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The Perspective of the Theology of Suffering in the Vatican’s “Charter for Health Care Workers”
Varying Perspectives on Suffering 2
Putting Suffering Into Perspective • “The meaning of pain defines suffering. An athlete may expect and even embrace pain during a game but may suffer if his injury disables him or causes his team to lose. A person who is injured intentionally and ignored is likely to suffer more than one who is hurt accidentally and treated with care…. • “The task of putting profound suffering into perspective can require grappling with larger questions. For example, serious physical illness often prompts individuals to reassess what gives their lives significance. Survivors of childhood sexual abuse may need to rebuild their shattered assumptive worlds so as to achieve a new take on themselves, on their hopes, and on reality…. • “in recent years mental health professionals have increasingly recognized the clinical relevance of spirituality…. However, relatively little attention has been directed to the implications of different belief systems embraced by patients for accomplishing basic psychotherapeutic tasks such as integrating suffering. ” 4
Putting Suffering Into Perspective The Relationship Between Suffering & World View • “A person’s world view helps to shape the meaning of her painful experience. • “An individual who trusts in God as a protector of good people may feel cheated, if not punished, by a dx of cancer. • “A believer with a different understanding of God may wonder if the same illness is intended to discipline him or bring him closer. • “Cancer may remind a Buddhist of the need to transcend desire & attachment, • “an atheist of his most important accomplishments or values. • “suffering can also influence one’s world view…. In a survey of 350 members of the American Association for the Advancement of Atheism, they found that ½ of the younger atheists had lost one or both parents before the age of 20. A large # of this group also described themselves as unhappy in childhood & adolescence. ” 5
Putting Suffering Into Perspective Therapist’s Role • “Jews can find in the Psalms & in the story of Job precedent for the sufferer to call out to and question God. • “Christians can also see in Christ’s suffering evidence that God cares about their suffering because he has taken it on himself—thus dignifying suffering on behalf of others. • “Buddhists find in the dharma support for detaching from the desire that leads to suffering. • “Atheists faced with suffering may instead take pride in their own integrity, intellectual honesty, or stoicism…. • “Individuals with a spiritual or theistic world view often feel that someone cares about their pain and that they are not ultimately alone. However, • they may also be struggling with the concept that a God who is powerful enough to have spared them illness did not choose to do so…. • “Clinicians will usually find that believing patients (like nonbelievers) …most often want a chance to be heard & to talk about their concerns…. They may also need to reflect on, & to think through, their own beliefs & doubts. The account by the Christian apologist C. S. Lewis of his experience of his wife’s death, A Grief Observed, is a compelling description of this process…. 6
Putting Suffering Into Perspective Therapist’s Role • “Individuals with a naturalistic or atheistic world view consciously reject a purposeful explanation for the universe…. they may feel ultimately alone and anxious in bearing pain…. they see illness as no one’s fault, except perhaps their own through mistakes they made in bringing it on or failing to detect it in its early forms. Instead, they often struggle to achieve a kind of Eriksonian integrity, or ability to live and die consistent with who they are…. • “Suffering makes many patients realize that they are uncertain or ambivalent about their philosophy of life. They may consider themselves as ‘lapsed’ churchgoers or skeptics who have rejected organized religion but retained a strong sense of personal spirituality. • A number of challenges face clinicians in attempting to help agnostic patients clarify their beliefs about what matters most, think through their questions, and consolidate their values so as to live in accord with their deepest commitments…. • “Perhaps the most difficult challenge is presented by those agnostic patients (often character-disordered, with narcissistic traits or substance abuse) who lack both a framework of meaning and the insight that they need direction. The psychologist and philosopher Søren Kierkegaard would have diagnosed them with ‘the sickness unto death, ’ or ‘the despair that 7 does not know it is in despair’….
Suffering from a Hindu Perspective 8
Suffering from a Hindu Perspective • Hinduism encourages “ a resigned attitude based upon the belief that there is nothing much one can do about what happened in the past or what is happening now & what is going to happen in the immediate future…. • [It] “provides an opportunity to every individual to shape his future & he is inclined spiritually, to liberate himself from the world of births & deaths…. • “True liberation comes when one achieves self realization and becomes free from the cycle of births and deaths. ” 9
Suffering from a Buddhist Perspective 10
Suffering from a Buddhist Perspective “’…. The essence of life is suffering, said the Buddha. At first glance this seems exceedingly morbid and pessimistic…. Take any moment when you feel really fulfilled and examine it closely. Down under the joy, you will find that subtle, all-pervasive undercurrent of tension, that no matter how great this moment is, it is going to end. No matter how much you just gained, you are either going to lose some of it or spend the rest of your days guarding what you have got and scheming how to get more. And in the end, you are going to die. In the end, you lose everything. It is all transitory. ’ Henepola Gunaratana, from 'Mindfulness in Plain English'. “The reason that we experience suffering comes ultimately from our mind. According to Buddhism, our main mental problems or root delusions are: attachment, anger and ignorance. Because of these delusions, we engage in actions that cause problems to ourselves and others. With every negative action (karma) we do, we create a potential for negative experiences…. If we can control our body and mind in a way that we help others instead of doing them harm, and generating wisdom in our own mind, we can end our suffering and problems. “The Buddha summarised the correct attitude and actions in the Eight-fold Noble Path: (The first 3 are avoiding the 10 non-virtues of mind, speech and body: ) Correct thought: avoiding covetousness, the wish to harm others and wrong views (like thinking: actions have no consequences, I never have any problems, there are no ways to end suffering etc. ) Correct speech: avoid lying, divisive and harsh speech and idle gossip. Correct actions: avoid killing, stealing and sexual misconduct Correct livelihood: try to make a living with the above attitude of thought, speech and actions. Correct understanding: developing genuine wisdom. (The last three aspects refer mainly to the practice of meditation: ) Correct effort: after the first real step we need joyful perseverance to continue. Correct mindfulness: try to be aware of the ‘here and now’, instead of dreaming in the ‘there and then’. Correct concentration: to keep a steady, calm and attentive state of mind. ” 11
Suffering from the Perspectiveof Confucianism 12
Suffering from the Perspectiveof Confucianism • “In all the greatest cultures of the world, there have been prominent teachers, leaders and reformers who are still honoured and revered to this day. From amongst those of the Chinese tradition, one man stands foremost, and that is Confucius, the great sage, teacher & reformer…. • “In his teaching he emphasised righteousness - correct behaviour based on duty, which in turn is based on one's situation in society…. Confucius was the rare combination of an idealist and practical business man…. • “earthly minded, [He] never acknowledged a personal God. Confucius was neither interested in where man came from or where his soul departed to after death. • “Of himself he said, ‘I have striven to become a man of perfect virtue and to teach others without weariness, ’ His ideal was ‘the superior man carrying out in his conduct what he professes’…. • “Since the death of Confucius, a whole school of philosophy has developed from his teachings, and his fame and reputation have spread throughout the world. To some he was a God, to others a remarkable administrator, a great reformer, the first teacher or the supreme teacher. “ 13
Suffering from an Islamic Perspective 14
Suffering from an Islamic Perspective • “our present life, with all its joys and sufferings, is merely transitory & illusionary…. Death may be the ultimate human suffering in this world, but it is certainly not the end of life…. the 2 nd phase of human life is reflective of how we conduct ourselves in the first phase of life. The joys as well as the sufferings shall continue in the life Hereafter…. • “Islam acknowledges that life is full of suffering, starting as early as the very process of human conception in a mother's womb and during the process of childbirth…. . • • …. the disasters that are caused by natural laws are no reflection of the Creator's cruelty over humans. According to the Holy Quran, the study of natural phenomenon makes us understand that, despite the devastation suffered by some humans, God's Mercy (rahmah) is the most overwhelming attribute in Nature that creates, maintains and evolves all forms of life including human life. • “there are the man-made infliction that cause other humans to suffer…. causing suffering, pain and death to others through the misuse and abuse of one's free will, humans remain responsible to God, & not God to humans…. to establish, a JUST society is one of the most important obligations taught by Islam. Those who may escape the corporal punishment in this world, for them God's punishment shall be waiting in the life to come…. . • “there acts of ‘self-inflicted suffering’: …. The Holy Quran prohibits inflicting selfinjuries, specifically committing of suicide…. “it does not matter how much a person suffers in this world, as long as he or she is engaged, according to his or her capacity, in repelling the evil and doing the good works. The joys and comforts of the life yet to come are far greater, unparalleled and everlasting as compared with human sufferings of this life!…. for us Muslims and all others, the important thing should be is to learn how to handle human sufferings retaining full faith in a loving God!” 15
Suffering from a Jewish Perspective? 16
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“I believe in God. But I do not believe the same things about Him that I did years ago, when I was growing up or when I was a theological student. ” “I recognize His limitations. He is limited in what He can do by laws of nature and by the evolution of human nature and human moral freedom. ” 18
"We could bear nearly any pain or disappointment if we thought there was a reason behind it, a purpose, to it. But even a lesser burden becomes too much for us if we feel it makes no sense…. “Let me suggest that the bad things that happen to us in our lives do not have a meaning when they happen to us. They do not happen for any good reason which would cause us to accept them willingly. But we can give them a meaning. “ 19
Not Very Satisfying! 20
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(from Peter Kreeft’s web site) 23
Reasons to Believe: First Cause Argument Four of Aquinas' 5 proofs are variations. Whether it be • motion, • the beginning of existence; • present existence or • goodness/value, everything needs an explanation. 24
Reasons to Believe: Argument from Design • Monkeys could have banged out the greatest musical masterpieces. Common sense instead points us to great composers. • The existence of the universe points to a creator. 25
Reasons to Believe: Argument from Desire "Creatures are not born with desires unless satisfaction for these desires exists. . If I find in myself a desire which no experience in this world can satisfy, the most probable explanation is that I was made for another world" (C. S. Lewis)26
