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JUBILEE OF THE SICK PERSONS
and HEALTH CARE WORKERS
February 8-11, 2000, Rome
Homily of the Holy Father (Feb. 11, 2000) The Catholic Doctors'Challenges for the new Millennium (Pr Gian-Luigi Gigli)
HOMILY OF THE HOLY FATHER
On a brilliantly sunny Friday morning, 11 February, the feast of Our Lady of Lourdes, thousands of the sick gathered in St Peter's Square for the Jubilee of the Sick and Health-Care Workers. The Holy Father was the principal celebrant of a solemn Eucharistic liturgy, at which the Anointing of the Sick was administered to 200 of the pilgrims who had come from around the world. During the sacred rite the Pope preached the following homily in Italian. Here is a translation.1. "The day shall dawn upon us from on high" (Lk 1: 78). With these words Zechariah foretold the Messiah's imminent coming into the world.
In the Gospel passage just proclaimed, we relived the episode of the Visitation: Mary's visit to her cousin Elizabeth, Jesus' visit to John, God's visit to man.
Dear brothers and sisters who are sick and have gathered in this Square today to celebrate your Jubilee, the event we are observing is also the expression of a special visit from God. With this in mind, I welcome you and greet you warmly. You are in the heart of Peter's Successor, who shares your every concern and anxiety: welcome!
Today I deeply share this celebration of the Great Jubilee of the Year 2000 with you and with the health-care workers, family members and volunteers who are at your side with loving devotion.
I greet Archbishop Javier Lozano Barragán, President of the Pontifical Council for Pastoral Assistance to Health-Care Workers, with his staff, who have organized this Jubilee meeting. I greet the Cardinals and Bishops present, as well as the prelates and priests who have accompanied groups of the sick to today's celebration. I greet the Health Minister of the Italian Government and the other authorities here. Lastly, a grateful greeting goes to the many professionals and volunteers who have made themselves available to serve the sick during these days.
Cross of Christ is key to understanding suffering2. "The day shall dawn upon us from on high". Yes! Today God has visited us. In every situation he is with us. But the Jubilee is the experience of a very special visit from him. In becoming man, the Son of God came to visit every person, and for each one he has become "the Door": the Door of life, the Door of salvation. Man must pass through this Door if he wants to find salvation. Each person is invited to cross this threshold.
Today you especially are invited to cross it, dear sick and suffering people gathered in St Peter's Square from Rome, from Italy and from the whole world. The invitation is extended to you who are connected by a special television link-up and are united with us in prayer from the shrine of Cz{l-eogonek}stochowa in Poland: I offer you my cordial greeting and gladly extend it to everyone who is following our celebration on radio and television in Italy and abroad.
Dear brothers and sisters, some of you have been confined to a bed of pain for years: I pray God that today's meeting will bring you extraordinary physical and spiritual relief! I would like this moving celebration to offer everyone, the healthy and the sick, an opportunity to meditate on the saving value of suffering.3. Pain and sickness are part of the human mystery on earth. It is, of course, right to fight illness, because health is a gift of God. But it is also important to be able to discern God's plan when suffering knocks at our door. The "key" to this discernment is found in the Cross of Christ. The incarnate Word embraced our weakness, taking it upon himself in the mystery of the Cross. Since then all suffering has a possibility of meaning, which makes it remarkably valuable. For 2,000 years, since the day of the Passion, the Cross shines as the supreme manifestation of God's love for us. Those who are able to accept it in their lives experience how pain illumined by faith becomes a source of hope and salvation.
Dear sick people, called at this moment to carry an even heavier cross, may Christ be the Door for you. May Christ also be the Door for you, dear friends who accompany them and care for them. Like the Good Samaritan, every believer must offer love to those who live in suffering. It is not right to "pass by" those who are tried by sickness.
Instead, it is necessary to stop, to bend down to their illness and to share it generously, thus alleviating their burdens and difficulties.
The Redeemer bore our griefs and carried our sorrows4. St James writes: "Is any among you sick? Let him call for the elders of the Church, and let them pray over him, anointing him with oil in the name of the Lord; and the prayer of faith will save the sick man, and the Lord will raise him up; and if he has committed sins, he will be forgiven" (Jas 5: 14-15). We will relive the Apostle's exhortation in a particular way when, in a little while, some of you dear sick people will receive the sacrament of the Anointing of the Sick. By restoring spiritual and physical vigour, this sacrament shows clearly that for the suffering Christ is the Door that leads to life.
Dear sick people, this is the crowning moment of your Jubilee! In crossing the threshold of the Holy Door, you are joining all those in every part of the world who have already crossed it and those who will be crossing it during the Jubilee Year. May passing through the Holy Door be a sign of your spiritual entry into the mystery of Christ, the crucified and risen Redeemer, who for love bore "our griefs and carried our sorrows" (Is 53: 4).5. The Church enters the new millennium, clasping to her heart the Gospel of suffering, which is a message of redemption and salvation.
Dear sick brothers and sisters, you are exceptional witnesses to this Gospel. The third millennium awaits this witness from suffering Christians. It also awaits it from you who work in the health-care apostolate and in various ways carry out a mission to the sick that is highly significant and most appreciated.
May the Immaculate Virgin, who came to visit us at Lourdes, as we recall with joy and gratitude today, bend down to each of you. In the cave of Massabielle, she entrusted to St Bernadette a message which brings us to the heart of the Gospel: to conversion and penance, to prayer and trustful abandonment into God's hands.
With Mary, the Virgin of the Visitation, let us too praise the Lord with the Magnificat, the hymn of hope for all the poor, the sick and the suffering of this world, who exult with joy because they know that God is beside them as their Saviour.
So, together with the Blessed Virgin, let us proclaim: "My soul magnifies the Lord" and turn our steps towards the true Jubilee Door: Jesus Christ, who is the same yesterday, today and for ever!At the end of the liturgy the Holy Father greeted the pilgrims in various languages.
