CONTEMPORARY HEALTH CARE and the CHOICE for LIFE

I have set before you life and death . . . choose life!
— Deuteronomy 30:19

The choice that Moses set before the Israelites as they prepared to pass into the Promised Land is a choice that is set before us today in a variety of ways. The exhortation to choose life applies to the decisions we make to serve the Lord of life and treat others with the justice that human dignity demands. It applies to the choices we make in political life to secure the rights of the needy and defend the unborn, aged, infirmed, and disabled. We are called to choose life. We are to protect, nurture, and sustain our own lives and the lives of others, acting as faithful stewards of God, who is the Lord and giver of life.

We are not, however, to sustain bodily life at all costs. Consider the Passion of Christ and the death of the martyrs. Jesus and his faithful witnesses gave up their lives willingly, not by choosing to cause their own deaths, but by choosing that which is greater that bodily life: faithfulness, truth, the salvation of the world, eternal life in God’s kingdom. For Christians, suicide and martyrdom are opposites. Suicide is the choice to cause one’s own death. Martyrdom is the choice to allow one’s death to be caused by others for the sake of greater life.

Most of us will not have the opportunity to die as martyrs. Many of us will, however, confront challenging circumstances that require us to distinguish between choosing to cause death and choosing to allow death to occur naturally for the sake of a greater good.

This dilemma occurs frequently in the world of contemporary health care. Medical technology has given us better methods for both preserving and destroying human life. People with terminal diseases have more ways of keeping themselves alive and more ways of hastening their deaths. Pregnant women have greater means at their disposal both to save the lives of their unborn children and to end them. How can these people know when allowing death is morally right? How can they distinguish between permitting of death as an unfortunate side effect and choosing death in an act of killing?

The Catholic Church has the resources with which to answer these questions. The Church’s moral tradition distinguishes between ordinary and extraordinary means of preserving life. It identifies the conditions according to which an evil result can be permitted as a side-effect of a good action. Often these principles can be applied easily and straightforwardly to the situation at hand. Sometimes applying such principles correctly is difficult and complicated. In every case, however, arriving at the right answer begins with asking the right question.

The right question is not the question of life or death: Should I live or should I die? Is life worth living or not? Does that person’s life have any value? These are questions we have already answered in responding to the exhortation of Moses. We choose life! We choose to value, uphold and defend the dignity of all human life. We reject the choice to cause death. God is the master or life and death. We are not. Our task is to protect, nurture and sustain our lives as long as God’s providence permits.

The question that is ours to ask and answer is not whether life is worthwhile; it is whether or this or that procedure, treatment, or intervention is worthwhile. We know that life is always good. Our question is whether this or that lifesaving measure is good or whether it is evil, overly burdensome, or otherwise unreasonable. It is to this question, not the question of life or death, that we apply the resources of the Church’s moral tradition.

We start by choosing life, affirming its value and God-given dignity. We choose to protect, nurture and sustain life and never to make death our aim. If we are firm in this life-affirming choice and rely on the guidance of Catholic teaching we can be confident that, even when we decide to allow the natural process of death to occur and entrust our loved ones to mercy of God, we remain faithful to the exhortation of Moses:

I have set before you life and death . . . choose life!

REPRODUCTIVE TECHNOLOGIES and the RIGHTS of PARENTS and CHILDREN

Our society generally uses the term “reproductive rights” to refer to the options that should be made available to a woman insofar as she is a potential (or sometimes actual) mother. The Catholic Church teaches that mothers and fathers and children all have rights regarding the manner of their reproduction. According to the Catechism of the Catholic Church, a husband and wife have the “right to become a father and a mother only through each other” (CCC 2376). In the same paragraph, the Catechism refers to “the child’s right to be born of a father and mother known to him and bound to each other by marriage.” Both the rights of the parents and the rights of the child, according to CCC 2376, can be violated by the use of reproductive technologies. Here is the full paragraph, which quotes from the Congregation of the Doctrine of the Faith’s document, Donum Vitae:

Technologies that entail the dissociation of husband and wife, by the intrusion of a person other than the couple (donation of sperm or ovum, surrogate uterus), are gravely immoral. These techniques infringe upon the child’s right to be born of a father and mother known to him and bound to each other by marriage. They betray the spouses’ “right to become a father and a mother only through each other.

In what follows, I will expound upon this teaching by commenting upon the rights of the child and the spouses that are referred to in the Catechism.

The Rights of the Child

“The child’s right to be born of a father and a mother known to him and bound to each other by marriage” touches the heart of the Church’s teaching on marriage and human sexuality. The stable and exclusive union between husband and wife is the proper place for sexual activity largely because it is the proper setting for the rearing of children. The kind or reproductive technologies referred to in CCC 2376 intrude upon the exclusivity of the marital union. A child conceived by an anonymous biological father or born to a surrogate mother is deprived of the unambiguous identity of being the child of one father and one mother in the security of one family. A child has a right to a family in which he or she is the fruit of the love of a husband and wife who become a mother and a father in the expression of their exclusive union. The right on the part of the child implies a corresponding obligation on the part of the parents. They are morally obliged to conceive children only through their shared acts of conjugal love and free from intrusive technologies or third parties.

The Rights of the Parents

The rights of spouses “to become a father and mother only through the other” are implicit in the vows they make at their wedding. Fidelity to those vows requires that their sexual relationship be exclusive. Even if they were to agree to do otherwise, their conduct would betray the vows they made to each other before God. Fidelity also requires that their child bearing be the fruit of that exclusive relationship. Even if they were to agree to bring in a third party to effect the fertilization or gestation of their child, it would be a violation of their vows and an intrusion into the exclusive relationship that is proper to husband and wife. A husband and wife have mutual rights and obligations that are definitive of their marriage. Among them are the right and obligation of both to become father and mother only through each other.

Husbands and wives have the right and obligation to give and receive the exclusive conjugal love by which a child might be conceived. They do not, however, have the right to conceive a child. Husbands and wives are right to want to have children. That is a natural and praiseworthy desire. But the desire that is praiseworthy is the desire to receive a child as a gift – a gift from God received through the mutual giving of husband and wife – not the desire to receive a child as an entitlement. Sadly, by asserting this false right to a child, potential parents can be inclined to make use of reproductive technologies in ways that violate the true rights of both parents and children to be gift and family only through each other.

TOWARD a SPIRITUALITY of HEALTH CARE

Christian revelation tells us that seeking what is truly good — and seeking the one who is Truth and Goodness — is not just something we do, but something God does in us. It is only by the power of God’s grace, with which we must freely cooperate, that we are made able to attain the goal for which we were created, which is God Himself.      

This means that ethics in general, and medical ethics in particular, is closely related to what we might call “Christian spirituality.” Studying what is good for us to do, it turns out, has everything to do with how God is acting in our lives and leading us more deeply into relationship with Himself. For Christians, doing what is good is always about cooperating with God’s grace. We recognize that in our weak and fallen state we cannot direct ourselves toward God through our own feeble efforts. We need the transforming power of God’s grace in order to do the good that will lead to true happiness. Infused with God’s grace, our good deeds transcend the limits of our natural capabilities. Our actions are no longer limited to what we can do on our own, but are elevated by what God can do in us. In the light of Christ, ethics opens out into spirituality; human action is infused with the Spirit of God.

