drugs which must be both finan- plans and the course of his life for a cially and geographically accessi- man who is lying wounded and sick ble. at the side of the road. This would mean, for example, He gives his time and money for the industrial countries—which ac- this stranger. And the promises to count for about 90% of pharmaceu- return, which means that he takes tical research and production in- on a responsibility in the longer vestment in the word—agreeing to term. support or undertake admittedly The figure of the Good Samari- lengthy and expensive research on tan takes us far beyond compliance the drugs and products needed by with the rule and the letter of the the greatest number of people, es- law. It illustrates the notion of ser- pecially in developing countries, vice and willingness. In that, it sets even when profits seem marginal. an example for medical practice to- This long-term effort is what the day and for the approach to health World Health Organization has policies. With the accelerated de- been trying to elicit from and pro- velopment of techniques and the mote among its Member States, fragmentation of disciplines—the whether they be donors or benefi- 216 DOLENTIUM HOMINUM ciaries of cooperation. We try en- Samaritan expresses a truth and a take care of that person, is the one sure that the priorities and activities moral command that transcend the who gives sense and reality to the of national health or international rule and the letter of the law. law. cooperation programmes are not es- The law says that we should treat And above all, as the Good Samar- tablished and evaluated exclusively our neighbour as we treat ourselves. itan shows, the value of moral oblig- in quantitative or economic terms. However, the law in t hose days ation and acting on the responsibility WHO therefore wants to develop strictly defined the boundaries of that forms the basis of solidarity can and promote the use of health indi- the community and one’s neigh- never be limited to the members of cators based on notions such as the bour, just as it set out the relation- the group to which each of us be- social integration of people, the de- ship of duty and solidarity within longs by birth or by tradition. Soli- velopment of autonomy and the the community. The Samaritan was darity is a universal human responsi- quality of life of each person. outside that group; he was a bility. These are notions that highlight stranger, and even the archetype of The World Health Organization the close link between respect for one’s potential enemy. Thus, in the- has embarked on a wide-ranging re- the dignity of individuals and peo- ory, the Samaritan is typically out- view of its role and mission at global ples, irrespective of their level of side the network of clan solidarity. level. In order to rethink and refor- income, physical capacity or eco- In contrast, the priest and Levite are mulated our policies and activities nomic and social productivity, and at the centre of the group. These for health, we must put them in the their access to health, understood as men of the temple are the guardians context of discussion of principles a state of personal wellbeing which of the law, in word and in deed. But and of the ethical aims of interna- goes along with their integration in as the parable here tells us, the ex- tional cooperation. WHO is called society. ample of solidarity, the word and upon to provide access to health for Science and technology are the act of truth, come from the Samari- everyone in the world, starting with products of human reason and are tan, the foreigner, the enemy, the the poorest, the smallest and weak- powerful instruments which should outcast. est—those who are “marginalized” be firmly kept in the hands of hy- It is not the law or tradition that to use the fashionable term, or, in manity in the service of human dig- say who our neightbour is. The other words, those who are main- nity and mutual respect and respon- neighbour is not the beneficiary of tained outside the system by the sys- sability between social groups, indi- solidarity but its originator. Who- tem itself. viduals and cultures. In this field, as ever decides to approach the other Promoting access for all to His Eminence Cardinal Angelini person, to acknowledge respons- health, continually seeking to im- rightly pointed out, we must be ability for the other person and to prove this level of health, quality of aware that no decision we make can life and autonomy for everyone, be neutral. We must therefore help such is the first calling that defines to ensure that these decision are the field of competence that is the taken in a full-informed and demo- World Health Organization’s. What cratic way, with due consideration the Hippocratic oath and the figure for the moral, social, political and of the Good Samaritan teach, is that scientific responsibilities involved. every health action is intended for It is also an ethical responsibility other human beings, whose basic for WHO which our Organization dignity must be recognized and re- wishes to fulfil by helping to set up spected. forums for encouraging debate and The desire of WHO to base its new regulation, at both regional and health-for-all policy on the princi- global levels, on various aspects ples of equity, respect, and solidarity, health policies, exchange of knowl- going beyond social, economic, po- edge and technology development. litical, and cultural boundaries, fol- There is one further lesson—and lows on from that teaching. an important one—to be drawn from the parable of the Good Dr. FERNANDO ANTEZANA Samaritan. The Hippocratic oath, Address delivered on behalf of Dr Hiroshi Nakajima which sets out the rule, says that the Director-General, physician must treat everyone— World Health Organization men and women, free men and by the Deputy slaves—in the same way. The Good Director-General Round Table

The Good Samaritans of Our Time 218 DOLENTIUM HOMINUM

ENNIO APECITI Marcello Candia: A Good Samaritan of Our Time

1. Introduction seem to have been a regular church- Obviously enough, the roots of the goer but he knew how to inculcate in vocation of Candia to charity can be “Can a manager be holy?” Gian- his children that love and respect for found in this accompanying of his carlo Galli asks in his book L’Era dei values which make man great. Mar- mother, and in the testimony of his Managers. “The answer is obviously cello said of his father: mother.8 A strong religious spirit and negative if we subscribe to the “From my father, who was not a a passion for works of charity were widely shared view that the manager practicing Catholic, I inherited a expressed early on in the young Mar- or the entrepreneur is engaged in the strong sense of duty and honesty and cello: his school friends remember acquisition of wealth and not in its respect for freedom: the rights of him engaged in prayer, in study and distribution. It is the man who gives the individual must never encroach in the charitable works of the Con- everything to the poor who is holy.”1 upon the rights of others.”4 ferenze di San Vincenzo. This orga- But is this really true? Is not the ex- His mother Luigia Mussato was a nization brought him into contact ample of Marcello Candia evidence cultured and educated woman “of a with a glorious association of young to the contrary? But who actually very special human warmth” who Milanese Catholics—the Associ- was this man? “was able to give a word of comfort azione Giovani Studenti Santo Marcello Candia loved Alessan- to everybody.”5 She was a woman of Stanislao.9 This association had as a dro Manzoni and often quoted a sen- intense and deep religious senti- member another servant of God, tence pronounced by Cardinal Fed- ments and beliefs, and instilled in her Giuseppe Lazzati, a figure who was erico: “Life is not already destined children the values of faith and char- to have a major impact on the role of to be a weight for many and a party ity, especially towards those most in the lay faithful in Italian society. The for a few—it is a task for all, and need. Santo Stanislao association followed every man will be called to account In other words, Marcello Candia the impulse given to it by the blessed for how he has discharged that had two exceptional parents, or as he Cardinal Andrea Carlo Ferrari and task.”2 It seems to me that this is the himself said: “I had two wonderful sought to train and prepare young most suitable image by which to be- parents, and for this I never cease to people for the task of giving a Chris- gin to understand this Samaritan of thank the Lord.”6 As he said to Gior- tian character to society. The aim our times. gio Torelli when this latter visited was to ensure that committed mem- Brazil: “Look, I had two parents bers of the Catholic laity would pro- who gave me a love for life. Parents, mote the ideals of the Gospels in the 2. His Life as you know, are our closest broth- world at large. ers.... I remember my mother im- This was certainly a period of Marcia Candia was born by acci- parting the same ideas and beliefs as great personal growth and develop- dent, as it were, in Portici (Naples) I had heard from the local parish ment for Marcello. These were the on July 27, 1916. His family was ac- priest. My mother was always on the years when the Catholic laity of Italy tually from the North of Italy and side of the poor and she had a ten- lived perhaps one of its happiest pe- more precisely from Lacchiarella der Christian love. As a boy I riods. One need only think here of a near Melagnano, in the so-called watched her and accompanied her young person such as the blessed Bassa Milanese. He was born by ac- on her visits of solidarity.... She went PierGiorgio Frassati and the tensions cident, as it were, because the Can- to the homes of poor people and I between the Fascist regime and the dia family went to live in Naples dur- went with her to carry the parcels. I Catholic Church in relation to ing the First World War.3 heard her speak to them. It was in- Catholic Action, a tension which His father, Camillo, was a busi- evitable that my faith would grow culminated in that prophetic docu- nessman who brought up his five in the inseparable bond with every ment, the encyclical Non Abbiamo children (three girls and two boys, brother. Love for God was always, Bisogno (1931). Marcello being the third eldest) to always, linked to love for one’s These were the years when the respect the values of honesty, a sense neighbor.... What else would I have venerable (soon the blessed) Cardi- of duty and of hard work, and love done given that I carried those nal Alfredo Ildefonso Schuster often for what is beautiful. He does not parcels for my mother?”7 spoke to the parish priests of his dio- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 219 cese and gave them a criterion by saints. There gathered around Father his worries and his trials. which to judge the success or other- Genesio a coterie (as we would call it “The Log,” however, was not only wise of their role in training and edu- today) of people from very different a place of cultural development and cating young people. It was a crite- social, cultural and spiritual back- refinement—it also had a charitable rion based on that other great docu- grounds. This group of people met function. The members of this group ment of the Magisterium of the twice a week in the monastery of the visited and helped the poor families Church, the social encyclical Capuchins in Viale Piave, that build- in council houses (case minime) in Quadragesimo Anno (1931). The ing which had seen and heard the fir- Baggio, an area on the far outskirts Cardinal of Milan declared: ing of the guns of General Bava Bec- of Milan. “It is above all else in their regular caris on an unarmed crowd of work- Before meeting Father Genesio, visits to the poor in their homes, to ers in May 1898. There gathered however, Marcello had begun to the sick in hospitals, to prisoners, to around this “master of the spirit” a spend time with another Capuchin, those who are half frozen to death in group which became known as “The namely Brother Cecilio Cortinovis. attics in the slums of the big cities, Log” because its members used to sit This figure was a simple member of that our good young people experi- beside a log-fire which was lit to pro- the order who spent over seventy ence the complete fulfillment of their years of his life as a porter in the Mi- lives as Christians.”10 These charac- lanese monastery of Viale Piave. He teristics seem to have become more had been the founder of Opera di pronounced in Marcello when his San Francesco, an organization ded- mother died when he was sixteen icated to helping the poor, and died years old (7 February 1933). The famous for his holiness on April 10, suffering caused by this event 1984. Indeed, on April 10, 1995 the brought him to a state of physical diocesan stage of the process of can- and nervous exhaustion which he onization of Brother Cortinovis was was able to overcome after a year of brought to a positive conclusion.14 treatment and rest through a “radical This friar, who bore a benevolent choice in favor of God,” the discov- smile, encouraged Candia to adopt ery of (or a decision for) God which an attitude of active charity, and to would lead him to declare: “Trust in, express respectful and delicate love and rely upon, God who is called for the poor. During the cause for Compassion.... God is our father and canonization, indeed, constant refer- wants to forgive us.”11 ence was made to the welcoming These were very significant words smile which this friar gave to the in relation to the path Candia was to hundreds of poor people who came take if we consider that this painful to the monastery—all of them were experience of death left the mark of a welcomed, and then said goodbye to, very acute sensitivity within him, with a smile, with a parcel of food and involved great anxiety and pro- and with an inevitable sentence: voked a propensity to compensatory “You know, don’t you, that God activism. We should bear these limi- loves you?.” tations in mind in order to recognize Here we can see a very special that Marcello was not a youth or a coming into contact of holy men; a man predestined for holiness or for very special chain of holiness which great things. In him, too, there was a duce a warm and friendly atmos- linked together many members of veritable struggle to ensure that the phere. As one of the group was later the city of Milan during the first seeds of good which God sows in the to recall: decades of this century. It is worth- heart of each and every human being “Side by side could be found a while to observe that Father Alberto broke the hard soil of human limits clerk belonging to the old Socialist Beretta, the brother of the blessed and bore fruit, as the Gospels have it, tradition and a monarchist aristo- Gianna Beretta Molla, lived in this in the measure of one third, two- crat..., a worker of the Falk factories monastery before going on mission- thirds, and to the full. and a highly placed building con- ary work to help the sick and those At that same time, however, when structor, an industrialist in chemicals suffering from leprosy. A fine he was still very young, there was an (perhaps Candia?) and a Catholic friendship animated by a common encounter which was of fundamental writer, a famous sculptor..., and the ideal linked Father Alberto to Can- importance in the spiritual journey of Communist editor of Epoca. There dia. This ideal involved serving Marcello Candia—he came into con- was also an idealist chemist and his those who were most in need. To- tact with a Capuchin, Father Genesio atheist friend.”13 gether these two friends worked for da Gallarate. This friar “entered into All of these people met to reflect, the poor who came to Viale Piave souls to such an extent that they be- to discuss, and to pray. It was almost and they also developed the idea of came associated with his immensely a professorial chair of non-believers offering themselves for service in elevated spiritual experience”12 and a decade or two before its time. Here northeastern Brazil. accompanied Candia for about thirty Marcello Candia certainly devel- Charity, therefore, became the years, directing him towards auster- oped his ability to talk and to listen ideal of Marcello’s life and he de- ity, long prayer, and the study of the to the voices of contemporary man, voted all his energy to this ideal. In- 220 DOLENTIUM HOMINUM

deed, he was convinced, as he later found the Macap mission17 on the de Cooperation Internationale). declared, that “the apostolate [sic] is Amazon river where he would subse- With the then Archbishop Giovanni essentially charity. When we meet a quently become the first bishop of Battista Montini he created the Col- brother who is in need, we must not that area. Monsignor Pirovano would legio Internazionale per gli Studenti only speak of our faith. We must act always remain linked to Marcello di Oltremare to help foreign students according to our faith.”15 For this rea- Candia and was later to say of him: in Italy, and the Segretariato di Co- son Marcello united constant prayer “What always struck about Mar- operazione Missionaria to establish with a broad range of commitments. cello was his life of prayer. He was links between the various lay mis- To one fellow member of the course very active, never stopped working, sionary movements in Italy. The he confided that every day he recited planning, or trying to convince other Collegio Internazionale per gli Stu- the whole of the rosary and it is well people. He was an engine which was denti d’Oltremare should be remem- known that he went to mass every constantly running. But all this ac- bered because it gave rise to the hos- day. After mass he spent about ten tivism was imbued by a union with pital at Macap, as indeed Candia minutes giving thanks, as was once God, a constant prayer which was his later made clear: the custom, and this was done with “The idea was not mine. It be- traditional prayers in the “grandfa- longed to the then Archbishop of Mi- ther” style as we would say today, lan, Monsignor Montini, with whom with “I love you, my God,” the “An- I had set up a college in Milan for ima Christi,” and so forth. young people from the third world In the meantime, and perhaps be- who wanted to earn a degree in med- cause of this strong spiritual dimen- icine. However we discovered that sion, he graduated in chemistry in the project had a defect—the young 1939, in pharmacology in 1940, and people wanted to remain in Europe in biology in 1943. Only the war and and did not go back to their coun- the management of his father’s com- tries. It was for this reason that a pany (where he worked from 1939 hospital in the equatorial jungle was on) prevented him from gaining a created with the aim of bring Christ- degree in medicine, which was ian witness to everybody, and to something to which he greatly as- poor people as well.”19 pired. On the night of October 22-23, However, Brother Cecilio did not 1955, when Candia was already communicate only the spirit of char- thinking of selling the company and ity to Marcello. In the monastery of going to Amazonia, an explosion the Capuchins in Viale Piave in Mi- (for which Candia bore no responsi- lan reverence was paid to the mem- bility at all) destroyed the factory. ory of Father Daniele da Samarate, a Candia was not discouraged but re- missionary in Amazonia (Tacun- built everything, without, however, duba) who died of leprosy in 1924, a reducing his commitment to mis- disease he had caught while in the sionary work.20 Indeed amidst the service of the lepers. In many re- rubble of the factory he declared: spects Father Daniele was like the “First of all...I must provide work for blessed Father Damiano, a Belgian. everybody.”21 In the summer of 1937 the father life. He thought only of God, of the On the other hand, he was consent Marcio and his brother Riccardo poor, of works of charity. I do not vinced that “my workmen are my to Brazil to “see the world.” Mar- know if he actually had other land of missionary work.” Marcello cello was “magnetized” by the thoughts. He was in love with God Candia faced up to this moment with poverty of the favelas of Rio de and the suffering humanity which that courage which springs from Janeiro and by the heroic dedication the Lord had led him to meet.”18 faith,22 and with the same decisive- of the missionaries and nuns.16 The Over the course of the years Can- ness—but also with the same inter- feeling that he had a missionary vo- dia’s missionary work took practical nal wounding—as Job.23 A year after cation is, indeed, to be traced to this form and spread. He founded the As- the disaster he wrote to Monsignor visit. sociazione Laici in Aiuto alle Mis- Aristide Pirovano and confided: “I After the end of the Second World sioni, the first organization in Italy to think that one of the elements in War Marcello took over the manage- be concerned with lay missionaries. preparing oneself for a life of charity ment of his father’s company. His fa- He established the review La mis- is the acceptance with simplicity and ther died on April 27, 1950. Marcello sione in order to promote the culture sincerity of the will of God.... [Com- displayed excellent managerial skills of missionary work. He organized ing to you] is my greatest wish and I and the Fabbrica Italiana di Acido the Centro di Assistenza Missionari hope above all that this is the will of Carbonico Dottor Candia rose to oc- Reduci, which was the medical the Lord.”24 cupy a high position on the European school for missionaries at the Uni- In addition to the reconstruction of horizon. versity of Milan. He became secre- the factory other buildings sprang In 1946 Marcello Candia met tary of the SILM (Secretariat Inter- into being. At Macap on January 25, Monsignor Aristide Pirovano del Pile nationale du Laicat Missionaire) 1961 the first stone was laid of the who was about to leave for Brazil to and of the UCCI (Union Catholique Hospital of St. Camillus and St. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 221