I warmly greet the English-speaking pilgrims taking part in this special Jubilee Celebration for the Sick and for Health-Care Workers. Commending all of you to the powerful intercession of the Blessed Virgin Mary, Help of Christians and Comfort of the Afflicted, I invoke upon you strength and peace in her Son, our Lord Jesus Christ.
I extend a very cordial greeting to the sick and to those accompanying them. You have come to celebrate this Jubilee together and you form a magnificent community of faith and hope. Your witness and prayer are a precious treasure and constitute an essential mission for the Church and the world. In fact, every prayer, even the most hidden, helps to raise the world to God. To serve one's brothers and sisters is to serve Christ. May the Virgin Mary guide you each day!
I now address the Spanish-speaking pilgrims taking part in this Jubilee Celebration for the Sick. May the Jubilee grace help you to bear courageous witness to Jesus Christ by offering your lives, your joys and your sorrows with him for the salvation of all.
I very warmly greet all the German-speaking pilgrims who have come to Rome to celebrate the Jubilee of the Sick. I express my esteem to all who are dedicated to the care and assistance of the sick. May the celebration of this liturgy help to strengthen your faith, so that you can draw from it new courage for living.
I extend a friendly greeting of solidarity to all the Portuguese-speaking sick who are taking part physically and spiritually in this Jubilee pilgrimage. I wish to assure you that I entrust your calvary each day to the God and Father of all consolation, so that your faith and hope in the divine Crucified One will never fail. He can change your affliction into joy and your pain into a remedy of salvation for those you love.
I cordially greet the sick and suffering who have come from Poland, as well as those who are accompanying them and attending this gathering for the Great Jubilee of the Year 2000. Through your suffering you are especially close to Christ. In this suffering may Christ always be your strength, he who redeemed the world through his passion and death on the Cross. Dear suffering brothers and sisters, we are indebted to you. The Church is indebted to you, as is the Pope! Pray for us.
THE CATHOLIC DOCTORS'CHALLENGES FOR THE NEW MILLENNIUM
Gian Luigi Gigli, MD, President of FIAMCA. CHANGES IN MEDICAL PROFESSION
The medical profession has changed tremendously during the last fifty years of the 20th Century. This has been due, in part, to the revolution imposed by the expanding knowledge in biomedical sciences and, in part, to the dramatic changes in society, which could not remain ineffective on medical doctors.1. The increase of scientific knowledge in biomedical sciences and the process of hyperspecialization
The increase of scientific knowledge in biomedical sciences continues with an expanding pace. As a result, the number of the medical journals has increased to the point that the impossibility of reading the entire scientific production, even in very specific areas, is given for granted and there is a proliferation of journals offering abstracts or short versions of the full articles, on paper or on line. Certainly, this is not the single cause of the process of hyperspecialization that is modifying the medical profession, but may be one of the most important, together with the idea that, working as a specialist, it is possible to make more money, compared with general practitioners.
Hyperspecialization is transforming the medical profession, substituting the holistic approach, i.e. the approach that takes care of the person entirely, including his physical, mental and spiritual needs, to a practice based on organ pathology. This long lasting stream leads to influence medical schools also, where internal medicine has been fragmented in a series of teachings based on organ pathology. The process seems to have no end, since it affects also specialistic disciplines, in which the academic success is often offered by the ability of the doctor to further specialise in uncovered fields, trying to become the number one of a little domain.
There is a joke, defining the specialist as the doctor who knows more and more on less and less things, to the point of knowing everything about nothing. Of course, this joke contains a paradox, but certainly also a fair amount of truth.
It is not surprising that medical students are often unable to consider the patient as a unit of body, mind and soul, but have instead a distorted vision of a mere assemblage of organs and tissues. A vision that is reinforced by the undoubtful successes of the transplant medicine, which urge us to wonder where the principle of unit regulating that organ assemblage is located.
The rate of increase of scientific knowledge is so fast that there is no time to metabolise it and nobody seems to be able to attempt the organisation of the new items of knowledge in an harmonic and coherent picture.2. The technological invasion of medicine
The second part of the 20th century has also been the era of technological invasion of medicine. A realm of measurable events has substituted the old medical art, made of observational abilities, skilful hands and wisdom. As a result, the access to technology is the most important requisite conditioning success.
Technology is a crucial element, undermining even the budgets of economically developed societies and discriminating people of different countries in terms of their right to have access to high quality standards of assistance. Of course, technological development has certainly created new wonderful possibilities for better diagnoses and treatments.
However, apart from the ethical dilemma, posed by technology, as for example in the field of artificial reproductive technology, some doctors unconsciously got the wrong message that it was possible to solve most of the problems of the patient, by simply depending on machines. Thus, the communication with the patient has been considered less and less important, even for history collection and physical examination, losing great opportunities for using communication as a therapy in itself.
The extreme of this anonymous and impersonal approach of the patient-doctor relationship is shown by the increasing number of web pages where patients can have access to present their complaints and receive suggestions for diagnostic procedures and pharmacological treatment. Internet is a wonderful instrument to facilitate communication between doctors living in different parts of the world. In addition it is a magnificent tool for continuing medical education, with possibility of access to major libraries and journals, the only limitation being time (the joke says that Internet is an instrument for insomniacs and unemployed). On the other side, communication through computers cannot be certainly considered as a substitute for the tête-à-tête encounter between patient and doctor, despite the real business that is behind this kind of operations.3. The expansion of the alternative medicines
It is not surprising therefore that an increasing number of people is turning their back to an impersonal medicine and searching relief to their complaints in the so called alternative medicines.
In a society that has expelled the traditional faith, heritage of centuries and fundamentals of modern civilisation, we observe an invasion of sects, magicians and vague new age spiritualism. The same is happening to medicine. More and more people are turning their back to a cold and impersonal medicine, unable to have care of the patient in all his dimensions, and prefer a kind of interventions that, despite any evidence of real effectiveness, nevertheless shows an almost sacred charisma. Pranotherapy, Tibetan medicine, herbs and powders of pre-Columbian cultures, healing powers: very different approaches, unified by the fact that the specific therapy is less important than the contact with the therapist, considered endowed with a special healing flow.
