FAUSTO GOMEZ OP

Bioethics is life ethics or the ethics of human life from its beginning to its end. As a normative science, bioethics is concerned with the ethical problems connected with life, health, illness, and death. It is the ethical dimension of the life sciences.

In our globalized world, bioethical problems and dilemmas are to be addressed today – and the new coronavirus is making it totally clear – globally and grounded on ethical universal principles and values. We address the bioethical problems related to the Covid-19 pandemic from a global perspective.  

We reflect first on the bioethical dimension of the novel coronavirus in general and second on the dramatic dilemma posed by the scarcity of resources - of ICUs (Intensive Care Units), of ventilators, or assisted respiration.

BIOETHICAL GUIDELINES

Every human person is an individual and a social being. He/she possesses a precious unique dignity and inviolable rights, which are not given by others – by civil or religious authorities – but are inherent in the nature of the human person. The human person is the center of all ethical and bioethical concerns. Every human being, an ethical being, has unique and excellent dignity, which may be described as the possession of human rights that are inviolate: the right to life, to freedom, to the pursuit of happiness, etc.  

Certain universal ethical principles guide decisions concerning human life, in particular the principles of respect for every human being, for his/her dignity and rights. Essential values that help us practice respect for every human being:  life, freedom, justice and solidarity, truth, and the common good. At times, there may be a conflict among principles, for instance in the case of the coronavirus and other pandemics there is the tension between the principles of personal human rights and rights and the common good.

THE USE OF MECHANICAL VENTILATORS

The main ethical dilemma here, particularly for healthcare professionals, is selecting among patients who should use the insufficient intensive care units (ICUs), including ventilators. The dramatic decisions to be taken ought to be according to basic and universal bioethical principles grounded on human dignity and rights and the common good.

            The main principles to guide us are justice, solidarity, and fraternity. Justice speaks of equality: to give to each person what is due to him or her, radically his/her rights. Solidarity leads us to work for the common good. Fraternity takes all humans as brothers and sisters, in a particular way the wounded on the roads of life, the affected by Covid-19.

All human beings are equal in dignity and rights and therefore “equal cases deserve equal treatment.” Unfortunately, as it happens in this pandemic and others, there are not enough ventilators needed by patients in serious condition: the demand of needed treatment is much greater than the supply of available means; there are too many patients for the use of an insufficient number of ICUs needed. In this case, experts speak of the painful application of the principle of catastrophic justice to decide who should be incubated and who cannot be.

Before applying the proper principles for a fair selection of patients, all other possible options should have been taken, so that rationing becomes the last and only option. What are the other possible options? Our experts mention the following: caring for patients in serious condition cannot be provided by other means; the patient cannot wait until a ventilator is available; a ventilator cannot be used by two or more patients at the same time; the patient to be discarded cannot be taken to another hospital with the required ICUs and ventilators; the relocation of other medical means destined to other patients who are not fighting for life is not possible, etc. We repeat: it is understood that the ICU is used in emergency situations and for patients that really need it and cannot be treated otherwise.

So the number of ventilators is not sufficient to cover the greater number of patients who need them. Among them, whom to give priority? This is not a new question. It was also the question in other pandemics and catastrophes from nature, and in wars. In wars: to choose among the many wounded whom to save, considering that not all could be treated by the few available doctors and nurses and facilities. It is also a problem regarding organ transplants: the demand is much higher than the supply. To whom may the kidney be given? PAV states: “The search for treatments that are equivalent to the extent possible, the sharing of resources, and the transfer of patients, are alternatives that must be carefully considered, within a framework of justice” (Pontifical Academy for Life, Global Pandemic and Universal Brotherhood. Note on the Covid-19 emergency, March 2020).

PAINFUL SELECTION OF PATIENTS

What are the criteria for selecting some patients over others? The general ethical principle applied in these rationing situations is the so-called triage selection. Triage is usually defined as “the process of deciding which patients should be treated first based on the degree of sickness or severity of the injury.” Selecting some patients entails excluding others. The Pontifical Academy for Life writes: “In such cases, after having done at an organization level everything possible to avoid rationing, it should always be borne in mind that decisions cannot be based on differences in the value of human life and the dignity of every person, which are always equal and priceless.  The decision concerns rather the use of treatments in the best possible way on the basis of the needs of the patient, that is, the severity of his or her disease and need for care, and the evaluation of the clinical benefits that treatment can produce, based on his or her prognosis.” 