St. Thomas Aquinas gives us an illuminating way of understanding this dynamic when he says that charity is the form of all the virtues. Now charity, for St. Thomas, “is the friendship of man for God” (Summa Theologiae II-II q. 23 a. 1). It is “the movement of love whereby we love God” (ST II-II 23.2). Charity is the love that God creates in us, which elevates our ability to love and so makes us capable of loving God truly. It is therefore charity above all that makes us able to attain our ultimate goal, which is God Himself. In St. Thomas’ words, “The ultimate and principal good of man is the enjoyment of God . . . and to this good man is ordered by charity” (ST II-II 23.7). This means that charity is not only the greatest of the virtues, since it directs us to our greatest good. It is also the form of all the other virtues, because “it is charity which directs the acts of all other virtues to the last end” (ST II-II 23.8).

What this means for us is that every good action we perform can be an act of love for God. When our souls are enlivened with charity, all our virtuous deeds are informed by our friendship with God and contribute to the attainment of that perfect enjoyment of God that is our principal good and ultimate end. This is not to say that our good actions are any less ours. What God does in us by his grace does not cancel or diminish the freedom God has given us as integral to our human nature. Rather, the grace of God elevates and perfects our God-given freedom, making it capable of the love for which God made it.

In addition, to say that charity is the form of all the other virtues is not to say that those virtues lose their distinctiveness or their distinctive importance. The diverse virtues that order different human actions toward their common goal remain diverse. The virtue of chastity, for example, by which we do what is good in matters of sexuality, is not less important for being informed by charity, but more important. We would be wrong to think, “It doesn’t matter so much if I’m chaste as long as I love God.” The correct conclusion is rather, “Chastity matters more to me because being chase is one way I can live in friendship with God.”

Applying this to the practice of health care, we can conclude that our daily activities matter much more that we might have thought. When those actions are right and good, we don’t just serve our patients well, we also render to God acts of supernatural love and advance toward our ultimate purpose. Conversely, when our actions are unjust, unkind, or poorly considered, we fail not just to be good clinicians, but to love God and to advance on our way toward Him. By the grace of God, we have the opportunity each day to care for others in a way that can have eternal importance both for them and for us. This should motivate us to come to the practice of health care with both generous hearts and ethically informed minds. For when we care for the health of others in a way that is truly good – caring, competent, and ethical – our seemingly mundane actions can be elevated by the infusion of divine love to become deeds of supernatural consequence. When we allow God to work in us and through us, ethically informed practice becomes a spirituality of health care. When we do what is good in our everyday actions and decisions, we can recognize with eyes of faith the presence of the Spirit of God, who elevates our human actions beyond the limits of human achievement and transforms them into expressions of divine friendship.

The EUCHARIST, the CHURCH, and the HOSPITAL

"The Church draws her life from the Eucharist.” With these words, Pope Saint John Paul II began his 2003 encyclical Ecclesia de Eucharistia. He continues, 

In a variety of ways, she [the Church] joyfully experiences the constant fulfillment of the promise: ‘Lo, I am with you always, to the close of the age’ (Matt 28:20), but in the Holy Eucharist, through the changing of bread and wine into the body and blood of the Lord, she rejoices in this presence with unique intensity

The Pope goes on to explain how the communion we share in receiving the Eucharist builds up the communion of the Church. “The Eucharist thus appears as the culmination of all the sacraments in perfecting our communion with God the Father by the identification with his only-begotten Son through the working of the Holy Spirit” (EE 34). He calls the Eucharist “the supreme sacramental manifestation of communion in the Church” (EE 38) and says, “The Eucharist creates communion and fosters communion” (EE 40).

The Eucharist gives life to the Church by uniting Christians more perfectly with Christ and with one another. When we celebrate the Eucharistic sacrifice, receive the Eucharist in Holy Communion, or adore the Eucharistic presence of Christ in prayer, we are made the body of Christ by the body of Christ; we are constituted as the Church by our common participation in the Eucharist. The Eucharist creates communion. It brings us into communion with the whole Church and not only with those assembled. Pope Saint John Paul II writes,

Given the very nature of ecclesial communion and its relation to the sacrament of the Eucharist, it must be recalled that ‘the Eucharistic Sacrifice, while always offered in a particular community, is never the celebration of that community alone. In fact, the community, in receiving the Eucharistic presence of the Lord, receives the entire gift of salvation and shows . . . that it is the image and true presence of the one, holy, catholic and apostolic Church.

When we bring Holy Communion to the sick, we extend to the sick persons the communion of our local churches. When a sick person who is confined in her home or in a hospital receives the Eucharist that is consecrated and offered in the worship of a local community, she is united to that church and shares in that assembly. But the Eucharist is never the celebration of one local community alone. Through Communion in our Eucharistic Lord, we receive Jesus’ presence completely and are perfected in our communion with the universal Church that is one, holy, catholic and apostolic. When our sick brothers and sisters receive Holy Communion, they are made one with Jesus, with the communion of Jesus’ believers in a particular church, and the Church universal that is Jesus’ body.

“The Church draws her life from the Eucharist” and the sick person draws her life from the Eucharist by which she shares in the communion of Christ and his Church. When ministers of Holy Communion bring that Blessed Sacraments to sick and suffering men and women confined in homes or in hospitals, we give them the Eucharist; but at the same time we give them the Church. Those sick persons are separated physically from the local community in which the Eucharistic sacrifice is celebrated. Nevertheless, by receiving the Eucharist, whether physically or spiritually, the sick person is brought into communion with the worship of the assembly and the communion of the Church universal. Though that sharing in the Eucharist and the communion it creates, the sick person in the hospital truly is  “the image and true presence of the one, holy, catholic and apostolic Church”

The RIGHT to LIFE: the RIGHT of a CHILD; not the RIGHT to a CHILD

That illnesses can now be diagnosed and treated when a child is still in the womb represents a significant advance in modern medicine. Some diagnoses can be achieved by testing the genetic make-up of an unborn child either in utero (in the womb) or in vitro (in a test tube). Pre-natal diagnosis and treatment are, as I say, significant medical advances. However, they also raise significant ethical questions.

In vitro diagnoses frequently accompany in vitro fertilization (IVF), which itself presents ethical problems that we will not consider here. When IVF is accompanied by prenatal genetic testing, additional ethical problems can occur. An embryo that is found genetically undesirable is likely to be destroyed precisely for that reason. In such a case, the injustice of discrimination is added to the injustice of killing. Moreover, the attempt to identify and implant a genetically desirable embryo is likely to lead to the fertilization and destruction of increased numbers of newly conceived human beings.

Prenatal genetic diagnoses during pregnancy are not so ethically problematic. Genetic diagnostic testing is commonly administered as a standard aspect of prenatal care. It can be of help to parents in preparing to cope with the challenges of raising children with genetic disorders such as Down syndrome. In some cases, prenatal genetic testing can even lead to the diagnosis of disorders that can be successfully treated by gene therapy.  In these cases, prenatal genetic diagnoses can be morally good. Difficulties arise when prenatal genetic diagnoses are made for the purpose of aborting unborn children that are found genetically undesirable. As in cases of genetic testing in vitro, this use of genetic testing in utero compounds the evil of killing the innocent with the evil of unjust discrimination. It also leads to the proliferation of abortions.

The ethical problems presented by prenatal genetic diagnosis seem to be rooted in a kind of mindset that people can have about bearing children. Many people, especially married couples, want very much to have children. This desire is natural and good. Having children is something to which we are naturally inclined. Having children is also a task given us by God, whose first words to the human beings He created were, “Be fruitful and multiply” (Gen 1: 28). So when couples find themselves unable to have children it can be a source of great sorrow. Married couples faced with this situation deserve compassion and can often profit from the assistance of natural methods and medical specialists to achieve pregnancy through their acts of conjugal love.