The invasion of alternative medicines should raise important questions to medical doctors, who should ask themselves why they lost charisma and how they lived their relationship with patients. Instead, very often there is only a manifestation of rationalistic disgust, typical of the man of science closed in the ivory tower. The same attitude is sometimes manifested towards new professions, like for example chiropractors, or acupuncturists, despite the fact that their modalities of intervention are much more understandable for the traditional medical education.4. Patient's autonomy and freedom of choice
Continuing our reflection about the changes in the doctor-patient relationship, two more aspects need our attention. First, there is an increased request of freedom of choice by our patients. This is not only in the case of immoral procedures, like abortion, or in the case of the refusal of common practices by certain minorities, like hemotransfusion by Jehovah witnesses, but also in the case when the patient selects modalities of treatment that are not sufficiently validated by scientific research. This is likely to happen especially for chronic disabling pathologies, for which current treatments are not able to stop the progression of the disease and are the cause of very severe side effects, like in the case of many types of cancer and of multiple sclerosis.
Last year Italy was agitated by demonstrations of oncologic patients and their families, requesting the possibility of deciding a treatment alternative to standardised chemotherapy. I refer to the case of the so-called Di Bella Therapy, which was largely diffused on the media. This alternative therapy was requested on the base of anecdotal cases and of Dr. Di Bella's charisma, despite the lack of any solid scientific evidence of efficacy. Under the pressure of the demonstrations, the government was compelled to authorise the payment of the unorthodox therapy by the National Health Service. The Di Bella case showed, on a national wide basis, that the asymmetric relationship of the doctor with his patient was ended and that paternalism had been substituted by patient's autonomy.5. The conflict between patient and doctor
This brings us to a second aspect. If paternalism was certainly wrong, autonomy risks to degenerate into frequent conflicts. In fact, mutual trust is increasingly substituted by legitimate suspicion, with the patient and the doctor considering one another as a potential enemy. The medical intervention is requested to be effective under any circumstance. The consequences are the enormous business of insurances, the transformation and perversion of the forms for informed consent, from instruments for correct information into bureaucracy for the protection of the doctor. In my country, a so-called Tribunal for the Rights of the Patient is active in every hospital. The name "Tribunal" is self-explicative about the underlying mentality.6. The allocation of resources
These are some of the changes at the level of the patient-doctor relationship. Our profession, however, is also challenged by external factors, the most dramatic one being probably the increasing emphasis on limitation of resources.6.1. The limits of resources in affluent societies
Needs and resources are the heart of the economic relationship in health policy, but they are characterised by an internal tension that can lead to a difficulty of choice, to an impasse. On one hand, it is clear that health has a cost, but, on the other hand, health is a priceless possession. For this reason, health pressure can be potentially aversive for an economic system, since it tends to spend the most, to satisfy the maximum of needs.
To bypass the obstacle, health authorities have been limiting the role of public finances in health assistance: the welfare state has been criticised and is under revision all over the world. However, once the budget is the most important concern, new moral issues come to our attention.
Affluent societies permit the scandal of having a large part of their population, without coverage of basic health needs. The value of human life can come to depend on age, with the access to expensive procedures denied to elderly people. Free access to certain expansive diagnostic procedures can become so restricted in reality that whenever the examination is urgent, the patient is de facto compelled to pay and therefore discriminated according to census.6.2. The lack of resources in developing countries
If this is happening to health systems in post-industrial societies, in the developing countries we continue to assist to the biblical calamities afflicting the poor societies, devastated by maternal and infantile mortality, malnutrition, old and new infections, without local resources to be used for health assistance and with external aid conditioned by the acceptance of programs for birth control, while pharmaceutical companies have no interest in producing drugs to cure the diseases of the poor.6.3 The medicine of desires
On the contrary, in the affluent societies, for those who can afford the costs, there is the explosion of a kind of medicine based on personal desires.
Aesthetic surgery, sex changes, cosmetic dermatology, strange dietetic regimes are only examples of a medicine based on desires. Doctors accept to be involved with procedures that have little to do with the relief of human sufferings. The contradiction becomes even more striking, when systems compelled to limit the health services offered to the general population, nevertheless continue to reserve part of their budgets to the satisfaction of personal desires. In this very City of Rome, the quality of oncologic assistance outside of the hospitals is rather insufficient and patients are told that resources are insufficient to improve the service. However, you can change your sex at zero cost in a public hospital in Rome.6.4 The Evidence Based Medicine (EBM)
The problem of the allocation of resources is not only at the macroeconomic level, but it involves the physician in his personal activity too. Just to make an example, it is more and more common to hear about the so-called Evidence Based Medicine. This is on one side the attempt of the scientific community to found medical profession on solid bases, explicating the criteria of behaviour. Peer reviewed publications and experts' opinions, after discussion and consensus conferences, bring to the production of diagnostic and therapeutic protocols or guidelines. These are created by medical doctors for other medical doctors. However, guidelines and protocols are more and more often produced also by health authorities, for example to direct medical profession according to the availability of resources. This leads to an increasing pressure upon medical doctors, with possible limitations to their diagnostic or therapeutic freedom.7. The end of the centrality of hospitals
The limitation of resources for health systems in affluent societies is pushing in the direction of a giant trend that will change the idea itself of western medicine, based on the centrality of the hospitals. The hospital is no longer the house of the hospitality, it is becoming only the place for diagnosis and treatment of acute diseases that cannot be addressed in an outpatient clinic.
Nursing homes, residential homes, rehabilitation centres are considered to be more convenient than hospitals for the care of chronic and disabling diseases, which therefore are pushed out of the hospital. Emphasis is placed on the advantages of bringing medical and nursing assistance directly at the patient's home, forgetting the difficulties experienced in the assistance of chronic patients by today's fragile families, exposed to rupture, with few or no children and with no adults at home. More and more often in the future we will be confronted with the situation of people in need living completely alone, but our medical schools continue to pay very little attention to educational programs focused on chronic disabling diseases with strong social impact.
