This article appears in the November 2004 edition of the Catholic Medical Quarterly
Challenges for the Christians in Europe in Medicine and Healthcare
Cardinal Javier Cardinal Lozano Barragan
President of the Pontifical
Council for Health Pastoral Care
This is the text of the keynote speech given by the Cardinal to the Federation of European Medical Associations at their congress in Bratislava July 2004
In Europe today, one of the main challenges for the Christians in the field of medicine and health care is the progress of science in the area of biological chemistry, especially in Biogenetics. The debate is about the use of stem cells, cloning, the nature of embryos or pre embryos, their refrigeration, and the use of the tissues from them, genetic therapy, the map of
the human genome and the elucidation of patents for their use. Eugenics, manipulation of the chromosome, the chromosomal identity and privacy, its commercial, political or medical use; palliative care, organ transplants. Cerebral death, the privatisation or socialisation of the health care services, the right to health or to health care, etc.
Why are these scientific and technical issues challenges for the Christians? Certainly not because of progress, since science and faith are not opposed to each other. The challenge for the Christian lies beyond the laboratory experiments in the field of biogenetics, it resides in Bioethics, or more precisely in "Metabioethics".
Today people speak of Global Ethics, and it is commonly said that Christian Ethics is outdated, given the current pluralism which does not engage in its old models. It believes
it is necessary to forge a new Ethics, the Ethics of consensus, in which everybody agrees to the opinion of the majority or the special groups accepted for their scientific progress, technology and wealth. Aternatively, one may prefer to avoid ethical discussions and problems, and be guided by the cost/benefit dynamics. In which case, the only guiding principle of conduct is Utilitarianism.
The Fundamental Challenge in the Medical Culture
The fundamental challenge in medicine and healthcare is whether there still exists an objective and immutable norm by which to measure the ever growing mutability of the experiments in the field of science and life. Whether man in his integral perception of himself is the measure of the whole humanity, or is each individual so distinct and without relationship to others, that he closes in to himself as the ethical norm. With such a view it would be impossible to have a global norm indicating the behaviour to be followed: everyone would be the centre and source of decisions, and they would be obligatory for others depending on the force of imposition, either economical, technical, scientific, or even military. In other words, the challenge for Christians in the field of medicine and healthcare is the validity or invalidity of objectivity in ethics.
1. The Metaphysical and Epistemiological Challenge
As we try to give an answer, we must recall the problems of epistemiology. What is the last criterion of truth? How do we arrive at evidence? What about verifiability in physical experimentation, the clear and distinct ideas as first principles and the intuition of essence? Or is it that there is simply no criterion of evidence, no valid knowledge, no available basis, and that one must only follow the current theories?
From the epistemiological problem there necessarily arises an ethical problem and behind it one finds the metaphysical problem. Nowadays, to mention metaphysics seems like talking of something esoteric, belonging to the dark ages of human thought that has already been surpassed by science. But science is also out-modelled by the presence of the evolving daily life, mute but perceptible in an ephemeral presence. If we don't pay attention to the demagogic thoughts of public opinion, of websites, editorials or periodicals, or the claims of post modernity, and we look for the serious thought of one who is really concerned about finding a right direction for life, I think that it is not be ingenuous to say that we adopt the last conclusion and plainly ask ourselves whether being exists or not.
If starting from experience we overcome total scepticism, we will necessary arrive at the "intuition of essence" as the last evidence principle, and there we will find what we call the first principles, the principle of identity, of contradiction and of convertibility:
- "What is, is".
- "Nothing can be and not be at the same time."
- "Being, truth and the good, are inter-convertible".
2. The Ethical-metaphysical Challenge
Understanding that being, truth, and the good converge, and verifying in our own minds that being, truth, and the good converge in each of us in a limited way, we must accept that we are part of a harmonic or dysharmonic whole in daily life. We are therefore conscious that we have a necessary relationship. We also become conscious that we can grow. Our being has an inner dynamism growing towards the truth and the good.
This relation implies a necessary dynamism that includes the "being" as starting point, but also "to become" what we are not yet, as the point of arrival. "To become" receives the qualification of "Good", because it is suitable, and that which fits somebody is good. Experimenting is the necessity "to become", the necessity for the "suitableness" of good, and one sees that which fits must be realized continuously, because the human capacity to grow is indefinite, and therefore, one must walk towards a model that means fulfilment in the being, in truth and goodness.
This continuous walking from "being" to the "Being", from "truth" to the "Truth", from "good" to the "Good" is Ethics. It is that which objectively realizes the subject. It enables the subject to grow, assimilating the object that is found in its growth. Consequently, excluding contraposition between subjective and objective is not valid. The objective "ob jacet" (is there, outside the subject), it is true; but that which "ob jacet" makes itself subjective (it is now in the subject), one assimilates it in his continuous walking towards the realization of his own being, truth and goodness.