Reasons to Believe: Pascal’s Wager • If you've got everything to gain and nothing to lose, why not believe? • If there is a God, don't we want to give Him His due? 27
Reasons to Believe: Arguments from History Similar to the argument from design, we could argue • 1 st, that humanity's story is meaningful. • 2 nd, that God's justice is revealed in this story. • 3 rd, that various "coincidences" testify to Providence, • as do miracles (which is 4 th). • 5 th, that honest examination of evidence forces the question of Christ's identity: • Lord, lunatic, or liar? • 6 th , that if not God, what causes martyrs' joy? • 7 th, that if not for God, how would Christianity have been so successful at winning converts? • 8 th, what happens when you pray the prayer of the 28
Reasons to Believe: Argument from Conscience Some basic beliefs about right & wrong enjoy universal agreement. Who but God gives the inner "still, small voice" telling us to do good? 29
John Haas, Ph. D. , STL President of the National Catholic Bioethics Center 30
Some Very, Very Basic Beliefs about Right & Wrong Enjoy Universal Agreement Dr. John haas notes that "the ancient Babylonian code, the Code of Hammurabi, [and]. . other ancient pagan religions, . . . have rules against adultery, murder, theft, & bearing false witness. " Because there truly are objective moral standards, Dr. Haas says we can "dialog with other peoples who may not share our. . . religious beliefs. . basic moral teachings. . . apply to everybody. . we all share the same human nature. " Traditionally, this has been called the “Natural Law” or “Natural Moral Law. ” In his letter to the Romans, the Apostle Paul said the " demands of the law are written in their hearts. " The "Natural Law" or "Natural Moral Law" is concerned with universal & unchanging principles of morality. Who but God gives the inner "still, small voice" telling us to do good? 31
So, What is this “Natural Law” (aka, “Natural Moral Law”? 32
Norms of Christian Decision Making in Bioethics are consistent with the "Natural Law, " that applies to all: "NATURAL LAW" is not the same as the (prescriptive) the road map to true human happiness "LAWS OF NATURE" (descriptive) (". . . demands of the law are written in their hearts. . . " (Romans 2: 15)) "Natural Law“ (prescriptive) is also not the same as the "Might is Right" nor "Morals Are Mores" nor "Right Is What Brings Pleasure" nor "Right is the Greatest Good for the Greatest Number" (Utilitarianism) First Principle of Morality: Choose the goods which will promote the true good of humanity (Do not impede, damage, or destroy a "Basic Human Good. ") ("God looked at everything he had made, & He found it very good. " (Genesis 1: 31)) l l l l l We always choose "goods; " we are concerned with how we choose. Arguments about how to choose BHGs get confused. Life, Knowledge, Skillful performance/ aesthetic appreciation Integrity Authenticity, Friendship, Religion, & Marriage. 33
According to authors/Dominican priests Benedict Ashley & Kevin O'Rourke, "Christian ethics might be specified by the priority it gives to certain values. . St. Paul, summarized these Christian priorities as faith, hope, and love (Rm 13). . 34
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Norms of Christian Decision-Making in Bioethics Norms of Christian Faith & Prudence Principle of Well-Formed Conscience Principle of Free and Informed Consent Principle of Moral Discrimination Principle of Double Effect Principle of Legitimate Cooperation Principle of Professional Communication Norms of Christian Love Principle of Human Dignity in Community Principle of Participation (aka, subsidiarity) Principle of Totality & Integrity Norms of Christian Hope Principle of Stewardship and Creativity Principle of Inner Freedom Principle of Personalized Sexuality (aka, The Principle of Family-Oriented Sexuality) Principle of Growth through Suffering 37
NORMS OF CHRISTIAN FAITH & PRUDENCE (6) • Principle of Well-Formed Conscience Good, decent, well intentioned people can “follow their conscience” and still be objectively wrong. In any ethical decision-making, I have the responsibility to “step to the plate” equipped with facts, as well as a conscience well-formed by the relevant ethical principles. 38
NORMS OF CHRISTIAN FAITH & PRUDENCE (6) • Principle of Free & Informed Consent This principle is sometimes misinterpreted as meaning that my health care provider is morally free to perform any procedure which is agreed-to by the patient. 39
NORMS OF CHRISTIAN FAITH & PRUDENCE (6) • Principle of Moral Discrimination According to the Natural Law’s “First Principal of Morality, ” I should always make my moral choices in a manner which will promote “Integral Human Fulfillment, ” the true good of humanity (This should NOT be confused with other types of moral decision-making, such as the notions of "Might is Right, " "Morals are Cultural Mores, " "Right Is What Brings Pleasure" or "Right is the Greatest Good for the Greatest Number" (aka, Utilitarianism)). In making choices, I should NEVER impede, damage or destroy a “basic human good” (i. e. , Human Life, Knowledge, Skillful performance/aesthetic appreciation, Integrity, Authenticity, Friendship, Religion, & Marriage. ). Along the lines of this principle, provision of nutrition/hydration (even if via an “artificial” means) would ordinarily constitute obligatory “care, ” rather than “treatment” (which MAY not always be obligatory). 40
NORMS OF CHRISTIAN FAITH & PRUDENCE (6) • Principle of Double Effect In a situation where I am choosing a good action, but in which my action will have both good & bad effects, my intention must be the good effects and the avoidance of the bad effects. The anticipated good effects must outweigh or at least equal the bad effects; the anticipated good effects must NOT be products of the bad effects. My action must produce those good effects at least as immediately as the bad. This principle would absolutely NOT justify doing an inherently bad action, so that good may come of it. 41
NORMS OF CHRISTIAN FAITH & PRUDENCE (6) • Principle of Legitimate Cooperation This principle concerns “cooperation” with the immoral act of another person. It is really an extension of Double Effect. To “formally cooperate” in an immoral act means to assist without moral reservation; formal cooperation is always wrong. Any other type of cooperation with the immoral act of another is called “material cooperation. ” If my material cooperation with the immoral act is “immediate” (i. e. , if I am “an instrumental agent of the principal agent”), it is also always wrong. When my my material cooperation is not immediate, it is called “mediate. ” If my mediate, material cooperation with the immoral act is “remote” (rather than “proximate”), it may be acceptable – “depending on the degree of the good to be achieved or evil avoided by the cooperation" (Ashley & O’Rourke, pp. 193 - 199). Even with remote, mediate material cooperation, I should consider the d danger of scandal that my cooperation may entail. Formal Cooperation (always wrong) v. Material Cooperation immediate v. mediate (always wrong) proximate v. remote Making a referral for a morally excluded service would be an example of formal cooperation or immediate, material cooperation in the immoral act of another. 42
NORMS OF CHRISTIAN FAITH & PRUDENCE (6) • Principle of Professional Communication This principle entails trust, and honest/ appropriate sharing of information: “For the Christian. . . confidentiality is not only professional; it expresses respect for the dignity of the human person, whom only God has a right to judge (Mt 7: 1 -5)" (Ashley & O’Rourke, pp. 199, 200). This principle would NOT necessarily exclude sharing information with the Center for Disease Control. 43
NORMS OF CHRISTIAN LOVE (3) • Principle of Human Dignity in Community According to the Natural Law’s “First Principal of Morality, ” I should always make my moral choices in a manner which will promote “Integral Human Fulfillment, ” the true good of humanity In making choices, I should NEVER impede, damage or destroy a “basic human good” (i. e. , Human Life, Knowledge, Skillful performance/aesthetic appreciation, Integrity, Authenticity, Friendship, Religion, & Marriage. ). 44
NORMS OF CHRISTIAN LOVE (3) • Principle of Participation (aka, subsidiarity) This principle seems best understood with an illustrative example: The family is the basic unit of society. The government would be wrong to interfere in a parent's relationship with her/his child, other than for very serious reasons, such as the abuse of the child. 45
NORMS OF CHRISTIAN LOVE (3) • Principle of Totality & Integrity “Everyday clinical practice generally accepts a limited form of disposing of the body and certain mental functions in order to preserve life, as for example in the case of the amputation of limbs or the removal of organs. Such practice is permitted by the principle of totality and integrity (also known as therapeutic principle). The meaning of this principle is that the human person develops, cares for, and preserves all his physical and mental functions in such a way that (1) lower functions are never sacrificed except for the better functioning of the total person, & even then with an effort to compensate for what is being sacrificed; & (2) the fundamental faculties which essentially belong to being human are never sacrificed, except when necessary to save life…. “For the application of the principle of totality & integrity, the following conditions must be met: (1) there must be a question of an intervention in the part of the body that is either affected or is the direct cause of the life-threatening situation; (2) there can be no other alternatives for preserving life; (3) there is a proportionate chance of success in comparison with drawbacks; & (4) the patient must give assent to the intervention”
NORMS OF CHRISTIAN HOPE (4) • Principle of Stewardship & Creativity While Genesis teaches that humans were given dominion over God's creation, we are to have the mentality of a creative steward. We are NOT free to thoughtlessly use worldly resources. 47
NORMS OF CHRISTIAN HOPE (4) • Principle of Inner Freedom Obsessions we experience are not simply crosses to bear passively. We have moral responsibility to seek treatment for an obsession. 48
NORMS OF CHRISTIAN HOPE (4) • Principle of Personalized Sexuality (aka, Family. Oriented Sexuality) Sexual acts have "unitive" & "procreative" dimensions. Reserved for marriage, they unite a couple. Each act is to be open to the transmission of new life. 49
NORMS OF CHRISTIAN HOPE (4) • Principle of Growth through Suffering For the Christian, pain is a sharing in Christ's own suffering and a uniting with Him in His redemptive sacrifice, offered in obedience to His father. This does NOT mean that all suffering/pain must be accepted, & that all efforts to alleviate suffering/pain should be foregone. 50
and www. youtube. com/watch? v=rr. HIS 9 gi 1 UQ 51
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SALVIFICI DOLORIS - ON THE CHRISTIAN MEANING OF HUMAN SUFFERING Encyclical letter of Pope John Paul II INTRODUCTION "'In my flesh I complete what is lacking in Christ's afflictions for the sake of his body, that is, the Church'. . "Now I rejoice in my sufferings for your sake". . the Redemption was accomplished through the Cross of Christ, that is, through his suffering. . . 53
The World of Human Suffering…. “Sacred Scripture is a great book about suffering. . above all moral suffering: danger of death. . . death of one's own children. . . especially. . . the firstborn & only son. . . the lack of offspring. . . nostalgia for the homeland. . . Persecution & hostility of the environment. . . mockery & scorn of the one who suffers. . . loneliness and abandonment. . . the remorse of conscience. . . difficulty of understanding why the wicked prosper & the just suffer. . . unfaithfulness and ingratitude. . . misfortunes of one's own nation. . . “the reality of suffering prompts the question about the essence of evil: what is evil? . . “The Christian response. . . is different. . . [from] traditions which hold that existence is an evil from which one needs to be liberated. Christianity proclaims the essential good of existence & the good of that which exists, acknowledges the goodness of the Creator & proclaims the good of creatures. “Man suffers on account of evil, which is a certain lack, limitation or distortion of 54 good. . .