Particular attention will be requested by the centres for palliative cares, where only the presence of people who love life will be able to offer a meaning to the death of people alone with their disease.8. Ageing and denatality
The explosive combination of ageing and denatality can provoke the financial collapse of the health systems and modify the type of patient and the clinical problems that the physician will meet in the near future. Despite the general consensus about the risks, not only medical, of an old society without children, the aggression to life at its beginning and at its very end continues, following the trend inaugurated in the second part of the 20th century with mass contraception, with legislation on legal abortion in many countries and with the first laws on euthanasia.
Our societies are not yet fully aware of the danger of anti natal mentalities. In the name of progress and of its superior interests, pressures in favour of a change by an inversion of current cultural sexual trends, familial policies, and fiscal laws are considered to be not politically correct and anti natal practices continue.9. The manipulations of human life
Finally, at the turn of the millennium, we had the privilege of assisting to a wonderful expansion of the knowledge on human reproduction, foreseeing possible future application in the treatment of genetic diseases, previously with no chance of intervention. As always with science, the applications of marvellous scientific discoveries can be diverted, without strong moral issues, into instruments of oppression against human beings. Knowledge on human reproduction is now being confronted by a parallel expansion of threatening manipulations of human life.
It is already done the elimination of embryos, produced in excess in order to increase the probability of outcome of in vitro fertilisation. Genetic knowledge is increasing the number of the conditions for which it is possible a pre-implant diagnosis, with consequent genetic selection and elimination of the embryos with genetic alterations. In the case of unwanted twins, it is proposed a reduction of the number of embryos. It is possible that in the future the so-called twin fission will become a routine, with the aim of obtaining a twin embryo to be used for diagnostic investigation and to keep a bank of homologous tissues.Summarizing, the doctor, at the beginning of the new millennium appears at risk of losing a holistic and personal approach to the patient and having difficulties in managing the flow of information. He is a doctor whose activity is more and more depending on technology and more and more conditioned in his activity by the decisions of government health and social policies. The relationship with his patient is made more difficult, not only by problems of communication, but also by a latent conflictual confrontation and by a decreased charisma, while the patient his pretending more autonomy and the satisfaction of personal desires, not strictly linked to preservation and recovery of health. A profound revision of educational programs is required to let him operate more easily in a society with too many old-old and very few children, to prepare him to work outside of the hospital and to have care of chronic and disabling diseases. The doctors at the beginning of the new millennium appear to be not well equipped to resist to the pressure of alternative medicines, to the cultural pressure in favour of practices against life, to political systems that would like him to be neutral in front of the inequalities of our time.
B. THE RESPONSIBILITY OF THE CATHOLIC DOCTORS
If this is the scenario, what can we do as catholic doctors of the third millennium to overcome these challenges, to be prophets, resisting to temptations of money and disengagement, preventing society and our patients from dangerous risks?1. The personal level
I think that the first answer is at the level of personal attitudes. We cannot simply live with the culture and the values proposed by the media. We have not to seek the conflict for itself, but we have to be proud of our diversity, convinced that we are the salt of the earth and that our proposal is more joyful and full of life.
Pressed between an utilitarian idea of health, which recognises only some health rights considered socially useful, and the health ideologies, which propose health practices as a form of cult for a sort of new religion, for which death seems almost to be avoidable and health and fitness are modern Gods, we cannot simply withdraw on the line of a mercantile ideal of medicine where profit (personal and institutional) is the meter of what is right.
Again, we have to place the subject at the very centre of our attention and to promote a net of human relationships based on solidarity.
We have to manifest the courage of placing again the fundamental questions about life, suffering and death. The pagan vision that is behind the cult of health is afraid of suffering, ageing, death and even birth. To this vision we have to witness the Christian perspective, looking at birth, disease, sufferance, care, healing and death as opportunities of growth. The experience of our limits (finitezza in Italian) helps us to discover the infinite and the reality about ourselves, breaking the dream of omnipotence and invulnerability.
These should be elementary concepts of our Christian experience, but our way of acting is usually quite distant from the ideal. Even to speak about the possibility of finding spiritual redemption through suffering sounds odd to modern hears, including those of Catholic doctors or of hospital chaplains. A few weeks ago, after the death in Tunisia of an Italian socialist leader who had been sentenced for corruption and had lived for years sick and exiled, I had the grace to listen to his daughter on television, reading a passage of a letter from him to the Pope. In the letter, this man, strong, aggressive, arrogant, intelligent, apparently distant from a Christian lifestyle wrote that he was offering his sufferance to God for the good of Italy and for the intentions of the Holy Father.We have to be convinced that the genuine religious experience can help the men and the women of our era to keep spiritual and physical health together and to solve the apparent conflict between the need of personal health and the resources of the health systems, because health (salus) and healing are part of the process of salvation (salus) and salvation cannot exist if man is not healed in his entirety.
