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Website: http://www.fiamc.org

DECISIONS
JOURNAL OF THE F.I.A.M C.
FÉDÉRATION INTERNATIONALE DES ASSOCIATIONS MÉDICALES CATHOLIQUES
INTERNATIONAL FEDERATION OF CATHOLIC MEDICAL ASSOCIATIONS
Spring 1999 Issue 15

Joint editors:
G. L. Gigli, Udine; W.Osswald, Porto; T.P.Linehan, London

Editorial Board:
F. Blin, Paris; P. Deschepper, Waasmunster; A. Ferrero, Buenos Aires; G. Isajiw, Upper Darby;
J. Lee, Singapore; J. Marek, Prague; K.H.Meng, Seoul; Fr. V. Feytor Pinto, Lisbon; Fr. V. Pozaic, Zagreb

CONTENTS

19th WORLD CONGRESS OF FIAMC
and 67th CMA Annual Meeting (USA)
Medical Ethics in the Third Millennium
New York, September 1998

Walter and Domingas Osswald with
Prof. Leonas Maciunas (Vilnius, Lithuania)
after the closing Mass at St. Patrick's Cathedral

Two former Presidents of FIAMC on the stage:
T.P.Linehan presents the
Special Award of FIAMC to Gino Papola

This highly successful Congress took place between the 10th and the l3th September last in Midtown Manhattan at the Sheraton New York Hotel. A success judged by the quality and breadth of the papers presented, and a record breaking attendance.

The theme "Medical Ethics in the Third Millennium" succeeded in attracting papers that well covered contemporary Catholic ethical problems. Truly the Federation had carried out the dictum of the Holy Father Pope John-Paul II when he addressed the international meeting in October 1982 in Rome and said: "Individual action is not sufficient. Collective, intelligent, well planned, constant and generous work is required, and not only within the individual countries, but also on an international scale. Coordination on a world wide level would in fact allow better proclamation and a more effective defence of your faith, of your culture, of your Christian commitment in scientific research, and in your profession". These words encapsulate the work of the Federation at the International level and encourage us in our continuing development and especially working together.

The Congress was the second to be held in the USA, the previous one being held in 1970 in Washington DC. The first International Congress was held in Brussels in 1935, but because of World War II, it was not until after the war that a Congress was held in Lisbon. Since then many countries have played host to the Congress: London (l962) - Manila (1966) - Washington DC (1970) - Barcelona (1974) - Bombay (1978) - Rome (1982) - Buenos Aires (1986) - Bonn (1990) and Porto (1994). These venues illustrate the international scope of the Federation and in the year 2002 the next International Congress will take place in Seoul, South Korea. It is hoped to publish selected papers read at the Congress at a later date.

POPE JOHN XXI PRIZE FOR ETHICS

This prize for original work in ethics during the four year period leading up to a Congress was donated many years ago by the Portuguese National Association. Dr Kathryn R. Watson, MD (Van Nuys, California) was the winner and the prize was presented by Professor A. Laureano Santos, President of the Portuguese Association

Cardinal O'Connor
during his homily
Dr Kathryn R. Watson
(Van Nuys, California)
is awarded the Pope John XXI Prize, presented by Prof. Laureano Santos, President of the Portuguese Association
The Ecclesiastical Assistant, Fr. V. Feytor Pinto,
presents a token of appreciation to his predecessor,
Msgr. James P. Cassidy
Alfred W.Murphy, M.D., and Elizabeth M.Murphy, MA, RN, CNAA, represent FIAMC at UN headquarters in New York, where we have a status of NGO

DISTINGUISHED SERVICE AWARD
An award rarely given for special distinguished work for the Federation was presented to Dr Gino Papola, a previous President of the Federation (Bryn Mawr, Pennsylvania), by Dr Thomas Linehan.

THE FIAMC AWARD FOR A MAN OF SCIENCE AND HONOUR
This award was presented to Dr Robert Walley (St John's, Newfoundland). The presentation was made by the President of the Federation, Prof. Walter Osswald. Dr Walley has contributed greatly on a voluntary basis to gynaecological career in Nigeria and is a Professor of gynaecology in St. John's, Newfoundland.

Official guests were the Most Rev. Archbishop Renato Martino, Apostolic Nuncio and Permanent Observer of the Holy See at the United Nations; Brother Pierluigi Marchesi delivered a message and represented the Pontifical Council for Pastoral Assistance to Health Care Workers as the President of the Council, the Most Rev. Archbishop Lozano, was not able to be present. Cardinal John O'Connor, Archbishop of New York, celebrated Mass and gave a homily during the Congress.

The Federation owes a great debt to our host The Catholic Medical Association of the USA for arranging this highly successful Congress in the "Big Apple". Work of the various committees was much appreciated and it is proposed only to single out one person whose efforts and work for the Congress were extraordinary, namely Dr George Isajiw, the Program Chairman, ably assisted by his hard working wife, Pat.