The desire to have children is good. It becomes ethically problematic when their desire for a child leads a couple to suppose they have a right to a child. When a couple thinks they have a right to a child, they necessarily think of the child they might conceive in a false way. In their minds, their potential child is no longer someone they might receive as a gift from God, but someone they might produce with the assistance of technicians. The child is then thought of not as a human subject possessing rights of his own, but as an object that his parents have the right to possess. As Donum Vitae puts it, 

A true and proper right to a child would be contrary to the child’s dignity and nature. The child is not an object to which one has a right, nor can he be considered an object of ownership: rather, a child is a gift, ‘the supreme gift’ and the most gratuitous gift of marriage, and is a living testimony of the mutual giving of his parents
— CDF, Donum Vitae II, 8

This kind of mindset becomes even more troublesome when people imagine they not only have a right to a child, but a right to the child they want: the perfect child. Coupled with the practice of prenatal genetic testing, this way of thinking can lead to tragic results. If a couple imagines they have a right to a genetically flawless child, they can use genetic testing as a means of producing such a child. The tragedy is that to produce the “right” child, it is often found necessary to destroy the “wrong” child, if not multiple “wrong” or “unnecessary” children. This misuse of prenatal genetic testing can, in turn, reinforce the troublesome mentality. Insuring the genetic wellbeing of one’s children is a desirable thing. Now that this desire can be fulfilled through prenatal testing, it becomes tempting to fulfill this desire at all costs, even the cost of unborn human lives.

The right to life is the right of every human being, including unborn children. It is the right to have own life valued and respected. It is not the right of one human being to the life of another. Human beings should be valued for who they are themselves, not for the fulfillment they bring to others. Human beings are subjects to be loved, not objects to be used. Human life is not a commodity. Having children is not like picking apples. We can’t just keep the one’s we want and throw out the ones we don’t.

HEALTH CARE and the HOLY SPIRIT

Every year at Pentecost the Church commemorates the outpouring of the Holy Spirit upon the apostles and the Blessed Virgin Mary as they gathered in Jerusalem awaiting the “promise of the Father” (Acts 1:4): the gift of the Holy Spirit that continues to be poured out upon the disciples of Jesus. At Pentecost, we celebrate all the ways in which the Holy Spirit is present and active in our lives and in the lives of those we love and serve. For those who have devoted themselves to the service of the sick and suffering, we might reflect upon the ways in which the Holy Spirit is present and active in the lives of the persons for whom we care and how the Holy Spirit can work in us for them.

The Holy Spirit is the Giver of Life

In the Nicene Creed we profess, “I believe in the Holy Spirit, the Lord and giver of life.” We see this life-giving work of the Holy Spirit in the creation of the world. Genesis tells us that when “God created the heavens and the earth” (Gen 1:1), “the Spirit of God was moving over the face of the waters” (Gen 1:2). We see the Holy Spirit’s role most especially in the creation of the human being. When God formed a man out of the dust of the ground, He “breathed into his nostrils the breath of life” (Gen 2:7). In the Biblical languages, ‘breath’ and ‘spirit’ are signified by the same words. When we read that God breathed into the body of the man, we are meant to understand that God gave life to the man through the working of God’s life-giving Spirit. When the God’s people had fallen into sin, God promised to restore them by the gift of the Spirit: “I will put my spirit within you . . . and I will be your God” (Ezek 36:27-28). The Holy Spirit is also the giver of new life in Christ. We read in Saint Paul’s letter to the Romans, “If the Spirit of him who raised Jesus from the dead dwells in you, he who raised Jesus from the dead will give life to your mortal bodies also through his Spirit who dwells in you” (Rom 8:11).

The Holy Spirit is the giver of life, the restorer of life, and the renewer of life. When a person is sick, it the Holy Spirit who is able to restore again the life that is His gift. We do well to pray to the Holy Spirit for healing. In fact, “gifts of healing” are among the gifts of the Spirit enumerated by Saint Paul (see 1 Cor 12:9). We also pray to the Holy Spirit for the renewal of the inner life of the sick person. Saint Paul tells us that the Holy Spirit dwells in us as in a temple. When a person is sick, especially if that person is in danger of death, we pray that the Holy Spirit will be working in their hearts and giving life to their souls.

The Holy Spirit Speaks through the Prophets

We also profess in the Nicene Creed that the Holy Spirit has “spoken through the prophets.” This certainly means we believe the Holy Spirit has inspired the spoken and written words of the Old Testament prophets and the Biblical writers. But Scripture also says that the Holy Spirit speaks in us. Jesus tells his disciples, “Do not be anxious how or what you are to answer or what you are to say, for the Holy Spirit will teach you in that very hour what you ought to say” (Luke 12:11-12). Saint Paul says, “No one can say, ‘Jesus is Lord’ except by the Holy Spirit” (1 Cor 12:3).

It can be difficult to know what to say to a person who is sick and suffering. Yet, the kind words of a doctor or nurse can be a great consolation to a hospitalized patient. Words of encouragement, faith and prayer from a chaplain or Eucharistic minister can go a long way. The Holy Spirit can give us those words. The Holy Spirit can speak through us and give to our words the power of God’s Word.

The Holy Spirit is the Advocate

“The Advocate, the Holy Spirit that the Father will send in my name – he will teach you everything and remind you of all that I told you” (John 14:26). The Holy Spirit is the Advocate. The Greek word we translate as “advocate” (paraclitos) can also be translated using a variety of other English words, including “counselor’, ‘comforter’, ‘defender’, and ‘mediator’. This range of meanings suggests that we can call upon the Holy Spirit for different kinds of help in different sets of circumstances. Saint Paul tells us that “the Spirit helps us in our weakness” and “intercedes for us with sighs too deep for words” (Rom 8:26)

It is comforting to know that the Holy Spirit is an advocate and intercessor for the sick people in our care. We are all weak and in need of the Spirit’s comfort, counsel and protection. However, the sick and suffering are afflicted with different kinds of weakness and have a variety of particular needs. It is good to know that the Spirit helps them in their weakness. It is also good to remind our sick brothers and sisters of that promise. Come, Holy Spirit!

 

HUMAN CONSCIENCE and PATIENT AUTONOMY

Conscience, according to Saint Thomas Aquinas, is the act of the human intellect by which “we judge that something should be done or not done.”1 This judgment is to be based on our knowledge of what is right and wrong for us to do, knowledge that we acquire both from our natural God-given ability to discern right from wrong (natural law) and from the truth about right and wrong that God has revealed to us through Scripture and Tradition (divine law). When we make correct judgments of conscience and act accordingly, we participate in God’s wisdom and act in accord with God’s will. Pope Saint John Paul II has referred to this human participation in the law of God as participated theonomy.2 In a similar vein, the Second Vatican Council document Gaudium et Spes calls conscience, “Man’s most secret core and his sanctuary. There he is alone with God whose voice echoes in his depths.”3 When we act according to correct judgments of conscience, we act from the depth of who we are as free persons who are at once masters of our own acts and children of our heavenly Father.

A person’s conscience is to be respected and protected as an essential element of that person’s human dignity. Barring exceptional circumstances, no one should compel another person to act against her conscience. A person’s conscience is her honest judgment about what is right and wrong to do. To act against one’s conscience is to do what one honestly thinks to be wrong. For that reason, conscience is said to be binding. Everyone is morally bound to do what he think is right. Even if someone is in fact wrong, that person is bound to do what he honestly thinks is right.

