Medicine as ‘therapeutic art’

During  the 2018 Plenary Session of the Congregation for the Doctrine of the Faith, with regard to issues concerning the accompaniment of the sick in the critical and terminal phases of life, the fathers of the Dicastery suggested the expediency of a document that would deal with this theme, not only in a doctrinally correct manner, but also using strong pastoral tones and comprehensible language, in keeping with the progress of medical sciences. It was necessary to deepen, in particular, the themes of accompaniment and care of the sick from a theological, anthropological and medical and hospital point of view, also focusing on some relevant ethical issues involved in the proportionality of therapies and concerning conscientious objection and the pastoral accompaniment of the terminally ill.

In light of these considerations, after several preliminary phases of study in which several experts offered their qualified editorial contribution, a first draft of the document finally took shape. The text, alongside the figure of the Good Samaritan, offers a brief reference to the figure of the suffering Christ, a participating witness in the physical pain, in the experience of precariousness and even of human desolation, which in him become trusting abandonment to the Father’s love. This trusting surrender of self to the Father, in view of the Resurrection, gives a redemptive value to suffering itself and discloses the light of the afterlife beyond the darkness of death.  Thus, in the text, the perspective of those who take care of people in the critical and terminal phases of life has been appropriately joined with a perspective of hope for the suffering experienced by those who are entrusted to the loving care of healthcare workers.

Each sick person, in fact, “has the need not only to be heard, but to understand that their interlocutor ‘knows’ what it means to feel alone, neglected, and tormented by the prospect [of death], of physical pain. Added to this is the suffering caused when society equates their value as persons to their quality of life and makes them feel like a burden to others” (n. 9). Thus, “while essential and invaluable, palliative care in itself is not enough unless there is someone who ‘remains’ at the bedside of the sick to bear witness to their unique and unrepeatable value.... In a time when autonomy and individualism are acclaimed, it must be remembered that, while it is true that everyone lives their own suffering, their own pain and their own death, these experiences always transpire in the presence of others and under their gaze. Nearby the Cross there are also the functionaries of the Roman state, there are the curious, there are the distracted, there are the indifferent and the resentful: they are at the Cross, but they do not ‘remain’ with the Crucified. In intensive care units or centers for chronic illness care, one can be present merely as a functionary, or as someone who  ‘remains’ with the sick” (n.11). Thus the document, presented to the attention of the Holy Father and approved by him on 25 June 2020, bears the title Samaritanus Bonus. The literary genre of the Letter was chosen along with the date of 14 July 2020, liturgical memorial of Saint Camillus de Lellis (1550-1614). In the 16th century — the era in which our Saint lived — the incurable were mostly handed over to mercenaries; some of them, who were criminals, were forced into that work; others surrendered themselves to this work, having no other way to earn a living. Camillus wanted “men for a new care”. And he was seized by an enduring thought: to substitute mercenaries with people willing to stay with the sick merely out of love. He wished to have people with him who “not for a wage, but voluntarily and for love of God would serve them with that care that mothers usually have for their own sick children”.

Although the teaching of the Church on the subject is clear and contained in well-known magisterial documents — in particular the encyclical Evangelium Vitae of John Paul II (25 March 1995), the declaration  Iura et Bona of the Congregation for the Doctrine of the Faith (5 May 1980), the New Charter for Healthcare Workers (2016) of the then Pontifical Council for Healthcare Workers, in addition to numerous discourses and interventions made by recent Supreme Pontiffs — a new organic pronouncement of the Holy See on the care of people in the critical and terminal phases of life seemed opportune and necessary in relation to the current situation characterized by an international civil legislative context increasingly permissive in regard to euthanasia, assisted suicide and dispositions on the end of life.

In this regard, the pastoral accompaniment of one who has expressly requested euthanasia or assisted suicide is a wholly special case in which it is necessary to reaffirm the teaching of the Church. To be able to receive absolution in the Sacrament of Reconciliation, as well as the Anointing of the Sick and  Viaticum, it is necessary that the person, perhaps registered at a designated association to guarantee them euthanasia or assisted suicide, demonstrate their intention to reverse this decision and cancel his or her registration at that institution. No external action is permissible on the part of those spiritually ministering to these sick people that could be interpreted as an even implicit approval of the act of euthanasia, such as, for example, being present at the moment it is carried out. This,  along with the offer of help and listening are always possible, always granted, always to be sought, together with an in-depth explanation of the contents of the sacrament, for the purpose of giving the person, up until the last minute, the tools to be able to receive the sacrament in full freedom (cf. Section v, n. 11, pp. 41-42).

As well stated in the first section of the document, entitled “Care for One’s Neighbour”, “care for life is therefore the first responsibility that guides the physician in the encounter with the sick. Since its anthropological and moral horizon is broader, this responsibility exists not only when the restoration to health is a realistic outcome, but even when a cure is unlikely or impossible. Medical and nursing care necessarily attends to the body’s physiological functions, as well as to the psychological and spiritual well-being of the patient who should never be forsaken. Along with the many sciences upon which it draws, medicine also possesses the key dimension of a ‘therapeutic art,’ entailing robust relationships with the patient, with healthcare workers, with relatives, and with members of communities to which the patient is linked. Therapeutic art, clinical procedures and ongoing care are inseparably interwoven in the practice of medicine, especially at the critical and terminal stages of life” (n. 6) .

Christian witness shows how hope is always possible, even when life is enveloped and weighed down by the “throw-away culture”. And we are all called to offer our specific contribution, because — as Pope Francis said (Address to Directors of the Orders of Physicians of Spain and Latin America, 9 June  2016) — the dignity of human life and the dignity of the medical vocation are at stake.

Luis Francisco Ladaria Ferrer
Prefect of the Congregation for the Doctrine of the Faith