Louis. This hospital had been to this mandate. He finished the con- ately returned with a glass of water planned for a long time by Candia struction of the hospital of Macap and I felt the authentic joy, as had of- and Monsignor Pirovano, and Mar- (1967) and the hospital was later ten happened many times in my life, cello wanted to go there as soon as placed in the hands of the Camillians of receiving more than I had sought possible. Indeed he was convinced, (1978). to give. To my question as to how I as he declared one day to his sister, The experience of his encounter could help her, I heard her reply that that “it is not enough to give eco- with lepers was, however, of crucial for a long time she had been waiting nomic help, we must share in the importance in his journey along the for a sewing machine. Thereafter an lives of the poor, or at least as far as path of charity. To describe that atmosphere arose in relation to the this is possible.”25 This would be the event we need go no further than the lepers which was one of simple and leitmotiv of his long stay in Brazil. words he himself used in a letter cordial friendship, which was per- Each time that he returned from a written in 1977. We are here in the haps the thing they aspired to the journey to the interior he would re- leper colony of Marituba which was most.... We must see the leper not flect upon the poverty he had seen then popularly known as the ante- only as a person who has to be there and would observe: “If we are chamber to Hell: helped but as a richness within the really Christians we must share what Mystical Body of Christ. This is be- we have.”26 cause the leper, too, has things to Thus it was that on June 7, 1965 give.”30 he sold his interests (three compa- In order to demonstrate the shared nies in Milan, Naples, and Pavia) affinity between Candia and his and put his family’s business affairs brother lepers we can cite the reply in order. He then moved once and for of perhaps the most popular of the all to Amazonia. He was forty-nine Hansenians of Marituba, Lucio Para- years old and he was alone. A few cauary Calado, known as Adahlucio: months earlier (in April 1965) “Ask? Ask (why there is leprosy?).... Pirovano had been called back to I neither ask why nor how because I Italy as superior general of Pime. have always had faith. For me it is This was when the virtue of Candia enough to believe. I repeat this sen- emerged in a very special fashion. tence: I will believe in you for ever, As he said to a female friend and Lord.”31 helper: “Before becoming involved Marcello’s activity was ceaseless. in the undertaking he suddenly lost a He built the City of Milan Social friend, the superior, the guide who Center (1966) in the leper colony of had provided him with protection Marituba (Belem) and placed it in and help. I remember that he said to the hands of the missionaries of me at that time: `I now place myself Pime. This became a model leper completely in the hands of God.’”27 colony, and it is no accident that Candia, who never learnt to speak when John Paul II expressed a wish Portuguese perfectly and always suf- to visit a leper colony during his fered at the hands of the local cli- apostolic pilgrimage to Brazil in July mate, took his managerial skills to 1980,32 he was taken to this center. Brazil. As Candia himself said, “The Perhaps the most beautiful testimony effectiveness of works of charity is a of that visit was given by a blind form of prayer.”28 The program he “I spoke to many lepers. Unfortu- Hansenian. This man was radiant was to implement had been dictated nately with some of them the con- with joy at having “seen the Pope.” (or advised) by his long-standing versation stopped almost immedi- A nun, sister Celestina Magni, Archbishop, Giovanni Battista Mon- ately, and this made me immensely smiled and asked him how he could tini, to whom he was always linked sad. The whole of the morning went have seen the Pope given that he was by sincere—and mutual—devotion. by in this way. At about midday, be- blind. The Hansenian replied: “Sis- The future Pope said to him: cause of tiredness, fasting and a little ter, one can also see from within; one “If you go to Brazil and build a heart trouble, I sat at the feet of a tall can also see with the heart!”33 These hospital, make it Brazilian. Make mango tree to get my breath back. I are touching words—the miracle of sure to avoid all forms of paternal- was immediately called from my love of Marcello Candia, his mis- ism, do not impose your ideas on thoughts by the voice of a woman sionaries and his nuns had trans- others, even where your intentions who kindly inquired as to whether I formed the antechamber of Hell into are of the best. Create a hospital not felt well. The brotherly impression a place in which the blind could see only for the Brazilians but with the provoked in me by that voice was in (cf. Mt 11:5): Marituba, therefore, Brazilians, and make it your ultimate contrast with the deformed face of was a House of the Gospels. aim to no longer be necessary. When the woman who seemed more than Care and concern for spiritual life the moment comes when you feel forty years old but in reality—as I was no less important. The Little useless because the hospital can go learned after successive visits—was Carmel of St. Thérèse of the Child on without you, at that moment you only nineteen. She had been in the Jesus in Macap (1977) and Belo will have achieved a real work of hu- leper colony for ten years and had Horizonte (inaugurated after his man solidarity.”29 Candia was loyal never received a visit. She immedi- death in 1984) thus came into exis- 222 DOLENTIUM HOMINUM tence. In relation to such initiatives, a motive rooted in faith.... I myself river and think to myself: everything in the same letter which has already have seen that in serving the poor, that you do, Marcello, is just a drop been cited Candia wrote, “Only a forming friendships with the poor, I in the Rio.... At times this throws me word of faith and love for Christ, tes- have found my treasure: I have re- into a state of crisis, but it is a crisis tified to in the leper colony by the ceived, as the Gospels have it, my which has a good effect because I al- presence of a religious community, hundred for one.”37 ways remember that we humans are could create within them a hope for And he went on: small and that God is great!”39 life and make them aware of their “The absolute priority is the spiri- These words remind us of those value in the Community of the Peo- tual priority: the technical and eco- written by Pope John Paul II in the ple of God.”34 In this sense, it is no nomic instruments are important and encyclical Redemptoris Missio: accident that the bell of the Carmel we should use them, but they are in Macap, which was donated by worth nothing if they are not accom- “The missionary is the man of the Giuseppe Lazzati, has inscribed on panied by friendship, by attention beatitudes.... In a world troubled and it: “Voice of love that solicits lov- being paid to the individual, and by oppressed by so many problems, ing.”35 help from God.”38 which generate pessimism, the pro- Candia also took part in the sup- claimer of the “Good News” must be port and development of very many a man who has found true hope in other works of charity: the Santana Christ.”40 Hospitality House (in the port of At the outset, naturally enough, Macap), the leper colonies of Prata Candia was surrounded by suspi- and Porto Velho, the hospitals of cion. Doctor Macedo, the president Gaja and Balsas (State of Marah- of the Institute of Social Security of nao), the Favela do Borel in Rio de Macap, admitted that he did not Janeiro, the social centers in want to sign the requests of the hos- Caloene and La Cruz Liriada, the pital because he believed that Can- Base Community in Rio Branco, dia was mad: “Who is this madman and the Camillian seminary in who has come to build a hospital in Macap. This list brings to mind the Amazonia?”41 Candia was also sub- testimony of Monsignor Luigi Gius- sequently investigated for “having sani: “One of his characteristics was brought medicines into Brazil ille- that all the good that he found on his gally.”42 path was one good, a special call for But with the passing of time the him.... He was really ecumenical. honesty of his intentions was recog- He had neither boundaries nor barri- nized and the Brazilian government ers. He was always ready to do any- itself gave Dr. Candia the honor of thing as long as there was good to the Cruzeiro do Sul, the first time be done.”36 In all his works Candia such an honor had been conferred always paid especial attention to the upon a foreigner and the most im- spiritual aspects of things and portant honor for services rendered sought to give not only medical help to the nation that exists in Brazil. In and charitable support, but also spir- 1975 the review O Manchete, the itual sustenance, to all those—and most widely read weekly publica- they numbered millions—who tion of the country, proclaimed him turned to him. We can understand Not everything is easy, but diffi- “the best man in Brazil.” Equally the spirit which animated him from culties are also a means and an in- prestigious forms of recognition one of the interviews that he gave: strument by which to grow. Thus it were accorded him in Italy: the An- “What I think is most important in was that one day he had the courage gelo Motta or “Goodness” Prize in our work—that of myself and my to recognize his weaknesses and 1970, the City of Florence Prize in helpers—is the personal relationship fragility. He confided as follows to 1976, and the Feltrinelli Prize in that we have with the people who Piero Gheddo: “A crisis befell me at 1982. This was conferred on him by need us. The hospital that we have times when I touched in tangible the then President of the Republic, built, the equipment, and the work of form the difference between what Sandro Pertini, “for an exceptional the doctors and surgeons is not so we actually did and what we might undertaking of high moral and hu- important as making them under- have been able to do. I see that work- manitarian value.” stand that we do not work for the lep- ing all day and at times also the Candia suffered from a bad heart, ers but with them—that is, with fra- whole of the night, I and those who and from 1967 to 1977 he had five ternal love and human solidarity. If work with me are always merely a heart attacks and was forced to un- this spirit were not present, what drop of water in the river of human dergo an operation for a triple by- would be the value or use of all these suffering which surrounds us. Here pass. But it was not his heart which facilities, the funds, and all the rest? at Macap the branch of the Amazon surrendered. In August 1982 he was It is for this reason that I always say river which flows in front of us and diagnosed as having cancer of the to myself that we need a religious then flows into the ocean is twenty- liver, and in this way the great trial of spirit if we want to serve the poor two kilometers wide, and at times I Candia begun. In addition to the well, that is to say a spiritual motive, sit upon the banks of this majestic physical suffering he had to endure VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 223 there was also the disappointment detachment, with humility, with an from some of the answers that he caused by some of those to whom he adherence to the profound will of himself gave. The first is that given had entrusted his work—there were God, and these elements, in the mo- to Piero Gheddo who once asked false accusations that money had ment of extreme suffering, revealed him about the reasons for his untir- been stolen from the lepers. How- their incandescent authenticity”45. ing activity. Candia replied: ever, he did not cease to struggle and The Archbishop emeritus of Milan, “I consider my vocation as a ser- when he felt the end draw near he de- Cardinal Giovanni Colombo, echoed vice, by a layman, to the Church, to cided to return to Italy to settle the these views in a homily on the thirti- missions and to the poor. A service question of the Dr. Marcello Candia eth day after Candia’s death (Sep- which is not limited in time or in ex- Foundation, which was to continue tember 30, 1983): tension. Now, since we must always his work. He died in Milan on Au- “Although Manzoni was not a stay young I believe that the best gust 31, 1983, leaving himself with saint, like Candia..., to Candia the way to do so is to always answer trust in the hands of God. A few days Milanese could offer a place...at the the calls of the Lord. For this rea- before dying he said to a friend of top of the dome all to himself so that son, in everything that the Lord his: “If the Lord wants my work to with the golden Madonna he also makes me meet on my path and in- go on, it will go on. Now he calls me spires me to help I give myself to and I am ready to turn out the the utmost.”47 The second answer light.”43 which Candia gave, which was al- The words he exchanged with his most complementary to the first, parish priest and spiritual director demonstrates the primary impor- Don Peppino Orsini were even more tance of contemplation: significant, and they were as fol- “My ‘secret’ is available to every- lows: body and is not even a secret.... The “Death does not frighten me be- only thing which matters is union cause it is a passage from a God who with God in every form that it takes: is Father and little understood to a prayer, meditation, reflection. For God who is Father seen face to me the moment of union with God face.... Yes, indeed, the highest act of constitutes the essential source of en- love which Jesus has manifested to ergy for everything else. First prayer me is to have placed me in suffering, and then any form of apostolic ac- giving me thereby the opportunity to tivity. This is the fundamental force give myself to him with all my joy for any proclamation of the truth and and with all my love. witness to love.”48 Jesus today has made me live the I believe that we can thereby un- most beautiful experience of my life derstand why the prayer which in- and has made me understand that it spired Marcello Candia during his is not enough to work for the King- life was that favored by a man who dom of God; it is not enough to pray was very similar to him—Raoul to the Lord. Of greater importance is Follereau. It is an anonymous prayer the acceptance with humility and of the fourteenth century: readiness of pain how and when God allows it.... This is really very beauti- Christ does not have hands; ful. Only in suffering can we he only has our hands achieve an understanding of the love could participate in the senate of our to do his work today. of God.”44 saints who intercede not only for the Christ does not have feet; Cardinal Carlo Maria Martini of People of God but also for the whole he has only our feet Milan celebrated the funeral rites, city.”46 to guide men and, among other things, he had this The fame of holiness of Marcello along his road. to say: Candia was such that there were im- Christ does not have lips; “I still have in mind, in this very mediate requests for the introduction he has only our lips moment, his face of only three days of the process of canonization, and to speak to the men of today. ago held by intense pain but bearing this was officially initiated by Cardi- luminosity in his eyes and with the nal Martini in the Church of the Holy Christ does not have means; murmuring of prayers on his lips Guardian Angels of the parish of he has only our help which expressed his intimate union Candia on 12 January 1991 and con- to lead men to him. with the suffering of Jesus for his cluded at the same place on February We are the real bible Church. And it was in that moment, 8, 1994. which men still read! in that brief conversation with him, We are the last message of God that there appeared the most lively written in works and words. sign of the authenticity of his entire 3. How Should We Take mission: commitment, effort, en- Our Leave of Him? Candia himself added his own thusiasm, organization, attention to comment: all needs, an ability to bring forth What was the secret of this man? I “Profoundly convinced by the energies..., but all this was lived with believe that it can be understood truth and the contemporary relevance 224 DOLENTIUM HOMINUM

of this message, which is so stimulat- Bibliography 7 GIORGIO TORELLI, Da Ricco che era. La ing, I have decided to continue my Frontiera del Dottor Candia sul Rio delle SERGIO BORTOLANI, Macapà: una Rosa Amazzoni, (Editoriale Nuova, Milan, 1985), journey until the end, at the service of all’Equatore, (Morcelliana, Brescia, 1980). pp. 35-36. 8 all my sick and needy brethren, with a GIORGIO TORELLI, Da Ricco che era. La This emerges from the subject: Piero Frontiera del Dottor Candia sul Rio delle Gheddo, Marcello Candia. Un Manager a special predilection for the Hanseni- Servizio dei più Poveri, (Paoline, Milan, 49 Amazzoni, (De Agostini—Editoriale Nuova, ans.” Milan, 1985). 1994), p. 57. But perhaps an observation made Mondo e Missione, 112, 1983, n. 22. A 9 MARIA CRISTINA FORESIO DAPRA, La during a conversation with a nun special edition on the occasion of his death. Santo Stanislao di Milano. Un’Esperienza PIERO GHEDDO, Marcello dei Lebbrosi, (De Studentesca del Cattolicesmo Ambrosiano, who had pointed out that he was not Agostini, Novara, 1990). (NED, Milan, 1983). Id., “Santo Stanislao, obliged to be poor is more revealing. PIERO GHEDDO, Marcello Candia. Un Associazione,” in Dizionario della Chiesa Candia replied to her: “But I, with Manager a Servizio dei più Poveri, (Paoline, Ambrosiana, 5, (NED, Milan, 1992), pp. Milan, 1994). 3212-3215. my baptism, have made a pact with 10 ALFREDO ILDEFONSO SCHUSTER, Memori- Christ.”50 And this is the pact of ale ad Parochos. Lettera Pastorale al Ven. Clero per la Quaresima dell’Anno someone who shares the awareness Notes MCMXXXIX, (SEI, Turin, 1939), p. 34. of Peter: “Lord, to whom should we 11 PIERO GHEDDO, “Perché la Sanità Scuote go? Your words are the words of 1 EUGENIO FORNASARI, “Marcello Candia: le Coscienze,” in Mondo e Missione, 112, Manager e Santo,” in Vita Pastorale, 2/1993, 1983, p. 607. eternal life” (Jn 6:68) And now, to 12 p. 96. PIERO GHEDDO, Marcello dei Lebbrosi, conclude this paper, I would like to 2 ALESSANDRO MANZONI, I Promessi Sposi, (De Agostini, Novara, 1990), p. 28. chapter 22. 13 Ibid., p. 30. 14. The description of this make my own the words of his sin- 3 cere friend: “One must and can only Marcello Candia’s father had moved to holy friar offered by Teresita Schenoni Naples in 1915 to enlarge the second factory should be cited here. TERESITA SCHENONI “Il thank the Lord for the present which of his Burgeoning company, La Fabbrica ital- Tempo non Conta, se ci Lascia un Santo,” in he made us, placing him on our path iana di Acido Carbonico Dottor Candia e C. L’Avvenire, May 6, 1984: “His life was 51 It was therefore in Naples that Marcello spent in the service of God, beyond all the to make us uneasy.” (1916) and his sister Emilia (1918) were born. frontiers of selfishness.... Only now is it pos- However, the youngest brother, Riccardo, was sible to discern the gigantic stature of this born in Milan in 1922. 4. PIERO GHEDDO, most simple, most innocent, most hard- Marcello Candia. Un Manager a Servizio dei working, strong as an oak tree, smiling as he Rev. ENNIO APECITI più Poveri, (Paoline, Milan, 1994), p. 15. knew how to smile, friar. He spent his long Professor of Church History 5 Ibid., p. 16. days paying no heed to tiredness, calm beat the Seminary of Venegono, Italy 6 Ibid., p. 10. fore the at times cruel events which reality VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 225

presented to his gaze. And his answer was mountains.” (Piero Gheddo, Marcello Can- Poveri (Paoline, Milan, 1994), p. 111. always the same: give, give love with infi- dia. Un Manager a Servizio dei più Poveri, 34 Ibid. nite patience and understanding so that Paoline, Milan, 1994, p. 73). 35 Taken from PIERO GHEDDO, Marcello dei God’s creatures would not fall into tempta- 21 PIERO GHEDDO, Marcello dei Lebbrosi Lebbrosi (De Agostini, Novara, 1990), p. 205. tion, so that they would refind that peace (De Agostini, Novara, 1990), p. 125. 36 Ibid., p. 141. which had been lost along the dark paths of 22 PIERO GHEDDO, Marcello Candia.Un 37 Taken from “La Testimonianza di Mar- life. Not one of those over the long years Manager a Servizio dei pi Poveri (Paoline, cello Candia,” in Mondo e Missione, 112, who approached Brother Cecilio ever went Milan, 1994), p. 34. 1983, p. 586. away without experiencing a mysterious 23 He welcomed Monsignor Pirovano, who 38 PIERO GHEDDO, Marcello Candia. Un consolation. This was his secret, a secret that had come to visit the ruins of the factory with Manager a Servizio dei più Poveri (Paoline, the Lord had entrusted to him for the illumi- a quotation from Job: “The Lord has given, Milan, 1994), p. 115. nation of his mission and to fill his days with the Lord has taken away, blessed be the name 39 PIERO GHEDDO, “Perché la Santità that certainty of the divine which belongs to of the Lord,” (PIERO GHEDDO, Marcello dei Scuote le Coscienze,” in Mondo e Missione, saints!” We who chaired the commission of Lebbrosi, De Agostini, Novara, 1990, p. 125). 112, 1983, p. 611. diocesan inquiry for the cause of canoniza- 24 PIERO GHEDDO, Marcello Candia. Un 40 JOHN PAUL II, Encyclical Redemptoris tion of this friar share this judgement. Manager a Servizio dei più Poveri (Paoline, Missio, December 7, 1990, no. 91. 15 PIERO GHEDDO, Marcello dei Lebbrosi Milan, 1994), p. 75. 41 PIERO GHEDDO, Marcello Candia. Un (Novara, 1990), p. 113. 25 Ibid., 82. Manager a Servizio dei piò Poveri (Paoline, 16 Cf. ibid., pp. 47-48. 26 PIERO GHEDDO, Marcello dei Lebbrosi Milan, 1994), p. 87. 17 RUGGERO ALCINO, “La Prelazia di (De Agostini, Novara, 1990), p. 162. 42 Ibid., p. 97. Macap, l’Ambiente, il Pime,” in Quaderni di 27 PIERO GHEDDO, Marcello Candia. Un 43 Ibid., p. 145. Infor-Pime, no. 11, Rome, 1978. Manager a Servizio dei più Poveri, (Paoline, 44 Ibid., p. 147. 18 PIERO GHEDDO, Marcello dei Lebbrosi Milan, 1994), p. 69. 45 The Archbishop at the funeral. Mondo e (De Agostini, Novara, 1990), p. 15. 28 Ibid., p. 90. Missione, 112, 1983, p. 630. 19 Taken from Piero Gheddo, Marcello 29 Ibid., p. 93. 46 Taken from “Gli Amici ne Parlano,” in Candia. Un Manager a Servizio dei più 30 From the letter for his “Missionary Spir- Mondo e Missione, 112, 1983, p. 619. Poveri (Paoline, Milan, 1994), p. 92. itual Community,” dated February 27, 1977. 47 Ibid., p. 155. 20 As Monsignor Aristide Pirovano makes Taken from “La Testimonianza di Marcello 48 PIERO GHEDDO, Marcello dei Lebbrosi clear: “He wrote a letter to me in Macap in Candia,” in Mondo e Missione, 112, 1983, p. (De Agostini, Novara, 1990), p. 301. See also: which he really appeared as a modern Job en- 585. GIORGIO TORELLI, Da Ricco che era. La Fron- gaged in a titanic struggle to rebuild and pay 31 GIORGIO TORELLI, Da Ricco che era. La tiera del dottor Candia sul Rio delle Amazzoni off debts in order to realize the dream of his Frontiera del Dottor Candia sul Rio delle (Editoriale Nuova, Milan, 1985), p. 49. life and become a missionary in Brazil. I am Amazzoni (Editoriale Nuova, Milan, 1985), 49 Ibid., p. 227. convinced that the Evil One sought to destroy pp. 82-83. 50 Ibid., p. 214. this man and deprive him of the opportunity of 32 The visit took place on July 8, 1980. 51 Taken from Eugenio Fornasari, “Mar- fulfilling his dream. But Marcello was very 33 Taken from PIERO GHEDDO, Marcello cello Candia Manager e Santo,” in Vita Pas- stubborn and had the faith which moves Candia. Un Manager a Servizio dei più torale, 2/1993, p. 99. 226 DOLENTIUM HOMINUM