This doesn’t mean that a person who follows his errant conscience is necessarily excused from guilt. Such a person may or may not be morally responsible for the wrong he does, depending on whether that person should have known better. We are duty bound to follow our consciences, but we are also duty bound to form our consciences. Errant judgments of conscience are without excuse if we have not make an honest effort to discover what is truly right and good.

According to the Catechism of the Catholic Church, “Conscience must be informed and moral judgment enlightened.”4 The duty of forming one's conscience is a prerequisite for living a morally upright life. At the same time, “The education of conscience is a lifelong task”5 that we are to engage in with the help of parents and teachers, with the benefit of experience and moral maturity, and guided by the light of God’s Word and the authoritative teaching of the Church. Such an education leads a person to authentic virtue and the freedom to act with excellence in concert with the Divine Wisdom “whose voice echoes in his depths.”

This understanding of human conscience is the basis for correctly understanding and applying what bioethicists have called the Principle of Autonomy, by which they mean “the right to make moral decisions that affect oneself” that are “free from interference by others.”6 In the medical context, the right to autonomous decision making is seen as belonging primarily to patients. Patients should be free to make decisions about their own health care without interference from others. This right can be seen to be both based on and limited by a Catholic understanding of human conscience.

The right of a patient to autonomous decision making is founded on her right to follow her conscience. To make judgments of conscience and act on them is to exercise the rationality and self-determination that are at the core of human dignity. At the same time, to make well-formed judgments of conscience and act on them it to participate in the wisdom and freedom of God. To prevent a human person from following his or her conscience is therefore to prevent that person from exercising the aspects of his or her personhood that are most authentically human and most approximately divine. Such restriction of personal freedom is usually oppressive and generally to be avoided.

A patient’s autonomy is limited, however, by the involvement of other human beings in that patient’s care. Doctors, nurses, and family members have consciences too. Those who approve, perform, or consent by proxy to a course of action desired by a patient cannot set their own consciences aside. These people are bound by the same duty as the patient both to form and follow their consciences. They, no less than the patient, must follow their honest judgments about what should be done, and thus remain true to their own dignity as autonomous human beings and children of God.

1 Summa Theologiae I, q. 79, a. 13.

2 Veritatis Spendor 41.

3 Gaudium et Spes 16.

4 Catechism of the Catholic Church 1783.

5 Catechism of the Catholic Church 1784.

6 Ashley, deBlois, and O’Rourke, Health Care Ethics 5th ed.,

  p. 257.

The ROAD to EMMAUS: ACCOMPANYING the SICK on their JOURNEY

In recounting the events of Easter Sunday, The Gospel of Luke presents us with the beautiful narrative in which Jesus walks with the two disciples travelling on the road to Emmaus. The disciples were speaking to each other about their sorrow and disappointment about what had happened to Jesus. They “were hoping that he would be the one to redeem Israel” (Luke 24:21). But his crucifixion led them to believe that their hopes had been dashed. The Risen Jesus walks with them unrecognized, opens the scriptures to them and shows them the necessity “that the Messiah should suffer these things and enter into his glory” (Luke 24:26). Then, he reveals himself “in the breaking of the bread” (Luke 24:35). This gospel narrative is marvelously rich and has so very much to teach us. For those of us involved in the ministry of health care, it has something special to teach us. We are invited to understand this gospel account of Jesus’ accompaniment of the two disciples on the road to Emmaus as a model for how we are called to accompany the persons in our care.

One of the words most frequently spoken by Pope Francis is the word “accompany.” To accompany is to be a companion on someone’s journey. When Pope Francis uses this word, he is often speaking about the call to accompany the poor and the needy, to walk with them and assist them in their journey through life.

People who suffer illness and are hospitalized are some of the neediest we are likely to encounter. They are in need of medical care, but they are also in need of comfort, consolation and the assurance that they are not alone in their struggle. They are on a journey. For many, the journey will take them down the path of suffering and fear, but will lead to recovery and health. For some, the hard road of suffering will lead to death and they and their loved ones will need to be assured that the journey will go on and that death is not the end. As disciples of Jesus, how are those of us involved in the ministry of health care to accompany these people?

As always, Jesus is our model. On the road to Emmaus, Jesus accompanies the disciples first of all by listening. “He drew near to them and walked with them” (Luke 24:15). He asks them what they are “discussing as they walk along” (Luke 24:17) and, when they tell him, he inquires further about “what sorts of things” (Luke 24:19) they are referring to. Jesus didn’t draw near to the disciples just to tell them something. He did teach them, but only after he listened to them, taking an interest in their lives, their hopes, and their fears. This is what it means to accompany, to be a companion. We can only walk with a person along the journey of his or her life if we are willing to listen to that person’s story and hear that person’s concerns.

Having listened to the disciples, Jesus opens their minds to the truth of God’s word. “Beginning with Moses and all the prophets, he interpreted to them what referred to him in all the scriptures” (Luke 24:27). This was no mere academic exercise. What Jesus shows them is not just a timeless truth or a correct hermeneutical approach to Sacred Scripture. The truth of God’s word that Jesus reveals provides the answers to the very questions with which the disciples were struggling and shows the meaning and purpose of the events that had so discouraged them. Jesus words address their problems and give new direction to their journey. “They set out at once and returned to Jerusalem” (Luke 24:33). When, having first listened, we have the opportunity to speak to the sick persons we accompany, we are called to do likewise. We are to speak the word of God, expressing the truth that comes from God and not from ourselves. We are to demonstrate how the truth God reveals addresses the concerns of the persons we accompany and gives them new direction and new hope.

After Jesus “spoke to [the disciples] on the way and opened the scriptures to [them]” (Luke 24:32), he stayed with them and broke bread with them. It was only then that “their eyes were opened and they recognized him” (Luke 24:31). When we accompany the sick as disciples of Jesus, we bring the presence of Jesus with us. This is especially true for ministers of Holy Communion. When we administer Holy Communion, Jesus is most truly and really present to the sick persons we accompany. Through that ministry, and in all the ways we are enabled to serve as his ministers to our sick brothers and sisters, Jesus uses us as his instruments to open their eyes to his presence. When we faithfully serve Jesus by accompanying the sick through listening, speaking God’s word, and administering Holy Communion, we can truly say of the persons we accompany what Saint Luke said of the disciples Jesus accompanied on the road to Emmaus: “He was made known to them in the breaking of the bread” (Luke 24:35).

"PEACE BE with YOU": the GIFT JESUS KEEPS ON GIVING

The risen Jesus says to his disciples, “Peace be with you. As the Father has sent me, so I send you” (John 20:21). And again, “Receive the holy Spirit. Whose sins you forgive are forgiven them, and whose sins you retain are retained” (John 20:22-23). Each of these statements is composed of two sentences that communicate a twofold gift. There is the gift of Jesus to those disciples: Peace be with you. . . Receive the Holy Spirit. Then there is the gift of Jesus through those disciples: As the Father has sent me, so I send you. . . Whose sins you forgive are forgiven. Saint Paul says the same thing: “God has reconciled us to himself through Christ and given us the ministry of reconciliation” (2 Cor 5:18). Through Christ, God grants reconciliation to Saint Paul and his fellow apostles and through them to others.

These gifts of God through Christ – His peace, His Spirit, reconciliation with Him – granted to and through the apostles, are likewise granted to and through those to whom the apostles are sent. This further extension of God’s gifts through Christ happens in at least two ways.