Please note that original work for the Pope John XXI Prize prepared during the four years between 1998 and 2002 can be considered for this prize and can be sent to the Secretary General any time from now.

The Federation is grateful for the support, encouragement and interest of the Holy See, the Pontifical Council for Pastoral Care of Health Care Workers, and the Pontifical Council for the Laity. Our outgoing President, Prof. Walter Osswald, stated in his message to the Congress: "It is a great privilege to welcome so many delegates from Catholic doctors Associations, so many friends from so many countries, knowing that language barriers and cultural differences will not prevent us from sharing n common faith, a system of ethics and a universal task, namely that of serving the sick, the destitute and the oppressed in the spirit of Christ's healing love as we have been taught by his Gospel of Life". The Congress certainly succeeded in doing all this.

T.P.Linehan

ELECTION OF THE OFFICERS
1998 - 2002
George Isajiw, Program Chairman
(elected Vice-President of FIAMC)
and his wife Pat
Maya El-Hashem, François Blin, Fr. Feytor Pinto,
Gian Luigi Gigli, George Isajiw;
Dr. Gigli wears the chain of office of President of FIAMC
President: Prof. Gian Luigi Gigli (Udine, Italy);
Vice President: Dr George Isajiw (Upper Darby, USA)
Secretary General: Dr François Blin (Paris);
Treasurer: Dr Alejandro Ferrero (Buenos Aires);
Ecclesiastical Assistant: Rev. P. Vitor Feytor Pinto (appointed by the Holy See).

The Executive Committee is composed of these officers, past Presidents, Presidents of Regional federations and two members from each of the six regions of the Federation. The Assistant Secretary General and Treasurer are nominated by the Committee.

THE PAPAL MESSAGE
to the 19th World Congress of FIAMC

Your Excellency,

The Holy Father was pleased to learn of the Nineteenth World Congress of the International Federation of Catholic Medical Associations taking place in New York from September 10-13, 1998, and he asks that you convey to all present his greetings in the Lord and the assurance of his prayers.

His Holiness welcomes the choice of the theme, "Medical Ethics Approaching the Third Millennium: The Love of Christ through the Spirit of Life", since it goes to the very root of the Catholic meaning of the Federation and the contribution which it is called to make to the Church's great task of serving the human family in the light of the Gospel. In society today, certain developments in medical technology are bringing marvellous benefits to people's health and well-being, while others can lead to an array of serious ethical problems. It is the task of groups such as the Federation to ensure that medical ethics looks always to the good as God has revealed it, for "only the act in conformity with good can be the way leading to life" (Veritatis Splendor, 72).

Christ is our supreme model. In him we see the love of God, a love offered unreservedly to heal all wounds and cast out all evil in those who came to him. It is Christ, the giver of life (cf. Jn 10:10) who reveals a new horizon for the ethical action of Catholic physicians: doctors and medical staff are Christ's co-workers in loving and promoting life, the life of all who entrust themselves to their professional competence. The ethics of the Catholic physician must be anointed with affection, esteem and respect for the sick. They must be filled with the Holy Spirit so that through the service of medicine Christ himself may offer his life to those dwelling in the shadow of death. It is in this sense that "the therapeutic ministry of health workers forms part of the pastoral and evangelizing action of the Church" and that they truly become "witnesses to the Gospel of Life" (Charter for Health Care Workers, 5). As His Holiness noted in addressing the Plenary Assembly of the Pontifical Council for Pastoral Assistance to Health Care Workers on March 9, 1998: "Every act of care for the sick, if performed in a spirit of faith and fraternal sensitivity, truly be comes an act of religion" (L 'Osservatore Romano, March 9-10, 1998, p.6).

Guided by the Scripture, the Church is insistent in affirming that human life is a "fundamental good, the condition here on earth of all other goods" (Evangelium Vitae, 5). Therefore the sacredness of human life is the primary value and the fundamental truth upon which Catholic medical ethics are based. Whatever the psychophysical capacity of human persons, they have an inestimable value in the eyes of God. In ad dressing participants in the International Congress on "The Roots of Bioethics" (February 17,1996), the Holy Father made it clear that "bioethical reflection on the ontological and anthropological roots of the norms which ought to orient options of such decisive importance is urgent. The tree of ethical reflection, to conserve its vitality and bear fruit, must be firmly rooted in the ontological truth of the human being, created in the image and likeness of God, redeemed by Christ".