RICHARD BRULLMANN

Albert Schweitzer: A Good Samaritan of Our Time

During a mission meeting Albert everything that breathes; defend all Jewish wandering salesman from the Schweitzer discussed passages from living things from evil and let them mocking and teasing of children, he the bible with a number of African stu- sleep in peace!” used to accompany that person dents. When he came to the parable of The second piece was as follows: through the streets of the village. the Good Samaritan, Schweitzer used "I was perhaps seven or eight Albert Schweitzer was concerned the words of Jesus to ask them: “who years old when something happened with the question of the coexistence was a neighbor to the man who had which left a deep impression on me. of the two principal currents of been attacked by thieves?.” The an- Together with Henri Braesch I made Christianity even before there was swer he received was spontaneous: some catapults. One Spring morn- talk of ecumenicalism, and this was “You, Doctor!” Who was this man ing, an Easter Sunday, Henri said to certainly a part of his work and mis- who was the subject of such an an- me: “Come on, let’s go into the vine- sion. In discussing his childhood he swer? In Alsace, at the gates of the me- yards and go for the birds!” Even wrote as follows: “My child’s heart dieval town of Kaysersberg, there is a though the idea horrified me I did not was happy at the fact that in our vil- house with a bell tower which is used dare to say no out of a fear that I lage both Catholics and Protestants as a community center by the Evangel- would be teased. We went up to a held their services in the same ical Church. On one side of the en- tree which was still bare but which church...I would like all the churches trance there is an inscription: “Birth- was full of birds. They were unafraid of Alsace which are in the hands of place of Dr. Albert Schweitzer—Jan- of us and sang happily on that clear both denominations to remain as uary 14, 1875.” morning. Going forward in bent such, as future testimony to that reli- But the real homeland of Albert fashion like an Indian on a hunt, gious concord to which our hopes Schweitzer is Gunsbach in the Mu- Braesch held the stone and pulled the should be directed if, indeed, we nich valley. It was here, six months band of the catapult. Obeying his want to be real Christians.” As after the birth of the child, that Albert powerful look, I did the same. My Schweitzer’s family was meloma- Schweitzer’s father was made pas- conscience tortured me but I niac, Albert began to study piano at tor. It was here that Albert spent a promised myself that I would not the age of five. At the age of eight he happy adolescence free from wor- aim properly. At that moment the went on to the organ. Eugene Munch ries. But this was a period of his life church bells began to toll and their gave him a real and authentic train- which was by no means a source of harmonies mixed with the chorus of ing in the organ, and it was thanks to pleasure. This was because Albert the birds in that radiant sky. Munch that Albert came to know the noticed that everything went well for It was the first ringing of the bells music of Johannes Sebastian Bach. him and he was thus especially sen- before the main ringing which took But it was the organist and com- sitive to the suffering of other peo- place on the half hour. For me it was poser Charles-Marie Widor who ex- ple, whether they were near or far- if heaven was speaking. I threw ercised the greatest influence on the away. He had begun to see how ani- down my catapult, scared the birds musical activity and experience of mals suffer at the hands of men. so as to drive them away from the Schweitzer. At a very early age Al- For this reason he became above dangers of Braesch’s weapon, and bert Schweitzer came to be recog- all else the Good Samaritan of ani- ran as fast as I could to my home. nized at a world level as being an or- mals. Two pieces of writing by Al- Every time that I hear the bells of ganist of great talent. It was also bert Schweitzer well bear this out: Easter ringing in the Spring sky, with Widor who directed Schweitzer to- "I was unable to understand—and the trees stretching forth their naked wards the music of Bach and it was this was before I started my school branches, I experience the emotional thanks to this teacher that Albert days—why evening prayers in- remembrance of a commandment wrote first in French and then in Ger- volved calling for the well-being of which the strict voice of those bells man an introduction to the music of human beings alone. Thus it was that once brought to my mind: “Thou Bach—a work which remains today after my mother left me after giving Shalt not Kill!” an important point of reference. me a kiss and an affectionate “good Schweitzer soon became the Good For Schweitzer music was not night,” I quietly uttered another Samaritan of men. only a pleasure or a means to per- prayer: Good Lord, protect and bless As a student, in order to protect a sonal fulfillment. His organ concerts VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 227 enabled him to raise the funds neces- help with mission work in Gabon. spent the spring of 1912 in studying sary to allow him to continue with He realized at that moment what it tropical medicine. At the same time his studies and later meant that he was that he had to do. he began his medical thesis on the could provide financial support for This decision amounted to a “Yes” subject of the “psychiatric analysis his hospital in Labaréné. to Christ’s call to follow Him. of Jesus.” At the age of eighteen Albert Schweitzer wrote as follows: In preparing for his departure for Schweitzer began his undergraduate "I increasingly realized that I did Africa his wife—whom he had mar- studies in theology and philosophy at not have the right to accept the hap- ried on 18 June 1912—proved to be the University of Strasbourg. In piness of my youth, of my health, of the greatest help. Thanks to dona- 1898 he passed his first theology and of my ability to work, as being tions from his friends and money exam and in 1899 he went to Paris free gifts. A deep awareness of my raised from his organ concerts, and Berlin where he stayed for sig- privileges enabled me to understand Schweitzer managed to raise enough nificant periods of time. He then was with increasing clarity that parable money to establish a small hospital. awarded a doctorate after presenting of Jesus which declares that we do When everything was ready he sug- a thesis on the religious philosophy not have the right to lead our lives gested to the Society of Missions of of Kant. In the same year he was Paris that he become the medical made preacher at the church of St. doctor of the Lambéréne mission, Nicholas in Strasburg. and offered to pay for the expenses In addition to all this he also dedi- of the medical part of that mission. cated himself to the study of the New In this way his work as a Good Testament. On the 2 July 1900 he Samaritan begun in practical form. was awarded a degree in theology On 26 March 1913 Albert with a study on the Last Supper and Schweitzer and his wife left Bor- in 1902 he became professor at the deaux for Africa. On 18 April they ar- Faculty of Theology at the Univer- rived at Lambéréne where they were sity of Strasburg after presenting a welcomed with open arms by the study on the “Mystery of Messian- missionaries. ism and the Passion of Christ.” Lambéréne is in the Republic of In his new capacity as a university Gabon, and is about forty kilometers professor, he dedicated himself es- south of the equator, situated on the sentially to Jesus and to Paul. His re- banks of the river Ogoué. Schweitzer search led him to publish two works: would soon have to treat about forty “A History of Research on the Life sick people every day. The doctor of Jesus” and “A History of Re- was helped by his wife, who had search on St.Paul.” been trained as a nurse. The First In this way he came to be con- World War brought a rapid and vinced that the Christian faith—if it abrupt end to this promising and really wants to deserve the name— hopeful activity. Because Alsace at must express itself at a practical level that time was a part of Germany, Al- as a principle of life. And the imple- bert Schweitzer was seen as an en- mentation of this principle would infor our own advantage. The person emy by the French colony of Gabon. deed determine and shape the rest of whose life is full of blessings and At the outset he was allowed to con- Schweitzer’s life. In October 1905 benefits must in turn give such tinue his activity, but under strict Albert Schweitzer surprised both his things in equal measure. The person control. Later on, however, he was parents and his friends by telling who is spared suffering must help to prohibited from going on with his them about his plans to begin the reduce the suffering of others. All of work. These unexpected moments of study of medicine in the autumn, us must bear a part of the burden of freedom enabled Schweitzer to re- with the idea of then working as a pain which afflicts the world.” flect upon a question which had al- doctor in equatorial Africa. Indeed, As a result of special permission ready occupied his thoughts. The for some time he had had this plan in given to him by the government, in war brought out in brutal fashion the mind and he now began to put it into the years to follow Schweitzer was decadence of civilization. The ac- practice. His gratitude for the happi- both a teacher and a student at his ceptance of inhuman behavior which ness which had been given him from university. Whilst teaching theology the war involved demonstrated that the time of his university studies led he also studied medicine. At the men had stopped thinking about him to live for art and science until same time, however, he continued to good individual behavior and the the age of thirty and then to dedicate be a pastor at the church of St. construction of a truly humanitarian himself entirely to those who were Nicholas. society. less happy than himself. In October 1911 he passed his Fully aware of the uselessness of At that moment he did not know medicine exam. He had earned the going on deploring the decadence of how things would really turn out in money to prepare this exam at the civilization, Albert Schweitzer practice. But in the autumn of 1904 French music festival of Munich strove to find new ways of renewing Schweitzer found in his office a where he had performed the “Holy that civilization. In this way he came statement by the Society of Missions Symphony” of Widor under the di- to understand that the future would of Paris which asked for people to rection of the composer himself. He be strictly linked to the way life was 228 DOLENTIUM HOMINUM thought about. Only that person who to that of the people who surround Nicholas. was able to say “yes” to life and to him. At each moment he must em- In 1920, after Easter, Albert the world in which he lived would be ploy his conscience to the utmost to Schweitzer went to Upsala in Swe- able to promote civilization. A posi- decide what he must do in order to den. He had been invited by Arch- tive attitude towards life and the do what is good. bishop Nathan Soderblom to hold world involved an ethical sense— For Albert Schweitzer it was evi- conferences in the university of that that is to say responsible and honest dent that respect for life is in the end city. He held conferences and con- behavior on the part of man. nothing else but the message which certs in both Sweden and Switzerland For months Albert Schweitzer we encounter in Jesus. For this rea- and these enabled him to pay off the sought the answer to the question of son he wrote that: debts which had been contracted to how men could live in harmony with "The ethic of respect for life refers keep his hospital going during the each other and with the world. At to everything which includes ideas war. At the same time the idea grew dusk of the third day of a long jour- of loving, of devotion, of the sharing within him of returning to Lam- ney on the Ogoué in September of suffering, of the sharing of joys, béréne. 1915, the answer suddenly appeared and commitment to good.” Or in In 1921 he published his memoirs to him: “respect for life.” of Africa under the title “On the Bor- The person who thinks about the ders of the Virgin Forest.” The world and about himself sees that thoughts contained in this book may everything which surrounds him— still be considered useful in solving whether plants, animals or his fellow problems connected with promoting men—cling to life just as he himself development—problems which does. The person who understands have become very acute in today’s this must treat everyone and every- world. In this field as well Albert thing with respect. Schweitzer was a Good Samaritan. God has given life to every being In 1922, while preparing for his so that it carry out the task which it new journey to Africa, Albert has been assigned. In order to respect Schweitzer put the finishing touches God it is necessary to help each be- to the published versions of the con- ing to attain fulfillment—such is the ferences he had held at Birmingham good behavior which was originally on “Christianity and the Religions of envisaged for man. The person who the World.” Before leaving he re- behaves in this way, behaves well. wrote the conclusion to his book It is more than evident that the “Memories of my Childhood.” In ethic of respecting life becomes ef- both works he dealt with questions fective only when we manage to turn which were and remain at the centre it from being a mere idea into actual of our concerns. every day practice. Albert On February 14, 1922 Albert Schweitzer did not limit himself to Schweitzer left Strasburg and on behaving like this—he constantly re- April 19 was at the headquarters of minded us of our duties in similar the mission at Andende. Nothing re- vein. Our generation has before it the more simple terms: “The ethic of remained of the hospital except a small great question of the defence of the spect for life is an extension of the sheet-iron hut and the frame of a environment and more than previous ethics of love. It is the essential large bamboo hut. All the other generations it is able to understand thought of the ethics of Christ.” buildings had rotted away or col- how topical this need really is. For this reason Albert Schweitzer lapsed with the passing of time. Albert Schweitzer, of course, real- was a Good Samaritan in the spiritual The following months, therefore, ized that this basic principle was in field as well. With his concern for all were devoted to rebuilding what had contradiction with actual reality. In creatures and with his limitless sense previously been there. In the autumn nature a being lives at the expense of of responsibility towards everything of 1925 the hospital was already able another being, and even man himself which was alive, he helped people to to accommodate one hundred and cannot keep himself alive without give a meaning to their lives. fifty sick people and the people who taking the lives of plants and of ani- During the First World War accompanied them. Large-scale mals. But the person who feels him- Schweitzer was refused permission famine and a dysentery epidemic self touched by this great need un- to work in his hospital and passed a forced Albert Schweitzer to move the derstands his responsibilities. He no few months in a house near the sea in hospital to another and larger area. longer has a prejudicial approach to Cap Lopez. In 1917 he moved to With regret he decided to build the the life of other people because of France. After being in two intern- hospital for the third time, three kilo- neglect or for reasons of personal ad- ment camps he returned exhausted to meters higher up. On January 21, vantage. On the contrary, he strives Alsace after crossing the Swiss bor- 1927 the sick were moved from the in all situations to act with discern- der. When he had recovered he old hospital to the new. During the ment and to apply his conscience. worked as a medical assistant in a summer he built other huts in order to The more a man builds his daily life civilian hospital in Strasburg and provide room for two hundred sick upon such bases, the more is he able also took up his old duties as protes- people and to the people who accom- to give a meaning to his own life and tant pastor in the church of St. panied them. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 229

On June 21, 1927 Albert Schweit- Today’s World” and over the years to about six hundred people. The zer was able to take a much needed has not lost its topical relevance. number of patients was constantly holiday in Europe—in his work he The threat of atomic war led Al- increasing. was now surrounded by competent bert Schweitzer to break the silence On January 14, 1965 greetings doctors and nurses. In Europe he be- on such a subject which he had and congratulations arrived from all gan to travel and gave concerts and maintained prior to that moment. On over the world—it was Schweitzer’s held conferences. During his free April 23, 1957 he made an “appeal to ninetieth birthday. Until the middle moments he worked on “The Mys- the world” on Radio Oslo and called of august he was able to be content at tics of the Apostle Paul” and wrote for a halt to atomic experiments. The the state of his health, but his the first chapter of this book during unsuccessful results of the negotia- strength then began to diminish. On his return journey to Lambéréne in tions between Russia and the United September 4, 1965 he passed away, December 1929. States of America led him once at 11.30 in the evening. On Septem- Because the hospital was now again to shake the conscience of the ber 5, at 3 o’clock in the afternoon, known about for hundreds of kilo- world. The three speeches he made he was buried in the presence of the meters all around, on his third arrival appeared in the form of a book under whole of the population of the area. Albert Schweitzer had to deal with His thought and his work continue the problems of planning and putting to bear fruit. This reality will become up new buildings. ever more valuable if people reflect At the end of January 1932 he re- upon what a young person declared turned to Europe and at Frankfurt on after visiting Lambéréne: “My name the March 22 he gave the commem- is not Albert Schweitzer and in no orative speech on the centenary of way do I want the newspapers to talk Goethe’s death. He drew attention to about me. But I am unable to avoid the great humanitarian vision of the constant question: where is my Goethe, a man who very often ap- Lambéréne?” peared to him in the virgin forest as a The writings which Albert “smiling comforter.” Schweitzer left behind him at his In 1949 Albert Schweitzer made death have already been published, his first voyage to the United States or soon will be. They well show us of America. The great generosity of that his thought and ideas continue to the Americans and the donations be of great contemporary relevance. collected in Europe enabled him to They have a great impact upon the begin construction of a village for reader. lepers. In 1951 he received the peace The hospital of Lambéréne re- prize of German booksellers and was mains a living testimony to the made member of the Academy of Christianity and sense of mission Moral and Political Science. In 1953 which were behind its foundation. he was awarded the Nobel peace Those people who work there in dif- prize for 1952. With the money from ficult situations and offer their ser- this he was able to cover the houses vices to those who are less happy of the leper village with corrugated the title “Peace or Atomic War.” than they, and those who donate iron and thus make them more last- Two years after atomic experi- funds so that the hospital can con- ing and resilient. ments were renewed, and in continue its work, demonstrate in signif- In 1954 the village was inaugu- junction with Bertrand Russell, Mar- icant fashion that the call of Jesus to rated and was given the name of tin Niemoller, Robert Jungk and oth- follow Him is constantly heard. “light village.” This was because it ers, Albert Schweitzer launched an In an age in which many men provided a little light in the dark life “Appeal to Everybody. Atomic Ex- doubt that existence has a meaning of people who were subject to great periments do not Contribute to and find great difficulty in finding trial. It was for obvious reasons that Peace.” The appeal was published at the path they should take, the life and the members of this village said that Easter in 1962. thought of Albert Schweitzer should Albert Schweitzer had built a hospi- It was emphasized that there was be considered a source of great and tal for these sick people. And it is in no justification for the radioactive valuable help. this context that Schweitzer espe- pollution of the atmosphere and to The path which leads to a life cially revealed himself as a Good his great joy he was allowed to see which is full, is open to all those who Samaritan. the banning of atomic experiments identify with Albert Schweitzer’s On November 4, 1954 he was pre- in the atmosphere. definition of the destiny of man: sented with the Nobel prize for peace Unfortunately, present-day reali- “His vocation is to be a channel for at a ceremony at Oslo—the prize had ties well show us that a real and ac- the love of God here in this imperfect previously been awarded in his ab- ceptable solution has not yet been world.” sence. He took advantage of the oc- found to this major problem. casion to stress that war is inhuman In 1959 Albert Schweitzer re- Rev. RICHARD BRULLMAN President of the International and was an evil as malevolent as turned for the fourteenth time to Association for the Work of ever. The speech was published until Lambéréne. The hospital by now Dr. Albert Schweitzer in Lambéréne, the title “The Question of Peace in was able to give constant treatment Switzerland 230 DOLENTIUM HOMINUM