For this reason, presenting to our colleagues and students the sick person as the true image of Jesus (icona Christi), cannot be regarded just as a devotional attitude of some simple good spirits, but as the most important contribution, authentically revolutionary, to the process of improvement of medical profession and health institutions.2. The responsibility of the Associations
A second level of response is that of our Associations of Catholic Doctors.2.1 Spiritual growth
Our Associations, in a time of pluralism and secularisation cannot continue to be the clubs of some good persons who from time to time meet to discuss some interesting ethical problems or join for a beautiful celebration. They have to become a place of spiritual growth where it is possible to receive a Christian inspiration to our professional life, from the living Gospel of Jesus Christ. The Gospel, the Good News of Jesus Christ can be found alive in the living body of His Church. If our Associations want to continue to be a source of Christian inspiration in the middle of a society marked by practical atheism, it is necessary that they become communities of prayer. They must become, more and more, a strong support to live our faith. The members of our Associations of Catholic Doctors must have the possibility of feeling a spirit animated by communion and service.2.2. Communion
Communion is the fundamentals of our credibility. Jesus prayed that we might become a single thing, so that the world could believe. Communion is not flatness, it builds up on variety and is in favour of a variety intended as complementarity. A spirit of communion is necessary inside our national associations, between member associations inside FIAMC, and between our associations and local Churches, increasing the links with the bishops and the episcopal conferences.2.3 Service
Service to the sick person and, more generally to those in need. Service to the true image of Jesus, to the icona Christi, as a visible demonstration of our service to Him, manifested by simple but eloquent evangelical signs, like attention and availability to the sick person, diagnostic and therapeutic attention not only for the body, but also for the soul, predilection for the last persons and those for whom society seems not to have interest, attribution of only relative value to money and attempt to live social justice.2.4 The new evangelisation
Communion and service are the requisites to become effective agents of the new evangelisation. Evangelisation is regarded with suspicion by modern societies and it is out of fashion in the Church itself. The underlying axiom is that we have not to impose anything to anybody. However this kind of approach is misleading. We have not to impose, but we have the mission to present our faith. It is surprising, for example, that in European societies, where Islam is the second confession, and sometimes the first in terms of practise, no effort is made to present the Christian Good News. We seem to be indifferent to the faith of our brothers. Again, it is not a problem of imposition, but of being convinced of the beauty of the Christian life to be proposed, for us in the medical field, for others in other temporal realities, with the simple instruments of communion and service.3. Social and political witness
The third level is that of the social and political witness.
A personal and community attitude, like the one that I tried to describe, can generate a new culture, that requires to enter into contact with other's positions, convinced of our own position, in a dialog that has to be competitive, because, without attacking others'cultures, it wants to promote our way of living. I think especially of our presence in the Universities and to the institutional presence of catholic universities. We are not requested to manifest our Catholicism serving at the altar, but animating the temporal domains of health services with Christian values. There is an enormous activity to accomplish to permeate health systems with the ideals of solidarity and subsidiarity promoted by the Church's social doctrine.
Four examples will be sufficient in this context.3.1. Catholic Hospitals
First, we can work to transform some catholic hospitals reserved to rich people into hospital opened to everybody. At the same time we have to work for the government recognition and support of the non-profit institutions, both Catholic and non-Catholic) serving people in need.3.2 International Co-operation
Second, we can promote international co-operation, first of all as a contribution to justice and then as an expression of charity, that is of genuine Christian love. It is beautiful that also non-Catholic organisations are working in the field of international co-operation, but it makes me sad that catholic doctors are unable to express the same level of activity, while religious congregations are abandoning the field. Beyond the good intentions, in fact, some organisations work with a reductive vision of the health problems.3.3 Educational campaigns
Third, we can take part in promotional health campaigns, transforming them into true educational processes. The campaigns for the prevention of drug addictions, of sexually transmitted diseases and of car accidents, are typical examples of a philosophy of health founded on external protection, without any request for a change of lifestyles. For this reason they are intrinsically amoral. The same campaigns, to become really educational need people witnessing a different conduct and able to ask for a change.3.4. Promotion of a life centred culture
Finally, we have an enormous sociopolitical task in promoting legislation in favour of life. Apart from trying to reverse legislation permitting abortion, embryo wasting and euthanasia, or apart from fighting against the introduction of this kind of laws in other countries, we must feel ourselves engaged to promote social conditions where life can be accepted and to fight against those situations where the dignity and the sanctity of life is humiliated. Next Monday, here in Rome the fifth anniversary of the great Encyclical "Evangelium Vitae" will be solemnly celebrated. For the Catholic Doctors the "Evangelium Vitae should be continuously reminded as the greatest document of the Magisterium in this field, a sort of "Magna Charta" of our action in favour of human life. Rightly, somebody thinks that the "Evangelium Vitae" should be catalogued as a social Encyclical of the Church, rather than a document with moral teachings.
As a matter of fact, the respect and promotion of life is the basis of every social aggregation, worthy to be considered human. From this regard, to work in favour of life is, for the Catholic Doctors, the most important contribution to human civilisation.C. THE JUBILEE
I would like to end this talk with reference to the Jubilee we are celebrating, that is the occasion of our meeting here in Rome. Just as many brothers of previous centuries we came to the tombs of the Apostles Peter and Paul to rediscover the origins of our faith, to follow a path of interior purification, to open ourselves to a larger solidarity and fraternity.
May-be more, than middle age pilgrims, men and women living at the turn of the millennium need to begin a trip along the ways going in search of Good and of Truth, trying to understand the deepest meaning of our humanity, something that only Christ can reveal.
The pilgrimage to the tombs of the Apostles then, becomes the image of the other pilgrimage, the one lasting the entire life. For this reason, the pilgrimage of the Jubilee can help us to discover again the respect of life, the sense of human suffering, the solidarity with those who are closest to Christ on the cross, the meaning of death, that is not a window opened on nothing, but the true end of human pilgrimage on earth, that will open us to the vision of God's face.
The task of the Catholic doctors is to accompany today's men along the most important stations of their earth pilgrimage, so that it will never become a meaningless walk.
We have examined some of the challenges that touch the core of our Christian witness. As lay members of our Church, we are called to be present in the middle of our profession, trying to change structures and behaviours, so that they can become a clearer image of the healing love of Christ. It is exactly the message of the Jubilee that calls us to a renewal of our life, operating for the growth of the kingdom of God among temporal realities, i.e. in our profession, in the study, in scientific research, in teaching.
This will be possible if we renew our faith and have a stronger participation to the life of the Church, otherwise we have nothing special to say to our patients and colleagues.
SUMMARY
Dr Michael Shanahan, President, Catholic Doctors Association, Western AustraliaThe International Day of the Sick and Jubilee of Sick Persons and Health Professionals was arranged by the Pontifical Council for Health Care Workers and held in the Vatican Synod New Hall from Wednesday February 9, 2000 until Saturday February 12, 2000. This event consisted of several ceremonies held over two days which included a Congress of Bishops and Health Care Workers including representatives from doctors, nurses and pharmacists associations.