The Quest for an Answer to the Question of the Meaning of Suffering "pain, especially physical pain, is widespread in the animal world. . But only the suffering human being knows that he is suffering & wonders why…. “whereas the existence of the world opens. . . the eyes of the human soul to the existence of God, to his wisdom, power & greatness, evil & suffering seem to obscure this…. “it is not true that all suffering is a consequence of a fault and has the nature of a punishment. The figure of the just man Job is a special proof of this. . “The Book of Job is not the last word on this subject in Revelation. In a certain way it is a foretelling of the 55 Passion of Christ. .
Jesus Christ Suffering Conquered by Love "For God so loved the world that he gave his only Son, that whoever believes in him should not perish but have eternal life". . the very essence of Christian soteriology, that is, of theology of salvation. . . When one says that Christ by his mission strikes at evil at its very roots, we have in mind not only evil & definitive, eschatological suffering. . . , but also - at least indirectly toil and suffering in their temporal and historical dimension. . Though it is not licit to apply here the narrow criterion of direct dependance (as Job's three friends did), it is equally true that one cannot reject the criterion that, at the basis of human suffering, there is a complex involvement with sin. . . As a result of Christ's salvific work, man exists on earth with the hope of eternal life and holiness. And even though the victory over sin and death achieved by Christ in his Cross and Resurrection does not abolish temporal suffering from human life, nor free from suffering the whole historical dimension of human existence, it nevertheless throws a new light upon this dimension and upon every suffering: the light of salvation. . . 56
Jesus Christ Suffering Conquered by Love In his messianic activity in the midst of Israel, Christ drew increasingly closer to the world of human suffering. "He went about doing good” (32), & his actions concerned primarily those who were suffering and seeking help. He healed the sick, consoled the afflicted, fed the hungry, freed people from deafness, from blindness, from leprosy, from the devil & from various physical disabilities, three times he restored the dead to life. . . at the heart of his teaching there are the eight beatitudes. . Christ severely reproves Peter when the latter wants to make him abandon the thoughts of suffering & of death on the Cross. . . The Scriptures had to be fulfilled. . . Among all these, particularly touching is the. . Fourth Song of the Suffering Servant, in the Book of Isaiah. . Christ suffers voluntarily and suffers innocently. With his suffering he accepts that question which - posed by people many times - has been expressed, in a certain sense, in a radical way by the Book of Job. 57
Jesus Christ Suffering Conquered by Love Christ, however, not only carries with himself the same question. . . , but he also carries the greatest possible answer. . And this is the final, definitive word of this teaching: "the word of the Cross", as Saint Paul one day will say. . the prayer in Gethsemane becomes a definitive point here. The words: "My Father, if it be possible, let this cup pass from me; nevertheless, not as I will, but as thou wilt", and later: "My Father, if this cannot pass unless I drink it, thy will be done". . But precisely through this suffering he accomplishes the Redemption, and can say as he breathes his last: "It is finished". . Human suffering has reached its culmination in the Passion of Christ. . . it has entered into a completely new dimension and a new order: it has been linked to love. . The Cross of Christ has become a source from which flow rivers of living water. . 58
Sharers in the Suffering of Christ “. . In the Cross of Christ not only is the Redemption accomplished through suffering, but also human suffering itself has been redeemed. . . each man, in his suffering, can also become a sharer in the redemptive suffering of Christ. . “In the eyes of the just God, before his judgment, those who share in the suffering of Christ become worthy of this Kingdom. . Those who share in the sufferings of Christ are also called, through their own sufferings, to share in glory. . “Suffering is also an invitation to manifest the moral greatness of man, his spiritual maturity. . . not only in the martyrs for the faith but in many others also who, at times, even without belief in Christ, suffer & give their lives for the truth and for a just cause. . The gospel paradox of weakness & strength often speaks to us. . In such a concept, to suffer means to become particularly susceptible, particularly open to the working of the salvific powers of God, offered to humanity in Christ. . . “'More than that, we rejoice in our sufferings, knowing that suffering produces endurance, & endurance produces character, & character produces hope, & hope does not disappoint us, because God's love has been poured into our hearts through the Holy Spirit which has been given to us' 59
Sharers in the Suffering of Christ “. . Suffering as it were contains a special call to the virtue. . . of perseverance. . a dignity linked to awareness of the meaning of life. And indeed this meaning makes itself known together with the working of God's love, which is the supreme gift of the Holy Spirit. “The more he shares in this love, man rediscovers himself more & more fully in suffering: he rediscovers the 'soul' which he thought he had 'lost'. . . because of suffering. . 'Now I rejoice in my sufferings for your sake, & in my flesh I complete what is lacking in Christ's afflictions for the sake of his body, that is, the Church‘…. “In this Body, Christ wishes to be united with every individual, and in a special way he is united with those who suffer. . . “The sufferings of Christ created the good of the world's redemption. This good in itself is inexhaustible &infinite. No man can add anything to it. But at the same time, in the mystery of the Church as his Body, Christ has in a sense opened his own redemptive suffering to all human suffering. In so far as man becomes a sharer in Christ's sufferings. . to that extent he in his own way completes the suffering through which Christ accomplished the Redemption of the world. 60
Sharers in the Suffering of Christ “Does this mean that the Redemption achieved by Christ is not complete? No. It only means that the Redemption, accomplished through satisfactory love, remains always open to all love expressed in human suffering. In this dimension - the dimension of love - the Redemption which has already been completely accomplished is, in a certain sense, constantly being accomplished. . “this Redemption, even though it was completely achieved by Christ's suffering, lives on and in its own special way develops in the history of man. It lives and develops as the body of Christ, the Church, and in this dimension every human suffering, by reason of the loving union with Christ, completes the suffering of Christ. It completes that suffering just as the Church completes the redemptive work of Christ. . 61
The Gospel of Suffering “The witnesses of the Cross & Resurrection of Christ have handed on to the Church & to mankind a specific Gospel of suffering. . . at the side of Christ, in the first and most exalted place, there is always his Mother through the exemplary testimony that she bears by her whole life to this particular Gospel of suffering. . . “Christ did not conceal from his listeners the need for suffering. . The way that leads to the Kingdom of heaven is 'hard & narrow', and Christ contrasts it to the 'wide and easy' way that 'leads to destruction'. . “The Master does not conceal the prospect of suffering from his disciples & followers…. he reveals it with all frankness, indicating…the supernatural assistance that will accompany them in the midst of persecutions & tribulations 'for his name's sake'. These persecutions & tribulations will also be, as it were, a particular proof of likeness to Christ and union with him. . 62
The Gospel of Suffering “This first chapter of the Gospel of suffering, which speaks of persecutions, namely of tribulations experienced because of Christ, contains in itself a special call to courage & fortitude, sustained by the eloquence of the Resurrection. . “Down through the centuries & generation it has been seen that in suffering there is concealed a particular power that draws a person interiorly close to Christ, a special grace. . “When this body is gravely ill, totally incapacitated, & the person is almost incapable of living and acting, all the more do interior maturity and spiritual greatness become evident, constituting a touching lesson to those who are healthy and normal. “This interior maturity & spiritual greatness in suffering are certainly the result of a particular conversion and cooperation with the grace of the Crucified Redeemer…. 63
The Gospel of Suffering “This is not all: the Divine Redeemer wishes to penetrate the soul of every sufferer through the heart of his holy Mother, the first and the most exalted of all the redeemed. . . so that every form of suffering, given fresh life by the power of this Cross, should become no longer the weakness of man but the power of God. . “in general it can be said that almost always the individual enters suffering with a typically human protest & with the question "why“. . he cannot help noticing that the one to whom he puts the question is himself suffering and wishes to answer him from the Cross, from the heart of his own suffering. Nevertheless, it often takes time, even a long time, for this answer to begin to be interiorly perceived. . . “Man hears Christ's saving answer as he himself gradually becomes a sharer in the sufferings of Christ. The answer which comes through this sharing…is in itself something more than the mere abstract answer to the question about the meaning of suffering. For it is above all a call. It is a vocation. . . 64
The Gospel of Suffering “Saint Paul speaks of such joy in the Letter to the Colossians: 'I rejoice in my sufferings for your sake'. . “It is suffering, more than anything else, which clears the way for the grace which transforms human souls. . “the Church sees in all Christ's suffering brothers & sisters…a multiple subject of his supernatural power. How often is it precisely to them that the pastors of the Church appeal, and precisely from them that they seek help and support! The Gospel of suffering is being written unceasingly, &it speaks unceasingly with the words of this strange paradox: the springs of divine power gush forth precisely in the midst of human weakness. . . 65
The Good Samaritan "The name 'Good Samaritan' fits every individual who is sensitive to the sufferings of others, who "is moved" by the misfortune of another. . “the Good Samaritan of Christ's parable does not stop at sympathy and compassion alone. They become for him an incentive to actions aimed at bringing help to the injured man. . “a Good Samaritan is one who brings help in suffering, whatever its nature may be. Help which is, as far as possible, effective. He puts his whole heart into it, nor does he spare material means. We can say that he gives himself, his very 'I', opening this 'I' to the other person. Here we touch upon one of the key-points of all Christian anthropology. Man cannot "fully find himself except through a sincere gift of himself". . A Good Samaritan is the person capable of exactly such a gift of self. . “suffering. . . is also present in order to unleash love in the human person, that unselfish gift of one's "I" on behalf of other people, especially those who suffer. “The world of human suffering unceasingly calls for, so to speak, another world: the world of human love; and in a certain sense man owes to suffering that unselfish love which stirs in his heart and actions. . . 66
The Good Samaritan "How much there is of "the Good Samaritan" in the profession of the doctor, or the nurse, or others similar! Considering its "evangelical" content, we are inclined to think here of a vocation rather than simply a profession…. ”The family, the school &other education institutions must, if only for humanitarian reasons, work perseveringly for the reawakening and refining of that sensitivity towards one's neighbour and his suffering of which the figure of the Good Samaritan in the Gospel has become a symbol. Obviously the Church must do the same. . “The eloquence of the parable of the Good Samaritan, and of the whole Gospel, is especially this: every individual must feel as if called personally to bear witness to love in suffering. . “Christ's revelation of the salvific meaning of suffering is in no way identified with an attitude of passivity. Completely the reverse is true. . . “this parable. . . will enter into those disturbing words of the Final Judgment, noted by Matthew in his Gospel. . Christ said: 'You did it to me'. He himself is the one who in each individual experiences love; he himself is the one who receives help, when this is given to every suffering person without exception. . At one & the same time Christ has taught man to do good by his suffering & to do good to those who suffer. In this double aspect he has completely revealed the meaning of 67 suffering.