At the same time, Catholic physicians are called to work closely with medical schools and bioethics centers, and to be in the forefront of efforts to promote "the profound and interior quality of the medical professions intimately bound up with the Gospel of life" (cf. Address to Participants in the International Congress on "Training Doctors on the Threshold of the Third Millennium: The Role of Catholic Universities," November 25, 1996, in Dolentium Hominum, No. 32, pp.14-15). It is also important that there be dialogue and cooperation between all Catholic agencies and associations working in the health sector, in order to foster that general mobilization of consciences and shared effort in ethics upon which His Holiness has reinsisted (cf. Evangelium Vitae, 95).
It is the Holy Father's fervent hope that the Nineteenth World Congress will be a new point of departure for the Federation, leading it to be ever more a shining light in the world of contemporary medicine. Commending all present at the Congress to Mary, Mother of the Redeemer, His Holiness cordially imparts His Apostolic Blessing.

Cardinal Angelo Sodano, Secretary of State

PRAYER AT THE INAUGURAL SESSION
of the 19th World Congress of FIAMC
Lord our God,
through the power of the Holy Spirit
your Son healed our infirmities and diseases.
When he sent forth his disciples to preach the Gospel,
he commanded them to visit and to heal the sick.
Grant that this meeting of the Catholic Medical Associations
Will be fruitful.
Through your wisdom and strength
may physicians practice wisely the art of healing,
and may nurses and aides serve the sick with care,
recognizing that they are treating not merely diseases,
but persons with diseases.
And grant that their patients, comforted in their illness,
will be restored in body and spirit
and joyfully thank you for the favors they have received.
We ask this through Christ our Lord.
Amen.

Archbishop Renato R. Martino
APOSTOLIC NUNCIO, PERMANENT OBSERVER OF THE HOLY SEE TO THE UNITED NATIONS

CONCLUSIONS
of the 19th World Congress of FIAMC

We, Catholic doctors, as we bring to an end, in prayerful solidarity, the combined 19th World Congress of the International Federation of Catholic Medical Associations and the 67th Annual Convention of the Catholic Medical Association (USA), in New York City, September 10-13, 1998, do share with deeply held conviction the following conclusions:

"Christus Medicus" - Christ, our Healer, Christ the Divine Physician - is our enduring, steadfast source of saving grace, of moral courage, of professional excellence, and of spiritual inspiration and enlightenment. As Catholic physicians, we are each called to serve, in a unique sense, as "Alter Christus", as "Another Christ". Through the mystery of the Eucharist, Christ would use our hands, our minds, and our hearts, reaching out to our patients in their moment of need. We are challenged to realize, in touching and healing the wounds - both physical and psychologic - of each patient we treat, that we are privileged to touch and heal the very wounds of Christ, Our Lord.

The Magisterium of our Catholic Church, through its teachings, provides to us an ageless light, shining all the more brightly in the darkness of modern-day secular humanism. By studying, by promoting, and by incorporating into daily practice, the messages held in relevant papal documents - such as Evangelium Vitae, Donum Vitae, and Humanae Vitae, we, Catholic doctors, are strengthened in our calling to serve proudly and unapologetically as counter-cultural witnesses to the eternal truth of God's boundless and unconditional love.

The energetic involvement of Spirit-filled Catholic medical students has been a highlight of this joint convocation. The hope for the future of Catholic medicine rests on the success of our ongoing outreach to these students. We strongly encourage the active involvement, on a local, national, and international level, on the part of physicians-in-training at the pre-medical and medical school level, as well as in residency and fellowship programs.

The active involvement of women physicians in this meeting has been another highlight. We vigorously support and encourage the continued and increased involvement of Catholic women and minorities in all of our organizations.

Historic, at our meeting, too, has been our opportunity to welcome and greet in person, for the first time in over forty years, our colleagues and brothers in Christ from the island of Cuba, and to celebrate with many other colleagues - from Lithuania, Ukraine, the Czech Republic, Croatia, and elsewhere - their newly found freedoms.

Medical mission outreach to those suffering and in need - in Romania, in Honduras and Brazil, and throughout the world - is and must remain a foremost commitment. We welcome, with special enthusiasm, participation on the part of our Catholic colleagues from developing nations, such as the Philippines and Angola. Plans for future meetings should include goals for increasing participation on the part of our colleagues in under served parts of the world. At the same time, we Catholic doctors, stress the need on all of our parts, on a regular basis, to support and actively participate in Catholic medical mission activities, to those in greatest need, both abroad and within our own nations.

With the same spirit we are determined to in crease our efforts to be recognized as a Non Governmental Organization by the World Health Organization, to be more effective in serving the right of developing countries and the ethical needs of modern medicine.

We, Catholic doctors, renounce the evil of artificial contraception in all its forms. Most especially, we reject those agents, which, while masquerading as contraceptives, achieve their life-destroying effect through their abortifacient properties. We denounce the contraceptive imperialism of United States and United Nations governmental agencies, which propagandize, with missionary zeal, the worldwide spread of life-destroying abortifacients, condoms and contraceptives. Conversely, we celebrate the life-affirming vision of wholesome sexuality and parenthood, which Christ teaches us through our Catholic Church. And we practice and promote positive progress, such as Natural Family Planning, Natural Procreative Technology and Ecological Breast feeding.