SUSANNA AGNELLI

Florence Nightingale

She became famous as the “Lady spirit and held out great expecta- to a small élite at that time. But with the Lamp” bending with her tions, found itself the target of bitter when she returned to England in the lantern over the British soldiers she criticism on all sides. spring of that year, her fame soon was nursing in the field hospitals Herbert asked Florence Nightin- spread. She was the first woman to during the 1854 Crimean war. gale to select and recruit a group of receive a medal from the Queen for In reality, however, that was the nurses and to leave with them for services to the nation. Her stereo- only real first-hand experience she the Crimean front. He knew that he typed images were published in- ever had with the wounded and could rely on one of Florence’s creasingly in all the most popular sick, during the months she spent main qualities: her organisational magazines. on the Crimean front which spread skill. The Government asked her to her reputation far and wide and be- For the first time in British his- write a report on her experiences in gan to build her up as a public fig- tory women had been asked to play Crimea. She published a report over ure, and almost a legend in her life- an active role in a theatre of war 800 pages long “to vindicate the time. (there were 38 of them, 14 lay thousands of men to had suc- But there are other aspects in women, 10 Catholic nuns and 14 cumbed to disease but who could which those involved in nursing Protestant sisters). The difficulties have been saved if they had been even today, often without realising were many, and there was constant given the proper care”, as she her- it, continue in the footsteps of Flo- friction with the army officers who self declared. One of her qualities rence Nightingale. where reluctant to give up any of was that he always looked behind Florence was born on 12 May their decision making powers, even the surface of events to try to seek 1820 into an artistocratic, but above regarding health matters. Further- out the underlying reasons for a all, cultured family. The Nightin- more, Florence Nightingale’s au- particular problem and hence find gale home was frequently visited by thoritarian character and the way in the most appropriate remedies. That the leading intellectuals of the time, which she obstinately steamrollered is why this report not only set out with guests, not only from England through anything that fitted her the facts, but criticised the overall but also France, Italy and America. convinctions and levelled criticism lack of organisation and the inade- Between the ages of 20 and 30 at the British Army did little to in- quacy of the army medical services. she cultivated a keen interest in car- gratiate her with others in the But the figures on the war them- ing for the sick, and felt called to it course of her mission. selves spoke eloquently: 2,700 sol- almost like a religious mission. While the army officers and doc- diers died in battle, 1,800 soldiers The first chance she had to prac- tors squabbled daily with Florence died of their wounds, but the vast tise her vocation publicly was of- Nightingale in the Crimean, back at majority of the dead—about fered to her by Sidney Herbert, a home the legend of the Lady with 17,000—died of diseases con- family friend and Secretary for War. the Lamp began to take shape. The tracted in a climate that was very In October 1854 the articles written war was recounted in instalments in different from Britain’s, living in by The Times’s Crimean war corre- a popular weekly, the Illustrated atrociously unhygienic conditions. spondent fell like a bombshell on the History of the Expedition to the Florence’s experience in the tables of the British middle and up- Crimea, using drawings to depict Crimea enabled her to begin work- per classes—the only people who the most important events. In Feb- ing out her own concept of health read the newspapers: he described in ruary 1855, the magazine published care based on the key idea of pre- the dreadful suffering of the soldiers the portrait of a young lady wear- vention: cleanliness, a healthy diet, with all the gory details, and ad- ing a cross around her neck and car- and good ventilation were the basis dressed the controversial question of rying a lantern; it did not name her, of good health. But her interest in the complete inadequacy of health because she was intended to stand nursing was not a purely personal care in the army. The Government, as the symbol of all the British fixation of Florence Nightingale’s. which was waging in a war that en- women who where working for What was then called the “sanitary joyed the support of public opinion their country, and also because Flo- idea” had already been the inspira- which showed a strongly patriotic rence Nightingale was only known tion of philanthropists, politicians VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 231 and poets back in the 1840’s; it was was an art that had to be learned itself was designed as a residential the social situation in Britain, at a through practice and discipline and college and the training was free of time of far-reaching and rapid by moral training, and was not sim- charge to all. changes, that highlighted the whole ply a matter of storing up technical Although at the beginning it was question of the living standards of information. difficult to find trainees, as the years the working classes and the search When planning the school, Flo- passed increasing numbers of for ways of raising them, and made rence sent out complex question- women enrolled, not only at the it a matter of public debate. The ex- naires to various institutions in Nightingale School and the other pansion of industry had made the France and in the German-speaking nursing schools, but with many working-class districts of many countries in order to find out more other vocational training courses. In British towns overcrowded, un- about their training systems for the last twenty-five years of the healthy, and unhygienic in every re- nurses. In those years statistics ap- nineteenth century, the history of spect, with homes without any facil- plied to social problems was be- women in British society underwent ities to guarantee hygiene. Many coming standard practice, and in or- a major change of direction. Women surveys into living conditions der to be credible and acceptable to were increansingly leaving their showed an urban population that homes: industrialisation had taken was largely poverty stricken and of- away many opportunities for craft ten ill because of the wretchedness work in the home; and now not only of their daily lives. proletarian women but also lower- The hospitals catered for the poor middle class and middle class while those who could afford it were women were looking for jobs out- treated at home by their own doc- side the home. tors. Hospital care was in a disas- Meanwhile, the campaign to give trous state, and many patients died women the franchise was in full within the first twenty-four hours swing. Florence Nightingale signed following admission. Florence various petitions submitted by the Nightingale became involved in the suffragettes but she did not take a di- public debate and in measures to im- rect part in the campaign, partly be- prove the situation and played a de- cause she believed that she had an- cisive part in creating the modern other mission, but above all because nursing profession, to the extent that she was sceptical about the political even today in nursing schools’ text- maturity of women and feared that books she is depicted as an initiator they would merely vote along party and innovator. lines following their husbands in- In 1860, using government funds stead of supporting specific wo- over which she was given freedom of men’s issues. But Florence never had management, she founded the any doubts about women’s abilities Nightingale School for Nurses. This or their right to live an independent was not only intended as a means of life, and in her diary written in 1853 founding nursing as a profession that she said “I have no intention of hang- had never existed before, but above ing about around my mother’s sitting all it was designed to break down the the public any claim had to be sup- room... I shall go out out to find a job. prejudiced view that nurses were un- ported by facts and figures. Being Man is born for the world, woman for educated, of dubious morality and endowed with a highly scientific the family. Women must be born for even former prostitutes. mind, and by nature being used to the world to find joy and to practise At the same time, many other do everything thoroughly, Florence their skills.” schools were established to train Nightingale went out and argued She applied one of the key ideas nurses, but in most cases they based her views using masses of data of all her work, namely the need to their approach and character on the which she collected personally. Her give medical personnel proper train- “Nightingale method.” Florence questionnaires comprising hundreds ing, to one particularly sensitive laid down in paintstaking detail the of questions with which she flooded area: midwifery. As in every other duties and working methods, trying England and the colonies of the hospital ward, there was a high to make clear the difference in the vast British Empire and the other death rate among nursing mothers in role and function of doctors and the European countries soon became all British hospitals in the mid-19th nursing personnel. During the prac- both famous and feared. century. Indeed, the statistics tical training period in hospital, a The Nightingale school provided showed that the death rate was much monthly personal progress report access to the nursing profession to higher among mothers giving birth was made on each of the proba- women from every class, regardless in hospital than among mothers hav- tioner nurses, including both their of their social background or finan- ing their babies at home. The prob- technical skills and their moral and cial situation. The trainees were lem was therefore to provide women personal qualities (for example therefore divided into five cate- wishing to give birth at home with punctuality, reliability, ability to gories, some receiving remunera- properly trained midwives to assist stay calm). In her writings, Nightin- tion and others paying their own them. Here again, as for nurses, Flo- gale said that the nursing profession board and lodging, since the school rence Nightingale’s aim was to 232 DOLENTIUM HOMINUM transform an occupation that by tra- government programme was set in Nightingale replied that it was first dition had been exercissed by uned- mition to build new hospitals for necessary to carry out a survey to ucated women into a modern profes- sick paupers, but work proceeded see whether there was any such sion based on sound scientific slowly due to a shortage of founds need, and if so how great that need knowledge. and red tape. was. After distributing one of her In 1862 Nightingale inaugurated a Most of the people trained at the customary lengthy questionnaires, six-month training course for mid- Nightingale School were sent to she found that in London there wives. The school had a towfold so- work in the workhouse infirmaries were already twenty-six associa- cial purpose: to provide training to try to make them somewhat less tions dealing with home nursing, above all for women from the poorer inhuman. From this point of view managed by lay benefactors or reli- classes living in the countryside, and the school played a very useful so- gious groups. What was missing to ensure that qualified midwives cial role because the nurses trained was suitable vocational training for would work for four years in the in other courses preferred to take nurses. Associations usually sent a houses of the poor in their own ar- better paid jobs in the hospitals. charitable gentle-lady accompanied eas, receiving a wage from their But Florence Nightingale took by a woman from the lower classes parish. to the houses of the poor, both of Her initiative could scarcely be whom were fairly ignorant of medi- called a success in terms of the ac- cine and had no specific working tual immediate results. In five method. years, only 40 midwives had been In April 1876 Florence Nightin- trained. Few women enrolled be- gale wrote a letter to the Times cause the country parishes were not launching a campaign to seek finan- able to afford to pay for their candi- cial support for the new association dates, but also because the women to train home nurses to look after who were already practising mid- poor sick people; the Promoting wives could not afford to give up Committee included doctors, re- their work to take six months’ train- formers and parliamentarians. ing. Three training schools were But Nightingale had the capacity opened. The students were required to publicise her own schemes and to have a medium/high sociocul- attract interest and debate around tural background since they would the principles that underlay them. be working under difficult condi- In the case of the midwifery school tions and would have to be able to one very important aspect was that organise and run their work with a it had drawn the attention of the great deal of autonomy. public and the medical profession To Nightingale’s mind, home to the need to improve the quality care was not merely a matter of of care at childbirth. But it was to looking after people at home when take another 40 years before mid- they were sick. For her, a nurse wifery was officially recognised as should be able to give patients in- a profession and governed by Act formation about hygiene and mak- of Parliement. up a different position to that of the ing the most of all the sanitation fa- Nightingale’s interest in caring other reformers because of her radi- cilities available to them. for the poorer classes inevitably cal views about the workhouses. The leading social issues in late caused her to take part in the heated Even though she though it was es- nineteenth century Britain were political debate in the 1860s on the sential to improve the quality of mostly debated in theory and practi- Poor Laws, which were designed in nursing care provided by these in- cal measures taken to tackle them particular to regulate the institutions stitutions, for her the real problem by private citizens and associations. that took take in the destitute, lu- was the very existence of work- Even so, the radical Liberal reform- natics and the sick. In London alone houses themselves. In 1867 she ers believed it was necessary for 20,000 people lived shut up in wrote I believe that the purpose of Government to play a more direct workhouses just because they were nursing is to care for the poor in part in helping the poorer classes. poor and often old, where they their own homes. .. I want to abol- Florence Nightingale shared this worked if they could, in exchange ish all the hospitals and surgeries in view and in the course of the years for board and lodging. More than the workhouses. But it is futile talk- that followed, even though she ac- one third of the inmates were ill and ing about the year 2000. cepted occasional donations she many died because of a lack of She devoted a great deal of time virtually never appealed again for medical care. to one issue, which is high on the public support to finance her An association was founded to social policy agenda today on the school. For she believed that it was improve the quality of nursing care eye of the year 2000: the provision the duty of Government to provide in workhouses supported by such of home care. When whe was asked training for the nurses looking after outstanding people as Charles in 1874 by a member of Parliament, the sick poor, both in the hospitals Dickens, John Stewart Mill and Mr Rathbone, to found an associa- and at home. Nightingale herself. In the 1870s a tion of home nurses in London, The seventy-fifth birthday of VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 233

Queen Victoria in 1887 provided an conditions of the soldiers’ quarters questions signed by the strange opportunity to finance many social throughout the country. From the lady. schemes. Thanks to wise diplomatic information collected by the Com- Her report on the data collected moves by reformers and benefac- mission in the course of numerous was successfully submitted in 1863 tors the Crown agreed to provide inspections which were analysed by at the Edinburgh Congress of na- funds to open the Queen Victoria Florence, she proposed a set of tional associations for the advance- Institute to train home visitors to remedies. Thanks to her views, im- ment of social science. In the pres- nurse the poor. The school curricula provements were made which con- ence of the Prince Consort, Flo- were based on the ideas laid down siderably reduced the percentage of rence Nightingale read out her com- by Florence Nightingale. This was soldiers dying of disease. In 1855, ments on how people can live and the first step in a process that was to before the “Nightingale treatment” not die in India. lead to setting up a nationwide sys- the death rate was 17 soldiers out of The health care plan involved im- tem of district nursing in the cen- every thousand, while in 1860 the proving hygiene in the home, intro- tury that followed. number had dropped to 9.9 per ducing irrigation and water distrib- In the middle years of her life, thousand. ution methods, and innovations in Florence Nightingale played a part farming techniques. She even in British public life at several lev- launched the idea of giving loans to els. The issue with which she was Indian peasants through a special concerned were all linked to one in- rural savings bank to enable them terest: harmonising health care. to own the land they worked and to Through the years she studied, ex- irrigate it with water purchased tended and applied this to many dif- from the British Government. She ferent spheres. thereby though she could change In terms of social policy, as we Indian famers along the lines of the have seen, her attention wa devoted model used for small-holders in the to looking after the poorer classes. British countryside, but she failed Her voice was heard loud and clear to take account of the profound dif- in relation a number of British in- ferences in mentality and culture. ternational policy issues, for which India’s problems were to remain she examined and suggested solu- a source of great concern to her for tions. over 20 years, but her proposals Like most of Queen Victoria’s were not widely applied by the gov- subjects, Florence was also proud ernors of the colony. of Britain’s growth as a colonial The “Nightingale method” of power. In the second half of the training health care personnel found nineteenth century the British Em- its way to the most distant of pire reached the peak of its expan- British colonies. In 1866 the new sion. As Asa Briggs has put it, hospital in Sydney, Australia, was Britain was the world’s workshop, at the centre of heated controversy building site, postman, banker and over the poor quality of service it clearing house. offered the patients. But Florence’s In order to maintain the Empire The revolt against the British in fame had already travelled the seas: and its primacy on the international India in 1857 threw the country into to solve the problem the Secretary scene the British Government built turmoil. The many troops immedi- of the region, Sir William Parkes, up a vast army. Her Crimean expe- ately sent in to quell the trouble asked the Nightingale School to rience enabled the Lady with the were decimated by tropical dis- send a group of nurses willing to Lamp to experience first-hand the eases. move to Australia; six of them left daily lives of the soldiers. After re- From the heated debate on the In- and inaugurated the recently turning from the Crimean she did dian question in Parliament, the adopted British method in Sydney. everything possible to improve the newspapers and sitting rooms of After the nineties, Florence health and hygiene organisation in Britain, it became urgently neces- Nightingale gave up all public life. the military barracks as one of her sary to introduce measures not only Now old and sick herself, she only constant concerns. In particular she to strengthen the Army but also to took part in the debate or health was horrified by the large number change the way civilian life was or- care issues, writing long letters of soldiers, mostly recruited from ganised in the colony. from the bed to which she was now the working classes, who died of Florence Nightingale decided to confined. disease and the lack of proper med- enter the fray and study a system to Many of the conditions that had ical care. improve the health situation and the driven her on to fight her battles In the colonies the situation was quality of life of the British in India had changed. With new scientific even worse because of the climate, and the Indian people themselves. knowledge abut hygiene and the and diseases unknown in Britain. The amazed officials of 200 British spread of infection, the service of- In 1856 Florence Nightingale military stations sitting on the Com- fered by hospital wards and the pa- pursuaded the Government to set up mission found themselves con- tients were no longer only the poor, a Commission to improve the living fronted with sheets and sheets of but also members of the middle 234 DOLENTIUM HOMINUM classes who paid for admission. rated from the utmost concern for more than their sickness considered But the Nigtingale School was no the human persona and for man’s with scientific abstraction, to whom longer able to keep pace with and moral and spiritual dignity. our attention must be directed. adjust its curriculum to the changes These, in my view, are the most This is why I have always ad- taking place in a field which the outstanding features of her witness: mired Florence Nightingale: a school itself had helped to mod- the central position she gave to the woman with great intellectual vision ernise. human person in the pursuit of sci- and a profound Christian spirit, who Florence Nightingale died on 13 entific progress, and the priority she showed us the way to combine the August 1910. attributed to meeting the needs of principles of the Hippocratic Oath But her witness did not die with the sick when developing health with the love of the Good Samari- her. care. tan. Florence Nightingale, in her Florence Nightingale teaches us Today’s society is confronted earthly life, not only made such an that the ultimate purpose of both sci- with extremely difficult decisions. effective and radical mark on the entific research and medical care In the darkness of the unresolved re- world of health care, but she also must be to put ourselves at the ser- lationship between ethical/spiritual managed to endow her work with vice of man, to alleviate earthly suf- values and medical/scientific the value of a universal and endur- ferings. progress, the witness of Florence ing example. She urges us to focus not on the Nightingale stands like a beacon, as Hers was a great act of Christian pure and stark scientific achieve- a light of hope for us all. witness. ments, but on the real and priceless The pursuit of scientific and ma- lives we are able to save. terial progress in the work of Flo- She reminds us that in their hu- Hon. SUSANNA AGNELLI rence Nightingale was never sepa- man dignity, it is the sick rather Italian Minister of Foreign Affairs VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 235

CORNELIO SOMMARUGA

Henry Dunant

Henry Dunant certainly qualified became a model for us all, spread- tee of the Red Cross, of which he as a Good Samaritan in our time. ling from country to country, reach- was one of the five founding mem- His work and his words—which, ing all social levels and touching bers; by the National Red Cross So- while profoundly Christian, are uni- every continent; cieties, that were created upon his versal and independent of any reli- recommendation and as a result of gion—still influence our lives to- 6) a universalist whose humani- his efforts, and by their Federation. day. tatian message and deeds, like those The right of victims of conflicts to For Henry Dunant was at once of the biblical Samaritan, are un- receive protection and assistance is 1) a Christian who, through his conditional, transcending all politi- embodied in international law by faith and his writings, devoted most cal and relgious prejudice, advocat- the Geneva Conventions. The red of his life to spreading Christ’s ing assistance without discrimina- cross emblem is—like the subse- message of brotherly love among tion; the universal scope of today’s quently recognized red crescent— all human beings, even in wartime, international humanitarian law and the universally recognized symbol even among enemies; of the Red Cross and Red Crescent of respect due to the wounded and 2) an active Good Samaritan Movement can be directly attrib- sick, and also to the people who who, just like the biblical Samari- uted thereto; care for them, the vehicles that tan, was on a journey when he transport them, and the buildings came across great suffering and an 7) an idealist and a realist who, that shelter them. These two em- urgent need for succour, who knowing that charity could never be blems symbolize humanitarian ac- stopped, improvised, mobilized, a substitute for justice, nor humani- tion today. and put aside the trivial in order to tarianism for peace (though he was Yet the example that began in deal with the essential; awarded the first Nobel Peace Prize Solferino should not be applied in in 1901), always maintained the wartime alone. It must also be pur- 3) a media man, capable of mo- two distinct approaches; sued in peacetime, either to assist bilizing the public opinion of his the victims of natural disasters or time with the book “A Memory of 8) a committed relief worker who those in distress—that is the role of Solferino"—an eyewitness account always remained neutral: Henry the National Red Cross and Red of the suffering and abandonment Dunant’s example at Solferino in Crescent Societies, and their Feder- of thousands of wounded soldiers 1859, and later in France in 1870 ation. lying on the battlefield on 24 June and 1871, still serves as a source of Based on Good Samaritan Henry 1859, and a call for action through inspiration to the ICRC as it pur- Dunant’s example, it is now up to the example set by the “Good sues its activities in 30 conflicts to- us to perpetuate and expand on the Samaritan of Solferino;” day—humanitarian activities must deeds and the law that began in be practical, neutral, impartial, and Solferino, so as to ensure—even at 4) a diplomat who, as a pioneer undertaken for all victims of war, the hight of wartime violence—re- of the humanitarian cause, per- without distinction. “Tutti spect for life and the dignity of suaded major governments of the fratelli”—“They are all brothers,” every human being through practi- time to create National Red Cross said the women of Castiglione as- cal humanitarian action by the vic- Societies, to come to the negotiat- sisting Henry Dunant in the Chiesa tims’ side, through proclamation of ing table, and to sign the first Maggiore. the fundamental principles, and Geneva Convention in 1864; The words and deeds of Henry through codification and implemen- Dunant—who died on 30 October tation of international humanitar- 5) the creator of a network of 1910, the same year as Florence ian law. goodwill who, like the Samaritan in Nightingale and Leo Tolstoy, two If Henry Dunant’s work has been the parable, succeeded in mobiliz- personalities he admired—are just continued from the time of ing people, not only in the short as valid today. His humanitarian Solferino up to the present day, it is term but for many years to come— example is perpetuated by the not merely because of the memory for with one single act his example ICRC, or the International Commit- of an act worthy of the Good 236 DOLENTIUM HOMINUM

Samaritan in Christ’s parable—an crimination, like the Good Samari- not relics of times gone by, for they act that went on to become the tan, like Henry Dunant in Solferino. call on each and every one of us to linchpin of a world Movement and ¥ Neutrality: The ICRC enjoys lend a helping hand whenever and is now firmly established in interna- the confidence of all because it wherever needed. tional law—it is also because hu- does not engage in political, racial, Henry Dunant’s message and manitarian action is now inextrica- religious or ideological controver- work are as relevant today as they bly linked with a number of Funda- sies, but endeavours merely to alle- were more than a century ago. An ar- mental Principles, which guarantee viate human suffering and afford dent Christian whose initiative in its authenticity and effectiveness. ubiased assistance and protection to Solferino was worthy of the Samari- These Fundamental Principles were those who need it. It was never the tan of the Gospel, he succeeded in formally proclaimed 30 years ago at intention of the Good Samaritan or mobilizing public opinion and cre- the 20th International Conference of Henry Dunant, nor is it the inten- ated a network of goodwill at all so- of the Red Cross, held in Vienna in tion of the present-day ICRC to cial levels and in all countries; he was 1965. pass judgment, either on those who an able diplomat and a universalist Allow me to cite and briefly cause the suffering or those who ahead of his time. But above and be- comment on these seven Principles, fail to provide assistance. yond all those qualities and all those since they are in harmony with the ¥ Independence: If humanitarian achievements, it is the words and worlds and deeds of Henry Dunant action is to be respected, it must re- deeds of Henry Dunant, an idealist and with the spirit of Christ’s Good main independent as regards poli- yeat a realist, that still serve as a Samaritan. tics, religion and finance. source of inspiration for millions of ¥ Humanity: The principle of hu- ¥ Voluntary service: This princi- men and women today, that repre- manity means endeavouring to pre- ple underscores the purposeful and sent hope in the face of despair, that vent and alleviate human suffering disinterested nature of humanitarian bring a message of life in the face of wherever it may be found. This action. death and that, even in the midst of concept exists in all religions, all ¥ Unity: Unity signifies the cohe- hatred, sow the seeds of fraternity traditions, all civilizations, and all sion and harmony of the National and peace. philosophies. It is vital nowadays Red Cross and Red Crescent Soci- Henry Dunant was a Good Samar- that we understand that all human eties, as well as their willingness to itan of our time. His life and work re- beings make up one family, no mat- recruit, without discrimination, main symbols of hope, compassion ter to what religion, traditions, civi- members and workers who are and solidarity; as Victor Hugo wrote lization or philosophy they may be- called on to pursue humanitarian to Dunant, “You are arming the long. activities throughout the country’s cause of humanity and serving free- ¥ Impartiality: Impartiality means territory. dom.” recognizing that all men and ¥ Universality: The humanitarian women are equal, that care must be spirit knows no borders. It must pre- provide equality and according to vail everywhere, and at all times. The Dr. CORNELIO SOMMARUGA need. It means we should act impar- parable of the Good Samaritan and President, International Committee of the tially and without prejudice or dis- Dunant’s A Memory of Solferino are Red Cross (ICRC) VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 237