Conclusion "This is the meaning of suffering, which is truly supernatural and at the same time human. “It is supernatural because it is rooted in the divine mystery of the Redemption of the world, and “it is likewise deeply human, because in it the person discovers himself, his own humanity, his own dignity, his own mission. 'Through Christ and in Christ, the riddles of sorrow and death grow meaningful' 68
The Vatican’s “Charter for Health Care Workers” Charter for Health Care Workers 69
Ministers of Life • Scientific & professional expertise is not enough; personal empathy with the concrete situations of each patient is required. Health care is a type of Christian witness. • The health care worker is a "good Samaritan. " • The health care worker is "a collaborator with God in restoring health to the sick body. • Health care is a therapeutic ministry, sharing the Church's pastoral & evangelizing work. • All health care workers should be taught morality and bioethics. The Charter supports establishment of ethical committees in principal medical centers. • Catholic or not, health care workers are absolutely obliged to be faithful to the natural moral law which recognizes human dignity. The Church provides specialized teaching, the bioethical magisterium, to provide guidance. • The Charter is organized around the stages of human existence: procreation, living, dying. • The Bible indicates that only humans are made in God's image and likeness. We are unique in the animal world. Human procreation itself is rich with religious meaning. Charter for Health Care Workers 70
Procreation Charter for Health Care Workers 71
Fertility Control • In conceiving & giving birth, spouses "cooperate" with God's work of creation! • There is an "indissoluble bond" between the "unitive" & "procreative" meanings of sexual acts in marriage (Yet, few American Catholics seem to accept this. ). • In terms of moral judgment, intentions and motives are insufficient. People are encouraged to delve into a deeper understanding of human persons & human acts. • For serious reasons, spouses may utilize NFP (Natural Family Planning) to gain knowledge of the woman's fertility & forego marital relations in fertile times. • Unlike with contraceptives, the use of NFP does not aim to close the marital act off to the possibility of procreation. Health care workers are encouraged provide information on natural family planning. The proabortion culture is especially strong, where this teaching on contraception has been rejected. Charter for Health Care Workers 72
Once upon a time, it went without saying that childbearing went with sexual relations and sexual relations went with marriage…. In the 20 th Century, it became popular Wilhelm to try to divorce Reich sexual pleasure from marriage and procreation. . Hugh Heffner . 73
The so-called Sexual Revolution & Some of Its Generals «Hugh Heffner «Margaret Sanger «Wilhelm Reich 74
Hugh Heffner Hugh Heffner, founded Playboy Magazine in 1953: “In the first issue, Playboy identified its philosophy as antimarriage…. “Playboy attacked women as gold-diggers who bartered sex for a marriage license…. “When the Pill gave women the freedom to join men in their sexual rebellion, cultural attitudes shifted radically. Junk sex was no better than junk food, but millions of men and women greedily devoured the empty calories…. “[Playboy] vulgarized what most men and women in their deepest sentiments hold dear …. It turned courtship away from the patient pleasures of a gourmet meal with many courses and replaced it with a cheesy burger”
On Sept 21, 1957, Mike Wallace (of “ 60 Minutes” fame) interviewed Margaret Sanger….
Wilhelm Reich “At the end of the Second World War, Wilhelm Reich introduced American readers to some of his earlier writings under the title The Sexual Revolution (1945) …. The truth, according to Reich, was that Western civilization had made people sick by imposing on them an unnatural, destructive sexual morality…. even if we assume that in actual fact our ancestors behaved very much as we do, one very important difference remains: When they violated traditional sexual standards, they usually suffered from guilt…. we now decide for ourselves what sexual activity is proper…. there is nothing eternal or sacred about our sexual morality” (Haeberle, The Sex Atlas, New York: Continuum, 1983). 77
Incredible changes in a 1/2 century… In 1957, Time Magazine seemed to gush with the excitement of a junior high student: “Some of the most hush-hush medical research has been pursued in dozens of laboratories in the effort to find a contraceptive pill”
Incredible changes in a 1/2 century… • There are now 56 times more new STD infections each year, than there were overall STD infections in 1957: As per the Centers for Disease Control, 340, 687 cases of STDs were reported by state health departments in 1957
Incredible changes in a 1/2 century… • In the past half century, the rate of forcible rape of women has tripled: In 1960, there were 17, 190 forcible rapes of women (9. 6 per 100, 000 people)
Incredible changes in a 1/2 century… • Over the past half century, Americans have become less likely to marry. Of those fewer who do marry, they are more likely to divorce: In 1957, there was a marriage rate of 8. 9 per 1000 people
Pornography "Son, you shouldn't watch that other channel. It's only for mommies & daddies who love each other very much“ (Homer J. Simpson) “U. S. porn revenue exceeds the combined revenues of ABC, CBS, and NBC (6. 2 billion). Porn revenue is larger than all combined revenues of all professional football, baseball and basketball franchises. The pornography industry, according to conservative estimates, brings in $57 billion per year, of which the United States is responsible for $12 billion. ” § “The Internet accounted for US $2. 5 billion of § the adult industry’s revenues. ” § “Cable pay per view amounted to $2. 5 billion. ” § “Magazines accounted for $7. 5 billion. ” As reported in Bishop Robert Finn’s February 2007 pastoral letter, “Blessed Are The Pure In 82 Heart”
Pornography "Son, you shouldn't watch that other channel. It's only for mommies & daddies who love each other very much“ (Homer J. Simpson) • “ • There are 100 thousand websites offering illegal child pornography (U. S. Customs Service estimate). ” • “Child Pornography generates $3 billion annually. ” As reported in Bishop Robert Finn’s February 2007 pastoral letter, “Blessed Are The Pure In 83 Heart”
Pornography "Son, you shouldn't watch that other channel. It's only for mommies & daddies who love each other very much“ (Homer J. Simpson) • “ 70% of 18 to 24 year old men visit pornographic sites in a typical month. 66% of men in their 20 s and 30 s also report being regular users of pornography. ” • “One out of three visitors to all adult web sites are women. ” • “Eleven years old is the average of first Internet exposure to pornography. ” As reported in Bishop Robert Finn’s February 2007 pastoral letter, “Blessed Are The Pure In 84 Heart”
Somehow, the Idea that Pornography is “Victimless” Seems to Remain Popular…. “Annually, according to U. S. Governmentsponsored research completed in 2006, approximately 800, 000 people are trafficked across national borders, which does not include millions trafficked within their own countries. Approximately 80 percent of transnational victims are women and girls and up to 50 percent are minors. The majority of transnational victims are females trafficked into commercial sexual exploitation. ” from the U. S. State Department’s “Trafficking in Persons Report 2007” 85
Has there been a benefit to marriage itself from the “Sexual Revolution”’s divorce of sexual pleasure from marriage and procreation? Was Wilhelm Reich correct, in that people had been made sick by the imposition of such an unnatural sexual morality? 86
What is Marriage? (Harvard Journal of Law & Public Policy) 87
What is Marriage? (Harvard Journal of Law & Public Policy) 88
“The State of Our Unions 2010” • The University of Virgina’s National Marriage Project & the Center for Marriage and Families at the Institute for American Values •
“The State of Our Unions 2010” The University of Virgina’s National Marriage Project & the Center for Marriage and Families at the Institute for American Values
“The State of Our Unions 2010” The University of Virgina’s National Marriage Project & the Center for Marriage and Families at the Institute for American Values
“The State of Our Unions 2010” • The University of Virgina’s National Marriage Project & the Center for Marriage and Families at the Institute for American Values •
“The State of Our Unions 2010” • • • The University of Virgina’s National Marriage Project & the Center for Marriage and Families at the Institute for American Values
“The State of Our Unions 2010” • The University of Virgina’s National Marriage Project & the Center for Marriage and Families at the Institute for American Values •
“The State of Our Unions 2010” The University of Virgina’s National Marriage Project & the Center for Marriage and Families at the Institute for American Values
“The State of Our Unions 2010” • The University of Virgina’s National Marriage Project & the Center for Marriage and Families at the Institute for American Values •
Review Except for the marrying at 25+ part, isn’t this what your great grandparents would have told – or expected from - your grandparents? • Be prepared & ready to properly support your family! • Check that your intended has a good example of solid marriage from her/his own family! • Honor God always! • Sexual intimacy is only for marriage! 97
• Couples who reject contraceptives and adhere to methods of "Natural Family Planning" enjoy phenomenal success. In an era of an almost 50% divorce rate, estimates are that only 0 - 4% of couples using NFP end up divorced
In 2002, Mercedes Arzú Wilson presented fascinating sociological evidence, concerning women who utilize NFP. She found them to have… “lower rates of…divorce (0. 2%)…. “a high level of success in family life…, as well as strong religious faith. (“LINKAGE OF ARTIFICIAL BIRTH CONTROL TO SEXUAL PROMISCUITY, ABORTION & DIVORCE”,
100
Genetic Manipulation • Genetic therapy is not outright condemned. Certain genetic therapies truly aim to cure illness, while respecting human dignity. Genetic manipulations that do not aim to directly cure illness are illicit. • Moral evaluations must be enlightened by proper perspective on the dignity of the beginning of human life. • Sexual acts are reserved for marriage & each sexual act must be open to human life. Each new human being has the absolute right to life, to this type of origin, and to be born into a family with a mother and a father. Charter for Health Care Workers 101
On 12/12/08, the Vatican released an instruction, focused on human life at its origins – “Dignitas Personae. ” 102
Dignitas Personae further discusses gene therapy… • "25. . In theory, it is possible to use gene therapy on two levels: somatic cell gene therapy and germ line cell therapy. • Somatic cell gene therapy seeks to eliminate or reduce genetic defects on the level of somatic cells, that is, cells other than the reproductive cells, but which make up the tissue and organs of the body. It involves procedures aimed at certain individual cells with effects that are limited to a single person. • Germ line cell therapy aims instead at correcting genetic defects present in germ line cells with the purpose of transmitting therapeutic effects to the offspring of the individual. Such methods of gene therapy, whether somatic or germ line cell therapy, can be undertaken on a fetus before his or her birth as gene therapy in the uterus or after birth on a child or adult. ” 103
