This article appeared in the February 2008 edition of the Catholic Medical Quarterly
PROFILE OF THE CATHOLIC
TEACHER OF MEDICINE
Cardinal Lozano Barragan
The second characteristic of the Christian vocation is expressed with the preposition "with", with God. Any vocation is to be with God our Lord, who prepares man to carry out a mission which, without his strength, it would be pointless to carry out. In the book of Exodus we can read what Moses says to God on mount Horeb: "Who am I that I should go to Pharaoh and bring the Israelites out of Egypt, and God said: I will be with you..." (Ex 3,12).
2.1. Revelation of Christ the physician
In this section we set out the deepest values that should shape the identity of the Catholic physician. The personality of the Christian physician is identified with the revelation of Christ the physician. Christ sent his apostles to cure all ailments and disease and said to them, I will be with you to the end of the age (Mk 16,17; Mt 28,20). The physician performs the therapeutic ministry in this way, alongside the apostles, as a continuation of the mission of Christ and with his revelation.
The whole breadth of this revelation should be understood. The physician should reveal the whole life of Christ, which is the presence of Christ in the physician. Because Christ cures all ailments and disease with all his action taken as a whole. The miracle cures that he performed, including the resurrection of the dead, were not definitive in his struggle against the evil that exists in humanity, against its ailments and death, but rather just a sign of the profound reality that entails his own death and resurrection.
He took all suffering, all ailments, all disease, without exception, and summarized them in his own death as the death of God who had become man, so that no pain would be ignored, and from his death he exploited death itself. He conquered it in the plenitude of his resurrection. One of the physician’s main doubts is always the problem of pain. This question only has its answer in the resurrection, when pain does not appear as something negative, but rather as a positive which, although it ends in death, but in a death incorporating resurrection.
The physician should thus cures, revealing the death and the resurrection of Christ To identify the physician, as a healer, with Christ the healer, is necessary for this revelation. Such identification is now carried out especially through the Eucharist and the other sacraments. The sacraments are the historic presence of Christ in the present.
Consequently, the physician should realize that health is composit and bodily health should not be talked about as something radically different from the complete health that we call eternal health or salvation. The physician’s ministry is therefore an ecclesiastic ministry directed towards Health is a dynamic tension towards physical, mental, social and spiritual harmony and not just the absence of disease, and prepares humans to carry out the mission with which God has entrusted them, in accordance with the stage of life at which they are at.
The physician’s mission is therefore to attempt ensure that this dynamic tension moves towards a harmony, as required at each stage of the life of this specific man who is their patient, so that the patient can follow the mission with which God has entrusted them. Thus, is exposed the contradiction of reducing abnormal medical functions to the single physical and chemical aspect of the disease..
In this context, death is not a frustration for the physician, but rather a triumph, as they have travelled with their patients in such a way that they have been able to use their talents to the full at each stage of their life. When it has reached its end, the medical function ends, not with a cry of impotence, but rather with the satisfaction of a mission fulfilled, both by the patient and by the physician.
Thus, the physician truly is with Christ. The physician joins together with our Father God like a son with his father, and their professional love becomes the action of the Love of God in himself, which is the Holy Spirit.
A Christian physician is always guided by the Holy Spirit. From the Holy Spirit and with the Holy Spirit is all the sympathy that must exist between
the physician and the patient, all the due humanization of medicine and all the demand for updating and lifelong learning, as the Love of the Holy Spirit makes the physician an essentially open person for the rest, as they are obliged to do so before God because of their profession of Faith represented by their medical profession. We thus succeed in outlining the third trait of the medical identity, being for others, is the "FOR" of their vocation and of their professional identity.
When God chose Moses, it is very clear that he did so to remove his people from the power of the Egyptians. God says, "I have come down to rescue them from the hand of the Egyptians" (Ex 3,8).
Physicians cannot withdraw into themselves. They cannot simply think that they already have enough money, that they do not need to work any more, and that therefore they will now leave their profession. A true physician is a physician for life. If they have truly received this vocation, they will have it for ever and they must practise it for humanity as a mission specifically received for the good of all, and for which they must account to God when He says to them, "I was sick, and you looked after me" (Mt 25, 36.43).
3.1. Openness to the patient
We said that love of the medical profession imitates the love of God which is disseminated. Physicians cannot hide their knowledge in pure theories and laboratories, but rather should expand them in favour of the community. They have received the gift of taking care of life and making it grow. Their vocation is for life, never for death, which would be to blind the mission with which God has entrusted each human being. According to Pope John Paul II, nowadays the religious ministry is connected to the therapeutic ministry of physicians in the affirmation of human life and of all those specific contingencies in which life itself can be endangered by deliberate human will. Their deepest identity involves being ministers of life and never instruments of death. This is the most intimate nature of their noble profession. They are called to humanise medicine and the places where they practise it, and use the most advanced technologies for life and not for death, always having Christ, the physician of bodies and of souls, as their supreme model.
According to Pope Pius XII, Catholic physicians should place their knowledge, their strengths, their heart and their devotion at the disposal of the sick. They should understand that they and their patients are subject to the will of God. Medicine is a reflection of the goodness of God. They should help the sick to accept their illness, and they should make sure they are not dazzled by technology and use the gifts that God has given them and not give in to the pressure to assaults on life. They should remain firm in the face of the temptations of materialism.
The good physician must therefore have dianoetic virtues and skills and convert them into virtuosity, that is to say into a habit, so that both the virtues of theoretical science and those of practice come together in them as if they were second nature.