ANDRÉ RECIPON

Raoul Follereau: Apostle of the Lepers

Associations in over thirty coun- rolled as a lawyer at the forum of Argentine newspaper—La Nación— tries bear his name and continue the Paris and became part of an impor- asked him to write an article on “The battle he conducted his whole life tant law office. But the first case in steps of Father De Foucault.” He against leprosy and against all forms which he was called to be the de- therefore made a number of journeys of leprosy. fense lawyer was a divorce case. He to the Sahara and on his return from Who was this Raoul Follereau then left the forum and became sec- each one wrote articles and gave whose name gives rise to so much de- retary in the editor’s office of an im- talks. The proceeds enabled him to votion on the part of people of all ages portant Paris newspaper. finish the work on the Basilica of El and from all social backgrounds? In 1927 he set up his first associa- Goléa and to build the chapels of A man with a great heart, an ad- tion with the help of some poet Adrar and Timimoum. At that time vocate of the magnificent word. friends of his, including my grandfa- the “League of the Latin Union” be- He was born in Nevers in 1903. ther Michel Rameaud and a young came the “Charles De Foucault His parents were owners of a small priest who would later become Foundations.” business which worked for the agri- Mons. Ducaud-Bourget. This associ- It was during one of these jour- culture of the region. They were nei- ation was called “the League of the neys, in 1935, that he encountered ther rich nor poor. They enjoyed a Latin Union for the Defense of lepers for the first time. He was on simple and truly honest standard of Christian Civilization against all his way through the Sahara to the living. In 1914 his father was called forms of Paganism and Barbarity.” Niger. This is his own account of to arms and in 1916 was killed at He would write its extensive pro- what happened: Verdun. At that time Raoul gram much later. Follereau was thirteen years old. In 1929 the Ministry of National “How did this adventure which In 1920, when he was seventeen, Education gave him a special mis- would last for the whole of my life he published his first poems and his sion. The ministry was in his debt be- actually begin? It was because my first book of love: cause of a question arising from an car broke down! I had to do an arti- “To live is nothing—you have to love. examiner whose honesty had been se- cle for an important Argentine news- To love you have to pray: love is verely called into doubt—Follereau paper and I was in the center of baptism! had had to call for disciplinary sanc- Africa. That morning our car had Blessed are those that love be- tions in the case. His mission was to passed through a village when we cause they will investigate the causes of French in- had to stop our journey because the be blessed by the Lord.” fluence in South America. After eight engine was overheated. In 1923, at the age of twenty, he months he returned with two reports. After a short while a number of gave his first talk. It was at a cere- One was the official report on his frightened faces came out of the mony to commemorate the victims mission. The other was entitled: “the bush, then a famished body. I called of the war. The title of the talk was: Anti-Religious Laws of 1905 have on them to draw near. Some fled but “God Is Love.” Betrayed France.” some others—no doubt the most “The heart is the key to heaven. In both reports he declared: “all courageous— remained where they It is the great force of the universe, the clergymen and members of reli- were. But they did not stop looking at the only invincible force, the only gious orders which you have ban- me with their staring eyes so full of creative force" ished from our schools left for the pain. “Let us love each other—this is world. They have created schools, I said to my guide: “Who are these everything." colleges, and universities, all of men?” In the idea of love can be defined which have grown in number, from “Lepers,” he replied. and captured the entire philosophy Buenos Aires to Caracas and from “Why are they there?” and work of Raoul Follereau. His in- Rio de Janeiro to Valparaiso. Every- “They are lepers.” credible destiny began on the path of where you go French is learnt and “I understand but wouldn’t it be charity. ancient French songs are sung, and I better for them to be in the village? In 1924 he graduated in law and was welcomed by both!” Obviously What have they done to be so ex- letters. He then left to perform his enough, this was not what the min- cluded?” military service. When this was over, istry wanted to hear! "They are lepers,” replied the man a year later, he married. He then en- During this voyage an important in taciturn and stubborn fashion. 238 DOLENTIUM HOMINUM

“But are they at least treated and was no medical treatment for lep- to receive a huge correspondence cared for?” rosy. The exclusion of the victims of from sick people, medical doctors At that point the person I was leprosy was a result both of panic on and missionaries, all of whom said speaking to shrugged his shoulders the part of healthy people and of a the same thing: in this world there is and went away without saying a policy of abandonment by doctors. much more than Adzopé! They told word. That day I understood that There was also the impact of the him that “millions of people are there was a crime which could not be health regulations of the time. without treatment, succor or love!” forgiven. A crime without a memory Like Fr. Damien, who has recently He then left for Africa, Asia, and and without any prospect of an been raised to the glory of the altars South America. He held 296 confer- amnesty—leprosy.” by the Holy Father, only clergymen ences in thirty-five countries and Shortly afterwards the First World and members of religious orders was able to see how widely spread War was about to break out. The de- agree to leave everything—family, leprosy actually was. claration of war found Follereau in friends and country—to go and live On September 20, 1952 he made Argentina. He returned to France, in a faraway region which is often an appeal to the United Nations: was called to arms, and in 1940 man- hostile and unwelcoming and spend “The neglect by the civilized na- aged to escape capture. In 1940 he their lives with men and women tions of this question is such that to- arrived in St. Etienne at my grandfa- day no country is able to give even ther’s house, and for the rest of the an approximate estimate of the num- war my grandfather acted as his per- ber of lepers within its borders. At sonal secretary. the present time it is not possible to From 1940 to 1942 he went to declare that there are a few million communes throughout France and lepers suffering on our planet... tirelessly held the same conference Since I began my travels around on the subject of “what the world the world to investigate local situa- owes to France.” His aim was to re- tions and to ask the most qualified store confidence to the French who people about the way things are, I had been rudely shocked by the de- have come to the certain conclusion feat which had recently been in- that there are at least twelve million flicted upon them. This was the first lepers in the world—that is to say occasion I heard him speak. It was one for every two hundred inhabi- towards the end of 1941 and I was tants...In very many countries lep- sixteen years old. One year later, in rosy remains a condition of which to 1942, the conflict became world- be ashamed. Lepers are hidden, kept wide. At an international level all the from sight, and shut up. This is true nations of the world became indi- both of families and of nations.” rectly or directly involved in the con- He was able to speak with even flict. At a national level the French greater energy because in 1952 that began to divide into two groups is to say ten years after the launching which were separated by a hatred so of the “battle against leprosy”—a terrible that it is still alive today. drug which cures leprosy had been With the intelligence which charac- discovered for the first time, namely terized him he clearly perceived sulphonics. The joy caused by this from 1942 onwards that the “Mar- discovery to both the sick and those shallists” and the “Gaullists” would made lepers by our selfishness. responsible for their treatment and never become reconciled. The ap- These missionaries (of whom two care cannot be imagined. Finally, peal of the mother superior of the sis- out of every three are French) have medical science had triumphed over ters of our lady of the apostles— written the most beautiful pages of a disease as old as the world. Finally, which is where he was hidden—was the book of charity. those afflicted by leprosy would be a crucial factor in leading to the deci- In order to build the town for lep- able to be men like other men. sion to establish Adzopé and thus to ers of Adzopé funds were needed. In order to gain the world’s atten- begin the “battle against leprosy.” Raoul Follereau dedicated himself to tion Raoul Follereau took a powerful This was in November 1942. The the question. For ten years, and ac- initiative. In 1953 he launched the mother superior had returned from a companied by two nuns, he trod the idea of a world day of leprosy to be difficult and dangerous journey. She roads of France, Belgium, Switzer- celebrated on the last Sunday of Jan- had discovered an island in the Abid- land, the Lebanon, Algeria, Tunisia, uary. He defined the aims of this ini- jan lagoon where a group of rejected, Morocco and Canada. He held 1,200 tiative in the following way: abandoned and damned lepers lived meetings in ten years! The first took ¥ to ensure that those suffering in a state of desperation. place on 15 April 1943 at the mu- from leprosy are treated and cared She then conceived of a project to nicipal theater of Annecy. for like other sick people, with rebuild a small town for them in the “By that time I had been taken by spect for their freedom and their dig- middle of the virgin forest—a plan leprosy. I don’t mean that I had nity as men; which respected the local health reg- caught the disease. I was its happy ¥ to ensure that healthy people no ulations. Each family would have its prisoner. I had seen too much mis- longer have their absurd and at times own little house and a garden, and in ery, too much pain, too many faces criminal fear of this disease and of this way everybody would have the afflicted by the evil and by shame, those who are afflicted by it. feeling of being free. too many faces without hope." From the first day (31 January I remember that at that time there The conferences he held led him 1954) we were able to witness a VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 239 unique and wonderful event: people given us...My wife was suddenly at- are made to bow who lived in towns near to lepers tacked by severe appendicitis. We before its justice. marched “to the lepers.” The next were a thousand kilometers from the year, in 1955, the day was celebrated nearest doctor. During that moonless It has made maternity in sixty countries. In 1961 it was cel- night I saw her doubled up and I into a holy and venerated task. ebrated in one hundred and sixteen heard her moan. To defend us and to It has made the greatness nations of the world. This initiative protect her I had only a jammed pis- and tender power of Raoul Follereau, which involves tol, two centimeters of candle and of woman respected. the collection of funds from healthy three matches. In that crushing dark- It has made the individual people or solidarity with lepers in ness I had the strange and somewhat into a man. countries where the disease is en- terrifying impression that my hair demic, took place for the forty-sec- was going white, and I was only thirty It has protected the child ond time on January 29, 1995 in a years old. “to whom belongs large number of countries. In 1968 “Or of that evening when the en- the kingdom of heaven.” he asked me to continue his work gine of our canoe stopped in the mid- and inspired by this man of genius I dle of Amazonia and we strove in It has damned wars. proceeded to establish the necessary It has limited them national and international organiza- where possible. tions and structures. Without sharing the optimism of the World Health It has created hospitals Organization, we can state that lep- and schools. rosy is about to be defeated and that It has cared for, consoled an important role in this has been and healed without ceasing played by the organizations which for twenty centuries bear the name of Raoul Follereau in the name of that poor and carry out his work “against lep- man who said: rosy and all forms of leprosy.” “Love one another." On December 6, 1977 Raoul Follereau returned to the house of Christianity is universal. the Father after finishing his life and Its message is for all his work. I cannot finish my paper the peoples of the world. without reference to the role played by his wife, Madelaine Follereau, in Its civilization is like the battle against leprosy and against the face of Jesus... all forms of leprosy, and without Christianity reading you some pieces written by is revolution Raoul Follereau on Christianity and through charity. on charity. In this way perhaps you will understand why this men exer- Atomic Bomb or Charity cised such a great influence. in the first volume of his book “The Charity, light of our lives. Only Truth is to Love Each Other,” Charity, is not alms-giving. which was published in 1966, Raoul Follereau writes as follows: that night rent by our lamps to get to Charity, source of every joy. the bank of the river. We had to use Charity, order of God, My Greatest Fortune tins as oars to get to reeds full of reflection of his eternity... thousands of mosquitoes where “The greatest fortun enormous caymen passed the night. Charity must be done e of my life has been my wife. When “Only when you are in two are above all else we decided to get married our ages to- you invincible.” "for the love of God.” gether did not pass the thirty mark. Our To finish I would like to cite those Without the love of God parents were wise and smiled...Some pieces on Christianity which ap- who is the source of charity, fifty years later it is we who now smile. peared in 1948 in “The Age of it becomes generosity, altruism... “I have never gone on a journey Man,” and those pieces on charity It is very beautiful... without her. She has accompanied me which appeared a year later in the But it is not charity. in all the leper colonies of the world. work “Atomic Bomb or Charity.” She has been my support, always. And Charity at times my consolation. The Age of Man is the image of the face of Christ “I confess that I barely manage to on the face of the poor man, control my irritation when some good Christianity the suffering, the persecuted... woman says to her, and with a certain has given to men Charity hidden envy: “But you go on good jour- their only real freedom is the history and the glory neys.” their only lasting happiness, of Christianity. “Most of the time she smiles without their only just laws. answering. Perhaps she thinks of that It has broken the chains M. ANDRE RECIPON night which we spent in Bolivia, in a of slavery President of the Raoul Follereau Group, hut which the Quichuas Indians had and princes and kings France 240 DOLENTIUM HOMINUM

SIMONE TONINI

Abbot Hildebrand Gregory

Introduction: preacher and a very much sought af- Monk or Good Samaritan? ter spiritual director. In 1933 he was nominated superior of the mother The word “Abbot” tells us that we house of the order and in 1939 when are talking about a monk. We imme- the outbreak of the Second World diately ask ourselves how it was that War was in the offing he was elected a monk could also be a “Good Abbot General. Samaritan” in the common sense of In previous years his activity had the term. been very intense but during the war A “monk” should live a hidden it was only limited by the time avail- and quiet life within the walls of a able. In addition to being responsi- monastery, dedicated to prayer, to ble for his congregation—all the study, and to work. How can he be a houses remained open and func- “Good Samaritan” if he takes care of tional despite the very great difficul- orphans, the poor, the sick and the ties in relation to communications, elderly who live in the world out- movements, food and clothes—he side? If he dedicates himself to such became ever more involved in help- activity, can one really say that he is ing communities and people in diffi- consistent with his vocation? These culty. He opened his monastery of are legitimate questions if we are St. Stephen in Rome to people in ex- presented with a monk is held up as treme danger, both Jews and others, a Good Samaritan of our times. and even found means by which to But it is precisely this tandem of help refugees who were forced to monk and Good Samaritan which live far away from their homes attracts our attention to the person which were in the combat zone. One and the work of Abbot Hildebrand. wonders how it was possible for His Eminence Cardinal Fiorenzo such a man, who often had health Angelini, the first biographer of this problems, to live at such a pace. He Servant of God and also his spiritual age of fifteen when he was given the ate very little, slept even less, was son, understood this very well when religious name of Hildebrand. Dur- constantly moving around, and yet he entitled his book “from the her- ing the First World War he served in always found time for intense and mitage to the crowd,” a title which I field hospitals in a variety of places, lengthy prayer. would like to translate in perhaps and with his own hands he touched The plans which he had devel- more exact terms with the phrase the physical and moral ruins pro- oped during the periods of calm of “from the monastery to the people.” voked by the war. It was during this the First World War suddenly be- period that he begun to think about came of dramatic importance for helping young people to become him. He was the Abbot General and 1. Who was Abbot Hildebrand? useful and responsible citizens after therefore had the authority to act. the catastrophe of that war. But for him authority meant first and Abbot Hildebrand was born in the When the conflict had come to an foremost responsibility. He felt that small towm of Poggio Cinolfo, in end he finished his studies for the he could and should act. The painful Abruzzo, Italy, on May 8, 1994, and priesthood at the Gregorian Pontifi- sight of children abandoned and un- was baptized with the name of Al- cal University of Rome, and gradu- derfed, often left in the streets to fredo Antonio. He felt a strong at- ated in philosophy and theology. For look after themselves and the easy traction for the religious life from a nine years he dedicated himself en- prey of vice and disease, could not very early age but he was allowed to tirely to promoting and forming vo- leave the Abbot Hildebrand indiffer- enter a monastery of the Benedictine cations to religious life and the ent to their fate. Silvestrine Congregation only at the priesthood. He also became a In a place which had been given VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 241 him by a noble Roman family—a monastery of St. Stephen in Rome, many points of view they were in a site which no other religious order his more frequent office was the worse situation than infant boys. He wanted because the building was in bus, the train or the car. The amount managed to organize a meeting of ruins, the land was sterile, and there of correspondence he had to deal young women who wanted to conse- was no water—he managed to con- with was immense, and the same crate themselves to God and to their struct a house in record time with all was true of the number of contacts neighbor. kinds of materials that came his he had with all kinds of people. In He rented an old small monastery way. At first there were the the office of the postulation we have of the Capuchin friars, not far from “colonies.” These were a kind of more than thirty address books full where he had begun his work with summer camp for children threat- of addresses and telephone num- children, and begun another incredi- ened by tuberculosis who often did bers. He had a very strong sense of ble work of charity. In a short time not have a family or who were the gratitude and he gave a receipt for the two institutions had thousands of children of parents who were too every kind of help he received and children and provided them with poor to take care of their health or was always punctual in thanking the schools and other services. Another their upbringing. six monasteries of his order opened Abbot Hildebrand was not a man their doors to children and the num- who could send these children back ber of homes for infant girls grew to their homes after a few months rapidly as the female religious insti- stay in these camps (even supposing tution he had created attracted new that they had a home to be sent back recruits. Thousands of children, to) or to return them to the institu- both boys and girls, found a wel- tions which had sent them to him. come, new life, hope, dignity, and a He dreamed about places where future. these children could find a roof over their heads, care, education, and above all else love and hope. These 3. The Man of God summer camps thus became permanent. This meant new buildings and When faced with this unusual fig- structures. ure who was both a monk and a The meager existing structures Good Samaritan certain questions soon became insufficient to deal immediately pose themselves to us. with the hundreds of requests that How was Abbot Hildebrand able rained down from all quarters. A to engage in such extensive social kind of wonderful avalanche began: and charitable activity and at the barracks obtained as cast-offs from same time remain loyal to his voca- the army, then further boys, new tion as a monk? buildings and then new places. An- How did he manage to do all this, other six monasteries of the order why did he do it, and what led him were involved, other monks, other to do it, given that he was a monk? teachers and helpers. In a short time Abbot Hildebrand was certainly a there were hundreds of boys and lit- monk in the real sense of the term, a tle later thousands. monk without compromises. If the And what about Abbot Hilde- motto of the Benedictine monks is brand? How did he manage to keep “Ora et Labora,” he certainly em- everything in hand? As Abbot gen- bodied that motto with distinction. eral he was required to travel and benefactor. He had begun with noth- He was a man of prayer, and how visit monasteries not only in Italy ing and from nothing. He was poor much he prayed! Those who accom- but in the United States of America, and his order was also poor. He did panied him on his journeys can bear in Ceylon, in Australia and in India. not draw back from asking or from witness to the fact that the car be- It was he who had to find money, knocking, from going up the stairs came a chapel and an office. He of- food, clothes, furniture, books and of ministries, or from waiting for ten passed long hours during the every other kind of necessity. It was many hours (with humility and pa- night deep in prayer, in front of the he who had to find the staff, keep an tience) in the waiting rooms of peo- Holy Sacrament, at times literally eye on the administration, follow the ple who could help or were obliged prostrate on the floor. construction of the new buildings, to do help because of the jobs that There, in the silence of the night, keep documents, manage the corre- they held. he opened his heart to the Lord; spondence with ministries and such from the Lord he received the government offices as the ministry strength to go on; and in his love for of health, the ministry of education, 2. The Founder God he felt his compassion and love the ministry of public works, and for his suffering brothers grow many others. And here we touch upon another, within him. It was during the war Even though he had set up a kind in a certain sense unusual, activity that he became especially devoted to of rudimentary office in a small of Abbot Hildebrand. He, a monk, the Holy Face of Jesus Christ, a de- room next to the sacristy of his thought also about infant girls. From votion which had been dear to many 242 DOLENTIUM HOMINUM