Dignitas Personae further discusses gene therapy… • "26. . Procedures used on somatic cells for strictly therapeutic purposes are in principle morally licit. . • "Because the risks connected to any genetic manipulation are considerable and as yet not fully controllable, in the present state of research, it is not morally permissible to act in a way that may cause possible harm to the resulting progeny. In the hypothesis of gene therapy on the embryo, it needs to be added that this only takes place in the context of in vitro fertilization and thus runs up against all the ethical objections to such procedures. For these reasons, therefore, it must be stated that, in its current state, germ line cell therapy in all its forms is morally illicit. 104
Dignitas Personae further discusses gene therapy… • "27. The question of using genetic engineering for purposes other than medical treatment also calls for consideration. . the prospect of such an intervention would end sooner or later by harming the common good, by favouring the will of some over the freedom of others. Finally it must also be noted that in the attempt to create a new type of human being one can recognize an ideological element in which man tries to take the place of his Creator. . "the Church also recalls the need to return to an attitude of care for people and of education in accepting human life in its concrete historical finite nature. " 105
Artificial Procreation • "Nature itself dictates that the transmission of human life be a personal & conscious act and, as such, subject to the most holy laws of God: immutable & inviolable laws which must be acknowledged & observed. " "The dignity of the human person demands that it come into being as a gift of God & as the fruit of the conjugal act. " • While there may be "sincere and intense" desire for children, this "does not legitimize recourse to techniques which are contrary to the truth of human procreation & to the dignity of the new human being. . . the child has the right to be conceived only with full respect for its personhood. " • While some artificial means can be used to aid the marital act, those which replace the marital act must be rejected. Any artificial means to help unmarried people achieve pregnancy are unacceptable. • “Homologous artificial insemination" is not necessarily forbidden. The aim must be to aid the marital act or help it reach its proper end. The husband's semen must be obtained through a normal act of sexual intercourse. • In homologous FIVET (Fertilization in vitro with embryo transfer), fertilization takes place outside the wife's body. FIVET "is illicit because conception is not the result of a conjugal act. . the child is not born as a 'gift' of love, but as a laboratory 'product. '" • There are further aggravating factors with FIVET: • "numerous embryonal losses, which are procured abortions. . [& • possible] congealment, which means suspension of life, of the so-called 'spare' embryos, & often even their destruction. • Unacceptable is 'post mortem' insemination" Charter for Health Care Workers 106
Artificial Procreation (continued) • "Heterologous techniques" involve conception outside of marriage. Recourse to gametes of people other than the spouses is contrary to the unity of marriage & the fidelity of the spouses, & it harms the right of the child to be conceived & born in & from a marriage. . • "A further reason for unlawfulness is the commercialization & eugenic selection of the gametes. " • "Surrogate" motherhood is "contrary to the dignity of the woman, to the unity of marriage & to the dignity of the procreation of a human" • A child who has been conceived by illicit means is still made in God's image & likeness. • Down the road, we may see illicit efforts, such as • • "fertilization between human & animal gametes. . . gestation of human embryos in animal or artificial wombs. . . sexless reproduction of human beings through twinning fission, cloning, parthenogenesis. " "Medicine directed to the integral good of the person cannot prescind from the ethical principles governing human procreation" Charter for Health Care Workers 107
Life Charter for Health Care Workers 108
Beginning of Life & Birth • There is new life at the moment that the ovum is fertilized, even before implantation. With respect to prenatal life, "health care workers owe it the same respect, the same protection and the same care as that given to a human person. " • "If, despite every effort, the life of the child is at serious risk, health care workers should see to the child's baptism. . If an ordinary minister of the sacrament is unavailable - a priest or a deacon - the health care worker has the faculty to confer it. " Charter for Health Care Workers 109
The Vatican’s 10/31/000 “STATEMENT ON THE SOCALLED "MORNINGAFTER PILL" 110
The Vatican’s 10/31/000 “STATEMENT ON THE SO-CALLED ’MORNINGAFTER PILL’" • “a predominantly ‘anti-implantation’ function” • “it can never be legitimate to decide arbitrarily that the human individual has greater or lesser value…according to its stage of development…. • “the proven ‘anti-implantation’ action of the morning-after pill is really nothing other than a chemically induced abortion…. • “All who, whether sharing the intention or not, directly co-operate with this procedure also morally responsible for it. • “we strongly urge everyone who works in this sector to make a firm objection of moral conscience, which will bear courageous and practical witness to the inalienable value of human life, especially in view of the new hidden forms of aggression against the weakest and most defenceless individuals, as is the case with a human embryo. ” 111
Pope Benedict XVI’s 10/29/07 address to the International Congress of Catholic Pharmacists 112
Pope Benedict XVI’s 10/29/07 address to the International Congress of Catholic Pharmacists • “it is not possible to anaesthetize consciences, for example, concerning the effects of particles whose purpose is to prevent an embryo's implantation or to shorten a person's life. ” • “In the moral domain, your Federation is invited to address the issue of conscientious objection, which is a right your profession must recognize, permitting you not to collaborate either directly or indirectly by supplying products for the purpose of decisions that are clearly immoral such as, for example, abortion or euthanasia. ” • “it is important that all Catholic health-care professionals and people of good will join forces…. • “The biomedical sciences are at the service of the human being; if this were not the case, they would have a cold and inhuman character. All scientific knowledge in the health sector and every therapeutic procedure is at the service of the sick person, viewed in his integral being, who must be an active partner in his treatment and whose autonomy must be respected. ” 113
As mentioned, it was on 12/12/08 that the Vatican released an instruction, focused on human life at its origins – Dignitas Personae. 114
Dignitas Personae proclaims… • human dignity from the first moment of fertilization until natural death & • the right of everyone to originate in the loving embrace of a mom and dad, who are wife and husband. • each human being is owed uncompromising respect, no matter how she came to be • we must stand with the weak and powerless against exploitation. 115
Dignitas Personae. • Recent years have seen a vast increase in reports of infertility and interest in reproductive technology. • When employed by a husband wife, Dignitas Personae says assistance to AID the “marital act” toward procreation can be moral. • However, even when used by a husband wife, Dignitas Personae says that methods REPLACING the marital act - such as IVF - are immoral. • Exacerbating IVF’s immorality is the discarding or freezing of “extra”, unwanted embryos. • Dignitas Personae forbids using these new humans as research material or implanting one in the womb of a woman other than her mom. 116
Also recognized as immoral by Dignitas Personae are… • human cloning, • the mixing of human with animal genetic material (Yup, some “scientists” are doing that!), • germ line cell therapy, • “genetic engineering for purposes other than medical treatment” (# 27), • research using illicitly obtained cell lines. 117
Dignitas Personae is NOT to be dismissed as a laundry list of prohibitions. • “Behind every ‘no’ in the difficult task of discerning between good and evil, there shines a great ‘yes’ to the recognition of the dignity and inalienable value of every single and unique human being called into existence [# 37]. 118
My own examples of “a great ‘yes’ to the recognition of the dignity and inalienable value of every single and unique human being”: • Na. Pro. Technology
My own examples of “a great ‘yes’ to the recognition of the dignity and inalienable value of every single and unique human being”: • Another “great yes” is that stem cells can be obtained in manners, which are not morally objectionable! Obtaining stem cells from embryos results in the death of the embryo. Despite the research “science” presented to us by celebrities, this is NEITHER the only way NOR the most promising way to obtain stem cells. Stem cells can be morally obtained from adults and umbilical cord blood. 120
Dignitas Personae, Section 23 • This appears to require change at Catholic hospitals, regarding treatment of women identified as victims of sexual assault. • After trying to rule out pregnancy (&/or ovulation), so-called "emergency contraception" (aka, "morning after pills") HAS been allowed (Note: Some say it’s IMPOSSIBLE to ensure "emergency contraception" is NOT abortifacient. In fact, the FDA says that "If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation)“
Treatment of an Ectopic Pregnancy • Citing the principle of “double effect, ” Catholic health care has allowed the removal of a fallopian tube to save a mother’s life, in the case of an ectopic pregnancy. This unintentionally results in the death of the preborn child. • In the July/August 1998 issue of Health Progress (i. e. , the official journal of the Catholic Health Association of the United States), Father Kevin O’Rourke seemed to indicate that a Salpingostomy (i. e. , removal of the child from the fallopian tube) and use of the chemical Methotrexate might also be acceptable
Treatment of an Ectopic Pregnancy • Writing in the February 1999 Linacre Quarterly (i. e. , the official journal of the Catholic Medical Association), Dr. John E. Foran bemoans “toleration of salpinotomy(ostomy) & pharmacologic (methotrexate) treatment of ectopic pregnancy in Catholic health facilities…. since the immediate effect of methotrexate and saplingotomy(ostomy) is the death of the fetus, the principle of double effect is not applicable because the act is evil. In The Management of Ectopic Pregnancies: A Moral Analysis, William E. May points out that ‘it is morally imperative today to make every effort possible to discover and transplant into the uterus those unborn babies who have, unfortunately, implanted in the fallopian tube or other ectopic site’…. no matter how good the intention, salpingotomy/ ostomy and the use of methotrexate or similar pharmacologic agents result in the death of the infant as a direct effect of the action and culminates in the good effect. The death is the means chosen to the end. To willfully choose to terminate innocent human life, no matter how good the intent, is anywhere and everywhere morally wrong”
Treatment of an Ectopic Pregnancy • In the July 1999 Homiletic & Pastoral Review, Msgr. William Smith explains that “All Catholic authors agree that salpingectomy is a licit application of the principle of double effect. That is, full salpingectomy—the entire fallopian tube (together with the ectopic pregnancy) is surgically removed; or, partial salpingectomy—only the damaged segment of the tube enveloping the ectopic pregnancy is removed, and then the severed ends of the tube are brought together and sutured…. [By contrast] salpingostomy and this administration of MTX are direct abortions …. Since the procedures are not necessary to protect the mother’s life (salpingectomy can preserve that) but allegedly to preserve future fertility, I would judge that the final condition of double effect, proportion, is also not verified here and thus is not a legitimate application of double effect and is a direct abortion”
