Healthcare workers are ministers of a God who loves life

Health workers are ministers for a God who loves life

By Professor Jim McManus

Catholics have a long history of working in health and social care. From the examples of the saints who have founded orders to the history of hospitals, to the work done today, the evidence is all around us.

Indeed, the Catholic Church worldwide today remains one of the biggest providers of health and social care globally, and is the single biggest provider of HIV and Aids care.

So why are we so interested in health and social care? Simply and solely because we see it as a commitment to human dignity and wholeness, and that in itself stems from the mission of Christ.

The fact is the Catholic Church’s position is and has been consistent for some time. Human beings are precious because they are precious to God. So we should cherish life, however weakened and disabled. It is precious. We should support people to achieve best health. But the Church has always balanced that by saying we should embrace natural death when it comes.

That means participation in this mission of health and healing is important to the Church because of what it sees as its participation in the mission of Christ. And workers who participate in this mission of health and healing – indeed, have a vocation to this – are important because they are doing something – paid or unpaid – that the Church sees as valuable and in many ways is central to its mission.

The Church has produced a range of consistent teaching for many years on this. What it hasn’t done terribly well is codify this or always make it readily accessible for us. St John Paul II created a Pontifical Council for Health Care Workers, and in his Apostolic Constitution Dolentium Hominum taught us much about suffering and our understanding of it.

Many would say he taught us even more by his bearing of it personally. In creating the Pontifical Council for Health Care Workers, he gave us a range of resources including a Charter for Health Care Workers which, sadly, have not received the coverage they should have. The council was recently, after 30 years, subsumed into the new papal organisation for Integral Human Development. Some see this as a retrograde step.

I disagree. Health and health care have to be about integral human development across the whole life course. And this gives us some new opportunities to articulate what being healthy means across our whole life.

Within the last month, a document which I believe needs a much wider audience was produced by the Vatican. Entitled A New Charter for Health Care Workers, this document – as yet, only available in Italian – represents nothing less than a major opportunity for us. I’ve already received invitations to lecture and teach on this. I hope an official English version will be made available soon. For the present, I am on my fourth reading of this document and it is nothing less than inspirational.

So why is this document important? I would like to advance a few reasons. First, it is a document which does joined up thinking. Health is hugely important to us as a human good, and it was important to Christ. That means that the ministry of healing, and the work of health and social care, is an important part of the Church’s ministry. This document rings that message out loud and clear. If you are a carer – paid or unpaid – you live the Church’s mission by encountering people in pain and need.

The document begins with a rather beautiful ‘ministry of health’ introduction and a preface re-iterating the teaching of St John Paul II. It frames the whole discussion of health and healthcare as part of the Church’s mission.

…the health care worker is ‘the minister of that God who in scripture is presented as “a lover of life”’ (Wisdom 11:26). To serve life is to serve God in the person: it is to become ‘a collaborator with God in restoring health to the sick body’ and to give praise and glory to God in the loving acceptance of life, especially if it is weak and ill.

The therapeutic ministry of health care workers is a sharing in the pastoral and evangelising work of the Church. Service to life becomes a ministry of salvation that is a message that implements the redeeming love of Christ. Doctors, nurses, other health care workers and voluntary assistants are called to be the living image of Christ and of his Church in loving the sick and the suffering: witnesses to “the gospel of life”.

Second, the document sets the whole journey of human life, and the issues of health and suffering, within the context of integral human development.

Third, the document links Catholic Social Teaching to issues of health quite explicitly. There is a framing of rights people have to health and healthcare within the duty of justice. The document frames healthcare quality within the context of justice too, and this theme of justice continues throughout. People have a right to the means to health (education, employment, food etc) and to good quality healthcare.

Fourth, the document takes a whole life course approach. The text is divided into sections on procreation, living and dying so there is a bioethical theme running through it (which sometimes dominates) but if you read closely the social justice for all theme is strongly there.

Fifth, and here I think very profoundly, the document attempts to join up an understanding of health, health care and the mystery of suffering. Health is a ‘good’ to enjoy. Suffering in some senses is something to avoid and so healing when we can cure is a participation in Christ’s healing ministry. But suffering is not valueless. It has a redemptive quality. We can offer it to God and unite ourselves with Christ in his suffering. We can learn through our pain – and I say that personally here.