One way this happens is through what Catholic Christians call “apostolic succession.” That means the successive handing on of the specific ministry that Jesus entrusted to the apostles – the authentic, Spirit-led ministry of teaching, sanctifying, and governing – that assures the unity of the body of Christ. The beginnings of this successive handing on can be recognized in Saint Paul’s exhortations to Saint Timothy: “Stir into flame the gift of God that you have through the imposition of my hands” (2 Tim 1:6) and, “I charge you in the presence of God and of Christ Jesus . . . proclaim the word . . . convince, reprimand, encourage through all patience and teaching” (2 Tim 4:1-2). In the Catholic Church, that succession is understood to have continued down through time even to the bishops of today.

Another way this happens is through the witness of believers. There are many examples of this in the gospels, but consider the account of Jesus and the Samaritan woman in the Gospel of John (John 4:1-44).  After encountering Jesus at the well, “The woman left her water jar and went into the town and said to the people, ‘Come see a man who told me everything I have done. Could he possibly be the Messiah?’” (John 4:28-29). As a result, “Many of the Samaritans in that town began to believe in him because of the word of the woman who testified” (John 4:39).

One of the great joys of my life as a Catholic priest, Dominican friar, and health care minister is seeing how the people to whom Jesus has sent me have, in turn, been sent to others. Jesus says, “As the Father has sent me, so I send you” (John 20:21). Jesus sends his disciples and Jesus, in turn, sends those to whom his disciples are sent. Jesus is the one who does the sending. He bestows his gifts – including the gift of being sent – through the disciples he sends. But it is he, not they, who is the giver and the sender. I have received the gracious gifts of God through Christ, who has sent me many faithful ministers of his Church and witnesses to his love. I am grateful to all of them, and all of them would gratefully acknowledge that the gifts they bore me were from Jesus and not themselves. Jesus’ gifts to me have included the gift of being sent and the gift of seeing how some of the people to whom Jesus has sent me have, in turn, been sent by Jesus to others.

I would like to share two specific ways in which I am currently able to appreciate this gift. One of these concerns the ordinations to the Catholic priesthood that will take place at St. Dominic’s Church in Washington, DC on May 20, 2017 and at St. Patrick’s Cathedral in New York City on May 27, 2017. I intend to concelebrate both ordinations, joining my brother priests in imposing my hands upon the newly ordained who will have just received “the gift of God . . . through the imposition of” the bishop’s hands (2 Tim 1:6). Eight of those newly ordained priests – three in Washington and five in New York – will have completed our Health Care Ministry Internship Program. I, who along with other Dominican friars and collaborators have helped form these eight men for their future ministry in health care, will be deeply gratified to see them sent forth by Jesus through the grace of holy orders.

Another way that I am privileged to see Jesus sending those to whom he sent me is by visiting sick people in the hospitals we serve. I often encounter people who, through their own experiences of suffering and loss, are given newfound concern for others who experience suffering and loss. Two recent examples: One, I had an unexpected meeting after Palm Sunday Mass with a young woman who, having accompanied her mother through illness and death, is now studying to be a nurse in hopes of helping those who undergo similar suffering. Two, I visited a man who was hospitalized due to complications following a major surgery. He was reluctant to take Holy Communion or pray for himself because of his awareness of others in the hospital who seemed to need God’s blessings more than he did. He agreed to receive Communion if he could offer the graces of that sacrament for the children in the pediatric unit and their families. “As the Father has sent me, so I send you.”

O HAPPY FAULT!

On Easter Sunday the Church is full of rejoicing! That rejoicing is expressed in many ways, but never more beautifully than in the Exultet, the Easter Proclamation, which is sung at the solemn beginning of the Easter Vigil. In the Exultet, Mother Church unites with all heaven and earth in exulting with full-throated gladness in the triumph of our mighty King, Christ the Morning Star, who, coming back from death’s domain, has shed his peaceful light on all humanity. The Exultet names multiple causes for rejoicing. We are invited to rejoice that Jesus wiped clean the record of our ancient sinfulness... banished the darkness of sin... broke the prison-bars of death and rose victorious from the underworld. We cry out, O wonder of your humble care for us... O love, O charity beyond all telling... O truly blessed night! But amidst these jubilant outbursts, the Exultet names something that might not strike us as joyful: O truly necessary sin of Adam...O happy fault!

Why is the sin of Adam necessary? Why is the fault of our first parents happy? And why is it named along with all those other reasons for Easter joy? The answers are right in the Exultet. It sings, O truly necessary sin of Adam, destroyed completely by the Death of Christ! O happy fault that earned so great, so glorious a Redeemer! The sin of Adam was necessary so that it could be destroyed by the death of Christ. Adam’s fault is happy because it necessitated Christ’s redemption. The sin of Adam is greeted with jubilation because it created the problem to which Christ’s redeeming death and resurrection is the solution. It brought on the disease for which Easter is the cure.

To be sure, the sin of Adam is not itself good. It is not, in itself, a cause for rejoicing. It is, rather, an occasion for good. It is the tragic plot twist that sets the stage for the story’s glorious resolution. Our rejoicing is therefore not that Adam sinned, but that, out of Adam’s sin, God brought about a greater good. Indeed, in the redeeming death and resurrection of Christ, God brought to humanity a good far greater than the paradise Adam lost by his sin.

Adam’s fault is happy because it is the occasion for the saving life, death, and resurrection of Jesus Christ. It is the first and most consequential human sin that, as a sickness calls for a remedy, called forth the greatest and most consequential act of love. Adam’s fault is happy because it is a great evil that God turned to even greater good. It shows us how God has turned evil to good in the great story of human salvation that finds its climax at Easter. It can also show us how God can and does turn evil into good in our own lives.

God allowed the evil of Adam’s sin to take place, and God allows evils to take place in our lives as well. Those evils include the harm we do to ourselves through sin, aa well as the harms that come to us in the form of persecution, heartbreak, sickness, pain, and loss. God allows those evils, but only in order to bring about greater goods. Just as God did in the case of Adam’s sin, so He will do for us. That is the faith that we joyfully profess in the light of Easter. It is the faith articulated by the Apostle Paul when he wrote, “We know all things work for the good for those who love God” (Rom 8:28).

Sometimes we can see how God turns evil to good, working all for the good of those who love Him. Sometimes we stand at a vantage point from which God’s redeeming purposes are visible. That is happily the case with the fault of Adam. The Church, standing in the light of Easter, is able to see why God allowed Adam’s sin and to exult in the wonder of God’s providence. That is also the case with some of the events in our lives. All of us can reflect of events in our lives and recognize instances when God has brought good out of evil.

However, sometimes – perhaps most of the time – we cannot see how God brings good out of the evils in our lives. We are not yet at the vantage point from which God’s providential purposes are made visible to us. At these times, we are invited to trust in the God who showed His love for us in the death and resurrection of His only begotten Son. We are called to rely upon the God who has brought untold good out of the sin of Adam and the crucifixion of Jesus and who has turned evil to good in my life and in yours. And we are encouraged to believe that one day we will be led to the heavenly vantage from which we will look back on the entire course of our lives in the radiant light of Easter.

SUFFERING with JESUS who SUFFERED for US

Throughout our lives, and most especially in the season of Lent, the Church invites us to reflect upon and more fully share in the sufferings of Jesus. The practice of praying the Stations of the Cross is a characteristic of this Christian reflection. As we pray the Stations of the Cross, we walk station by station with Jesus as makes his via dolorosa to Calvary. As we go through life, and especially as we pass through Lent, we walk day by day with Jesus on that same journey. In our fasting, our almsgiving and our prayer, we seek to share more and more fully in the passion and death of our Lord, so that we might share more and more fully in his resurrection.