Since the existence of the finite being opens its way indefinitely, it is necessary that there exists a prospect of arriving at the infinite itself. The way towards this infinite fullness is precisely Ethics. The objective indication of this subjective way is called the Natural Law. It is the being that expands itself, the truth that enlightens itself, and the good that realizes itself continuously in an unrestrainable dynamism. It is the authentic convertibility between being, truth and goodness. Therefore the Natural Law is not an outmoded concept based in a biological constant; but the legitimate progression of the nature of man towards his own realisation as being and as truth; that is, the way that is proper to him as such, the way towards his own good. This good is the model we attempt to reach in a persistent pathway. From the consciousness of our limits and the desire to go further and arrive to more and more truth, more and more good, arises the necessity for a way, which must be constantly pursued. This way is Ethics. It is the true and objective fulfilment of the subject: his being, truth, and goodness are realized together as interconnected recipients. No good is possible if there is no being and truth at the same time. Therefore there is no Ethics without being and truth. Being and truth make the good objective, because being and truth that permit growing is out of the subject and is assimilated by the subject. So Ethics is at the same time the subjective and the objective in mutual relationship.
Because the growing capacity has no limits, it is necessary that the goal in Ethics must be the fullness without borders, the infinite. The way towards the unlimited goal of man is called the Natural Law. The Natural Law is the being that expands itself, the truth that progresses, and the good that realizes itself ever more in an unrestrained dynamism, which satisfies and makes one happy.
3. The Challenge to open the being to Revelation.
The current challenge for the Christian is to consolidate his Ethics in the dynamism of the being, and to acknowledge that the fullness of being is called God. It is to proclaim that God was incarnated in His Son Jesus Christ, and the only way to God is Christ (Jn 14,6).
The challenge then becomes a passage from Metaphysics to revelation in Ethics. As we have already said, Ethics is the result of the convergence between being, truth and goodness, and revelation tells us the reality about them. Passing from abstract thought to the concrete, the metaphysical principle of convertibility of the being that tends toward the infinite, culminates in the principle of following Christ, where the good to be acquired is the same Christ; God, who satisfies all the human potentialities of being, truth and goodness. So the Natural Law opens itself to the Divine Law, without lacunas or contradictions. Rather, in it there is unexpected harmony or fulfilment, because of the gift of the Lord. Through a growing participation, one then arrives to the divinisation (not a kind idealistic pantheism of some confused ideologies regarding reality), becoming a son of God in the same Son of God. So Ethics is the way of Christ in His infinite love that leads Him to give life as a gift to all of us. Christian Ethics is therefore impossible without faith and consists in a close union with the self giving Love of Christ. Ethics then becomes an action of the Holy Spirit.
4. The Challenge of the Global Ethics
The most urgent challenge is not to answer with prohibitions, or licenses to undertake this or that biogenetic practice, but to acknowledge a universal norm. Furthermore, the challenge is placed in the very roots of the European culture - that is, whether its fundamental values are no longer valid ?. Another challenge is that of not being involved in excesses of rhetoric like "A global Ethics must be absolutely new, it must break the Christian method that belonged to another cultural epoch, which is already dead." There is, in fact, a challenge to offer a "global" answer rooted in the fundamentals of culture, one that goes beyond a subjective and arbitrary position.
Nowadays people try to build a new Ethics as a "collage", postulating valuable elements from major religions and pretending that with the sum total of these it will be possible to construct a new paradigm acceptable to all. In this new spirituality (they do not call it religion), valid elements present in different creeds are not rejected. They are brought together to form global ethics. In this way, and in particular from the religions of the American native communities, are taken their respect for nature and the necessary interaction between man and nature. From
Judaism is taken the concept of holiness; from Buddhism, serenity and impassivity; from Hinduism, respect for animals; from Islam, the virtue of justice; and from Christianity, charity and mercy. They think that with pluralism, one can build a global Ethics, which deserves the worldwide consensus.
It is clear that in all religions there are elements of great value. The challenge in understanding and respecting this "pluralism", is to find the basis, from which it is possible to attribute value to them. The answer is because they refer to what man is, and his wishes; they correspond to his being, his truth and goodness; this is the meaning of the expression of man's own dignity. They translate into practice the correct conduct of the human person..
Consequently the first postulate of a global ethics is to always defend the absolute dignity of the human person, and value human life. This means defending human life from its conception till its natural end.
It is also said that as a necessary character of a global Ethics the norm cannot have a unique meaning, because it all depends upon the use of language. Speaking in political terms may not be the same as speaking in scientific terms; the same applies to philosophical and sports language, or theatrical, economic, or even the language of the intimacy of love and the home. Therefore, nothing is obligatory. Here we find another challenge for the Christian in the field of Medicine: to prove that the different fields of language use do not make the reality, but the reality shapes the diverse fields of language. The reality can be expressed in several forms, but it is the same, unique and unchangeable, in the truth and goodness of man, and it is evident in his own being.