Finally, I personally feel it says something profound about the nature of health. If people who suffer, or are disabled, are precious to God, health cannot be the perfect state of everything being wonderful that the aspirational 1948 World Health Organisation definition suggests. Health needs to be seen as an orientation to be the best we can be, for God, for self and for others, given our physical and psychological limitations. We need not be physically perfect. We must be realistic. But through it all we remain precious to God and the Church’s position on valuing all human life seen in this light is entirely consistent. Those we cannot cure we can support, sustain and learn from.

There is a wonderful section on death and dying which you would think was almost written as a development of some of the recent work on end-of-life care policy nationally. It says: ‘In the last days of life the dignity of the person should be understood as the right to die with greatest possible serenity, and with that human and Christian dignity which is their due.’ There’s a call to mission for Catholics if ever there was one.

It goes on to remind us of the importance of spiritual care at end of life. ‘The spiritual crisis which comes as death approaches, compels the Church to bear the light of hope to the dying person and their loved ones, a light which only faith can shed on the mystery of dying.’

Seen in this light, the Art of Dying Well website www.artofdyingwell.org is a clear attempt to communicate these riches of the Church’s understanding to a society which really needs them.

This document gives us some major opportunities. And it comes at the right time as in all of the four health systems of the UK, we see some significant changes being wrought.

The diocese of Westminster has already spurred a season – Called to Serve the Sick – which is intended to be a practical continuation of the Year of Mercy. This new charter lands right in the middle of that season.

A series of roadshows, championed by Bishop Paul McAleenan, will discuss a Catholic understanding of health and social care, why Catholics should feel a particular vocation to health and social care, and what parishes can do about it. “It is fitting that this season comes as a continuation of the Year of Mercy, giving us the opportunity to practise that most important act of Christian love, care for our neighbour,” says Bishop Paul. “Good health, poor health, disability and ultimately our death, are integral aspects of what it means to be humans precious to God, and so they are of huge importance to us as Catholics.”

To register and for more information and resources go to www.rcdow.org.uk/called-to-serve-the-sick

He added: “The Church has a special place of value for those who are sick, those with disabilities and those who work with and for them. Cardinal Vincent and I very much want priests, deacons, religious and lay faithful to understand that working with the sick is part of their core ministry and mission”.

At the same time, new resources are being published by CTS. A Priest’s Guide to Hospital Ministry and a Catholic Patient’s Guide to Being in Hospital are available from www.ctsbooks.org

Professor Jim McManus is director of public health for Hertfordshire, and a consultant to the Art of Dying Well.
For more, see www.artofdyingwell.org

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Archbishop’s response to the review of the Liverpool Care Pathway

Following the publication of the Review of the Liverpool Care Pathway, The Most Rev Peter Smith, Archbishop of Southwark and Chair of the Bishops’ Conference Department of Christian Responsibility and Citizenship, has made the following response:

“The Catholic Church has a long tradition of care for the dying combining acknowledgement of death with care for vulnerable patients. It was in response to concerns raised by Catholics and by others about end of life care in England and Wales that I called for an enquiry into the use of the Liverpool Care Pathway (LCP).”

“I welcome the report of Baroness Neuberger into the implementation of the LCP and the initial response to that report from the government. It is clear that the committee has taken its responsibilities very seriously and has listened to patients, relatives, doctors and nurses. The committee has sought to protect the positive aspects of the LCP while proposing a new more flexible and personalised framework of ‘end of life care plans’. This report and its recommendations are worthy of careful consideration.”

“From a Catholic perspective, the key issue is that, whatever pathway, plan or framework is adopted, it must be implemented ethically, with care for the patient always as the first priority.”

Related

More Care, Less Pathway A review on gov.uk of the Liverpool Care Pathway

Mary, help of the sick

 

Fr James Hanvey, SJ

There are many icons of Catholicism. Apart from the crucifix, the statue of Our Lady of Lourdes might qualify as one of the most common. It can be seen in Churches or in homes and whether it takes the form of high accomplished art or just the plastic statue bottle that holds the Lourdes water that thousands of pilgrims bring home with them, the image and the reality to which it points remains constant. Lourdes is the great place of pilgrimage for the sick. Over the centuries Mary, the Mother of God, has acquired many beautiful titles that celebrate her continuing place in the unfolding of our redemption and in the community of faith, but in Lourdes we can see that she is ‘mother of the Kingdom’. It is there, most vividly and practically, that the beatitudes can be experienced, for Lourdes is about a reversal – here the sick, whatever the manner of their illness or physical condition, ability or social standing, all have first place. Here, too, you can see the healthy – of every age and nation – practically employed in care. Lourdes is an experience of an unembarrassed Catholicism and an unapologetic faith.