We, Catholic doctors, renounce the evils of euthanasia and physician-assisted suicide. Most especially, we would warn of the dangers and pitfalls of "Living Wills" and related documents. We renounce pressure from governmental agencies and third-party-payers, who would have us act in the interest of cost reduction, at the expense of our own patients'best interests. Conversely, we celebrate the life-affirming vision of truly compassionate end-of-life care. We strongly encourage widespread education in palliative care and effective pain management. And we support life-affirming programs, such as Hospice Care.

Impressed by the striking social differences of New York City, and by the abundance of homeless and poor in the capital of an affluent world, we proclaim the right of every human being to receive at least the basic health care, especially when chronic or disabling diseases affect them.

Powerfully united together in prayer at this momentous meeting, we, Catholic doctors, commit ourselves to pray for one another on a daily basis, for the salvation of our souls, for our families and colleagues, for our patients, for the great gift of our One, Holy, Catholic and Apostolic Church, and for the world. Consecrated here to the Sacred Heart of Jesus, we, Catholic doctors, commit ourselves to Christ-centred practice of our professions and conduct of our lives. "Most Sacred Heart of Jesus, Thy Kingdom Come in Us."

LETTER FROM THE PRESIDENT

Dear Friends,

The 19th World Congress of FIAMC is over. It has been attended by more than 370 registered participants, coming from 24 countries of the 6 continental regions of FIAMC. The number could have been certainly higher if the costs of New York would not have prevented many others from coming. Among those who came, the significant presence of the Cuban and Lithuanian Associations has to be specially mentioned.

We experienced four wonderful days of communion and friendship. We shared experiences and opinions, we learned so much and we enjoyed strolling among the skyscrapers in the hectic atmosphere of the Big Apple. The quality of many of the speakers was excellent and the level of the organisation, despite being non professional, was excellent. I have to thank again here all those who volunteered and the speakers who accepted to invest their time in preparing the lectures. Particularly remarkable was the intense spiritual atmosphere that permeated every minute of the Congress, which found its real centre in the temporary chapel in the room of the 34th floor which hosted the Blessed Sacrament for the Eucharistical Adoration. Thanks for this to Archbishop Edwin O'Brien, the Episcopal Advisor of the Catholic Medical Association of USA.

The major responsibility of the Congress (and the hardest work) was on the shoulders of Dr George Isajiw (the new Vice President of FIAMC) and Dr Richard Watson (the new President of CMA-USA), who deserve our gratitude for having been able to carry on such an impressive work with very little help and limited financial resources. Last, but not least, I have to thank my predecessor, Prof Walter Osswald, who served as President of FIAMC in the last four years, bringing the Federation to expand in terms of number of member Associations and to grow in terms of representativity. I am sure that FIAMC will continue to benefit from his advice and support.

As I said in New York, I would like to continue his inspired action during the term of my Presidency, certain of the loyal cooperation of Fr Vitor Feytor Pinto, our Ecclesiastical Assistant, and of the new Officers: Dr George Isajiw (Vice President), Dr François Blin (Secretary General), and Dr Alejandro Ferrero (Treasurer).

We intend to serve the Church among our colleagues and patients and inside the medical institutions, in total, sincere and loyal fidelity to the Magisterium of the Church, with special regard to the promotion and defense of human life and in active cooperation with the central offices of the Church (namely the Pontifical Council for the Pastoral Assistance to Health Care Workers and the Pontifical Council for the Laity).

The importance of our presence will increase if we will be able to work jointly with the other Catholic Organisations of Health Professionals. For this reason, the next quadrennium will see our efforts to find modalities in which to share structures, means and abilities with Catholic Nurses, Pharmacists, Chaplains, Hospitals, etc. The International Day of the Sick and the Jubilee of Health Professionals, that will be celebrated in Rome on the 11th of February of the Year 2000 will offer us an excellent opportunity to do this.

It will be the quadrennium of the turn of the century and of the new millennium of the Christian Era. FIAMC will offer its little contribution, helping to redefine identity and profile of the Catholic Doctors in the new social conditions. This will be the theme of meeting for the International Day of the Sick. This is actually the content of the promise of the Catholic Doctor, that we would like to promote at every level. Further occasion of reflection will be given in July by the extraordinary Congress of the Jubilee that FIAMC will celebrate in Rome together with the European Federation (FEAMC) and the Italian Association (AMCI).

We would like to extend the membership of our Federation, promoting new Associations and gathering those that we know to already exist in several countries.

We hope that through our common work, FIAMC will become more and more a socially qualified corporate body, able to pursue effective actions in the cultural field and in the forum of International Organisations. The efforts for being recognised by WHO as a non governmental organisation will be a priority.