Treatment of an Ectopic Pregnancy • As per # 48 of the 2001 Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition, “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion”
The Value of Life: Unity of Body & Soul • The Bible indicates that humans are made in God's own image & likeness. We are unique in the animal world. "Human life is irreducibly both corporeal & spiritual. " It is our souls & bodies which God wants in Heaven. • At a time when medical science is moving towards greater specialization, we cannot isolate particular treatments from care "to the person of the patient in all his dimensions. " Charter for Health Care Workers 126
Indisposability & Inviolability of Life • "The body cannot be. . dealt with as a thing or an object of which one is the owner & arbiter. Every abusive intervention on the body is an insult to the dignity of the person & thus to God who is its only and absolute Lord" • Life belongs to God & not the human being, giving life a "sacred character. " Right reason can recognize this sacredness, even without religious faith. • Just because an action is technically possible, it need not be "morally admissible. " 127 Charter for Health Care Workers
Right to Life • From conception to natural death, whether healthy or sick, able bodied or disabled, rich or poor, every human being has the right to life - "the right to live with human dignity. " • Neither the health care worker nor the patient himself has the right to power over the life which is receiving care. No person has the right to "arbitrarily choose whether to live or die. " That decision is for God, alone. • The employment rights claims of health workers - just though they may be - must be subordinated to the care of the patient. Charter for Health Care Workers 128
Prevention • Health care workers can play a role in society's addressing special problems of groups, such as adolescents, people with disabilities, older people, etc. , as well as with health risks tied to modern living. • Prevention involves rediscovering & applying forgotten values. Charter for Health Care Workers 129
Sickness • "Sickness and suffering are not experiences which affect only the physical substance of the human being, but they affect him in his entirety and in his somatic-spiritual unity. " • The Charter presents counter-cultural notions about suffering: • "The Christian knows by faith that sickness and suffering share in the salvific efficacy of the Redeemer's cross. . the sick person can say with the Apostle: 'I fill up in my body what is wanting to the sufferings of Christ, for the sake of his body which is the Church' (Col 1: 24). From this new Christian meaning, the sick person can be helped to develop a triple salutary attitude to the illness: an'
Diagnosis • "the health care worker should seek, first & foremost, to find the illness & analyze it in the patient: this is the
Prenatal Diagnosis • Prenatal diagnosis is licit, when its aim is to benefit the baby and the baby's mother - "if the methods used, with the consent of the parents who have been adequately instructed, safeguard the life & integrity of the embryo & its mother & does not subject them to disproportionate risks. " • Prenatal diagnosis is absolutely illicit, when it is carried out with the possibility of opting for abortion. Charter for Health Care Workers 132
Therapy & Rehabilitation • "Therapy is a medical action" & "Rehabilitation. . . an amalgam of medical, physiotherapeutic, psychological measures & functional exercises. " • A patient has a right to any treatment from which he can receive curative or salutary benefit. • All "proportionate" treatments must be applied, while it is acceptable to forego "disproportionate" treatments. • A principle of "appropriate medical treatment in the remedies": As a last resort & with the patient's consent, it is acceptable to use methods from advanced medicine that are still experimental stage and not without some risk. It can be acceptable to interrupt the use of such experimental, risky methods when the results are disappointing & these methods show themselves to be disproportionate. • It is not suicidal for a patient to forego disproportionate treatment. • "Therapeutic manipulation of the organism, " involving "modification, mutilation or removal of organs" is justified by the "principle of totality" or the "principle of therapeuticity. " • While physical or "corporeal" life is a fundamental good, "there are higher values for which it could be legitimate or even necessary to expose oneself to the danger of losing it. " Charter for Health Care Workers 133
Analgesia & Anasthesia • Pain has a therapeutic function: "it eases the confluence of the physical and psychic reaction of the person to a bout of illness, " &. . . it appeals to medicine for an alleviating and healing therapy. • While not calling it by this name, the Charter discusses the "Theology of Suffering": For the Christian, pain is a sharing in Christ's own suffering & a uniting with Christ in His redemptive sacrifice, offered in obedience to His father. Some Christians may opt to forego some painkiller medication, trying to consciously associate with Christ's sufferings. This does not mean that all suffering/pain must be accepted & that efforts to alleviate suffering/pain should be foregone. • "beyond certain limits of endurance it is. . . a duty for the health care worker to prevent, alleviate and eliminate pain. " • "analgesic & anaesthesic techniques & medicines" can sometimes suppress or diminish "consciousness & the use of the higher faculties. " Where "loss of consciousness & freedom" is merely an unintended side effect of efforts "at dulling sensitivity to pain, & are limited to the clinical need alone, " they can "be considered ethically legitimate. " Charter for Health Care Workers 134
The Informed Consent of the Patient • The "express or tacit consent of the patient" is a necessity for medical intervention. A patient should receive "a precise idea of his illness & therapeutic possibilities, with the risks, the problems & the consequences that they entail. " • Consent cannot be presumed for a "patient who is in a condition to know. “ For a patient who is not "in a condition to know, " "the health care worker can, & in extreme situations must, presume the consent to therapeutic interventions, which from his knowledge & in conscience he thinks should be made. • "If there is a temporary loss of knowing and willing, the health care worker can act in virtue of
Research & Experimentation • Human dignity restricts biomedical sciences from the same investigative freedom which they have with mere things. "Any research contrary to the true good of the person is immoral. " • When a patient is unable to expressly provide it, consent can be presumed for truly therapeutic experimentation. While experimental danger & risk cannot be completely avoided, consent cannot be presumed - or even explicitly given - for certain procedures. A patient is forbidden "to endanger his life, his equilibrium. his health, or to aggravate his illness. “ • It can be proper to first test new pharmaceutical products/ techniques on animals. • A sick person's condition & the foreseeable effects of experimental treatment must be compared, to assess whether a treatment is proportionate: In desperate cases, when the patient will die if there is no intervention, if there is a medication available, or a method or an operation which, though not excluding all danger, still has some possibility of success, any right-thinking person would concede that the doctor could certainly, with the explicit or tacit consent of the patient, proceed with the application of the treatment. " • There are circumstances, for humanitarian reasons, under which a healthy person could legitimately volunteer for an experiment, when his "own substantial integrity is safeguarded" & the experiment would be interrupted upon disappointing results. 136 Charter for Health Care Workers
Research & Experimentation (continued) • "Research on human embryos & fetuses can only be allowed only when "there is moral certainty that there will be no harm either to the life or the integrity of the expected child & the mother, & on condition that the parents have given their consent. " (NOTE: Embryonic Stem Cell Research (ESCR) is more explicitly condemned in the later Dignitas Personae. ESCR necessitates destruction of the embryo. ) • Experimentation is only licit "for clearly therapeutic purposes, when no other possible remedy is available. “ Otherwise, this "is a crime against their dignity as human beings"; parents cannot consent to such. To keep "human embryos alive, actually or in vitro, for experimental or commercial reasons, ' is especially & 'altogether contrary to human dignity. '" Charter for Health Care Workers 137
Donation & Transplanting of Organs While donation & transplant of organs can be an incredible "service to life, " there are concerns. Charter for Health Care Workers 138
Donation & Transplanting of Organs (continued) • In "Autoplastic transplants, " the donor of the explant & the recipient of the implant are the same person. The "principle of totality" can justify disposing "a part for the integral good of the organism. " Removal of organs should "not constitute a serious & irreparable impairment for the donor. " Charter for Health Care Workers 139
Donation & Transplanting of Organs (continued) In "Homoplastic transplants, " the donor of the explant & the recipient of the implant are of the same species both human beings. The donor may not be still alive. These can be justified by the principle of solidarity and by charity. Where there is removal of an organ from a corpse, there must be certainty the corpse really is a corpse! There must be safeguards that "the removal of organs does not cause or even hasten death. “ As per the Charter (1995), "When total cerebral death is verified with certainty. . . it is licit to remove organs & also to surrogate organic functions artificially in order to keep the organs alive with a view to a transplant“ [Note: In William May's more recent (i. e. , 2000) "Catholic Bioethics & the Gift of Human Life, " he discusses D. Allan Shewmon's challenge Care Workers 140 Charter for Health to brain death criteria. ]. ”
What Pope John Paul II said about “brain death criteria” in his 8/29/00 address to the International Congress on Transplants. . . • "With regard to the parameters used today for ascertaining death -- whether the 'encephalic' signs or the more traditional cardio-respiratory signs -- the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity. . • "the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict. . • "Only where such certainty exists, & where informed consent has already been given by the donor or the donor's legitimate representatives, is it morally right to initiate the technical procedures. . . for the removal of organs for transplant". 141
Is John Paul II’s 8/29/00 Guidance Implemented? A large number of physicians & others - including Fr. David Albert Jones of the Linacre Centre for Healthcare Ethics & Bishops Fabian Bruskewitz & Robert F. Vasa - comment on the Pope's address in a 2000 Statement Opposing Brain Death Criteria ("'Brain Death' - Enemy of Life and Truth“;
Non-Heart Beating Donation (NHBD) (As per George Isajiw, MD’s & Nancy Guilfoy Valko, RN’s March 2004 address at the Vatican: 'Non-heart beating organ donation' & the 'vegetative state'
Non-Heart Beating Donation (NHBD) (As per George Isajiw, MD’s and Nancy Guilfoy Valko, RN’s March 2004 address at the Vatican: 'Non-heart beating organ donation' & the 'vegetative state'