February 11th is the feast of Our Lady of Lourdes; it is also the day which the Catholic Church has marked as the World Day for the Sick. It is especially dedicated to people who are incurably sick or terminally ill. Although the whole Church is asked to make it a special day of prayer for the sick, it will be celebrated in Seoul with a series of liturgical events and conferences. Such days deepen our consciousness of a daily reality which is not just physical but spiritual and social. As always in the Church, liturgy and prayer lead to action and sustains it. It is a call to transform and transcend those structures and attitudes that block our human solidarity and deprive people of basic needs. The World Day for the Sick reminds us that so much sickness is preventable through basic hygiene and clean water. So much sickness and suffering is preventable if medicine is made affordable and available. In the case of terminal illness, we are asked to extend the great well of practical compassion and care, so evident at the waters of Lourdes, to all in society. In our own country and through the world so many die alone or without adequate palliative care, not because we do not have the economic means to prevent it, but because we do not have the vision to see them. How we die is as important as how we live and how we care for a person in the final stage of life is a measure of how we value every person in their vigour and productivity.

The World Day for the Sick is a moment when we experience the fact that sickness, even terminal illness, does not cut us off from the community. It also reminds us that illness is never just a physical event, it is unavoidability spiritual even when we don’t believe. Within it hovers the reality of our own frailty and mortality, our value and purpose. We realise that ultimately we are not autonomous and in control but dependent and in need – as the Zulu saying has it, ‘people are people through people’. Even more than in its physical dimension, sickness is a counter-cultural moment of terror. But within it comes this other reality, that there are those, maybe even those we do not know, on whom we have no special claim, who care for us. They will spend their time and energy in seeking our good and care enough to want what is right and just for us. Sickness crosses all our boundaries and opens up a world of unexpected gift. This world surrounds us even in our moment of dying, and whether we are conscious of it or not, keeps a vigil for us. All our life is lived in this communion. It does not come just from our common humanity but from the Love in whose image we are made.

This communion means that sickness, even if it leads to death, is never useless. In such moments Christian faith is not some ‘opiate’ for those who have not the stoic’s strength. Faith does not pretend that illness is other than it is, nor does it celebrate suffering. It just tries to let it become a moment of encounter. At this point faith must let itself become mystical.

Christianity does not ask that we should be heroic and self-determining when faced with suffering or death, only that we should trust and step out into the mystery of Christ – it is a moment when our life is given a Eucharistic form: “Through Him, with Him and in Him, the unity of the Holy Spirit, All Glory and Honour is Yours, Almighty Father.” Through such and offering in faith, a life can catch, hold, and reflect the redemptive light for us all.

The state of societies can be measured in many ways, but it may be in our care of the sick and the dying that we have the one of the best indications of our social health. The feast of our Lady of Lourdes and the World Day of the Sick may point us towards the sources of healing that we all need.

 

Prayer to Mary, Health of the Sick

 

O Virgin Mary, «Health of the sick»,

you who accompanied Jesus on the way to Calvary

and remained near the cross on which your Son died,

participating intimately in his suffering,

take our suffering and unite them with His,

so that the seeds sown during the Jubilee

continue to produce abundant fruits in the coming years.

 

Most tender Mother, we turn to you with confidence.

Obtain from your Son the strength to return soon,

completely restored, to our duties,

so that we be useful to our neighbour through our work.

Meanwhile stay with us at the moment of trial

and help us to repeat everyday with you our yes,

sure that God will bring out from every evil a greater goodness.

 

Immaculate Virgin, may the fruits of the Jubilee Year

be for us and for our dear ones

a pledge of renewed vigour in Christian life,

so that in the contemplation of the Face of the Risen Christ

we will find the abundance of the mercy of God

and the joy of a more complete union with the brethren,

the beginning of the joy without end in heaven. Amen.

 

Pope John Paul II

Drug trials must not abuse peoples’ rights, European Bishops tell EU

Drugs trials necessary but must respect the vulnerable

Drugs trials are necessary before drugs come to market, but those conducting them have ethical duties to obtain consent and respect the rights of those from developing countries, says a statement on behalf of all Catholic Churches in the European Union.