The Opening Ceremony and Mass, held in St Paul's Basilica, was attended by several thousand people, including the sick in wheel chairs and their carers together with health professionals.
On Friday 11, the International Day of the Sick, about 35,000 people filled St Peter's Square for a very moving ceremony. Mass was concelebrated by the Holy Father together with Cardinals and Bishops. Following the Mass, the Sacrament of the Sick was administered to people in wheel chairs and stretchers. In the evening, a spectacular candle light procession and a festival of sound and light held in St Peter's Square, finished off a memorable day.
Further events were held on Saturday February 12 viz, "Via Crucis" at the Colosseum and in the evening the Paul VI Hall was packed for a nationally televised concert titled "Feast of Joy and Hope". The participants were people of talent and sporting achievement who were disabled and handicapped. Again, sick and disabled people in wheel chairs and their carers occupied much of the hall.The celebrations demonstrated the care and compassion the Church has for the sick and the people who look after them. In his address on Friday February 11, Pope John Paul II stressed the Church's support for people in their suffering. His message reminded us of the spirit of the Good Samaritan and the need to recognise the face of Christ in the sick.
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During the period, executive meetings of the International Federation of Catholic doctor associations took place. My representation at the meeting was as a consultor for the Pontifical Council for Health and as Oceania representative for the FIAMC on the executive committee
The general assembly of delegates dealt with the "Challenges for Catholic doctors for the Third Millennium". Professor Gian Gigli, President of FIAMC, gave the first talk.
Following Professor Gigli's talk, delegates discussed the subject in their various groups of doctors, nurses and pharmacists.
The challenge, for the doctors, was identified by a short talk from six delegates representing the continents of Oceania, Asia, South America, Africa, America and Europe.
These talks were followed by a paper on the "Identity of the Catholic Doctor" presented by Archbishop Lozano, President of the Pontifical Council of Health, to the doctor's group.
The general assembly of all delegates then came together the next day for a combined meeting. Details of the outcome and conclusions of various papers will be summarised below.
Dr Gian Gigli, President of FIAMC acknowledged the great changes during the last half of the 20th Century. He spoke of the almost impossible task of keeping up with the information journals that had proliferated as a result of the high amount of scientific production now taking place. He spoke on the role of the Catholic doctor and also that of the Catholic doctor associations.
Hyperspecialisation has led to a distortion in the full medical education of students who do not appreciate the personality of the patient and have a narrow-minded ambition. This translates into the "career doctor" focused on status and financial success.
Communication and trust become victims of the doctor/patient relationship. The patient then turns to alternative methods of healing [due to dissatisfaction], such as, the Internet, treatments with untested medications, and the new professions such as acupuncture. As a result of this lack of trust in the doctor, distortions occur in the doctor-patient relationship with patients, at times, demanding inappropriate and immoral procedures.With the increased demand on limited economic and health resources, the State, unable to meet the demand, rations financial support, and thus is unable to provide equal health for all, and only those who can afford to pay are treated at will.
Developing countries suffer more severely. Their populations suffer from widespread disease aggravated by poverty, ignorance, malnutrition and lack of access to medical resources, including drugs beyond their capacity to pay.
Further difficulties arise with the ageing of the population with increased demand for management of chronic illness requiring medication, hospitalisation, investigations, surgery and nursing care. Hospitals are now being used for shorter stays, with increased turnover, and patients are sent home early to be nursed at home. With the rising cost of medical care, attempts are now made to reduce the early onset of disease by rejecting the imperfect embryo, after checking the genetic structure, and at the other end of life encouraging euthanasia.
At the personal level, the Catholic doctor has to reject the utilitarian culture of health and promote a deeper understanding of dignity of the patient, by witness of the Christian perspective, which recognises the spiritual and human dimensions of the patient. Doctors then come to share with the patients their lives, suffering and death. Colleagues and students will recognise that the sick patient is being treated in the image of Jesus and may imitate the example.
The role of the Catholic doctor associations is to be a source of Christian inspiration for their members in the practice of medicine in a secular world. The bonding of association members by communications, conversations and sharing spiritual stimulation is the essential activity.
Beyond this, there is the need to facilitate actions based on our convictions as Catholic doctors. This can be achieved by promoting service to the poor and disadvantaged along with advocation of the right to life for all.
Evangelisation, which is misunderstood by the secular world, and viewed with suspicion by other religious, is also required. This is promoted by the faithful Catholic doctor providing his services for the sake of his convictions. Not less important is the evangelisation of his colleagues who are influenced by contact and collaboration, especially in teaching institutions, universities and hospitals.The associations spread their influence by international co-operation, working in areas of mutual interest. Education of the secular world in health ethics and the right to life are promoted. Political pressure is exercised when governments attempt to pass laws that allow for laws against life such as euthanasia and abortion.
These are the challenges facing Catholic doctors entering the new millennium.
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Six representatives then discussed Continental experiences.Oceania - Dr Michael Shanahan from Australia
This report focused on the struggle of the Catholic doctor associations and the Catholic health institutions to be effective. Both need to find new inspiration, which will come from the next generation of Catholic doctors. How to motivate this change is the challenge of the new millennium. There is a need for a physical presence or "critical mass" of Catholic Health Care Workers in important positions to maintain Catholic Identity of the health care institution.
The difficulty of motivating the next generation may be overcome by appealing to their sense of mission toward social health issues - eg drug problems, indigenous health, etc. The Catholic institutions themselves need to invite Catholic doctors to join them on ethics committees and other management areas especially those focussing on 'mission'. Education in ethics and ethos for all Catholic health Care Workers needs to be promoted by the associations through the Catholic hospitals, Catholic universities and bioethics centres. Developing stronger links between the associations in Australia and regional areas is required for mutual support and more effective action. The associations need to collaborate more closely with the Church who can give support and encouragement.Asia -Dr Joon-Ki Kang from Korea
Dr Joon-Ki indicated the diverse role of the Catholic doctor in Christ's mission to heal the sick and the responsibility to use their talents.