What Pope John Paul II said about “brain death criteria” in his 2/2/05 message to the Pontifical Academy of Sciences. . . • • "you have chosen to explore once again, in a serious interdisciplinary study, the particular question of the 'signs of death, ' on the basis of which a person's clinical death can be established with moral certainty, in order to proceed with the removal of organs for transplant. . "the moment of death for each person consists in the definitive loss of the constitutive unity of body and spirit. Each human being, in fact, is alive precisely insofar as he or she is 'corpore et anima unus' ('Gaudium et Spes, ' 14), and he or she remains so for as long as this substantial unity-in-totality subsists. In the light of this anthropological truth, it is clear, as I have already had occasion to observe, that 'the death of the person, understood in this primary sense, is an event which no scientific technique or empirical method can identify directly' (Address of 29 August 2000, 4, in: AAS 92 [2000], 824). "From the clinical point of view, however, the only correct way -- and also the only possible way -- to address the problem of ascertaining the death of a human being is by devoting attention and research to the individuation of adequate 'signs of death, ' known through their physical manifestation in the individual subject. . "I wish to assure you that your efforts are laudable and will certainly be of assistance to the competent Dicasteries of the Apostolic See -- especially the Congregation for the Doctrine of the Faith -- which will not fail to ponder the results of your reflection, and then to offer the necessary clarifications for the good of the community, in particular that of the patients and the specialists who are called to dedicate their professional expertise to the service of life. " 145
“‘Brain Death’ is Not Death!” (Subsequent to the Pontifical Academy of Sciences’ 2/05 meeting, a statement was released by Paul A. Byrne, Cicero G. Coimbra, Robert Spaemann, and Mercedes Arzú Wilson: ) • “In 1968 the ‘Harvard criteria’ for determining brain death were published in the Journal of the American Medical Association…. without substantiating data, either from scientific research or from case studies of individual patients. For this reason, a majority of the presenters at the conference in Rome stated that the ‘Harvard criteria’ were scientifically invalid. • "In 2002 the results of a worldwide survey were published in Neurology, concluding that the use of the term ‘brain death’ worldwide is ‘an accepted fact but there was no global consensus on the diagnostic criteria’ and there are still ‘unresolved issues worldwide’…. • “Many physicians, who feel that the Hippocratic Oath is being violated by acceptance of such disparate sets of criteria, feel the need to expose the fallacy of ‘brain death, ’ because the noble reputation of the medical profession is at stake…. 146
“‘Brain Death’ is Not Death!” (Subsequent to the Pontifical Academy of Sciences’ 2/05 meeting, a statement was released by Paul A. Byrne, Cicero G. Coimbra, Robert Spaemann, and Mercedes Arzú Wilson: ) "Conclusions reached after examination of Brain-Related Criteria for death, at the Pontifical Academy of Sciences meeting 1. On the one hand the Church recognizes, consistent with her tradition, that the sanctity of all human life from conception to natural end must absolutely be respected and upheld. On the other hand, a secular society tends to place greater emphasis on the quality of living. 2. The Catholic Church has always opposed the destruction of human life before being born through abortion and she equally condemns the premature ending of the life of an innocent donor in order to extend the life of another through unpaired vital organ transplantation. . 3. 'Nor can we remain silent in the face of other more furtive, but no less serious and real forms of euthanasia. These could occur for example when, in order to increase the availability of organs for transplants, organs are removed without respecting objective and adequate criteria which verify the death of the donor. ' 147
“‘Brain Death’ is Not Death!” (Subsequent to the Pontifical Academy of Sciences’ 2/05 meeting, a statement was released by Paul A. Byrne, Cicero G. Coimbra, Robert Spaemann, and Mercedes Arzú Wilson: ) 4. 5. 6. ‘The death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self. It results from the separation of the life-principle (or soul) from the corporal reality of the person. ' Pope Pius XII declared this same truth when he stated that human life continues when its vital functions manifest themselves even with the help of artificial processes. ‘Acknowledgement of the unique dignity of the human person has a further underlying consequence: vital organs which occur singly in the body can be removed only after death--that is, from the body of someone who is certainly dead. . Many in the medical and scientific community maintain that brain-related criteria for death are sufficient to generate moral certitude of death itself. Ongoing medical and scientific evidence contradicts this assumption. Neurological criteria alone are not sufficient to generate moral certitude of death itself, and are absolutely incapable of generating physical certainty that death has occurred. 148
“‘Brain Death’ is Not Death!” (Subsequent to the Pontifical Academy of Sciences’ 2/05 meeting, a statement was released by Paul A. Byrne, Cicero G. Coimbra, Robert Spaemann, and Mercedes Arzú Wilson: ) 7. 8. 9. It is now patently evident that there is no single so-called neurological criterion commonly held by the international scientific community to determine certain death. Rather, many different sets of neurological criteria are used without global consensus. Neurological criteria are not sufficient for declaration of death when an intact cardio-respiratory system is functioning. These neurological criteria test for the absence of some specific brain reflexes. Functions of the brain not considered are temperature control, blood pressure, cardiac rate and salt and water balance. When a patient on a ventilation machine is declared 'brain dead, ' these functions not only are present but also are frequently active. The apnea test--the removal of respiratory support--is mandated as a part of the neurological diagnosis and it is paradoxically applied to ensure irreversibility. This significantly impairs outcome, or even causes death, in patients with severe brain injury. 149
“‘Brain Death’ is Not Death!” (Subsequent to the Pontifical Academy of Sciences’ 2/05 meeting, a statement was released by Paul A. Byrne, Cicero G. Coimbra, Robert Spaemann, and Mercedes Arzú Wilson: ) 10. 11. 12. 13. There is overwhelming medical and scientific evidence that the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem) is not proof of death. The complete cessation of brain activity cannot be adequately assessed. Irreversibility is a prognosis, not a medically observable fact. We now successfully treat many patients who in the recent past were considered hopeless. A diagnosis of death by neurological criteria alone is theory, not scientific fact. It is not sufficient to overcome the presumption of life. No law whatsoever ought to attempt to make licit an act that is intrinsically evil. . The termination of one innocent life in pursuit of saving another, as in the case of the transplantation of unpaired vital organs, does not mitigate the evil of taking an innocent human life. Evil may not be done that good might come of it"
February 2006 Comments from John Shea, MD • “It is not ethical to harvest organs from living persons if it will result in their deaths. That is true even if we don't know for sure that the person is living or dead, as in the case of some people in coma & on life support…. The typical scenario for such organ harvesting is a young person between the age of 5 -55 who is in good health, is in intensive care due to an automobile accident & is on a ventilator. The doctor makes an arbitrary decision that treatment is futile. They take the patient off the ventilator and if the heart stops beating they sometimes wait a couple of minutes & then remove the organs. They do not know how long a heart will stop beating & might recover again…. we have no agreement on determination of death soon enough to harvest the heart before its deterioration”
September 2006 Catholic News Service report • “"The Vatican academy invited some 20 neurology experts from all over the world to take part in a Sept. 11 -12 working group on "The Signs of Death" to go over the latest evidence"
Donation & Transplanting of Organs (continued) The brain and gonads can never be legitimately transplanted, as these organs "ensure the personal & procreative identity. " Charter for Health Care Workers 153
Donation & Transplanting of Organs (continued) • "Heterogeneous transplants" involve an explant from another species or the implant of an artificial organ. The "transplant of animal sexual glands to humans must be rejected as immoral; but the transplant of the cornea of a non-human organism to a human organism would not create any problem if it were biologically possible & advisable. " • The lawfulness of the implant of artificial organs "is conditioned by the beneficial effect for the person and respect for his dignity. " Charter for Health Care Workers 154
Donation & Transplanting of Organs (continued) The Charter encourages people to donate parts of their body, after death. In transplanting (even blood transfusions), the health care worker mediates "the gift of self by a person - even after death - so that another might live. " Charter for Health Care Workers 155
Dependency The Charter notes a rise in dependency which it attributes to "the crisis of values & meaning, " as well as stress, frustration, activism, high competitiveness & social anonymity. Charter for Health Care Workers 156
Drugs • Many deaths from drug overdose are "voluntary suicides. “ "The way to recovery cannot be that of ethical culpability or repressive law, but it must be by way of rehabilitation which, without condoning the possible fault of the person on drugs, promotes liberation from his condition & reintegration. “ In detoxification, there should be an attempt to help the person discover or rediscover his dignity and personal resources. • A person does not have a right to do as he pleases with his body. Charter for Health Care Workers 157
Alcoholism While "alcohol is not in itself illicit, " its abuse is "reprehensible. “ A "program of integrally human rehabilitation" is needed with Medical assistance , human assistance, and psychotherapy. Charter for Health Care Workers 158
Smoking Similar to alcohol, it is the abuse of tobacco which is problematic. "Smoking poses the problem of dissuasion and prevention, which should be done especially through health education and information, even by way of advertisements. " Charter for Health Care Workers 159
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“The Catholic Contribution to the 12 -Step Movement” “A Catholic non-alcoholic who profoundly influenced AA in its early days was Fr. Edward Dowling of the Society of Jesus …. he was favorably impressed and saw parallels between the 12 steps and aspects of Ignatian spirituality-perhaps especially the Ignatian admonition to pray as if everything depends on God and to work as if everything depends on oneself…. 161
“The Catholic Contribution to the 12 -Step Movement” “Having surrendered to God & received back his sobriety, Wilson [Bill W. ]could not retract his surrender by demanding an accounting from God when life did not unfold according to preconceived expectations. Even the sense of dissatisfaction could be an occasion of spiritual growth…. “Wilson was deeply attracted to the Catholic Church and even received instruction from Fulton Sheen in 1947…. 162
“The Catholic Contribution to the 12 -Step Movement” “Another important, though somewhat later, Catholic influence on AA was Fr. John C. Ford, S. J. , one of Catholicism's most eminent moral theologians. In the early forties, Ford himself recovered from alcoholism with AA's help. He became one of the earliest Catholic proponents of addressing alcoholism as a problem having spiritual, physiological, and psychological, dimensions. “Ford said that alcohol addiction is a pathology which is not consciously chosen, but he rejected the deterministic idea that alcoholism is solely a disease without any moral component: …. 163