The initiatives of international cooperation in health projects will foster the visible presence of FIAMC. The ongoing projects in Mozambique and in Albania witness this intention.

These directions of work will be possible only if the members Associations of FIAMC will work in close contact with the Federation. For this reason we intend to promote the communications between our headquarters and the National Associations and among the different Associations.

The new technologies will help us tremendously in this effort of communications, but it is necessary that every Association creates its own mailbox for the electronic mail, communicating us all the new e-mail addresses. This will allow the possibility of exchanging in formation, in a faster, easier and cheaper way.

Electronics will also permit us to extend the audience of our meetings and debates. The preparation of a FIAMC web page on internet is already in progress*. Besides the space for the Federation, it will give to each member Association a possibility for presenting their activities and documents in a self managed window. You are cordially invited to think about this opportunity and to have a look on the draft of our web page, sending us your comments and suggestions.

Finally, l cannot end this first circular letter, without thanking you for supporting my election to the Presidency of FIAMC. It has been for me a great honour and yet a heavy responsibility. I am aware in fact that the Church and our Associations expect very much from the Federation, but I am also aware of our limited organisation and of the lack of financial resources to achieve our goals. I invite all of you to identify possible patrons and sponsors, able to support our present activities and to permit us to address new fields of intervention.

However the first resource of FIAMC remains the volunteer work of its people and the strength of our common prayer. With your support and your prayer, I am confident that also the next quadrennium will be a period of important growth for FIAMC.

To the Sacred Heart of Jesus, to Whom we consecrated us in New York, and in the hands of Mary Salus Infirmorum, I commit my activity at the Presidency of FIAMC. To them I promise to serve you honestly and hardly.

Yours,
Gian Luigi Gigli

12th CONGRESS OF THE ASIAN FEDERATION
OF CATHOLIC MEDICAL ASSOCIATIONS
Health Challenges in Asia in the New Millennium

This Congress will be held in Kuala Lumpur (Malaysia) from 12 to 15 July 2000, and its major themes will be:

• Ageing,
• Organ Transplantation,
• Genetic Engineering,
• Artificial Reproductive Technology,
• Care of the Handicapped,
• Catholic Response to Health Challenges,
• Ethical Dilemmas,
• Cancer,
• Communicable Disease,
• Stress Disease.

In his preliminary announcement, the Organizing Committee Chairman, Dr. Freddie Loh, states: "Our Continent - Asia - is home to a major proportion of humanity and we live in such diverse circumstances, from highly developed and rich nations to poor and underdeveloped ones. All these nations and it's people will face tremendous challenges in the area of health. Communicable and infectious diseases from adverse environment and dwindling resources, stress related diseases, the scourge of cancer and Aids, increasing mental illness and the problems of an ageing population are only some of the problems. We welcome you to Kuala Lumpur in the year 2000 to actively participate in the Congress so that the Catholic doctors of Asia can identify and find ways to meet these challenges. " You may register or ask for further information by addressing the Secretariat: Catholic Doctors Association of Malaysia 20 Jalan 21/11B, 47300 Petaling Jaya, Selangor, Malaysia. Tel: 03-776 9976 (O), 03-775 3499 (H), Fax: 03-777 4342; E-mail: <ablestar@tm.nct.my>

THE LICHINGA PROJECT IN MOZAMBIQUE

First contact with a consultation room

Outside a dispensary in the outskirts of Lichinga
two expatriates and a local nurse

As previously reported (Decisions, issue 14), the Lichinga Project, sponsored by FIAMC, is well under way. From October 1997 to September 1998, 13 health professionals (doctors and nurses) have stayed, in teams of 2-4 persons, for at least three months in the dioceses of Lichinga, near Lake Nyassa, working in the Hospital of Lichinga and Cuamba, as well as in Health Centers and Diocesan Dispensaries.

The need to adapt to local conditions and to cooperate in a frank and honest way with the local doctors and nurses was the fundamental norm to be observed. Thus, surgical and medical interventions were always put into practice by teams formed by the expatriate professionals and by the local ones, so that from the beginning it was clear that the mission of the expatriate professionals was to help, to develop, to increase knowledge and to improve abilities and certainly not to impose attitudes or to exert authority. The fact that all professionals spoke the same language (the expatriate being Portuguese) greatly facilitated inter-personal relations and understanding.

Dr. Isabel Miranda, an Obs.Gyn. specialist,
meets the women waiting for her consultation
Teamwork is funny

Obstetrics, Gynaecology and Paediatrics were the main areas of activity, although there were also common actions in Surgery, Orthopaedics and Medicine. Caesarian sections, correction of vesicovaginal fistulæ and management of prolonged labour were predominant, due to the frequency of these pathologies. Postgraduate training, establishment of protocols for different pathological situations, organization of the pharmacy, education for health attitudes (including food processing and cooking) and sexual education were some areas of important activity. A short course on Hospital Infection, symposia on the role of the Hospital in health care and on essentials of nursing were some of the activities at the teaching level.