Although, obviously income is required to exist, we must not forget to practise forms of being the Good Samaritan.
He recognised the spirit of Christ, which motivates us all. Respect for life has to be practised in a secular world. The Catholic doctors' commitment is indicated by their professional activity.
Asia has monumental differences extending from opulent Japan and Korea to extreme poverty in Laos and Myanmar and between the practice of modern medicine and traditional beliefs. This means that a diversity of problems exist, with solutions which can give rise to difficulties between the Church and society such as birth control or the use of condoms for the prophylaxis of AIDS.
Because of active opposition from communities without religions, evangelisation, whilst a challenge, is also a problem in Asian countries. The balancing of the management of the sick who also suffer poverty and squalor, whilst providing modern Western medicine, for the affluent, which is the ethical dilemma. Of the 8% Asian Christian population, Catholics are only 3%. That is an obvious challenge, especially for Catholic doctor associations in Asia, of bringing Christ to the secular community.South America - Dr Francesco Diaz Herrera
Dr Francesco Diaz Herrera talked of the challenge of commitment through our belief in Jesus leading to a deep conviction in our vocation.
The next commitment was to inform the Church about scientific advances and to hear from the Church her response.
The physicians need ethical orientation and to be aware of both the privilege and responsibility of their vocation. They should value their Christ-like service to the sick and the disadvantaged, and protect the lives of the smallest and elderly patients.
The challenge is to reaffirm both vocation and mission and not to give in to difficulties that surround us all. We need prayer, work, determination, and to seek solidarity with those around us in South America.Africa - Dr John Wilson.
Dr Wilson's paper was most challenging to all participants. It expressed the difficulties of the health of the people of Africa. Many of their diseases have been eradicated in the Western world. But still plagues of infection occur in all ages and much of Africa is without basic resources and technology to deal with this tragedy.
AIDS, up to 50% in some countries, is affecting the whole fabric of society - from the family breakdown to Government services. Affected children are born in families where the mother/father die of AIDS.
The low salaries paid to doctors result in many leaving the country in order to find better incomes. Drugs, if available, cannot be afforded and ignorance is a big problem.
The challenges for the Church and for the Catholic doctors faced with these difficulties to practice ethical medicine, are huge. Agencies will pay generous allowances for doctors who promote practice of sterilisation, abortions, thus disadvantaging the 'good' doctor who works amongst the poor.
Maternity mortality may be as high as 2000 per 100,000 live births. At the turn of the century, this is still increasing due to poverty and ignorance. The resources of governments are plundered by poor prices and corruption. The provision of what health facilities are present is restricted by vast distances.
These are only a few of the challenges for the Catholic doctors in Africa who need to look to each other for mutual support and will need to look also for outside help. There is apathy in the Catholic doctor associations - as the instinct to survive is paramount. Regional groupings are needed with the support of Bishops giving guidance and spiritual support.North America - Dr George Isajiw
Dr Isajiw spoke on the North American challenge and the loose federation with Canada and Mexico.
He pointed to the challenge of society that increasingly devalues human life. Physicians have become "killers" where the State of Oregon allowed assisted suicide as a "medical benefit".
The use of human embryo stem cells for experimentation is another manifestation. He pointed out Pope John Paul's statement that a "blow struck against the whole moral order" occurred when abortion is carried out. He also mentioned the practice of withdrawal of nutrition and hydration for the non-terminal unconscious patient, which had occurred in a US Catholic hospital, which caused concern. He also mentioned the problem of the "living will".
He called for reforms in our own Catholic world where errors had occurred, and the formation of a proper medical conscience, which may need to accept professional and personal hardship. He did note the increasing number of converts to natural family planning. Institutions - Catholic hospitals may also need to experience hardship in loyalty to their Catholic mission. He also praised the courageous work of some religious leaders in health care comparing them to the prophets and martyrs of old.
By prayer and faith in the Holy Spirit we will meet the difficult challenges of the third millennium. He looked to the Bishops to help the Catholic physicians.Europe - Dr Paul Deschepper
Dr Deschepper spoke on the "Challenges of the European Catholic Medical Associations".
He spoke from the perspective of Belgium and Holland. He first of all noted a decline of Catholics in Belgium with 13% practising and 33% Catholics who were faithful but non-practising. Bishops have caused concern by nomination of an increasing number of pastoral workers, possibly creating a risk of parallel clergy, and the lack of basic Catholic beliefs by some priests and pastoral workers. Thus the fundamentals are being influenced more and more by the secular society of belief and practice, with its own subjective system of values.
He expressed the view that youth is now less attached to idealism especially with religious practice.
A need for more spirituality by witness to the Gospel which brings hope and happiness is, he believed, the challenge for Catholics in Europe. There was a need to be islands of hope in a sea of solitude and confusion like the first Christians.Archbishop Lozano Barragan : "The Identity of the Catholic Medical Doctor"
Archbishop Lozano noted very different motivations behind being a medical doctor and a Catholic medical doctor. The former look to fame and financial success and treat patients as clients. However not all are self-centred and many are generous with their time and expertise. His paper focused on the identity of the Catholic medical doctor.
Firstly, this concept is incomprehensible to those who have no faith in Christ and His Church. The Charter of Health Care Workers calls for the Catholic doctor to be the guardian and servant of human life. The doctor's activity is based on interpersonal relationship with the patient - a meeting of trust and conscience - to care and cure the patient. The doctor's attitude must be one of sympathy for the patient. Suffering by personal participation and the doctor's whole humanity is involved.
The doctor becomes like the Good Samaritan, working for the love of God and the healing charity of Christ. This mission is integrated with the same mission of the Church. Thus the doctor exists with God for the benefit of others.