“The Catholic Contribution to the 12 -Step Movement” “’To answer the question: Is alcoholism a moral problem or is it a sickness, I think the answer is that it is both. I don't think it is true to say that alcoholism is just a sickness, in the sense that cancer or tuberculosis are sicknesses…. On the other hand, I don't think it is true either to say that alcoholism is just a moral problem…. “’When you look at the agony that the alcoholic inflicts upon himself over the course of the years, it seems to me to be very difficult to say he wants to be that way or he does it on purpose. . I think it is fair to speak of alcoholism as a triple sickness-a sickness of the body, a sickness of the mind, and also a sickness of the soul. ’ John C. Ford, ‘The Sickness of Alcoholism: Still More Clergy Education? ’, Homiletic and Pastoral Review, Nov. 1986: pp. 10, 12. ” 164
“The Catholic Contribution to the 12 -Step Movement” “Wilson, impressed by Ford's insight, asked him to edit Twelve Steps and Twelve Traditions (with the Big Book, this is the basic text of 12 -step recovery) and Alcoholics Anonymous Comes of Age…. “Ford's contribution to AA was therefore twofold: He drew on both religion and psychology to show alcoholism as a synthetic problem requiring a synthetic remedy, and he took seriously the quasi- compulsive nature of addiction while rejecting both absolute determinism and the attendant pitfalls of a purely therapeutic approach…. “In so many ways, Ford's approach to addiction and recovery remains a model of spiritual discernment for our own time. ” 165
Psycho-pharmaceuticals • "Psycho-pharmaceuticals are a special category of medicines used to counter agitation, delirium & hallucinations and to overcome anxiety and depression. " • The Charter supports psycho-pharmaceuticals being under medical control. • Psycho-pharmaceuticals are legitimate, when "Administered for therapeutic purposes & with due respect for the person. “ • Further, "the informed consent of the patient is required & his right to refuse therapy must be respected, taking into account the ability of the mental patient to make decisions. • "Also to be respected is the principle of therapeutic proportionality in the choice & administration of these medicines, on the basis of an accurate etiology of the symptoms & the motives for the subject's requesting this medicine. “ • "Non-therapeutic use & abuse of psycho-pharmaceuticals is morally illicit if the purpose is to improve normal performance or to procure an artificial & euphoric serenity. “ 166 Charter for Health Care Workers
Psychology & Psychotherapy • Psychotherapy aims to liberate a person from past problems & enable him to "assume his identity, role and responsibilities. " Psychotherapy is morally acceptable, but it must be practiced with proper respect for the patient: His privacy cannot be violated without his consent. His will cannot be unduly influenced or forced. All types of psychotherapy are "acceptable, provided that they are practiced by psychotherapists who are guided by a profound ethical sense. " • Psychiatrist Viktor Frankl survived a Nazi concentration camp & wrote, "Man's Search for Meaning. " He noted that a person who had a reason to live could put up with lifes' most horrific circum-stances. Based on the human need for meaning, he developed "logo-therapy. " "From the moral standpoint, " the Charter says, "logo-therapy &
Pastoral Care & the Sacrament of the Annointing of the Sick • Pastoral care of the sick is a fundamental right of the patient & a Church duty. It is the primary role of the health care pastoral worker, but all health care workers are bound to facilitate it. • Health care structure must facilitate religious assistance. • When such assistance cannot be given by a pastoral worker, the health care worker should (within certain limits) provide it directly, while respecting the patient's freedom and affiliation & not detracting from the patient's other rights for health care assistance. • "Pastoral care of the sick. . . is a matter of
Pastoral Care & the Sacrament of the Annointing of the Sick (continued) The "Anointing of the Sick" is for "any Christian who is in a life-threatening condition" & not just those at death's door. It "is a remedy for body & spirit, relief & strength for the patient in his corporeal-spiritual integrity casting light on the mystery of suffering & death and bringing a hope which opens the human present to the future of God. . It "should. . . be preceded by a suitable catechesis“ The proper minister of the Anointing of the Sick is a priest. It cannot be conferred on someone who is already dead. Charter for Health Care Workers 169
Pastoral Care & the Sacrament of the Annointing of the Sick (continued) Viaticum is Communion in a special form. "'The one who eats my flesh & drinks my blood has eternal life, & I will raise him up on the last day' (Jn 6: 54)“ "it is the duty of a Christian to request & receive Viaticum, and the Church has a pastoral responsibility to administer it. " Charter for Health Care Workers 170
Death It is up to God alone to decide a person's final moment. Charter for Health Care Workers 171
Terminal Illnesses • Assistance in dying constitutes helping someone to live intensely the end of their life. The Charter supports allowing a patient to spend his last days at home, with appropriate medical help. While a terminally ill patient needs palliative care and symptomatic treatment, the "most important assistance is 'loving presence' at the bedside of the dying person. “ At the approach of death, a health care worker's faith & Christian hope is a powerful witness. 172 Charter for Health Care Workers
Death with Dignity • Responsibility for life "does not always & in all cases involve recourse to every means. " There is a "so-called 'therapeutic tyranny, ' of 'the use of methods which are particularly exhausting & painful for the patient, condemning him in fact to an artificially prolonged agony. ' This is contrary to the dignity of the dying person & to the moral obligation of accepting death & allowing it at last to take its course. " There is a "principle of appropriate medical treatment": 'When inevitable death is imminent, despite the means used, it is lawful in conscience to decide to refuse treatment that would only secure a precarious & painful prolongation of life, but without interrupting the normal treatment due to the patient in similar cases. Hence the doctor need have no concern; it is not as if he had failed to assist the person in danger. '" • "The administration of food & liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him: their undue suspension could be real & properly so-called euthanasia. " Charter for Health Care Workers 173
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“The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented. ” 175
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“A patient in a ‘permanent vegetative state’ is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means. ” 177
The Use of Painkillers for the Terminally Ill • "Human & Christian prudence suggests the use for most patients of medicines which alleviate or suppress pain, even if this causes torpor or reduced lucidity. " The Use of Painkillers with the Dying, However, Is Not Without Its Problems • Painkiller use can be judged licit, even with a possibility of hastening death, as an unitended side effect. Painkillers can cause unconsciousness: "Without serious reasons, the dying person must not be deprived of consciousness. " Charter for Health Care Workers 178
Telling the Truth to a Dying Person • "The person cannot be abandoned to unconsciousness in the decisive 'hour' of his life, taking him away from himself & from his final & most important decisions. “ • "The truth must not remain unspoken, but neither must it be given in all its bare, crude reality. “ • "It is not simply a matter of giving clinical facts, but of meaningful communication" Charter for Health Care Workers 179
The Moment of Death • "To ascertain & interpret these signs [of death] is not a matter for faith or morals but. . . medical science: . . 'Scientists, analysts & scholars must continue their research &. . . studies to determine in the most precise way possible the exact moment &. . . irrefutable sign of death'" "the Pontifical Academy of Sciences has made an authoritative contribution "First with regard to the
Religious Assistance for the Dying • There is a "crisis" with the dying process, prompting "the Christian & the Church to be a bearer of the light of truth. " "Death. . . must be evangelized. " Through charity, prayer & the sacraments, the Gospel is announced to the dying in "especially expressive & effective forms. " While the hospital chaplain has a special obligation in this regard, "It is a pastoral duty of the ecclesial community in each one of its members, according to the responsibilities of each. " • The Charter defines "Charity" as "that giving & receptive presence which establishes with the dying person a communion born of attention, comprehension, concern, patience, sharing and selflessness. " Through Charity, the relationship with the dying person can "expand in prayer, that is, in communion with God. " Charter for Health Care Workers 181
Religious Assistance for the Dying • "A privileged moment of prayer with the dying person is the celebration of the
The Suppression of Life Health care workers are called "to safeguard life"; conditions call for particular attention to abortion & euthanasia. Charter for Health Care Workers 183
Abortion • "broad sectors. . . [try to] justify certain crimes against life in the name of the rights of individual freedom. . . they claim not only exemption from punishment but. . . authorization by the state, so that these things can be done with total freedom & indeed with the free assistance of health care systems. " • "The Church. . calls all health care workers to
Abortion • (The "pill" can be abortifacient. ) "The use of substances or means which impede the implantation of the fertilized embryo or which cause its premature detachment is also. . . abortion. " • We can never obey intrinsically immoral laws. Hence, doctors & nurses are obliged to be "conscientious objectors“ • Those who procure abortions automatically excommunicate themselves from the Church, whether or not anyone else knows of their action: "It is a forceful call from the Church, meant to arouse insensitive consciences, to dissuade people from an act which is absolutely incompatible with Gospel demands, & to awaken unreserved fidelity to life. “ • "Health care workers have special obligations with regard to aborted fetuses. An aborted fetus, if it is still alive, should be baptized if at all possible. A dead aborted fetus must be given the same respect as a human corpse. . If at all possible it should be appropriately interred. . the fetus cannot be used for experimentation or transplant if the abortion was caused voluntarily. " Charter for Health Care Workers 185
Terri Schiavo Videos are available at
Euthanasia • Euthanasia is homicide. • Euthanasia is "an action or omission which of its nature or by intention causes death, in order that all suffering may be eliminated. " However, "This is not a question of helping a sick person, but rather the intentional killing of a person. " • The Charter does not distinguish between formal v. material, immediate v. mediate, proximate v. remote, in saying that health care workers must absolutely not "cooperate" in euthanasia, even if requested by the patient & "much less at the request of the relatives. . • "the individual does not have the right to euthanasia, because he does not have a right to dispose arbitrarily of his own life. . 187 Charter for Health Care Workers
Euthanasia • "There is a radical difference between 'death dealing' and 'consent to dying': • "the former is an act suppressing life, • "the latter means accepting life until death. " • "The pleas of gravely ill persons who sometimes ask for death are. . . almost always a case of an anguished plea for help & love" • Doctor-patient relationships are "life-trusting"; euthanasia disrupts this. Charter for Health Care Workers 188