The professionals also went to schools, dispensaries and health centers in order to give lectures and courses on practical aspects of healthy living. The team also was successfully in getting from different donors surgical appliances (especially gloves, sutures, surgical irons), which are always scarce in this region, as well as drugs, disinfectants, contrast media and i.v. sets.
Due to this activities, the teams have met with sympathy and praise. From a letter of Cesar Massimbo, a local priest, we quote the following lines: "I wish to speak on behalf of our people: the doctors and nurses came to work here with soul. They have patience, kindness, are always in good mood and tireless. One of them, a lady, is called by all the mother-doctor. This shows that she is not only a professional, but also a vocation."

It is our intention to continue this Project, if possible allowing local doctors and nurses to come to Portugal for short training periods and visiting them on a regular basis in Lichinga. For this purpose, support is needed&emdash; you may help with donations, ear marked for the Lichinga Project and sent to our Office in Rome (address: see impressum)

Three expatriates coming home from the market,
in the Project's own car...
...which is not immune to poor road conditions.

1999, THE INTERNATIONAL YEAR OF OLDER PERSONS

It was in October 1998 that the United Nations declared the beginning of the International Year of Older Persons, adopting as its denomination "Towards a Society for All Ages". This is an excellent theme, because older people should not be considered as a special group, apart form their fellow citizen &emdash; intergenerational relations and exchange are vital to society's survival.

But the facts are there and ask for responses. Never before did older persons represent such a large proportion of the population: The United Nations ECOSOC estimates that there are now 66 million people who are 80 or more and that this number will increase to a staggering 370 millions in 50 years from now. Never before did the age pyramid appear, as it does to-day in many countries, turned upside down. Its is also unprecedented to find an initiative like this taken by the United Nations, declaring an International Year and dedicating an annual World Day to older people (to be celebrated on October 1 each year). As the UN Secretary General stated, our society is one that considers older people as "agents and beneficiaries of development".

Unprecedented is also the health situation of older people. At least in developed countries, the prevalence of chronic, incapacitating disorders is falling, i.e., older people are living healthier lives and may expect to remain fully functional until they approach their nineties. As John Rowe stated, already in 1997 (Science, 278: 367, October 1997), we need a new Gerontology, aiming not just at avoiding or delaying disease, but primarily at maintenance of functions and full engagement in life.
THE CHURCH AND OLDER PERSONS

The Church and the elderly

It is universally recognized that the Catholic Church has always lent attention, understanding and help to older people, especially to the poor, the frail, the dependent ones. However, in recent times it became clear that the Church has to "revise her approach to the pastoral care of older people in the third and fourth ages", as stated in "Dignity of Older People and their Mission in the Church and in the World" (Vatican City, 1998). We may cite the following events as characteristic of this renewed interest and new approach:

• International Forum of Experts on Active Ageing (Castel Gandolfo, 1980)

• Addresses of Pope John Paul II to the United Nations (27 July 1982), to the pilgrims of Vie Montante (Rome, 4 October 1984) and to an assembly of older people (Rome, 23 March 1984). The motto was: "You still have a mission to fulfil and a contribution to make" (Insegnamenti, VII, 1, p.744, 1984).

• Official recognition of Vie Montante Internationale (International Ascent) as a Catholic International Organization of lay people dedicated to the spirituality and active engagement of older people.

• "The Church and the Elderly" is the theme of the 13th. International Conference held in Rome by the Pontifical Council for the Pastoral Assistance to Health Care Workers (29.31 October 1998; see more details on page 7)

• FIAMC prepares and publishes a position paper entitled "Ageing, Health and Society" as a contribution to the International Year of Older People (see Decisions issue 14, p.7-10, 1998)

• The Pontifical Council for the Laity presents its document "The Dignity of Older People and their Mission in the Church and in the World" (Vatican City, 1998). This document was drawn with the contribution of a working group with inclusion of representatives of the Secretariat of State, various offices of the Roman Curia and of various ecclesial organizations (including FIAMC). This important document condenses in its 50 pages all the problems associated with old age, but also the positive characteristics of older people, "who still have a great deal to offer to the Church and to Society". As already shown in its title, it does not deal exclusively with service to older people but instead puts its accent in the need to correct the current - largely negative - image of old age, as a task which ought to involve all generations. It urges the Catholic communities to take initiatives, to find new forms and methods, as well as new pastoral plans for encouraging older people to make their own contribution to the mission of the Church. Very aptly, Pope John Paul II's testimony is remembered: he describes himself as an "elderly priest", does not conceal his age and frailty and lives his old age in faith, in the service of the mission entrusted to him by Christ, to which he continues to dedicate himself.