 

We share in Jesus’ suffering by identifying ourselves with him, seeking to enter into Jesus’ suffering so that our suffering can have the same redemptive meaning as his. But sharing in Jesus’ suffering is not primarily about what we do. It’s about what Jesus has done and what Jesus makes possible for us. Our sharing in Jesus’ suffering is only possible because Jesus has shared in our suffering.

 

Jesus shared in our suffering firstly by his incarnation, when he made our human nature his own. In Jesus, the Son of God has become fully human, and he has done so precisely in order to share our suffering. Consider these passages from the Letter to the Hebrews:

He had to become like his brothers in every way, that he might be a merciful and faithful high priest before God to expiate the sins of the people. Because he himself was tested through what he suffered, he is able to help those who are being tested.
— Heb 2:17-18
We do not have a high priest who is unable to sympathize with our weakness, but one who has similarly been tested in every way, yet without sin. So let us confidently approach the throne of grace to receive mercy and to find grace for timely help.
— Heb 4:15-16

Jesus is human like us in every way. He was tempted like us (though without sin); he got hungry and thirsty like us; he felt sorrow and wept like us; he bled and died like us. Jesus knows through experience the full extent of human suffering. And because he is the all-knowing God, he also knows every detail of our personal sufferings. Therefore, he is able to sympathize with us, which means to suffer with us.

 

Jesus also shared our suffering by inviting us to unload our burdens onto him. This invitation comes to us from a gospel passage that I often read when administering the sacrament of the Anointing of the Sick to patients in the health care centers served by Dominican Friars Health Care Ministry of New York:

Come to me, all you who labor and are burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble of heart; and you will find rest for yourselves. For my yoke is easy, and my burden light.
— Matt 11:28-30

Jesus invites us to come to him with our heavy burdens so that he can bear them with us. Jesus doesn’t promise to take our suffering away, but rather to take it on himself and to bear it with us. Yoked to Jesus, we will find that our heavy burdens have become light.

 

Finally, Jesus shares our suffering in his passion and death. John the Baptist calls Jesus “the lamb of God who takes away the sin of the world” (John 1:29). In his passion, Jesus took upon himself the sins of the whole world – the sins that are at the heart of the world’s suffering – much like the sins of Israel were placed upon the “scapegoat” on the Day of Atonement. Like the scapegoat that took the sins of Israel away into the desert, Jesus took away the sins of the world by his death (see Lev 16:20-22). As Saint Paul writes, “Obliterating the bond against us . . . he removed it from our midst, nailing it to the cross” (Col 2:14).

 

In all these ways and more, Jesus shared in our suffering. By sharing our suffering, Jesus enables us to share his suffering. Jesus has yoked us to himself through our baptism, making us members of the Church, which is his body. Jesus has united himself with us so that we can be united with him. He is with us when we suffer so that we can be with him, and so that our sufferings can share in the meaning and the value of his own. 

ASSISTED SUICIDE: the WRONG ANSWER to REAL PROBLEMS

In a recent Reflection (Feb 20), I characterized four common attitudes about death as those of “the secular, the scientist, the suicide, and the saint.” I now wish to suggest that the proposals of the suicide are, in large measure, wrongheaded responses to real problems caused by the prevailing secular and scientific attitudes in our society. The right response to those problems is, of course, that of the saint.

Consider the following:

Death was not an end result Eddie’s doctors discussed or I planned for. There were numerous discussions with social workers and discharge planners about preparation for Eddie coming home, but never once was there a discussion about the very real possibility that he could actually die.
Eddie told every doctor who examined him that he knew that he was dying, and that he wanted to be allowed to return to his favorite place on earth – his home – to die peacefully with his wife and four dachshunds by his side.
As he was wheeled into surgery, the vascular surgeon, who knew Eddie well, stated, ‘I will see you walking into my clinic three months from now on your prosthesis as if nothing had happened.’ Twelve hours later, Eddie was dead.
I was not by my husband’s side when he died, as we had planned. Instead, he died alone, surrounded by machines.

These are excerpts from the testimony of a woman unhappy about the way her husband died and frustrated with the medical culture that, as she sees it, prevented her husband from dying in the way he wished. I found her story on www.deathwithdignity.org, the website of the Death with Dignity National Center, a nonprofit that defends and promotes what it calls, “physician-assisted dying.”

I think this woman’s story bears articulate witness to real problems in our health care system and in our society. We are unable or unwilling to acknowledge the reality of death, even when a person’s death is an imminent likelihood. We are so determined to prevent death that we try every possible life-saving treatment and do not stop trying until it is too late for the dying person and his family to prepare for the kind of death they would have wished for.

These problems are characteristic of our secular and scientific society. We cannot or will not acknowledge death because, according to our secular worldview, it leads to nothing meaningful. We think and speak only about our life in this world because, whether theoretically or practically, we do not consider the life of the world to come to be real or to have real value. We are single-mindedly determined to prevent death because, according to our scientific worldview, science and technology should provide solutions to every problem. When they don’t, we perceive it as a failure: not only a failure for the dying person, but for science and for our worldview – failures we strive to avoid at any cost.

The woman whose story is posted on deathwithdignity.org rightly identifies problems with the ways our secular and scientific society treats, and fails to treat, dying people. Death is a reality that should be acknowledged and prepared for. Death is not something to be prevented at any cost, but to be accepted and welcomed when the costs of life-sustaining treatments have ceased being reasonable.

Nevertheless, this woman wrongly concludes that the answer to these problems is passing “choice laws . . . that embrace the final wishes of the terminally ill to die on their own terms,” when those terms presumably include “physician-assisted dying.” She is right that we should stop ignoring death and trying to prevent it at any cost. She is wrong to think the way to do that is to plan the ideal settings for our suicides.

The better answer is the saintly answer. Rather than trying to describe it, I will ask you to consider a few testimonies from www.judysbook.com about Rosary Hill Home, a facility for terminally ill cancer patients run by Dominican sisters in Hawthorne, NY:

The sisters and staff are like angels on earth. Words can never express the love my brother or our family received during the last few months of his life. God bless Rosary Hill sisters and staff.
The good Dominican nuns provide one on one spiritual and physical assistance to patients . . . What a blessed place!
My brother-in-law received the best possible care [at Rosary Hill] . . . beyond clean, beyond caring staff, beyond allowing the patients to retain their dignity. We were fortunate to have their blessed assistance.

JESUS' KIND of HEALING: the MAN BORN BLIND

The ninth chapter of the Gospel of John relates a healing encounter between Jesus and a man born blind. Let us consider some key passages from this chapter and what they tell us about our healing encounters with Jesus.

As Jesus passed by he saw a man blind from birth ... He spat on the ground and made clay with the saliva, and smeared the clay on his eyes, and said to him, “Go wash in the Pool of Siloam” – which means Sent. So he went and washed, and came back able to see. (John 9: 1, 6-7)

The story begins with Jesus healing a blind man. Jesus’ miraculous healing of this man is one of many such healings that are recorded in the gospels. This healing is notable, however, because of the way Jesus performs it. He doesn’t bring about the blind man’s healing by simply speaking a word. Rather, he uses spittle and clay and water. This is significant for us. Many people pray for Jesus to perform healings now just as he healed the man born blind. Jesus doesn’t just answer those prayers when he performs what we might consider miracles: healings that are beyond medical explanation. He also answers our prayers when he uses doctors and nurses and medicines to bring about healing, just as he used spittle and clay and water in the healing of the man born blind.