3.2. Fundamental qualities of the physician
The fundamental qualities of the physician have thus been classified under 5 sections: Awareness of responsibility, humbleness, respect, love and truthfulness. Awareness of responsibility leads them to work with the patient and be aware that it is the physician who gives the direction. Humbleness tells them that physicians look after their patients and not the opposite. Humbleness makes them see themselves as indebted to the patient. Physicians cannot talk about "their" patients, but rather the patients will talk about "their" physician. Physicians should receive their patients as written on the lintel of an old German hospital: "recipere quasi Christum"; they should receive their patients as if they were Christ himself. Respect and love for the patient, about which we have already spoken, are the basis for their humbleness. They know that they have received a mission for which they do not have the necessary strength, but rather they receive it from the person who sends it for this reason. Truthfulness entails being aware of the great trust that the patient places in them on revealing their personal matters. Truthfulness is required in the diagnosis and in the therapy, not just on the bodily but also on the complete, mental, social, psychic, spiritual level. They should never experiment on the patient if this involves a danger disproportionate to the good that they intend to do. This must be absolutely necessary and the patient must agree to it. They should notify the patient of the development of their illness, tell them the truth about their condition in the most appropriate way and at the most appropriate time possible. They should complement their action with the action of the priest as both missions, that of the priest and that of the physician, are closely connected.
3.3. Portrait of the physician
The "Portrait of the perfect physician", described by Enrique Jorge Enriquez in 16th century Spain in the flowery language of the time, is still current: "The physician should be fearful of the Lord and very humble, and not haughty and arrogant, and be charitable to the poor, meek, kind, affable and not vengeful. They should maintain secrecy, should not be talkative or gossipy, flattering or envious. They should be prudent, restrained, not be too audacious…, should be distinguished and given to honesty and reserved. They should work on their skill and flee from idleness. They should be a well-read physician and should know how to give information about everything".
Nowadays, we would talk about medical excellence. This would be what Aristotle called the "Teleios iatrós" (perfect physician), or Galen called "Aristós iatrós" (best physician).
3.4. Morality and Law
Initially we said that the medical profession is something that goes beyond the Law and is positioned in the framework of Morality, and this is true, but does not mean that we can do without medical Law. Medical Law without adequate morality would be arbitrariness based on shameful interests. Morality without medical Law would just be general principles without direct application. The rules of medical Law must be sufficiently clear and brief to aid the physician’s action. The leading principle is always the same: the physician’s purpose is to help and to heal, not to do harm or to kill.
It is worth mentioning in particular the field of Ethics, the field of Morality, in which the physician must be competent, but in which so often they are not specialists. Bioethical committees are therefore required in each health centre, and should also be created in the teaching centres, in open dialogue with the specialists in the different subjects taught.
Physicians are thus trained to bear witness to God in all the medical, trade union and political environments, etc. They can even be valid bearers of ecumenical dialogue and dialogue with other religions, as sickness does not know religious barriers. The physician will thus actively belong to the Church as an individual person and as a group.
In order to carry out such a demanding mission, physicians cannot stay enclosed in their own individuality, but rather should first open up to other physicians and be sufficiently humble to work in collaboration and as a team, both on strictly physiological matters, and especially on those relational matters connected to fields of which they do not necessarily have a command and which to a certain extent are outside their competence, namely sociological, anthropological and political aspects, and those from technical fields beyond their profession, namely everything connected to the strictly computing field.
In a certain way, within this opening-up, in the Spanish field of medicine what two authors call the decalogue of the new physician is designed. They express it like this: 1. Multidisciplinary teamwork with a single person ultimately responsible. 2. The more scientific the professional, the better. 3. The human aspects will be strengthened in professional practice. 4. Action will be adapted to agreed scientific diagnostic and therapeutic protocols. 5. They will be aware of the expense. In addition to the protocols, they will use guides to good practice. 6. They shall aid coexistence and solidarity with work colleagues and with the patients. 7. They shall think that all healthcare acts can involve a preventive action, and even a promotion of health. 8. They shall bear in mind at all times the need to care for the satisfaction of the user of the service. 9. The Patient Service Units will be strengthened, circulating the complaints and suggestions which arise among the people affected. Frequent opinion surveys will be held. 10. It will be essential to apply ethical principles to the professional activities.
Being a Catholic physician is a ministry which arises from a vocation in the Church. It is a therapeutic ministry. It is closely linked to God our Father, revealed in Christ the physician, full of the Love which is the Holy Spirit. Being a physician is a path to achieve the plenitude of the human being, to initiate the resurrection already. It involves proximity and a special intimacy with God, and at the same time represents an opening-up and a complete gift to others. This is the Catholic identity of the physician, to reveal Christ the healer.
Being a Catholic professor of medicine is to have far-reaching sight to be able to see the resurrection in death. It is not just this, though. It is the ability to sense a harmonious tension in health which leads to plenitude, in accordance with the different stages of the life of people. And it is to feel in medical science, technology and skills the all-powerful force of God who resurrects his Son Jesus Christ and who already gives us a foretaste of the resurrection in medical progress. Being a Catholic professor of medicine is to teach the Love with which the Holy Spirit delivers Jesus Christ on the cross to the Father, who with his loving strength brings him back to life. Being a Catholic professor of medicine is to teach the physician to be the loving caress of God who looks after his children in sickness and in death, making their condition more bearable for them and opening up for them a complete expectation of health which will not now be tension toward harmony, but rather the total harmony of love. Being a Catholic professor of medicine is to teach the physician to be the revelation of Christ the healer.
Vatican City, 15 April, 2007.
+ Javier Card. Lozano Barragán
President, Pontifical Council for the Health Pastoral Care