The Church and the Elderly (13th INTERNATIONAL CONFERENCE)

This 13th Conference was, as its earlier editions, an important and successful event. As usually, the roster of speakers was very impressive, the organization excellent and there was even time for discussion. Cardinals, Bishops, Professors, Politicians, Psychologists, Representatives of other religions, Sociologists dealt in depth and covered all pertinent aspects of the elderly and of the ageing world. Our President, Prof. Gian Luigi Gigli dealt with the theme "Health", in the round table dedicated to Strategies for Sociocultural Change in Connection with the Elderly. From theological-pastoral to demographic, cultural, economic, political, biological and social aspects, the coverage made by the diverse contributions was impressing. The Proceedings of this Conference are available in Dolentium Hominum, 14 (January 1999).

 BEYOND THE POLITICS OF ABORTION

"Hope and Healing" is a publication of the Elliot Institute, an institution founded in 1988 to promote post-abortion healing and to undertake original research and education on the impact of abortion in women, men, siblings and society. More information available on its web site [www.afterabortion.org], or by writing to the Elliot Institute, PO Box 7348, Springfield, IL 62791-7348 USA. We found the following leading article very interesting. (The Editors)

Everyone has an opinion about abortion. That's fine up to a point.
The problem is when these political and moral views get in the way of efforts to help those who are hurting because of a past abortion.
Just for the moment, set aside the question of whether or not abortion should be legal, and ask Yourself, "Shouldn't we all offer understanding and compassion to our friends and family members who are feeling grief over a past abortion?".
Most people would answer yes. Indeed, this is one of the few areas of common ground between both sides of the abortion debate. Unfortunately, people on each side generally believe that, while they are understanding and compassionate, those on the "other side" are not.
The truth is closer to this: both sides really want to be understanding and compassionate, and both sides are blind to the ways in which they are failing in this regard.
As a result, women and men who are struggling with unresolved grief over an abortion are caught in a trap. They're boxed in by the politics of abortion.
On one side, they are afraid to share their grief with friends who are "pro-life", because they fear being condemned and rejected. On the other side, they've learned that when they turn to friends who are "pro-choice" their grief may not be acknowledged as truly valid.

PRO-CHOICE DENIAL

In the latter case, pro-choice friends typically try to offer support, with words like, "Just forget about it. It was your best choice at the time. It wasn't really a baby yet. You can have another baby some day.
These statements are meant to offer reassurance. But those grieving a past abortion hear something else: "Just forget it. You didn't lose anything that was real".They walk away feeling that their grief is irrational, unimportant, or even abnormal, and so they bury their pain once more.
But this buried pain is exactly their problem! They want to expose it, work through it, and get beyond it&emdash; and they need the support of their loved ones to do this.
This is why people of every culture hold funerals and wakes. It is a time of open grieving when we acknowledge and validate each other's loss.
In abortion, something is lost. Whether you want to call it the loss of a child or just the loss of an "opportunity" to have a child, the loss is real. It has to he grieved and released. If friends and loved ones deny this grief the grief process will actually be prolonged.
Yet pro-choice advocates often hesitate to recognize the reality of post-abortion grief because they fear this means they have to recognize the death of a baby, which may somehow undermine the political argument for legal abortion.Some extremists will even go so far as to deny that abortion can ever cause emotional suffering, a claim that is insulting to the millions of women and men who know differently from their own experience.
In short, the politics of abortion are getting in the way of post-abortion healing. Those who are experiencing grief do not need rationalizations or slogans. They need the reality of their emotional experience to be understood, accepted, and respected.

PRO-LIFE JUDGMENTALISM

Now lets look at the other side of the trap.
Do women and men struggling with a past abortion feel comfortable talking about it with their pro-life friends? Rarely. This is because the pro-Life movement has done a far better job of condemning abortion than of promoting compassion for those who have experienced it.
Most pro-lifers probably do want to be compassionate. They really do "hate the sin, but love the sinner". Unfortunately, this seldom comes through in their antiabortion rhetoric.
Consider, for example, this comment made by many pro lifers: "I can't understand how anyone could have an abortion". Sadly, anyone who says this is merely exposing his ignorance of the immense pressures which drive people to choose abortion.
Polls show that at least 70 percent of women having abortions believe abortion is immoral. Most of these women thought they would never have an abortion. Many even considered themselves to be pro-lifers. But when they found themselves trapped in a hard situation, they ended up submitting to the "evil necessity" of abortion as their "only choice". With this fact in mind, a more humble pro life attitude would be to say, "who am I to throw stones at others?"
Secondly, pro-lifers who say, "I don't understand how anyone could have an abortion" are blind to how hurtful this statement can be. Think about it. What is the implication of this comment to a person who has had an abortion? Won't it be heard as, "Only an evil person could ever have an abortion"?
This is not what most pro-lifers intend to say, but it is the message that is heard.
Faced with comments like these, it is no wonder that most women and men hurting over a past abortion will go to great lengths to hide their secret. Would you share your secret grief over a past abortion with someone who "just can't understand" how anyone like you could do such a thing? Of course not.
Most pro-lifers probably don't intend to be condemning. Indeed, most would genuinely want to offer comfort, and understanding. But the truth is, most don't know how.