They said to the blind man again, “What do you have to say about him, since he opened your eyes?” He said, “He is a prophet.”... [Again] they said to him, “What did he do to you? How did he open your eyes?” He answered them, “I told you already and you did not listen. Why do you want to hear it again? Do you want to become his disciples, too?”. (John 9: 17, 26-27)

The man who was healed of his blindness is repeatedly questioned about the identity of the one who healed him. At first, he doesn’t know who his healer is. Then, upon further reflection, he concludes that he must be a prophet, since he performed the unheard-of healing of a man born blind. Upon yet further reflection, the man reasons that if his healer is a prophet in whom God works such mighty deeds, he should become his disciple. When we experience healing, we are invited to undertake the same process of reflection. If Jesus has healed me or healed my loved one, then he must be a prophet in whom God acts powerfully and lovingly on my behalf. I, therefore, want to become his disciple and want him to become my Lord.

[Jesus] found him and said, “Do you believe in the Son of Man?” He answered and said, “Who is he, sir, that I may believe in him?” Jesus said to him, “You have seen him, the one speaking with you is he.” He said, “I do believe, Lord,” and he worshiped him. (John 9: 35-38)

The illumination of the blind man’s faith is completed when he encounters Jesus for the second time. By now he has begun to believe in Jesus and wants to be his disciple. This is his second encounter with Jesus, but he sees him for the first time. He sees Jesus with his newly opened eyes. There is a double meaning here. His new vision applies both to his bodily eyes and to the “eyes” of his newfound faith. He worships Jesus as his Lord. We too can come to "see" Jesus in this new way. Reflecting on the healing work of Jesus in our lives, we are led not only to deepened understanding, but also to new encounter. When we come closer to Jesus, we find that it is Jesus who has come close to us, confirming our faith and eliciting in us the joy of worship.

Jesus said, “I came into this world for judgment, so that those who do not see might see, and those who do see might become blind.” Some of the Pharisees who were with him heard this and said to him, “Surely we are not also blind, are we?” Jesus said to them, “If you were blind, you would have no sin; but now you are saying, 'We see,’ so your sin remains." (John 9: 39-41)

At the end of this narrative, Jesus declares to the Pharisees what we have already seen in his encounter with the man born blind. The healing that Jesus came to accomplish is first of all a healing of the spirit. It is the enlightenment of faith. This is a healing that everyone needs, though only those with the humility to acknowledge their need can receive it. This is the healing that Jesus comes to accomplish in us. Jesus is concerned first of all with caring for the health of our souls, curing the blindness of our minds. This is the health care we all need most. Unlike the self-assured Pharisees, let us allow Jesus to open the eyes of our hearts. Blind no longer, may we see Jesus for who he is, follow him as his disciples, and worship him as our Lord.

DEATH with DIGNITY

Proponents of physician-assisted suicide have used the term “death with dignity” to present their cause in a positive way. The Catholic Church uses the word “dignity” to articulate the exact opposite view about assisted suicide. According to the Church’s official teaching, “An act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator” (CCC 2277).

The word “dignity” is used in very different ways and assigned very different meanings by those on opposite sides of contemporary disputes about the morality and legality of assisted suicide. “Human dignity” is cited by the Catholic Church as a reason to oppose assisted suicide. The Church uses this phrase frequently when presenting its teachings on the immorality of intentionally harming or destroying innocent human beings. Human “dignity” has a definite meaning in this context, a meaning that is rooted in a Christian anthropology, which is to say, a Christian understanding of what a human being is and what human life is for.

A Catholic Christian anthropology proceeds from the understanding that human life is a gift. As human beings, we are who we are because of how God has made us. We are, as the Bible says, “wonderfully made” (Ps 139:14), unique among the beings of earth in our understanding and freedom. The human being’s unique status (human exceptionalism, if you will) is expressed in many ways in the creation accounts in the Book of Genesis. There, God declares, “Let us make human beings in our image, after our likeness” (Gen 1:26). The Book of Genesis later states, “The Lord God formed the man out of the dust of the ground and blew into his nostrils the breath of life” (Gen 2:7). Uniquely created in God’s image and after God’s likeness, human beings have a value and dignity surpassing all other beings on earth. Gifted with God’s breath of life, human beings are endowed with unique spiritual souls.

According to this Christian anthropology, human dignity is expressed and manifested by its characteristically human activities. Human understanding and free will are especially God-like capacities that show forth the God-imaging quality of the human soul. However – and this is a crucial point – a human being is not accorded dignity because she can demonstrate her humanity through those activities. A human being is accorded dignity simply because she is human. God gives His breath of life to every human being. As human beings, our dignity is based on who we are and the unique and wonderful way in which God has made us. It does not depend on whether or in what degree we are currently able to express our humanity through characteristic activities.

Consequent upon this understanding of human beings and human dignity is the Christian notion of human inviolability. Because human being have the dignity of being God’s image-bearing creatures, human life ought not be violated. This is expressed retributively in God’s words to Noah: “Anyone who sheds the blood of a human being, by a human being shall that one’s blood by shed; for in the image of God have human beings been made” (Gen 9:6). It is expressed more famously in the commandment God issued through Moses: “You shall not kill” (Ex 20:13). Because human beings have the dignity of being made in God’s image, the human being should not be killed.

In contrast to this Christian anthropology is the anthropology in which it is possible to call assisted suicide “death with dignity.” According to this way of thinking, “dignity” is a quality that a human being may or may not possess. To say assisted suicide enables “death with dignity,” implies that, if a person is not made able to kill himself, he might suffer and die without dignity. Dignity, so understood, is not something that human beings possess by virtue of being human. Dignity is accorded to human beings based on what is judged to be their quality of life. A person’s dignity thus depends on his ability to function in characteristically human ways: to think and choose and be a productive member of society.

Those who promote “death with dignity” imply that the lives of those who suffer terminal illness may not be dignified or have worth. The Catholic Christian view is that human dignity is the inalienable possession of every human person whom God has created in His image. The dignity of the dying person is not lessened by the condition of her health. God has gifted her with His breath of life and God will never revoke that gift. 

GOSPEL ETHICS: both COMMANDMENTS FOR US and PROMISES FROM GOD

We have already considered how the ethics of the Christian gospel embrace both rigorous moral standards and extravagant forgiveness of sin. Let us now consider another both/and of gospel ethics: its moral precepts are both commandments and promises. The precepts of the gospel, like “Bless those who curse you” (Luke 6:28), “[Forgive] not seven times, but seventy-seven times” (Matt 18:22), and “Love one another as I love you” (John 15:12), are both obligatory commandments that we must keep and promises of life-giving grace that God will bestow.

Let us consider the moral precept we just quoted from the Gospel of John. Jesus explicitly calls it a commandment: “This is my commandment: love one another as I love you” (John 15:12). Yet Jesus gives this commandment within his discourse about the vine and the branches. “I am the vine and you are the branches,” he says, “whoever remains in me and I in him will bear much fruit, because without me you can do nothing” (John 15:5). The commandment reveals what it means to “remain in me.” He says, “If you keep my commandments, you will remain in my love” (John 15:10). He then sums up his commandments in verse 12, which we have quoted. So, how are we to understand Jesus' commandment? Is loving one another as Jesus loves us something we must do to remain in his love? Or is it something Jesus promises to enable us to do, since without him we can do nothing? It is both/and. The moral precept, “Love one another as I love you,” is both an obligatory commandment for us and a gracious promise from God.