Benedictine saints and mystics, both children, it is right that the authority of charity, he had a vision of what it men and women, in times past. of the Rule should provide for would indeed become. Through his intense and constant them”). When after the trials and tribula- union with Christ the Redeemer he A monk and a Good Samaritan— tions of the war, society finally took saw the suffering Holy Face in the this is what gives Abbot Gregory, shape again and moved towards face of his brethren in need. This the Servant of God, full right to citi- well-being, the new generations no was the force which moved him. zenship of this conference and justi- longer needed that kind of help. Ab- This was the spring from which he fies the inclusion of his name bot Hildebrand, who was by now drank and which gave him the en- amongst the Good Samaritans of our free of the weight of the office of su- ergy for his prodigious activity. His time, those figures which we are perior general, directed his thoughts “Labora,” his work, was the fruit of commemorating here today. As a to a new category of people who the first part of the Benedictine tan- monk, as a contemplative, as a mys- were falling into the hands of dem “ora” which he certainly lived tic, Abbot Hildebrand invites us to thieves—the elderly who had been out with impassioned intensity. the spring of our ideal and our discharged from hospital and who were often without homes and without people who wanted or were able 4. A Man for Others to take care of them. Abbot Hilde- brand began to take care of these With regard to the second part of new “poor,“ and upon their wounds the tandem, the Labora, nobody there flowed the oil of his charity. ever saw him at rest or on holiday. The Servant of God predicted what From the period when he was a was about to happen and foresaw young monk full of fervor he had re- what had to be done about it. He solved to never lose a minute of thus gradually begun to transform time, and this was a promise he kept the buildings which he had built for until the end. And he spent all his children and to create structures time working for others—his fellow which were suitable for elderly peo- monks, his boys and girls, his spiri- ple, and especially for the bedrid- tual daughters, and all those who den. At the same time he ensured came to him in search of material that many of his nuns became quali- and spiritual help. He loved paint- fied as nurses and were thus ready to ing, music, and poetry, but once had deal with the new situation. He tried finished his studies he had to leave to inculcate within them a great love his personal tastes to one side in or- for the weak and the needy, and this der to dedicate himself to others. because what elderly people have Can one say therefore that this most need of today is love and un- kind of life was “nonmonastic”? derstanding. The ancient Fathers of monasticism, namely Pacomius, Basil the Great, Martin of Tours, have welcomed 6. Atonement Abbot Hildebrand into their midst with joy, as they welcomed those One of the typical qualities of Ab- who contributed to the construction bot Hildebrand was always that of of Christian Europe. taking objects which had been Who does not know that in the thrown away or deemed too old, in- past the monasteries had wonderful cluding dilapidated properties and cures and medicines? (Cf. The buildings, or broken or valueless Name of the Rose by Umberto strength: the contemplation within artistic works, and restoring them or Eco!). St. Benedict, after all, in the the suffering Christ-God of those bringing them back to their original fourth chapter of his Rule calls upon who are in need and in pain. condition. What he managed to do the monks to “help the poor, dress with extraordinary success with the naked, visit the sick, bury the things he was able to do in even dead, to go and help the suffering, 5. The Man of Vision more admirable fashion with peo- and console the afflicted.” Amongst ple. The thin faces of children be- the precepts which the Rule lays Abbot Hildebrand was a man of came healthy and radiant once again emphasis upon with especial force vision: he described his vocation to and the sad expressions of the el- is that of caring for the sick (“care religious life as an unforgettable ex- derly once again became serene and for the sick must be more important perience and vision. During the First smiling. than anything else, and they must be World War, on the fields of battle, The austere monk also became served as one would serve Christ”) he had the vision of what it would be transformed when he was amongst and caring for the elderly and for necessary to do for children after the his children and his elderly folk. He children (“although human nature conflict was over. When he first saw laughed, joked and was happy at the itself is inclined to be compassion- the ruined place where he would parties and entertainment he orga- ate towards the old and towards have to set in motion his great work nized for them. He gave the name of VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 243

“Sisters for Reparation to the Holy “Our program—he once said to May your service be a real service to Face of Jesus” to the religious con- His Eminence and to his nuns my souls and to bodies.” gregation he established. This name program, your program, the program When reflecting on the parable of has too often been understood as re- of the nuns, is to do good, to do good, the Good Samaritan, I like to see ferring to a mere devotional ele- to do a great deal of good, the good of Abbot Hildebrand as another person ment: prayer and penitence in atone- souls and bodies.” In another impro- of the parable, namely the ment for the injuries done to the vised speech to the nurses and doc- innkeeper. We are not told that he Lord. For the Servant of God, how- tors of the Lateran Hospital of St. himself went to the wounded man— ever, the name had a broader and John, in Rome, where his nuns were on the contrary, the wounded man deeper significance: atoning for, and students, the Servant of God left the was brought by the Good Samaritan restoring, the Face of Christ, a face following message: and entrusted to the innkeeper. Yet which had been disfigured by hu- “The most valuable part of the hu- the innkeeper was certain that his man weakness and ingratitude; liv- man redemption has been entrusted Friend and Lord would have re- ing up to His commandment to love; to you: that of the ‘least’ of Jesus turned and would have repaid him and commitment to the renewal of Christ, handsomely for what he had done. the bodies and the souls of those of the poor and the elderly, Many of us are in the same situa- our brethren who are weakest and the man afflicted by cancer, tion—the poor and the needy in soul most in need. those struck down by every other and in spirit are entrusted to us by illness.... the Good Samaritan on different occasions during our lives. 7. His Message The young woman who bears the He has given us a great deal to be weight of guilt in addition to her spent in caring for His Last, those The message of Abbot Hilde- physical torment turns to you, whom he loves the most, and we can brand, through his work, his words the child whose suffering makes be certain that He will reward us, and his devotion to Holy Face of the him cry and call for his mother, the and in great measure, on His Return. Lord, is thus a message of love and child who perhaps does not have a In the same way as He did with his of hope. Just as the disfigured Face mother, turns to you. faithful inn-keeper, the Servant of of Christ can once again be splendid Dear teachers, thank God who has God—Hildebrand. and glorious in our Lord’s Resurrec- placed in your hands the most tion, so the suffering faces of chil- blessed of all arts—that of drying Abbot SIMONE TONINI dren and the poor can once again be tears. May the God Lord, dear doc- Postulator of the Cause for the radiant with love and hope. tors, help you to dry many tears. Canonization of the Servant of God 244 DOLENTIUM HOMINUM

JANUSZ BOLONEK Dr. Janusz Korczak

I would like to introduce Janusz cial strata. He also encouraged peo- Henryk Goldszmit was born on Korczak, one of the great men of ple to fight against evil and to do 22 July 1878 or 1879 in Warsaw, a Poland: doctor, writer and educator. good; believed in the existence of city which at that time was under Born in 1878 or 1879 in Warsaw, he universal moral rules and guidelines; Russian occupation. He was the son died fifty-three years ago and was and struggled to uphold and defend of a famous and wealthy lawyer, probably killed in the Nazi extermi- the rights of man, especially those of Josef Goldszmit, and of Cecylia nation camp of Treblinka in August poor and abandoned children. He Gembicka. The families of both his 1942 (so far nobody has been able to wanted and strove to organize the so- parents were of Jewish origins and establish with certainty the dates of ciety of children in harmony with the although they were fully assimilated his birth and of his death). principles of justice, fraternity and into Polish culture they were not Janusz Korczak is the assumed the equality of rights and duties. Christian. Whilst on the one hand name of Henryk Goldszmit. This Janusz Korczak now appears as a the Catholics and the National name was taken from the title of a exemplary model for how man Block could not forgive Korczak his novel by Jozef Ignacy Kraszewski: should treat his fellow man. The Jewish origins —indeed they used Historia o Janaszu i o Pieknej strength and influence of what he to say of him that although he was a Miecznikownie (“History of Janusz did has grown and spread through- good man he was also a Jew —the Korczak and the Beautiful Daughter out nearly the whole world. The Jews for their part rebuked and ad- of the Sword-Maker).” story of his life, his work and his monished him for his having be- Doctor Goldszmit did not have a teaching activity have reached and come Polish and for his full assimi- striking appearance and was not come to the attention of an ever lation into Polish culture and cus- very tall. He was bald and had a red greater number and breadth of toms. Henryk Goldszmit did not ac- beard. Throughout his life he had a founders and exponents of ideolo- tually know Yiddish or Hebrew. The soft and thoughtful countenance and gies, of religious creeds, of races formation of his personality was he was always noted for a by no and of continents. strongly influenced by the works of means commons nobility of heart In many countries associations two eminent and distinguished Pol- and beauty of spirit. He never ad- exist which take their names from ish writers: Stefan Zeromski (1864- hered to a political party and was Doctor Janusz Korczak, and these 1925) and Boleslaw Prus (1847- never a Communist or a freemason. associations have existed for a long 1912). He was a modest and hard-work- time. His writings have been and are Korczak was a talented and sensi- ing man who throughout his life published in a large number of lan- tive boy who was rather shy and walked on the path of truth, which guages. International conferences silent. He spent his childhood in he constantly looked for, and of discuss his life’s work and research conditions of prosperity until the se- deep responsibility. He was con- centers have sprung up which are rious illness and then death of his fa- stantly engaged in silent and com- dedicated to studying his initiatives ther. The years which followed — plete selfless service to those most and activities. The figure and the life the years of school and of university in need. He dedicated his entire life of this extraordinary doctor and —were difficult years because Kor- to the children of other people. As a teacher, and in particular his heroic czak had to look after his mother skilled medical doctor and an ac- death and that of his pupils, inspire and his sister. complished teacher he loved chil- musical and literary works, films After finishing the Russian philo- dren with his whole heart, with his and song, radio programs and televi- logical school he wanted to engage whole mind, and strove to the ut- sion broadcasts. From June 1978 un- in solid learning and study. He most to achieve their full develop- til September 1979 UNESCO cele- chose the discipline of medicine at ment and growth. He gave himself brated the centenary anniversary of the University of Warsaw and went unreservedly to the cause of chil- the birth of this great humanist by to the faculty of pediatrics. He chose dren. organizing suitable ceremonies to to study the medicine of children As a writer and freelance journal- celebrate and commemorate what “because in addition to the vice of ist he brought out and described the Korczak did during his life. thinking I also still had a heart.”1 whole range of human poverty and But who was Henryk Goldszmit This heart of his was tender in its at- misery, and also drew attention to the alias Janusz Korczak, and what did titude towards poverty and suffer- elementary needs of the poorest so- he do? ing, especially when abandoned, ne- VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 245 glected and distressed children were In 1918 he returned to Warsaw in with hard and severe hearts and un- involved. His heart led him to con- order to become the new head of an locked within them feelings of pity, cern himself with the condition of institute for Jewish orphans. For a compassion and help towards poor the children of the beggars of the short period he worked at the Lodz children and young people. poor Warsaw district of Powisle, hospital for infectious diseases After seven years of work and ser- children with whom he used to go which looked after dysentery vic- vice as a medical doctor he gave up and play and to whom he gave tims and he then spent some time pediatrics and chose teaching in- lessons. These children became the working in the same kind of hospital stead. He became an educator of or- subject of his first novel which was at Kamionek in the Warsaw region. phans. He wanted above all else to entitled “Dzieci Ulicy” (“Street He was keenly sensitive to the serve poor and neglected children. Children”) and which was published dilemma represented by the two ri- In order to dedicate himself com- in 1901.2 The book, which was in val concepts of medicina aurea and pletely to his mission he decided not truth perhaps a little naive and im- medicina pauperum. He earned high to have a family himself: “I remem- mature, described the lives and con- fees treating the children of the rich ber the moment when I decided not ditions of homeless orphans in the but he treated the poor for nothing to have my own family. It was in a city and narrated their dramatic at- park in London...I chose as my child tempts to survive in these harsh cir- the idea of serving children and their cumstances. It should be immedi- cause.”5 ately observed that Korczak placed He loved children with great af- his talent as a writer first and fore- fection and he dedicated himself to most at the service of the less so- their well-being without reserve. He cially fortunate children, and to such wanted to help them and to promote children would he subsequently de- their development from a physical, vote a large number of novels. intellectual and moral point of view. He finished his medical training He was both a doctor and a nurse for at Berlin, at Paris and at London. He them, but above everything else he returned to Warsaw in 1903 and be- sought to be their father. gan to work at the Berson and Bau- He also organized an intense so- man children’s hospital in Sliska cial activity in the free reading street. At the same time he wrote rooms of the Warsaw Charity Orga- critical articles on social questions nization and Association of Summer for such reviews as Glos and Kolce. Camps. He went as an educator to He also published a collection of hu- the summer camps of Michalowka morous short stories entitled Kosza- and of the villa Rozyczka of Go- lki Opalki (“Nonsense and Tall Sto- clawek near Warsaw. There he took ries”) (1905) and a second novel: care of weak and frail children Dziecko Salonu (“Son of the Salon”) whether Jews, as in 1907, or Chris- in 1906. The novel is based upon the tians, as in 1908. Two books for protest and the rebellion of a son of children were also the outcome of the bourgeoisie against the capitalist this summer work —Joski, Moski i environment and milieu of his par- Srule (1910) and Jozki, Jaski i ents and also describes his tragic Franki (1911). Korczak tried to fate and destiny.3 and at times also gave them money overcome and to break down the In 1905 Korczak was called to to buy the medicine which he had mutual prejudices and antipathies arms in the Russian army and was prescribed. He asked a mere token which prevailed between Jewish and sent to the front of the Russo-Japan- payment from poor Jews given that Polish children. His educational ese war which had broken out that the Talmud declares that: “A free work and endeavors were not con- same year. For more than six months doctor does not help the sick.” His fined to a narrow sphere of racial he was the senior doctor on the hos- generosity provoked the envy and separatism but rose above the na- pital trains which transported troops hostility of many of his colleagues tional and religious antagonisms of which had been seriously wounded who saw him as a corrupter of pa- the time. or were gravely ill. He reached as far tients and even went so far as to He also took part in the activities east as Lontan in Manchuria. He then think he was mad! Indeed, the most of the Polish Association for the De- worked at the evacuation centers of malicious and vindictive of his col- fense of the Child. He felt solidarity Harbin and Toataj-Dzou.4 leagues did not hesitate to send him with the Jewish section of the popu- During the First World War he patients during the period of night lation and thus felt especial concern was called up as a doctor and be- rest. for the orphans of the Jewish prole- came vice-director of a military hos- However, people on the so-called tariat. He was one of the organizers pital on the Ukrainian front. After social margins found in him a great of an institute in Franciszkanska this position he worked in a center and magnificent soul which was Street in Warsaw. In 1912 the Home for children in the Ukraine in the very sensitive to the needs of his for Orphans transferred to its new Kiev area and for a short while he neighbor. He was particularly kind site at n. 92 Krochmalna Street and was posted to a Polish boys institu- and caring towards sick and weak Korczak became its director. In his tion. Here he continued to evolve children. He became an authentic educational work he was helped in and develop his ideas and theories Good Samaritan for orphans. With very valuable fashion by a Jewish about the education and upbringing his smile and his dedication Kor- woman named Stefania Wilczynska. of children. czak had a disarming effect on those Today there is an institution for chil- 246 DOLENTIUM HOMINUM dren in this street, an institution Bankruptcy of Little Jack”) (1924), famous Swiss educator and writer which bears the name of Doctor which promoted (and argued in fa- called Johan Heinrich Pestalozzi Janusz Korczak. vor of) the cooperative movement. (1746-1827) and upon some of the A few years later, in 1919, Kor- There also followed the story ideas of the great Russian writer Lev czak set up another orphanage for “Kiedy Znow Bede Maly” (“When I Tolstoy (1828-1910), who advised the children of Polish workers. This Am Little Again”) (1925), a tale of a adults to learn from their children. orphanage bore the name of “Our man who returned to the world of In essential terms, the teachings Home,” and it was created with the childhood; “Bezwstydnie Krotkie” and teaching methods of Korczak help of another woman, Maria Ro- (“Unashamedly Short”) (1926), dia- were based upon dialogue with chil- gowska Falska. It was established at logues on the freemasons and the dren—that is, upon a dialogue be- Pruszkow in the Warsaw area. Later Jews; a small published program un- tween pupil and teacher. This dia- this institute was transferred to War- der the heading “Prawo Dziecka do logue rested upon a love rooted in saw in the Bielany district. Szacunku” (“The Right of the Child the inner conviction that only that These two homes were princi- to Respect”) (1929); and Prawidla which is lived can be really trans- pally for children between the ages Zycia. Pedagogika dla Mlodziezy i mitted to the child. This “teaching of of seven and fourteen. Doroslych (“Rule for Life. Teaching wise love” (Natalia Hanilgiewicz), Korczak was a teacher at the State Methods for Young People and for which is also called “teaching of the Institute of Special Teaching and at Adults”), which appeared in 1930. heart” (Danuta Solowicka), centers the Free Polish University of War- The Atheneum theater of Warsaw upon respect and love for the young saw. He also wrote a great deal, put on a play written by Korczak en- person, who is not considered a vir- chiefly about teaching and teaching titled Senat Szalencow. Humoreska tual man but a man in the full sense methods. As early as 1913 he had Ponura (“The Senate of Madmen. A of the term. The society of children published Slawa (“Glory”), a work Dark Humorous Tale” (1930), formed by Korczak was directed to- full of lyricism and humor which which describes the increasing mad- wards self-education: it had its own was a study of the psychology of ness of the world. Korczak also pub- self-government (the parliament of proletarian children. Two years later lished a number of children’s stories children and the council of self-ad- Korczak published Bobo (1914) — for the series Biblioteczka Palestyn- ministration) and a jury of honor. "some short novels about wrongs ska dla Dzieci (“The Little Palestin- Janusz Korczak was able to create done to children whose minds are ian Library for Children”) which and establish a model of universal described with great insight"6. were intended for both children and solidarity among children. During the First World War, adults: “Ludzie sa Dobrzy” (“Men When faced with the social con- whilst at the front, Korczak wrote a are Good”) (1938); “Trzy Wyprawy flicts which were becoming more two-volume book on education and Herszka” (“The Three Expeditions acute at that time, and more specifi- upbringing entitled: Jak Kochak of Herszek”) (1939); and “Reflek- cally the increasing separatism be- Dziecko (“How to Love a Child”) sje” (“Reflections”) (1938). tween Pole and Jew, and when con- (the first volume was published in It should also be recorded that in fronted with ever greater economic 1920, and the second, in 1921 and the years 1926-1931 Korczak di- difficulties (the struggle for the very 1929). In the years 1919-1926 he rected (together with a number of existence and the feeding and main- published a series of articles, as well children) the periodical review for tenance of the “Home for Or- as other articles, in a journal for chil- children and young people Maly phans”), Korczak at times felt disap- dren and young people called W Przeglad (“The Little Review”). pointed and discouraged. He even Sloncu (“In the Sun”). These articles This review was a supplement to the thought of moving to Palestine went under the heading of Co Sie Jewish publication Przeglad (“The where he went for brief periods in Dzieje W Swiecie? (“What’s Going Review”). the years 1934 and 1936. He then on in the World?”). He also wrote Korczak also served children began to write upon mystical sub- the introduction to a study by Je- through the radio. In the years 1935- jects and upon the bible. He wanted drzej Sniadecki entitled Rozprawa o 1936 he held a series of talks on in particular to write a work which Fizycznym Wychowaniu Dzieci teaching on Polish Radio which praised the work of the “chalucim” (“Dissertation on the Physical Edu- went under the title of “Gadaninki or pioneers. The project of a final cation of Children”) (1922) and a Radiowe Starego Doktora” (“Radio and definitive departure from small book with the title O Gazetce Story-Telling by an Old Doctor”) Poland, however, never came about, Szkolnej (“School Journalism”) and which were listened to eagerly and this was because Korczak “was (1921). The titles of his next books by adults and children alike7. These too linked to the Polish language, to were equally eloquent: Sam na Sam radio tales were published in 1939 Polish culture, and to Polish chil- z Bogiem. Modlitwy Ludzi, Ktorzy under the title Pedagogika Zarto- dren.”8 Sie Modla (A Tete à Tete with God. bliwa (“Humorous Teaching”). During the years of the Second Prayers of Those Who Do Not Korczak amazed people with his World War, whilst Poland suffered Pray”) (1922); Krol Macius Pier- extraordinary gift of being able to terribly under the Nazi occupation, wszy (“King Macius I”); and Krol establish direct contact with chil- Korczak organized and defended the Macius na Bezludnej Wyspie (“King dren and young people, a contact lives of the children who had been Macius on a Desert Island”) (1923), marked by full understanding. He entrusted to his care, and he man- a novel about a child drawn into the educated thousands of Jewish and aged to do this under very severe difficulties of the lives of adults and Polish children and ensured that and difficult conditions. He de- about the responsibilities of the indi- they became worthy adults. fended them from hunger and from vidual towards the nation. His teaching and teaching meth- attacks. Under the bombs and under Korczak also published the novel ods were full of medical science. He the artillery bombardment he ran up Bankructwo Malego Dzeka (“The also drew upon the experiences of a and down the streets of Warsaw. VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 247