The doctor's profession is a vocation, which carries obligation and responsibility and is called by God. The Hippocratic Oath is limited as it does not refer to the "love of God" which is the basis of a caring doctor - that is the love of our neighbour as ourselves. The figure of Christ who has compassion is the essence of the Good Samaritan. The identity of the doctor based on the love of God shows humanity, comprehension, sensitivity, care and concern.
The doctor will totally defend life at every stage. He has a duty to truth, based on scientific knowledge and clinical sciences, to become skilled and competent and co-operating with others as an advocate for his patient's welfare. The patients must not be treated as fragmented problems devoid of personality to be treated 'coldly', according to the economic imperatives.
The medical doctor must be exposed to continuous learning and also pass on skills to others - the presence of Christ the Physician must be the model.
Health is not just the absence of illness but a dynamic balance of physical, mental, social and spiritual harmony. Pain and suffering were integral to the life of Christ, and are difficult to appreciate and understand. Empathy between doctor and patient is needed to deal with pain and suffering until death occurs which is not regarded as a failure or a frustration to the doctor.
Medical doctors are physicians for life for the benefit of humanity (never retiring!). Their vocation is to go on caring for life, devoted to the care of the weak as a reflection of the goodness of God. The doctor's role is to humanise medicine especially with its advanced forms of technology.
The fundamental qualities of the doctor, based on faith in a loving and supreme God are, therefore, awareness of responsibilities, humility, respect, love and truthfulness as if the patients were Christ himself. Truthfulness is required in diagnosis, treatment and information so that the patient can make decisions regarding the management of the illness. The preservation of life is paramount therefore the doctor's purpose must never be to harm or to kill the patient. Competence in the field of ethics is necessary, so that the best management of the patient can be selected.
The committed doctor is prepared to work with others in a multi-disciplinary team, working together for the good of the patient. Health should be promoted with preventative actions and an awareness of expenditure. Patients need to be heard together with their complaints and their suggestions taken seriously.
The Catholic identity of the medical doctor is to be the transmittance of the Healing Christ.Conclusions
All speakers - doctors from various continents - nurses, pharmacists, the Bishops and the Holy Father's address pointed to enormous problems in health care of the world's populations. These problems extend from the poor to the wealthy in all countries and are the challenges of the new millennium.
The problems which affect mankind are severe. They range from the most basic provision of clean water and food to the overuse of expensive sophisticated medical technology. There are increasing social issues affecting health, such as the sexual abuse of women and minors and the spread of AIDS, and disintegration of the family unit leading to a breakdown of the fabric of social order and individual denigration, depression and death. Solutions to these problems lie beyond the capacity of any single organisation to provide. They will involve the change in attitude of individuals and countries of self-interest, greed, corruption, abuse and pride. Apathy, defeatism, and poor communication compound the problems.
To address these challenges requires collective actions taken firstly with individuals, then as a group association. National and international action can then be influenced.
The first step will be for the Catholic Health Care workers to individually be a witness for their faith by prayer and good example. Perseverance will come with faith in a loving God the Father and prayer to find courage and good will to be the Good Samaritan. The Catholic doctors should inspire those of similar service around them to become interested in helping, including ecumenical collaboration. Finally, there is the need for individuals to study and become conscious of the ethical issues that surround them, and learn to become better communicators on these issues.
Specific actions to be put in place by the FIAMC, regional and local associations of Catholic doctors are as follows:
Examine ways and means of promoting the teaching of bioethics based on the Catholic tradition for undergraduates and graduates of the professions in health care.
Investigate strategies and obtain data from member countries to promote the training of Catholics in the fields of obstetrics and gynaecology both nationally and internationally.
Promote the involvement of Catholic health professionals in the management of Catholic health institutions especially with the decline in religious orders and to counter the trend to purely secular institutions.
Develop strategies to seek out and involve the younger generation of doctors to become involved with such health issues as giving their time to the service of the poor or disadvantaged, and gain their support to oppose such issues as abortion and euthanasia.
Promote a deeper dialogue and better understanding between the hierarchy, priests and religious with the Catholic Health Care professional organisations. The Church should make clear and easily understood statements explaining ethical issues so that all can appreciate what is intended, and the full impact of implementation such as "living will" or "advance directives".
Improve communication, using all the modern technologies and equipment and use professional help where needed, including journalists.
Promote membership of the FIAMC and individual associations. Good communications is essential to stimulate and keep interest and support alive and flourishing between the associations of doctors.
Promote collaboration with associated Health Care Workers such as nurses (CICIAMS) and pharmacists. Collective action between the organisations will give a much greater effect than single groups, especially with national issues.
Declare support for the continued membership of the Vatican in the United Nations (as a non member State Permanent Observer) so that it can continue to counter the "culture of death", and promote a more equitable sharing of the world's resources - only 15% of all drugs used are available to 85% of the world's population.
To arrange and support medical services in those countries that are ravaged by war, poverty, disease and natural catastrophes. These countries include those in Africa, South America, Asia and the Indian sub-continent. Action required includes fund-raising and arranging personnel to go who are suitably trained to train and support local health services, and to give help even to a point where it may impact on profits.
To arrange and support medical services to special disadvantaged groups in individual countries such as drug problems, AIDS, poverty, indigenous peoples, and hospice services. Special help is needed for those women facing abortion.
To promote international meetings such as the Congress in Rome in July 2000 on "Medicine and Human Rights" followed by, also in July, the 12th AFCMA Congress in Kuala Lumpur on "Health Challenges in Asia in the New Millennium" organised by the Catholic doctor associations.
In Pope John Paul's message for the World Day of the Sick, he reminded all Health Care Workers to contemplate the face of Christ in the sick. To take up the challenge to defend life in all its perspectives and to promote health, worthy of the human being. Finally, to face these challenges with courage and in doing so, imitate the Divine Samaritan with the help of the Virgin Mother to build civilisation of love.Dr Michael Shanahan, MD, President, Catholic Doctors Association, Western Australia