Sustaining the validity of truth as transparency of the entity of the reality is not the same as remaining in an immobility opposed to the frenetic rhythm of the actual life. From the beginning of western thought, there has been the antithesis being-becoming. The solution is not to eliminate part of the antithesis; but to find the equilibrium upon which ethics is based. The growing and the continuous vital change presupposes a subject, who at the same time changes and remains; because if he does not remain he destroys himself and dies; and if he does not change, his inactivity kills him. In order to subsist, a culture must have the vital capacity to change, coinciding with the primordial conscience of its permanence.
The first challenge for the European Christian in the field of medicine and health care is the ethical challenge. It is the challenge to give an ethical and inculturated answer in the new circumstances of the wonderful progress of the actual sciences and techniques. But avoiding the possibility of committing suicide through a subjective relativism that opens the door also to economical, political or technocratic dictatorships.
5. The Challenge of Mechanicalism
Another challenge especially actual sciences of health and medicine is the challenge to overcome Mechanicalism. In some areas of scientific thought, one finds Cartesian Rationalism with its concept of "clear and distinct ideas" as a starting point. This in its initial formulation, means the total independence of the three self-sufficient themes "God", "Conscience" and "Extension". These three elements are designated as totally independent from each other and in their inner constitution. When in the evolution of this thought "the Extension" prevails as a unique substance worthy of consideration, then one finds the whole Empiricism, which as ideological background of the scientific investigation, proceeds from the basis of quantitative knowledge of unities that are independent between themselves. This background damages and makes the authentic scientific progress impossible, especially in the biological chemistry studying Biogenetics.
After the discovery of genes, whose complexity in man is comparable to a piano with three billion various pairs of keys that must be played during the whole life time, and seeing the diversity of each of those keys, because they are distinct from each other, one sees that it is impossible to understand the beginning of life from a mechanicalistic point of view, and therefore, to understand man through a science based on concepts which do not extend from a mechanical perspective that imposing a quantitative order based on closed unities.
Such a perspective, giving coordinated knowledge of one factor after another, without considering the relation between them is not adequate. It is necessary to have another vision, the vision of simultaneity, the holistic vision. The perspective of relationship must be applied whereby one point relates itself to many other points. Otherwise authentic scientific progress is impossible and we are left with empiricism
This challenge is very important. Scientific knowledge is not the unique valid knowledge. For a holistic knowledge there is the necessity of going beyond the scientific knowledge, in order to consider totality and simultaneity, and not only manipulability, but also observation. The observation knowledge, the former knowledge of medicine is not over, it must be added to the actual knowledge of manipulability. To the practical actual manipulability in medicine one must add the humble observation, as well as the respectful admiration and, why not, adoration?. The challenge is to prove scientifically that definitely man is not the master of his life.
II. The Challenge to Evangelise Health..
Having discussed the complex context, let me now touch upon two concrete points that are also important and fundamental challenges for the Christians in the field of medicine; the concept of health and the practice of pastoral health.
There is the concept of health given by the WHO: "A perfect well-being physical, mental and social and not only the absence of illness".
1. What is Health?
If we examine this definition seriously, we realize that it is not sustainable: it speaks of a perfect well-being which is a utopia. However, its assertion that health is not only the absence of illness is remarkable.
It underlines the physical and social aspects of health. It is true that the meaning of health is complicated, because it is linked with life and frequently is understood as life itself. We know that life is the organic unity, and death is the disintegrations of this unity. From this base, we can say that health is the tendency towards unity. So health would not be the perfect well-being but rather the battle against the disintegration of the unity of the human life; a fight against death, a dynamism towards the total harmony, but not the harmony itself.
2. Health and Harmony
Health is for harmony, or to be more precise, it is a certain way to walk towards harmony, a continuous search for harmony, although this harmony, at least in this world, is not totally attainable.
Harmony is not only physical, but also psychological, social, and finally spiritual. As physical, it is the tension towards the good functioning of the organism, a work of eliminating sickness and being healthy; and would involve also a relational state like the ecological equilibrium. As psychological, it means vital tension. Meaning a tension towards the self consciousness, towards the self-dominion and consciousness of ones proper place in the milieu in which the person lives. As social, it is the tension towards the complementary relationship with others. It is a growth in the social aspect of the human personality. It proceeds from within the person, to the home and further to the larger or international environment. Spiritual health is the tension towards the whole unity of the human being: towards his physical, psychological and social unification. It includes the unity of life as a project that will be fulfilled and gives sense to the other aspects of the personality. As spiritual tension, it is the tension in love, and towards more intensive love. Health then consists in the loving total self-donation to others.