Every day he challenged death itself long to any one religious faith or de- not a man of a single important ac- and went on long journeys from nomination, he felt a special sympa- tion. His last action was a conclu- Krachmalna Street to the center of thy for Judaism and for Christianity. sion which was consistent with what the city. He found lost children in Yes, indeed! He was known for a he had done previously in his life. It the streets, children who were positive attitude towards Christian- is not possible to understand this frightened and often wounded. He ity, which was demonstrated by an heroic action without recognizing carried them to shelters and to clin- acceptance of certain principles and his great fatherly heart, which ics and provided them with food and certain truths of the Christian faith. wanted to be near to children, espe- with clothes. He knocked at the In “Our Home” at Bielany he de- cially when they were in danger. doors of private houses and of social cided to create a chapel for the This action cannot be really under- institutions and asked for food for Catholic children and in the “Home stood at its roots without reference those protected by his “Home for for Orphans” in Krochmalna Street to the adherence to the moral princi- Orphans.” he constructed a house of prayer for ples which as a medical doctor and a In the autumn of 1940 this home Jewish children. He also formulated teacher he professed, animated as he was transferred to the Jewish ghetto. and elaborated many thoughts on was by a deep and spontaneous reli- Wearing the uniform of a major in education which conformed to the gious faith. Through his heroic the Polish army on the day of the re- spirit of Christianity. In his attitude death he expressed and confirmed moval, Korczak was arrested for not towards life one can detect a strong the mission of his life. If he had been having the required yellow star of tendency towards a spirit of ecu- a Catholic, he would have been pro- David sewn onto his sleeve. For a menism which was expressed in a claimed a saint and would certainly few months he was interned in the commitment which was full of dedi- have reached the glory of the altars. Pawiak prison. Released on bail by cation to both Jewish and Polish The “Samaritan for children” is three of his ex-pupils, and by now children. dear to our times, especially when over sixty years of age, he continued Like a good shepherd he gave his we realize that there are today mil- to take care of his pupils and chil- life for the cause of children. He died lions of abandoned, hungry, demor- dren. In addition, the city authorities at the beginning of August 1942. He alized, and illiterate children who entrusted him with the directorship was murdered at the German exter- are deprived of their basic human of a municipal help center which mination camp of Treblinka in Pod- rights, the “children of the streets” was situated at number 39 Dzielna lasie in the valley of the river Bug. who live on all the continents of the Street. The Pamietnik (“Diary”), The Nazis killed about 750,000 peo- world. Korczak can and should be which was written in 1942, is an elo- ple in that place, and these were an example and an inspiration for all quent document of this last and dra- chiefly Jews and people of Jewish those who strive and work for the matic period of the life of the “El- origin. Korczak did not want to take good of “the least of my brethren” derly Doctor” which was spent in advantage of the possibility of saving (cf. Mt 25:40-45). Korczak attrib- the terrible conditions of the ghetto. his own life but he freely decided to utes to these “least” a decisive role There also he dreamt of a great or- accompany two-hundred children on in achieving the spiritual rebirth of phanage below the Lebanon where the journey to the Shoah. An order mankind. every night through the sky-light he was issued in the ghetto to take away could watch the stars of the Palestin- the Jewish children and this meant Most Rev. JANUSZ BOLONEK ian sky. The “Diary” has survived inevitably that they would be taken Titular Archbishop of Madauro, because it was walled up in “Our to the gas chambers given that the Papal Nuncio in Romania Home” in Bielany. Nazis gave the Jews “the right of Through the many trials and tribu- precedence” for the gas chambers in lations that Korczak underwent dur- the German extermination camps. Notes ing his life and as a doctor, he never The “Home for Orphans,” with its 1. I. NEVERLY, introduction to and commen- lost his faith in God. This is borne educators and pupils, was forced to tary on: Janusz Korczak, Wybor Pism, (Writ- out by many elements, not least by empty during the first days of Au- ings), vol. I-IV, (Warsaw, 1957-1958). 2. H. MORTKOWICZ-OLCZAKOWA, “Gold- the book which has already been gust. “Then Korczak led his children szmit Henryk,"in Polski Slownik Bi- mentioned: “A Tete à Tete with God. for the last time down the streets of ograficzny, (Polish Biographical Dictionary), Prayers for Those Who Do Not Warsaw towards the so-called “Um- vol. 8, p. 214. Pray.” This work is a chorus of schlagplatz” (the railway junction in 3. Ibid. 4. Cf the articles by Korczak published in voices which beseech. At times they Stawki Street) where the Jews were “Glos” in December 1905 and the results of are full of laments and of protests, loaded for transportation. It seems the studies carried out by Kinga Sienkiewicz but more often they speak of love that at the last moment it was pro- using the documents kept by the Russian Central State Archive of Military History in and of gratitude. These prayers re- posed that he should receive a per- Moscow. flect the state of mind of people of sonal reprieve, but this suggestion 5. Letter from Korczak to Mieczyslaw Zyl- various ages who have a broad range was refused by Korczak. Until the bertal dated 30 March 1937. of jobs and social positions. A pro- very last moment he continued to 6. H. Mortkowicz-Olczakowa, art. cit., p. 214. found and creative faith was cer- calm his children by telling them 7. See J. PIOTROWSKI, Ojciec Cudzych tainly the inspiring force of his ser- they were going on a trip to the Dzieci. Wspomnieni o “Starym Doktorze” vice to his neighbor, a service full of countryside, and with them he went Januszu Korczaku, (Father of Other People’s 9 Children. Memories of the “Elderly Doctor” devotion. At the same time it was the to meet his death" . He remained Janusz Korczak), (Lodz, 1946). shortest path by which he walked to- faithful to the children who had been 8. H. MORTKOWICZ-OLCZAKOWA, art. cit., p. wards God, even though this path entrusted to him until that moment 215. was neither easy nor full of joy. when he met with his own “holo- 9. Ibidem. *Translator’s note: All spellings from the For the whole of his life Korczak caust.” Polish have been Anglicized. They thus di- sought God. Although he did not be- Janusz Korczak, however, was verge from the Polish alphabet. 248 DOLENTIUM HOMINUM

VINKO PULJIC

Pastoral Medicine in Bosnia and Herzegovina During the State of War, with Special Reference to Sarajevo, the Concentration Camp City

At the beginning of this paper I cupying Bosnia and Herzegovina in no provision had been made even for would like to extend a cordial greet- order to achieve its project of a essential reserves of food or other es- ing to each of those who are present Greater Serbia. The aggression had sential supplies. Furthermore, no here today at this important meeting. already begun in September 1991 arms had been stockpiled and there I would to thank in particular His with the destruction and the ethnic was no overall plan for the defense Eminence Cardinal Fiorenzo An- cleansing of the Catholic areas of the of the city. gelini for his invitation to me to re- west of Herzegovina where there is In addition to the total blockade of late some of the key experiences of the diocese of Trebinje. The entire the city and about 600 places of fire- this war. war arsenal which had been with- power made up of heavy artillery drawn from Slovenia and Croatia and tanks placed on the mountains was placed strategically in Bosnia around Sarajevo and pointed to- Introduction and Herzegovina. This war was wards the defenseless city, the mili- planned and launched as a result of tary strategy of the Serb aggressor I would like to describe to you the policy formulated by Belgrade and included other measures—the cut- land and the city I come from. had the aim of conquering new terri- ting of the water, gas and electricity Bosnia and Herzogovina is a state tories for a Greater Serbia which supplies, the destruction of the which was formally recognized as would be nationally homogeneous. telecommunications system, the ob- such by the United Nations in 1992. The barbarity of this war was dis- struction of free entrance and exit It covers five thousand, one hundred played in particular in the case of from the city, the killing and wound- and twenty-nine square kilometers. Belgrade. ing of the largest number of people According to the census of 1991 it At the beginning of April 1992 possible by merciless snipers, and had 4,365,600 inhabitants, of whom there begun a series of tragic events the systematic destruction of any- 43% (forty-three per cent) were and the systematic destruction of thing which could be useful to the in- Muslims (who during the war came Sarajevo. At the beginning of the habitants. For this reason food and to call themselves Bosnians), 31% war operations the Serbian Orthodox medicines in the city began to fall (thirty-one percent) were orthodox Church moved its center outside into short supply, and this situation Serbs, and 18% (eighteen per cent) Sarajevo and most of the orthodox lasted for about four years. Military were Catholic Croats. The rest be- priests abandoned the city before the specialists say that millions of shells longed to small minorities or were outbreak of the war. All this was in exploded in this city. simply Yugoslavians. line with a pre-established plan, as if In this state there are four Catholic it was already known what fate dioceses with three episcopal seats: awaited Sarajevo. 2. The Consequences of the Sarajevo, the seat of the archbishop When the city was hit by heavy Destruction Caused and metropolitan, Banjaluka, Mostar, bombardments and mortar fire it was by the War and Trebinje which is an apostolic ad- a real miracle that the people of Sara- ministration entrusted to the bishop jevo were able to organize them- 1) The impact of the horrors of the of Mostar. The capital is Sarajevo, a selves and defend themselves with- war. The first consequence was the city which before the outbreak of this out arms, and then to survive the disorientation of the organization of war had about 550,000 (five hundred siege. At the outset people believed people’s lives and activity. The de- and fifty) inhabitants. This city re- that the attack would not last long struction of the communications sys- flects the variety of religions, cultures and that the madness of the aggres- tem isolated and distanced people and nationalities which are present in sors would not go on for long. Un- from their neighbors even in physi- Bosnia and Herzegovina. fortunately, the explosions contin- cal terms. In particular, the destruc- ued inexorably day after day, fol- tion of the telephone system created lowed by fires and destruction. great uncertainty about what had 1. The War There were very many wounded and happened to friends and neighbors, dead people in the streets and in the and naturally enough it was impossi- In 1991 the ex-army of the Yu- houses. The city authorities were not ble for people to communicate with goslavian Federation was already prepared for war and for this reason them and thus help them. clearly displaying its intention of oc- they were taken by surprise. Indeed, 2) Fear caused by the terrifying VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 249 explosions. There were days when also vital for drinking and providing pending hunger—this afflicted shells exploded constantly without liquid for the human body. At the nearly everybody after the food re- interruption almost every minute or outset there was also the fear that the serves had run out. The parents in second. This led to a very worrying little water which was obtained at the particular suffered because they question being asked: who has been risk to people’s lives might perhaps were not able to satisfy the most el- killed and what has been destroyed? have been poisoned. Personal hy- ementary needs of their children. 3) Horror caused by the numbers giene and hygiene more generally Different kinds of depression also of dead and by the massacres. People could not be looked after because of had their impact and provoked night- forced to venture out to look for a the acute water shortage. time anxiety rooted in the presence piece of bread, water or other pri- 9) The impossibility of maintain- of the spilling of so much blood and mary necessities, often fell victim to ing personal hygiene and hygiene the massacres. Such traumas were the explosions in the streets and more generally. The water reserves present first and foremost in the el- many people lost their lives in their were soon exhausted and what little derly and the weak—people who homes—those homes being specific arrived through humanitarian aid feel themselves alone and aban- targets for destruction. was completely inadequate for such doned. The same may be said of chil- 4) The burying of the dead. There a large number of inhabitants. The dren whose parents were killed or se- were days when it was impossible to verely wounded and handicapped. carry the corpses from the streets be- To all this must be added the interior cause of the terrible bombardment. anxiety caused by uncertainty and At the same time, the cemeteries were worry about loved ones of whom in the line of fire and thus could not be nothing is known. used. As a result, the corpses were of- 11) Relationships with loved ones ten buried in parks or in places hidden interrupted. The war broke lines of from the snipers. In such circum- communication between the mem- stances, naturally enough, there was a bers of families, between husbands complete absence of those decencies and wives, between parents and chil- which are present when there are fu- dren, and between friends and ac- nerals in the civilized world. In this quaintances. Some were enrolled war about 12,000 people were killed and sent to the front, others disap- in the streets of Sarajevo, and about peared and yet others made sure that 1,500 of these were children. their whereabouts were not known. 5) Care for the wounded. It is esti- Deep wounds were been caused to mated that about 50,000 people were personal relationships, wounds made wounded at Sarajevo over the whole worse by fears and complete uncer- of this period. There were various tainty. kinds of wounds from the loss of nether limbs (in particular hands and feet) to total paralysis and loss of 3. The Bringing of Light into the physical autonomy and the conse- Darkness of War quent need to depend totally on other people. An especially serious trauma The Catholic Church, amidst all is that experienced by wounded lack of water made it impossible to these horrors of war, sought to orga- children who will have to remain maintain hygienic standards at a per- nize itself so as to provide every kind handicapped for the rest of their sonal level and in the work place. In of help possible to people who found lives. the sewers dangerous insects, mice themselves in the difficult situation 6) The lack of essential foodstuffs. and rats began to proliferate and to of war and pressed by so many trials. The few reserves of foodstuffs and infest the sewer system and people’s In order to achieve these aims the other vital necessities were soon houses. Mountains of garbage and Church took a broad range of steps used up. Humanitarian aid arrived in rubbish accumulated in the streets and engaged in a variety of initia- small quantities, and the food which because it was impossible to move it tives: was given was too uniform in char- to the public dumps. All this greatly 1) In the first place priests and acter and did not have the elements compromised the health and hygiene members of religious orders (both necessary to allow the human organ- situation in the city. men and women), led by their bish- ism to engage in normal work. 10) Various kinds of psychic trau- ops, remained next to the people and 7) The consequences of a lack of mas. Because people were forced to encouraged and supported them with energy sources. The disappearance pass days and nights in cramped, their presence so as to enable the in- of electricity and gas—elements dark and damp places, often in total habitants to bear all these privations which are vital to heating and cook- darkness, the “basement syndrome” caused by the war. ing—caused very great hardship to made itself felt, and this particularly 2) Despite the dangers of the war, the people. During the first winter of affected children, with obvious very the church assembled its faithful to the siege all of the trees in the city serious consequences for their men- pray and to celebrate the Eucharist in were soon cut down to provide heat- tal health. The large number of order to create the sense and feeling ing and fuel for cooking. nights spent in this way by the adults of a community. This played a very 8) The lack of water was another caused various kinds of neurosis, important role in overcoming a sense very great problem. Water is neces- principally because of uncertainty of loneliness and of being aban- sary not only for cooking but also for about what would happen the next doned. In this communion of faith a the most basic hygienic needs. It is day and because of the fear of im- nearness to God and one’s fellow 250 DOLENTIUM HOMINUM men was felt. In these meetings of system which involved regular visits minimum level of survival to the faith the dialogue with God and be- to these elderly people and brought people besieged in Sarajevo. tween men meant that people slowly them medicines and humanitarian 7) The activity of the mass media. managed to reduce the tension they succor. Such activity was carried out We organized an information service felt and to draw upon the spiritual above all else by female members of through a private radio system of the energy which was necessary to the religious orders. diocese and the distribution of overcoming of their difficulties. An 5) The purchase of heating stoves newsletters of various kinds in order especial source of spiritual energy in and their installation, especially in to counter and combat the other this process was personal and com- the homes of the elderly and the sick. forms of mass media which were in- munity prayer, participation in the Here we are talking about a kind of volved in the systematic propagation sacraments and in particular the stove which is able to burn almost of the poison of hate towards others word of God, reconciliation and every kind of combustible source of and intolerance towards others. We communion. Being fully aware of energy. When gas became available also sought to build a culture of love this, I strove to visit each commu- we helped many people to install it in and of life through radio broadcasts nity of the faithful as much as possi- their homes. on fundamental human values and ble and to encourage both priests and 6) The renewal of interrupted rela- through the transmission of the holy the faithful with the word of God. It mass and of the word of God. We was evident that after each meeting tried to communicate a little opti- of this kind, and after the celebration mism to people through our radio of mass, people were able, so to station “Vrhbosna” (which is the his- speak, to radiate from their eyes rays toric name of the diocese of Sarajevo of light, and they thus returned re- when the city had not yet come into newed to their homes. existence in the medieval period) 3) The organization of humanitar- and through the publication of vari- ian help through Caritas. Although ous books and leaflets with which there was a break in the systems of we tried to break the stranglehold on communications with the outside news and to combat one-sided infor- world, we made effective efforts to mation. find other ways of bringing aid to 8) Cultural activity. We organized Sarajevo and distributed it to the in- meetings of young people through habitants so as to ensure their sur- the Church and through the Croatian vival. In addition to bringing food, cultural association “Napredak” we also organized the arrival of med- (Progress) in order to combat the cli- icines, having provided to those who mate of barbarity which the war had helped us with a list of medicines installed and also to instill the values and health needs that we required. of peace in young people. Our inten- Some of this was distributed to the tion was to have a series of cultural civilian hospitals and the rest was demonstrations and events in the given to pharmacies organized by midst of the roar of war in order to Caritas and brought near to the peo- give a clear signal to the city and to ple throughout the city so that they the whole world. would not have to expose them- tionships. I, like so many male and 9) The opening of a Catholic selves to the dangers of the streets. In female members of religious orders school center where we established a the streets there was no public trans- and priests, could enter and leave the primary school, a secondary school port and snipers were constantly at city—and at great risk to our lives. and a medical school. In this way we work. We could thus act as postmen and were able to able to give students a Through Caritas we organized the deliver letters and parcels of medi- real future amidst the heavy and im- presence of doctors in parish centers cines and food. Caritas also did this. posing war atmosphere and the cli- and in other suitable structures. To Often this was the only way to en- mate of hatred and fanaticism. this end we opened the medical cen- sure that people received news about Lessons could be attended regularly ter of St. Vincent in the center of the their friends and relations and ob- and students could hear arguments city where we organized a phar- tained help in terms of money. and ideas which expressed the posi- macy, a clinic and a surgery. In this Through our vicariate at Zagabria tive values of reconciliation, toler- center we also set up a kitchen which we also organized a service for pro- ance and peaceful coexistence. Es- was programmed to produce a hot viding financial assistance to people. teemed listeners! I have sought to meal for thousands of people. In spe- The system worked as follows: peo- show you through these brief de- cial fashion an attempt was made to ple deposited a certain sum for their scriptive flashes how our people in help women in their special difficul- relatives in Sarajevo with our vicari- Bosnia and Herzegovina have had to ties, trying to give them advice with ate and our archdiocese paid that endure heavy suffering. Their lives regard to the problems that faced sum directly to the recipients in have been deeply disturbed by the them and their dilemmas of con- Sarajevo through Caritas. This was a war, and this is especially true in the science. subsidiary banking service—the capital city Sarajevo, a city which 4) Help to the aged. Seeing that an only one that worked—and naturally has been besieged and transformed ever increasing number of elderly enough involved no attempt at gain. into a concentration camp. I have people remained in the houses, and During the most difficult and serious also tried to show you what the that these people were often ill and in periods of the war it was often the Catholic Church has done and is do- need of help, we organized a help only means by which to ensure a ing to help these people in their trials VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 251 and tribulations. Just as the pain and the tears of the suffering, to feed the who are oppressed. the suffering of each individual can- hungry, to clothe the naked, and to If this does not happen the caring not be described, so is it impossible visit and tend the sick. In that great for wounds loses almost the whole of to describe even superficially what prison which is Sarajevo we were all its meaning and purpose. But I ask has been done for this poor people— together. All of this was possible and I ask you: what purpose and the care, concern, help and assis- thanks to the support and the pater- logic can there be to attempting to tance provided by priests and the nal help of the Holy Father, very feed the hungry and at the same time members of religious orders (both many bishops and priests our knowingly allow them to be killed men and women) under the leader- brethren, and numerous people who after they have received food? What ship of their bishop. But we know are united and joined with us through purpose and logic can there be to our that the omnipotent and wise Lord the grace of baptism or perhaps sim- declarations about the rights of man “who knows the secrets” of man sees ply through a disinterested love for when these rights are allowed to be all this. The Lord and his love for human beings. so brutally transgressed and betrayed each individual person is what has In this epoch more than ever be- every day? motivated, guided, encouraged and fore the Lord Jesus calls upon every The Catholic Church is trying and supported us. He alone will be for us one of his disciples to be a compas- will ever strive to help every man the final reward. sionate Good Samaritan. We must who is in need, but at the same time Jesus Christ did not give many sci- come to the help of the injured and she will go on condemning viola- entific and theological answers to the heal their wounds. But this parable tions against man and raising her question of pain and suffering. He when applied to the international voice in defense of the rights and the preferred simply “to descend to earth community does not stop here. It is dignity of the human person, of and become man” and out of pure certainly true that the international every individual. love embrace the cross. From that community must attend to wounds Thank you for having given me an moment until now that cross is the but first and foremost it must stop opportunity to draw once again the true significance and the answer to those who cause these wounds, attention of the Church and the med- the problem of pain and we in Sara- those who kill large numbers of peo- ical and political worlds to these jevo and in Bosnia and Herzogovina ple to whom by now we are unable very serious questions, concerns and have striven to share that cross, to to give any form of material help. difficulties. carry it together and to die on it with Before God and the whole world the our fellow countrymen and citizens, international community must find regardless of differences of religion, the means by which to ensure an ef- VINKO Cardinal PULJIC nationality, or culture. In this Via fective defense of those who are the Archbishop of Vrhbosna, Crucis we have sought to wipe away weakest of our brethren and those Sarajevo, Bosnia and Herzegovina 252 DOLENTIUM HOMINUM