LET'S FACE THEIR REALITY

Bottom line: whether you consider yourself pro-choice, or pro-life, it is essential to acknowledge the feelings of those who do feel pain after an abortion.
Your political and moral views about abortion will not change how they feel. Pushing your views may simply prolong or aggravate their negative feelings.
Everyone, on both sides, can do better. Our friends and loved ones need us to do better. Reading this publication will help you do better.

David C. Rearden (Director of the Elliot Institute, and author of "Making an abortion rare: A healing strategy for a divided nation")

IN SHORT

The Albania Project
FIAMC has sponsored a Project which aims at improving the abilities and increasing the professional standards of Albanian nurses, especially those who work in operating rooms. There is an acute need of specialist nurses and therefore two courses are being given in Tirana, the capital city of Albania. The courses are given in Italian, a language which is known to the majority of the students, and the teachers are voluntary nurses and doctors coming from Italy. The Project activities were interrupted due to the political and social upheaval taking place some months ago, but has now been resumed and should be concluded in a couple of months. Gian Luigi Gigli, President of FIAMC, is in charge of the organization and the Italian Episcopal Conference substantially funded this important Project.

Father José L.Redrado, O.H.
Secretary of the Pontifical Council of Pastoral Assistance to Health Care Workers,
consecrated Bishop of Ofena by the Holy Father
On 6 January 1999, Epiphany of the Lord, the new Bishop was consecrated in St. Peters by His Holiness John Paul II. We rejoice with the great community of all those involved in the Church's activity in the vast field of health and congratulate His Excellency, wishing him continuing success and joy in his fruitful action as Secretary to the Pontifical Council.

BOOK REVIEWS

MARY SENANDER
The Living Will. Expansion or Erosion of Patients'Rights ?
The Leaflet Missal Company, St-Paul, Minnesota, 2nd. edition, 1996.
During the 19th World Congress of FIAMC, Dr. John Lee (Singapore) forcefully argued that living wills do not represent an informed consent form and in practice take decisions away from the realm of patients, attributing them to other individuals and resulting in an extension of medical power. The booklet under review represents an easy to read, authoritative and timely response to the questions raised by living wills and durable power of attorney for health care. Although it is specifically aimed at the situation in the U.S.A., it will prove of interest to all those who are interested in honest and life-respecting solutions to important health care problems, as those raised by the insidiously growing acceptance of such documents. The author stresses the fact that living wills are compatible with catholic moral teaching, but that the expansion of the concept to include the right to refuse ordinary means or to request "merciful" killing is morally flawed and exceedingly dangerous. In his introduction, Cardinal O'Connor "enthusiastically recommends" this work, and so do we.

A.W. VON EIFF
Ins Angesicht widersprochen.
Herder, Freiburg-Basel-Wien, 1998
Professor von Eiff was an outstanding medical scientist, internationally recognized as a clinical researcher on the relationship of emotions, the autonomic nervous system and hypertension. He was an engaged Catholic Doctor and wrote more than 300 contributions, ranging from physiological basic research to Ethics of Sexuality, AIDS and contraception. This book represents a short, lively, overview of his life, work, and permanent dialogue with society and Church. From his resistance to nazi indoctrination to personal memories of meeting and discussing problems with some of the great figures of the Church in this century (like Cardinals Konig, Wyszynski and Wojtyla, the present Holy Father), it makes fascinating reading. This autobiographical work makes it clear that von Eiff never did attempt to separate his profession and social engagement from his deep religious convictions and responsibility as a catholic layman. A honest, sometimes polemic, thought-provoking book, which unfortunately is only accessible to those who read German.
Von Eiff died recently, and it is certainly fitting that the last chapter of his book deals with the Resurrection, stating that he longs to meet the Lord and to tell Him that he begs for enlightenment and for the resurrection of Easter.

JEROME GROOPMAN
The Measure of our Days: New beginnings at Life's End.
Viking, New York, 1997
The author is a distinguished haematologist and oncologist, supervising a large research laboratory in which postgraduate and post doc investigators do advanced scientific work. He has to write research papers, to hunt for grants and to teach students. Nevertheless, he found time to write about a number of his patients &emdash; all terminal cases &emdash; and chronicles how they face their death. He also found time for talking, listening, comforting, reassuring and grieving with his patients, their friends and families.
Humanization of health care (an awkward concept, since medicine must be humane or it loses its essence), as claimed by many, finds an excellent argument in this book, which moreover is very well written and represents an impressive testimony. The title, of course, is from Psalm 39, v.5: "and we may ask the Lord, as David did, to make us know our end and the measure of our days".