We can recognize the same both/and gospel ethic in Jesus’ Sermon on the Mount. There Jesus issues demanding precept after demanding precept, culminating in the seemingly impossible, “Be perfect, just as you heavenly Father is perfect” (Matt 5:48). As with Jesus’ commandment in John 15, however, Jesus’ complete discourse invests his individual precepts with fuller meaning. In this case, Jesus’ precepts are part of a sermon that begins with his beatitudes and is followed, shortly thereafter, by his words about his own fulfillment of the law and the righteousness required of his disciples. “Do not think,” he says, “that I have come to abolish the law or the prophets. I have come not to abolish but to fulfill” (Matt 5:17). He goes on, “I tell you, unless your righteousness surpasses that of the scribes and Pharisees, you will not enter the kingdom of heaven” (Matt 5:20). Jesus says he is the one who will fulfill the law. How? Surely, by his own righteousness. How are Jesus’ disciples to be righteous? Surely, not by their unaided ability, but by relying on the gracious care of their heavenly Father (see Matt 6:25-34), whose righteousness fulfills the law in the humanity of His Son and promises to fulfill the law in his disciples also. The moral precept, “Be perfect,” is both a commandment and a promise.

The same gospel ethic is evident in the writings of Saint Paul. “Obedient as you have always been . . . work out your salvation in fear and trembling,” he tells the Philippians, “for God is the one who, for his good purpose, works in you both to desire and to work” (Phil 2:12-13). The Philippian disciples are to work in obedience to God’s commandments; God is at work in the disciples to fulfill His good purpose for them. The commandments are both for them to obey and for God to fulfill in them. In his first letter to the Corinthians, Saint Paul assures them, “God is faithful and will not let you be tried beyond your strength; but with the trial he will also provide a way out, so that you may be able to bear it” (1 Cor 10:12). Trials will require the Corinthian disciples to be strong and endure, but their strength will not be enough. Both their endurance and God’s provident care will be necessary.

Saint Thomas Aquinas develops this both/and gospel ethic in his treatment of “The law of the gospel, called the New Law” in his Summa Theologiae. He asks, “Whether the New Law is a written law?” and answers, ”We must say that the New Law is in the first place a law that is inscribed on our hearts, but secondarily it is a written law” (ST I-II q.106 a.1). Saint Thomas says, “The New Law is chiefly the grace itself of the Holy Spirit, which is given through faith in Christ.” Secondarily, it is about “certain things that dispose us to receive the grace of the Holy Spirit, and pertain to the use of that grace.” The Law of the gospel is both about what human beings do in response to written commandments of God, which dispose them for God’s grace and help them make use of it, and – even more so – the Law of the gospel is about what God does in bestowing the grace of the Holy Spirit upon his people.

The ethical precepts of the Christian gospel are both commandments for us and promises from God. This insight not only helps us to understand God’s commandments better. It also helps us to understand God better. God does not fit Jesus’ description of the “scholars of the law [who] impose on people burdens hard to carry, but . . . do not lift on finger to touch them” (Luke 11:46). When God commands, He does not only demand something of us. He also promises to help us with His gifts of grace. So, unlike those scholars of the law, Jesus faithfully represents his Father when he says, “Come to me . . . for my yoke is easy, and my burden is light” (Matt 11:30).

LENTEN PENANCE: SUFFERING in UNION with CHRIST

Throughout the forty days of Lent, the Church invites us to practice penance by praying, fasting, and giving alms. As the gospel reading for Ash Wednesday (see Matt 6:1-6, 16-18) reminds us, that penance is not meant to be a matter of merely external observances, but is to proceed from a true conversion of heart that our outward observances are meant to express. Conversion of heart leads us to joy and the fulfillment of God’s loving purpose for our lives. For sinners like ourselves, however, conversion of heart also involves suffering. The Catechism of the Catholic Church says, “Conversion of heart is accompanied by salutary pain and sadness” (CCC 1431). That is because, “It is in discovering the greatness of God’s love that our heart is shaken by the horror and weight of sin and begins to fear offending God by sin and being separated from him” (CCC 1432). It is that interior suffering that we express outwardly in our penitential practices of prayer, fasting and almsgiving.

Acts of penance express the sorrow for sin that is the fruit of the conversion of our hearts. Acts of penance are also ways that we seek to make satisfaction for our sins, to make amends for the ways in which our sins have caused harm to others and to ourselves. Making satisfaction for sin through penance, however, is not something we do by ourselves. Jesus is the one who has atoned for the sins of the world and our acts of penance are only efficacious through his grace and in union with his sacrifice on the cross.

Jesus’ saving sacrifice is all sufficient for the redemption of the world and the atonement of the world’s sin. The only thing that is lacking in the suffering of Christ is our participation in it. It is in this way that we are to understand the words of Saint Paul: “I rejoice in my sufferings for your sake, and in my flesh I am filling up what is lacking in the afflictions of Christ on behalf of his body, which is the Church” (Col 1:24). It is not as though Jesus needs our suffering because his suffering wasn’t enough; it is that Jesus invites us to suffer with him so that we can participate in his work of salvation.

Penance is a way in which we share in Jesus’ own sorrow for our sins and the sins of the world. Recall Jesus’ words in the garden of Gethsemane: “My soul is sorrowful even to death. Remain here and keep watch with me” (Matt 26:38). Jesus suffered agony as he prepared to take upon himself the weight of the world’s sin and he invited his disciples to share that agony with him. When we do penance, that’s what we are doing. We are sharing in Jesus’ suffering. What is more, we are sharing in the purpose of Jesus’ suffering: the redemption and expiation of sin that Jesus accomplished for the sake of his body, which is the Church. By our penance, we participate in the saving sacrifice of Jesus that atones for our sins and the sins of the world.

The penitential practices that we adopt in the season of Lent are voluntary acts of self-denial. They help to unite us with Christ and with his saving passion. But they are not the most important forms of penance. More important than the penances we willingly impose upon ourselves are the sufferings that are imposed on us against our will, but which we willingly accept and offer to God as penance. Penance, as the Catechism says, “can consist of prayer, an offering, works of mercy, service of neighbor, voluntary self-denial, sacrifices, and above all the patient acceptance of the cross we must bear” (CCC 1460).

In the hospitals served by Dominican Friars Health Care Ministry of New York, I frequently hear the confessions of patients who are suffering from serious illnesses, invasive surgeries, and aggressive treatments. The celebration of that sacrament includes the imposition of a penance. And while I may ask patients to say an “Our Father” or “Hail Mary” when they have a moment of peace, I always tell them that the most meaningful penance that they will be doing is to endure their suffering patiently in union with Christ.

In our observance of the season of Lent, we are invited to do the same: to endure the suffering and pain that comes our way and to make of it a penitential offering to God together with Jesus, who suffered torture and death for the forgiveness of our sins. Whatever sorrow is ours to bear, let us bear it as an expression of our sorrow for our sins, offering it in union with Christ, who, for our sake, was “sorrowful even to death.” Not least, let us remember our brothers and sisters who suffer physical pain and mental anguish that is often far beyond the measure of our own suffering. Let us pray for them and practice works of penance on their behalf. Let us pray that their suffering may be alleviated and that the suffering that they must endure they may endure with patience and with Jesus. In his name and through his cross, may the sorrow and suffering that is theirs and ours “produce good fruit as evidence of repentance” (Luke 3:8).