COMECE, the Commission of the Bishops’ Conferences of the European Union, issued the statement through its Bioethics committee in response to the EU Proposal for “A Regulation on clinical trials on medicinal products for human use’ which aims at re-launching clinical research within the EU while at the same time ensuring protection to participants as well as the reliability of the acquired data. The European Commission proposed regulation which will be submitted to a vote of the European Parliament next 29 May

The statement on Ethical assessment of clinical trials on medicinal products: Respect and protection of vulnerable persons and populations  was released by COMECE this week in English and French.

Importance of consent

“Many people who are unable to give consent as well as people from less-developed countries often participate in clinical trials.” The COMECE statement asks how we can better protect them and vulnerable populations against abuse in the process.

The COMECE bioethics team conclude that  EU proposal could go further in the protection of the people concerned. A spokesperson said:

“The COMECE Secretariat welcomes this proposal for a Regulation as it goes in the right direction. The COMECE Reflection Group on Bioethics has monitored the issue from the launch of the public consultation by the European Commission and publishes today its Opinion on this proposal for a Regulation. ”

Key ethical concerns and principles

The COMECE team underlined some principles which they feel should be implemented in the proposed EU Regulation :

Volunteering

“The appreciation of the value of voluntary participation in research projects for the good of the community:  granting financial incentives to any person agreeing to take part in some medical research therefore raises ethical issues.”

Protecting those particularly vulnerable

“A key ethical consideration for research carried out on human subjects is that of respecting and protecting particularly vulnerable people and populations who could be unduly used as easily-exploitable objects for experiments.”

Benefits for the population concerned, especially in developing countries

“Clinical research with a disadvantaged or vulnerable population or community is justified only if it responds to its health needs and priorities and if it is likely that such a population or community will benefit from the results of the research.”

Security of the participants to tests

“The subject of research may agree to become involved in a research protocol that does not fully respond to the individual’s own interests but will do so for the good of others, in the “medical interest of the community” and consequently for the “common good”, insofar as the patient’s physical or psychological integrity is not endangered.” This underlines the importance of full and informed consent.

Benefits to the person incapable of consent

“Trial medicinal products should not be given to persons who are not capable of giving their consent except in cases where the same results cannot be obtained by resorting to persons capable of giving their consent and if the foreseeable benefits/predictable risks ratio is to their advantage.”

Ethics of testing in emergency situations

As for clinical trials in emergency situations, “the only acceptable research is specific research on individuals placed in such a situation that one may have good grounds for anticipating a direct benefit with regard to their condition and that would present a minimal risk and only impose a minimal burden. It is also important to give a sufficiently precise definition of the terms “minimal risk” and “minimal burden”. ”

The full statement on Ethical assessment of clinical trials on medicinal products: Respect and protection of vulnerable persons and populations is available in English and French

Vatican supports new direction on health for World Health Organization

This week has seen several interventions by the Vatican delegation to the World Health Organization’s key decision making body.

The Sixty-sixth World Health Assembly , which is the  decision-making body of the World Health Organization , and in turn the  public health body of the United Nations was taking place this week in Geneva.

Catholic support for improving population health

Archbishop Zygmunt Zimowski,  head of the Holy See’s delegation, in a brief but wide-ranging speech

  • called on WHO to affirm the centrality of spiritual needs to any approach to universal health care
  • supported the WHO’s aims to prevent non-communicable diseases such as Heart Disease and Cancer
  • affirmed the need to control and prevent disease in older people
  • supported WHO intentions to further reduce preventable deaths especially in women and children but differed on emergency contraception from WHO’s suggested stance
  • reminded the WHO of the significance of the Catholic Church’s health care agencies and infrastructure (up to 25% of HIV care worldwide, over 50% of health care in some countries)

Archishop Zimowski’s intervention is covered in more detail on Catholics in Healthcare blog.

Responding to WHO General Secretary on health of women and children

Dr Margaret Chan, Director General, outlined her goals for her time as Director General as including  “the health of women and of the people of Africa.” Archbishop Silvo Tomasi, the Holy See’s Permanent Observer to the United Nations and part of the Holy See’s delegation at the Assembly expressed his support for these objectives, and went on to explain the Catholic Church’s global and local experience in those areas.