BOZO LJUBIC

War Medicine

Taking into consideration that I territory of B&H. This all together thermore, not all were fortunate work in orthopedics, for the past prejudicified the definition of the enough to even be treated in appro- four years I have been in the center epidemiological picture and the priate hospitals. of War Medicine, and since I have health sector was placed into a po- The situation forced us to install been appointed health minister, I sition of enormous challenges of a several dozen so called war hospi- have within reach endless informa- professional medical nature. tals, which were not military hospi- tion about suffering and tragedy, In war years there is a registra- tals, but hospitals in which the especially for specific categories of tion of a high rate of morbidity treatment of already mentioned and the population (women, children, from infections and parasitic ill- not yet mentioned pathologies took wounded, the elderly, etc.). This nesses, because of difficult living place. has influenced me to devote myself conditions, high migrational move- The language of cold hard facts exclusively to the analysis of raw ment, lack of healthy water for have shown the impact of war in a facts. However, since this esteemed drinking and hygiene, and a lack of social and health sphere but the assembly is devoted to questions of fuel for cooking and heating pur- question is what do they mean for philosphy, ethics, sociology and poses. Therefore, the average mor- scientific consideration and in gen- theology, I could not stay exclu- bidity of infectious illnesses rose eral terms. sively on an empirical level. There- from 1358.50 (1990-1991) to Besides this quantified informa- fore, my knowledge from practical 2883.97 (1993-1994). During these tion, as a reflex and consequence of experience is presented as an argu- war years there has been a registra- war, there are multiple phenome- ment for elaboration, theoretical tion of significant changes in the nons from the areas of health, social thinking on a universal plane. In or- structure of movement of infectious pathology, and the work of medical der to introduce the situation to this illnesses. There was a significant staff. audience, please allow me to pre- increase in infectious intestinal ill- We are convinced that this enor- sent to you by using statical means, nesses which is statistically signifi- mous experience, tragic and the tragic situation in my country. cant when compared to pre-war painful, will be used not only by years. historians but in scientific thought At this moment it is very difficult in general. to uncover, and impossible to docu- The changed epidemological sit- Our knowledge, it could be sup- ment all the consequences of this uation requires that medical person- posed, is very relevant for theoreti- four year war in Bosnia and Herze- nel change their priorities from cal and philosophical research for govina which unfortunately still peace time conditions and place an war in a modern society, also we continues. accent on the care of wounded and will demonstrate this in an outline According to information from the prevention of an epidemic of in- as elaboration is impossible. the Committee for Health and So- fectious diseases. Knowledge gath- First, every effort to uphold tradi- cial Welfare,” (Bulletin No. 180. ered from military medical tional separations of medicine into September 25, 1995) since the be- acadamies and textbooks of war war and civilian services is impos- ginning of the war 146,245 people medicine was not always adequate sible and circumstantial. This as- have been killed, are missing, or for our needs. Here there was no or- sumption without doubt can be sub- have died from cold or hunger. Of ganization of stages of care or text- stantialized by the analysis of prac- this total number 16,838 are chil- book separations into so called es- tice which is still in progress. dren. According to the same source chalons as it was impossible to Second, in the type of war which there have been registrations of strictly implement them anywhere. we have come to know in my coun- 174,397 wounded and 12,302 dis- Civilians and soldiers, children and try, the central problem becomes abled persons. the elderly, the wounded and the civilians, the unprotected, and the Estimates are that about 2 million chronically ill, and sometimes the helpless in their effort to defend people have moved from their victum and the executioner were themselves from modern weapons. homes (refugees, displaced or ex- treated in the same hospital and Therefore, no longer is medicine’s iled persons) within or outside the sometimes in the same room. Fur- centers of attention placed on field VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 253 hospitals but in urban centres which withstand the overwhelming trend phenomenon of death, because are devastated from a distance and of destruction. death is a consequence, not a cause whose population is killed without Historical knowledge shows us of the apocalypse. Already for four selection. that every civilization has had its years, in my homeland, 3 of the 4 Third, this is not a classical war own spiritual progressions marked riders of the apocalypse have been where there is only the usurpation by great and novel accomplish- riding; plague still hasn’t visited us. of territory or the defeat of a nation, ments by which civilizations are I observe, however, that only War but it is an excuse for killing. Thou- separated from one other. In the today deserves to be analyzed in sands of both civilian and military meantime, along with great accom- detail since the other two are only persons have been wounded, im- plishments, civilizations have their consequences of war. prisoned, or killed just because they own accompaning pathological and War, it could be said, is both a belong to another ethnic group. dysfunctional occurrences. Some- source and consequence, somehow Fourth, in all earlier wars there times they were a “gift of nature” as a natural part of life and death. was a respect for the rules of the sometimes from society, sometimes This thought is not a product of an game, and more importantly a re- a combination of the two. That obsession with the present war in spect for international norms and my country; it can be recognized laws. It would appear that this does and factually shown. Hunger is a not hold true any longer, as in fact standard of the degree of the devel- the Red Cross, hospitals, and all opment of a society, theoretically a medical facilities were central tar- non-existent occurrence. Hunger is gets of attack. a determinant of society’s unfair Fifth, from European history we model of the distribution and the re- know that it is very difficult to lo- distribution of wealth. The plague, calize and contain wars in such a in its apocalyptic significance, is an small area. Powers have always unknown disease today. The phe- found reasons to come to the aid of nomenon of death belongs to the the victim. This was the first time sphere of the supernatural—that is, that political Europe for three full unreachable to scientific thought years coldly observed a horror and theory. War cannot be stopped evolve from the darkness of the civ- by the redistribution of wealth; ilized world, and could not summon medical science also has no influ- the strength in the name of moral- ence on it; war is not in a supernat- ity, universal norms of ethics or at ural category. War is not within the least in anthropological solidarity, sphere of religion or science, but is to stop the crimes. in the final instance a subject of It would appear that engaging in concern for all, that is, a total phe- the act of lamentation is not pro- nomenon. War does not succeed in ductive for ideas or judgments, revealing itself in its true light; it therefore I will try to put these does not have an archtype or a thoughts in basic terms; presented which separates our electronic soci- stereotype, except for its etymol- theortically, whit the entire phe- ety from others is its pathological ogy; its contents and target always nomenon of war and its problems syndromes, which are largely the mean death, destruction and antihu- investigate on the level of a theoret- product of man. manism. War is an unfortunate ad- ical perspective. Apparently, the electronic civi- dendum of progress, and today, and Also, if in these considerations lization has become entangled in a with the use of various methods of we were only to observe the sea of completely new energies of destruction, killing and torture, it killings, the wounded and the human destruction; multitudes of actually is amenable to the elec- abuse of victims in general, I think occurences represent an entire tronic degree of modern civiliza- that we would only paly reach our chain of reasons and consequences. tion. War is a socially determined goal because that would only ad- Different forms of degenerations— occurence and does not succumb to dress the consequences and I would personal, group, societal, and gen- natural legal judgements and laws. like to address the causes of the eral: terror, drug addiction, alco- If war is a part of mankind and a war itself as a phenomenon within holism, lasciviousness, prostitution, phenomenon whose effects and the perspective of the current war crime, atomic energy aimed against consequences remind us of a gen- in my homeland. I would like to mankind etc—form a synthesis of eral flood and the extinction of the speak about the position of doctors various side effects of fantastic human species, then the question is in war, upon whose shoulders a progress and development. What is the place and part of medi- great burden has been placed—not For his civilization and for his cine in war? as a surgeon or internist, but as a time, St. John described the dangers The shaken morals and ethical humanist and professional. These in the significant eschatological se- values of our civilization, as doctors have been placed in the po- quences of the rider of the apoca- changes of value scales at a univer- sition of mitigating the conse- lypse. Of the four sources of dan- sal level, found their reflection in quences of human destruction upon gers of that time, only WAR re- this war, as did the relationship of man himself and also helping man mains—that is, if we exclude the the world to this war. Therefore, I 254 DOLENTIUM HOMINUM think that it is more appropriate to tween ethical principles and the re- pecially in ours, medicine is no concentrate on the questions of ality which is presented to him. longer only a profession, speciality ethics and morality. Hippocrates In war, when moral, human and or vocation of particular merit, but and the acts of the Biblical Samari- ethical restrictions are abandoned, has become a phenomenon impor- tans suggest the search for a “new many become “free” in their choice tant for ethics. Hippocrates” and Samaritan in our of behavior. They hate, take re- All we have mentioned as forms times. venge, dissolve principles, throw of social pathology is now in fact a War puts all of those involved to about prejudices and xenophobias; cause and effect relationship. the test. Only in war does the entire a negative energy is induced in Killing (collective, group, personal, ethical value scale receive a new them. Pressured or limited by moral or totally without selection or meaning, and doctors fall into trials restrictions, their natural impulses recognition) and destruction with- of whether they will adhere to their can be exposed without fear of feel- out remainders of anything that has responsibilities due to their oaths or ings of guilt. spiritual or material value, are whether they will perfidiously In classical wars (even though we forms of perversity and immorality break them. In war everything has a have already mentioned that neither which have found appropriate space new meaning and changes the signs and conditions for themselves in of humanism. Morals, mercy, for- war. The raping of women, girls, giveness, and sympathy are, in grandmothers, in normal condi- peaceful conditions, the grounds of tions, are the methods of psy- ethics and morals, encompassing chopaths; here, it would appear, it everything. In war this seems and was a part of the war strategy (re- becomes a cynical, contemptible ported by an independent interna- idea. Man evolves into a nothing- tional monitor, who accused one ness; his behavior and deeds are side in the war of this). Nothing is based on killing, revenge, torture, too valuable or sacred not be de- and he is pushed into the need for stroyed or humiliated. destruction to the point of complete So, the moral crisis and insuffi- annihilation. But man, as seen in cient stance in the area of ethics are this war, has also proved to have not empty, rhetorical questions, but the highest ethical and moral princi- are being tested in practice in my ples, healing, helping, even sacrific- country. The specifics of the war in ing his own life for another human B&H and Croatia deserve attention being. not only from the medical commu- We, without doubt, discuss nity but also from philosophical and ethics, having for an ideal two great ethical reflection. historical ethical symbols (the doc- The moral, mental, psychologi- tor Hippocrates and the paradig- cal, emotional, and intellectual matic biblical Samaritan), and yet structure of doctors is not opposed we stand before the question of to thinking that the taking of oaths what kind of ethics to nurture and a stereotype nor an archetype exists) or the acceptance of universal strengthen (and how to do so) in enemies were depersonalized except moral principles can remain un- conditions where bellum omnium for identification through belonging changed and objectively and pro- contra omnes functions as a princi- to a certain nation or group. Mean- fessionally function without inter- ple in practice. while, the war which goes on in my nal and external conflicts. War, however, does not recog- country, witbout the stains of obses- It is not difficult to suppose the nize principles or commands; that sion or emotion, is a completely kind of ethical dilemma a doctor is, it very easily re-evaluates them, specific occurrence, I dare to say, must find himself in when he meets as we have unfortunately witnessed even in the history of warfare. those that are the perpetrators of in our experiences. Here we come In traditional wars, people are crime against his own children, to the key question of our analysis, recognized by their uniforms, sym- wife, parents, collegues or co-work- that is, the most important theme. It bols, signs, and languages, and es- ers. is not redundant to ask the question: pecially on the grounds of these In reality, when this type of war What do those do who treat the signs are killed, arrested, impri- is in question, not even medical body and soul as do murderers, sioned, and even tortured. Mean- personnel are spared from repres- rapists, perverse torturers, men who while, in this war, people subjec- sion and violence in a specific way, are filled with destructive energy? tively and personally know one an- because there are no recognizable How does one come to terms with other, even doctors. Further, they conventions or international respon- the fact that we heal such beings, also know directly or from wit- sibilities regarding human and who will, after their spiritual or nesses their behavior in the war. A moral behavior. Let’s remember the physical rehabilitation, once again criminal is concretely identified and first days of the siege of Sarajevo. practice killing and crime?! So, a not just by his collective corpus, as The favorite targets of snipers were spiritual laborer, who hears confes- in the past. This is the additional ambulances, and one of the first sion, gives advice, shows forgive- pressure on moral people who heal victims in Sarajevo (in which up to ness and mercy, is almost torn be- or forgive sins. So, in war, and es- this point in time, there have been VADE ET TU FAC SIMILITER: FROM HIPPOCRATES TO THE GOOD SAMARITAN 255 over ten thousand killed and over with contemporary democracies or oned or helpless but young and fifty thousand wounded citizens, of institutions of the UN) of 1991 healthy people, and in that same whom 1700 are children) was a could have saved hundreds of thou- day despite the efforts of thousands doctor of the emergency ward, Dr. sands of lives in the former Yu- of medical workers only a few lives Silva Rizvanbegovic. goslavia, with only credible threats were saved. Due to all of this, it would appear of action such as that taken in 1995. Using our empirical knowledge, that medicine in war is not a prag- Ancient civilizations and cul- noticing a correlation between war matic, empirical question, and not tures have always looked for ways and medicine, and the significance even a problem of traditional to challenge threatened extinction. and role of medicine in an actual morals based on fundamental val- They were not aware of scientific cataclysmic war, from the begin- ues. accomplishments of vast propor- ning a conclusion has been imposed The problem should be consid- tions, but they found ways that only in pure philosophy and ered and judged alongside phenom- through methods of example to re- phenomenology is it possible to enology, philosophy, and ethics. spond to acts of amorality and im- contemplate the problem, on a more For me, there is no moral dilemma. morality. generalized level. We consider that “The ten comandaments” are an ad- only in this way can our experience equate moral orientation; however, be of value, if this ever occurs again this is all a quite subjective under- anywhere. standing of morals, as all medical personnel (as well as the others) are For understandable reasons, con- not Catholic, and, in fact, not even clusions in the form of hypothetical religious. Nothing is the same as in determinants could not be com- the time of the doctor Hippocrates pletely elaborated and argumenta- and the biblical times of the merci- tively supported, but we have taken ful Samaritan, whose model of be- the liberty of separating them: havior was an exception and not the First, using as an ideal the New rule. Jesus used the parable of the Testament, scientific thought, espe- Good Samaritan, who was a mem- cially from the area of ethics, ber of a peripheral group of soci- should construct a completely new ety, as a lesson for the members of order of threats against society. The Israel’s establishment (pharisees eschatological order of the rider of and levites), who passed by the un- the Apocalypse, according to St. fortunate person with indifference, John, can be useful as a method- and yet they felt that they them- ological postulate. selves measured up to the highest moral principles of that time. Second, through judgements and We need to speak to the issue of work on the relationship between “new ethics” because challenging war and medicine, we have con- the process of dehumanization with cluded that ethics has no significant only noble pacifism and charity, es- role interest in the important and pecially in conditions whereby the substanial contents of war. How- competition of all values with dif- The motto of this conference ever, I believe that not only medical ferent meanings has been brought contains two eminent symbols from science but philosophy and ethics to perfection, cannot guarantee an the past: the doctor Hippocrates and can offer much to save the world explicit result. Spiritual leaders, hu- the Good Samaritan as a paradigm from ruin. manists, and other moral sources of mercy. The question is whether Third, the moral crisis has taken are doing all that is possible to today we need to find an ideal on a frightening form, and the de- lessen this frightening moral crisis, model of a new Hippocrates or a velopmental process of civilization but their gains are obviously limited new Samaritan and not just place has given it even more substance. because things are not accom- them in the medical profession. An- However, the question comes up of plished now as they were accom- other, more substantial question is whether European thought ade- plished in the time of great ethical who and how to heal. That is, med- quately considered the phenomenon achievements. In the past the entire icine always brings to mind the of moral crisis and its process. defense of morality and humanism healing of man and his biophysical Medicine, even war medicine, is was aimed at individual or subjec- reality. However, who will heal the only one small intervening factor tive acts. In modern society, indi- collective illness, who will heal so- which deals with the consequences vidual acts of amorality and im- cial pathology, and where is the lo- (in a biophysical, mental and epi- morality are almost marginal in cation of moral pathology and the demiological sphere) on a personal their consequences in comparison source of a possible cataclysm? and not social level. to the acts of collective social Their destructive and pathological Fourth, it is surprising that inter- groups. Apart from this, civilization power is aimed at man, and its national scientific institutions and is threatened by the danger of mod- spread causes fear and pessimism. organizations from the fields of phi- els of behavior which cannot be ex- There is evidence to substantiate losophy, ethics, and morals almost plicitly identified as amoral. Let’s that in only one day in this war in took no interest (it is unknown to us digress for a moment. We ask if the B&H (or Rwanda) there were if this was due to a lack of informa- international community (countries killings in the thousands of impris- tion) in the war in my country. 256 DOLENTIUM HOMINUM

Everything has been reduced to conclusions. This type of tragedy Samaritan, then we no longer ask military presence, monitoring, hu- could encompass other countries, the question: “Who is my neigh- manitarian aid and appeals from even those that think they are out of bor?” but “To whom am I closest?”, afar. Here, not far, “2 hours from reach. so that the center is no longer “me” London,” as someone has said, Fifth, I don’t imagine that a sin- but rather “them,” “man in trouble,” there ensued and is still ensuing, gle person or a conference can pro- a man who needs our help, be he a what we hope is an unrepeatable vide the answers to all the moral friend or enemy, a humanist or a experiment. This is neither an ap- dilemmas and conflicts which a war criminal. peal nor a cry from the wilderness, such as this places in front of hu- nor is it a warning to scientists (for manity, and before doctors. There- BOZO LJUBIC, M.D. Ph.D., they are the last to take heed). It ap- fore we must turn to the New Tes- ORTHOPAEDIC SURGEON pears that from our tragedy we can tament. If we adequately under- Associate Professor deduce general judgements and stand the moral ideals of the Good Minister of Health, R/F B&H