3. Spirituality and Health
This spiritual tension is the challenge of health for us as Christians, because it isthe tension towards the total donation to God and to others, under the action of the Holy Spirit. True life consists in being assimilated to the highest donation of Christ in his death and resurrection. This is the true harmony of health that penetrates and influences the other harmonies. Our challenge is to fill the existing gap between temporal and eternal health. They are both related and the eternal is prepared by the temporal health
As a paradox, health that leads towards the absence of illness may coexist with illness, but only in the instance where illness does not hinder the tendency towards harmony. It means that health is measured in varied ways according to the different stages of life: the parameters for measuring the health of a baby may not be the same used for determining the health of an old person. Health is then the capacity that everyone receives from God to accomplish the mission entrusted to him. Continuing in the line of the paradox we can say that death itself is the maturity of health, but only when death means the fulfillment of the received mission, and-uniting with the death of Christ, as a gateway to the individual's own resurrection. Then, the tension arrives at maturity: The full harmony
4. A Definition of Health
If we desire to synthesize, we can say that another challenge for the Christians in the field of medicine and health in Europe is that of making the true meaning of health understood. We try to describe it as: "A tension towards physical, psychological, social and spiritual harmony, and not only the mere absence of illness, which enables the person to accomplish the mission received from God, according the stage of life". This is in substance the description of health given by the Holy Father John Paul II, in his message for the World Day of the Sick in the Jubilee of 2000.
III. The Challenge to Evangelize Health Pastoral Care
1. Catholic Health Centers
In the Catholic Church we have 113,257 health centers run by Catholics; the question is: Do these centers offer true health pastoral care? It is true in many of these centers, especially in Europe, one receives excellent services, they achieve medical excellency, have outstanding technical instruments, and some of them take care of the poor people who have no insurances at all. These centers are inspired by Christian Charity and are also a fulfillment of the command of Christ to heal the sick. But the challenge is: Do these centers truly evangelize through the World of sickness and health? Does Europe become evangelized through these centers? Is there a Christian concept of illness and health in them? Are these centers witnesses of the resurrection of Christ?
The challenge arises because it is necessary not to confuse a philanthropic center with a charity center that ought to be devoted to evangelization.
2. Evangelization of Heath Pastoral Care
As a consequence of the Christian concept of health, the core of health pastoral is witnessing to the resurrection of the Lord. The Pastoral Care of Health must be a ministry that gives valid answers to the profound problems of the human existence, such as illness, suffering, pain, death, etc. And the fundamental answer must be entering in the Mystery of God, touching and experimenting in the fact of on s own suffering and death, the pain, suffering and death of Christ; and also realizing how his own suffering was assumed by the suffering of Christ,in His passion. This is the first step; the second step is the experience of the resurrection. It means to find happiness also in the same suffering. The first stage will be the actualization of the resurrection in the fulfilling "suffering" of the patient; the second one will be embracing death not as total frustration but as the day of the loving encounter with the risen Christ. And the challenge consists in being conscious that this encounter is not possible with our own human forces, but only by power and guidance of the Holy Spirit, into the sphere of the life of love.
It is evident to those who profess the Catholic Faith that all we say is not mere words, rather it is translated into concrete actions. The first action is the Sacrament of the Eucharist, which is at the center of all Health Pastoral Care, because Health Pastoral is the Eucharistic memorial, lived at the edge of existence, where death is the glorification, according to the language of St. John in his Gospel.
The challenge for Health Pastoral Care is not to be caught up in a weak Theism and in the practice of human compassion, but to put in action all the dynamism of our Faith as something that we truly believe, not only as a proclamation, but as a unique vital practice. The content of Health Pastoral Care constitutes the reason why we are Christians. This content means going beyond a light superficial pseudo cultural cover of a mere Christian title, which does not arrive at the very roots of the European culture.
The theme was "Challenges for the Christians in Europe in Medicine and Healthcare". I think that all the challenges can be reduced to one: The direction of Medicine and Healthcare. And not exactly how it must be, but what it is.
Today, medicine has progressed very much. We could compare it with a very powerful car, very beautiful and elegant, with plenty of technical instruments, and is now running at a maximum speed. But the engineer who invented this car forgot to put in it the steering wheel, or at least an electronic device to control it; it is running crazy, disorientated and without breaks. What will happen? What can we do?
I suggest that as first measure one must mount onto this vehicle and put in it the steering wheel, or an electronic device to guide it. Exactly that is the challenge I tried to assume in this intervention: mount onto the automobile of the current medicine and healthcare and insert in it the steering wheel, or an electronic device and brakes.
Delivered at the FEAMC Congress, Bratislava, July 1-4th 2004