Health of the people of Africa

The Archbishop went on to offer the experience of the Church in support of Dr Chan’s goal for improving the health of the people of Africa. “[M]any nations are still in the grip of famine, war, racial and tribal tensions, political instability and the violation of human rights.” Pope Benedict XVI’s exhortation to the international community is also very appropriate, “we must not forget Africa ….”

Emphasising the care of the whole person

Tomasi finalised his intervention with a vision of health that reminded the WHO of it’s own aspirational definition of health. We should seek a deeper care for every aspect of the human person.

“My delegation urges a perspective on health security that is grounded on an anthropology respectful of the human person in his or her integrity and looks far beyond the absence of disease to the full harmony and sound balance of the physical, emotional, spiritual and social forces within the human person.”

In recent years the Vatican has moved to emphasise not only its stance on reproductive health at WHO events but has taken on a stronger public health focus. This latest WHO Assembly has seen Vatican interventions aimed at sharing the wider health and social justice concerns of the Church.

World Health Organization told spiritual needs “integral” to universal health care

The Sixty-sixth World Health Assembly was told this week that any integral approach to universal health care coverage must include addressing the spiritual needs of populations.

The Assembly is the decision-making body of the World Health Organization , the health and public health body of the United Nations and has universal health care coverage as one of its key strategic aims.

In a wide-ranging intervention which also signalled strong Vatican support for universal health-care measures, Archbishop Zygmunt Zimowski, President of the Vatican’s Pontifical Council for Health Care Workers and head of the Holy See’s delegation to the World Health Assembly said that any “integral” approach to healthcare need must focus on “the spiritual state of the person” and not just medical interventions or economic growth.

“Health and development ought to be integral if they are to respond fully to the needs of every human person. What we hold important is the human person – each person, each group of people, and humanity as a whole.”

The archbishop said that health care contributes to the development of nations “and benefits from it.” The Holy See “strongly believes” that universal health care coverage as a goal of government policy is a more certain way to achieve “the wide range of health concerns,” including preserving present advances.

The archbishop said that health care contributes to the development of nations “and benefits from it.” The Holy See “strongly believes” that universal health care coverage as a goal of government policy is a more certain way to achieve “the wide range of health concerns,” including preserving present advances.

Archbishop Zimowski then turned to efforts to save the lives of millions of people who die each year “from conditions that can easily be prevented.” He praised a resolution before the assembly to improve the quality, supply and use of 13 “life-saving commodities.”

“The Holy See strongly agrees with the need to achieve further reductions in the loss of life and prevention of illness through increased access to inexpensive interventions that are respectful of the life and dignity of all mothers and children at all stages of life, from conception to natural death,” he said.

However, he voiced “serious concerns” about the assembly’s secretariat report and its executive board-recommended resolution that includes “emergency contraception.” He said some of these drugs have an abortifacient effect.

“For my delegation, it is totally unacceptable to refer to a medical product that constitutes a direct attack on the life of the child in utero as a ‘life-saving commodity’ and, much worse, to encourage ‘increasing use of such substances in all parts of the world’,” he said.

The archbishop welcomed the assembly’s proposed global action plan to control non-communicable diseases. He said his delegation was “especially pleased” that the plan recognizes the “key role” of civil society institutions including faith-based organizations in encouraging the prevention and treatment of these diseases.

“Our delegation is aware that Catholic Church-inspired organizations and institutions throughout the world already have committed themselves to pursue such actions at global, regional, and local community levels,” he said.

Archbishop Zimowski also voiced interest in aspects of preventing and controlling diseases in older age, noting faith-based institutions’ long tradition of care for the aged and the rapid growth of the elderly population. He noted that the Vatican will host an international conference Nov. 21-23 about caring for the elderly with neurodegenerative diseases.

 

Food for the journey, theological resources for healthcare

Food for the Journey, Theological Foundations of the Catholic Healthcare Ministry

The 2013 edition is now available from Catholic Health Association US.

For more than two decades, this formative resource has inspired the women and men who are leading and serving in Catholic health care.

The 2013 edition offers an updated look, but the same original text. In addition to the hardcopy edition, this resource is now available as an audio book in CDs or MP3 files as well as an eBook, which will be available in May. Also, CHA has produced a set of five notecards that includes some of the images from each of the chapters of the book and are blank inside.”