Writes an expert on bioethics: “An initial criterion for making this selection would be the possibility of obtaining a significant benefit and reversibility of the severity of the condition in the treatment of recipients, in whom invasive mechanical ventilation, for example, would be indicated. Careful assessment of the chances of survival of these patients and the magnitude of the sequelae they may suffer as a result of the progress of their disease is needed. Accordingly, those with the best prognosis for recovery and survival with the minimum of sequelae would be selected” (Julio Tudela, Instituto Ciencias de la Vida. Observatorio de Bioética, April 11, 2020).

The application of the principle of utility (utilitarianism), of social usefulness, may be discriminatory. One unethical possibility – unfortunately a reality in some places – is discrimination against some groups of affected patients such as the elderly and the disabled. Let us listen to the answer of experts on the matter. First the Pontifical Academy for Life: “Technical and clinical means of containment must be integrated into a broad and deep search for the common good, which will have to resist a tendency to direct benefits toward privileged persons and neglect of vulnerable persons according to citizenship, income, politics or age… Age cannot be considered the only, and automatic, criterion governing choice.  Doing so could lead to a discriminatory attitude toward the elderly and the very weak.” Tudela puts it briefly: “The application of other criteria in a discriminatory manner, such as the age of the patient or other circumstances such as psychiatric disorders, dementia or any other forms of disability or dependency, would not be bio-ethically acceptable, because it would mean acting against respect for the dignity that every human being possesses.”

PALLIATIVE CARE

The medical/ethical decision to exclude some coronavirus infected patients from using the ICUs they need is not a form of euthanasia, but usually a painful decision, part of the only possible medical/ethical option. The infected patients excluded from the use of mechanical ventilators should continue hospitalized, when possible: a hospital offers much better care than a nursing home, especially the needed palliative or comfort care.

Palliative care includes medical, social and spiritual care: doctors and nurses address mainly the health problems and pain; close relatives and significant others, provide “a warm heart” that fights the possible loneliness of patients, and priests and pastors care for the spiritual wellbeing and peace of the patients. In the context of the new coronavirus, the Spanish Bioethics Committee (April 2020) suggests that at least a close relative of the dying patient should accompany him or her.  “This accompaniment and the spiritual and religious support constitute part of the rights of the patient.” Our Christian faith favors and practices as much as allowed, those suggestions based not only on our humanity but in the praxis of the Church throughout the ages. They are expressions of the merciful love lived and taught by Jesus Christ who had a special love for the vulnerable, in the case of Covid-19 the elderly and disables.

Before ending our reflection, let us underline the importance of two ethical principles: solidarity and subsidiarity. The principle of solidarity (justice and love of neighbor) is witnesses with al, principally with the most vulnerable in our societies and communities. Subsidiarity comes from subsidium, which means “assistance,” “help.” Both principles are usually together: “Solidarity without subsidiarity, in fact, can easily degenerate into a ‘Welfare State’, while subsidiarity without solidarity runs the risk of encouraging forms of self-centered localism.” Hence the State’s role in society must neither be invasive nor absent” (Pontifical Council for Justice and Peace, CSDC, 351). Situations of emergency, states of alarm, or exception ought not to be prolonged more than necessary.

May this tragic tsunami of the coronavirus Covid-19 help us all to be more open to others, to help the needy and most vulnerable, and to practice solidarity and fraternity! As one family, we can get out of this pandemic more co-responsible, more humble and wiser. We hope and pray!

In the Sermon on the Mount, Jesus invites his followers to perform the three habitual practices of penance of the Jews: prayer, fasting and almsgiving (cf. Mt 6:2-7, 16-18). From then on and up to now, the three penitential practices have become for Christians the traditional and classical practices of the liturgical season of Lent.

THE VIRTUE OF PENANCE

The radical goal of Lent is to be closer to Christ, to the Crucified and Risen Lord; to let Christ rule our lives (“It is Christ who lives in me” - St. Paul), to be an authentic disciple, that is, to be “constantly ready to bring the love of Jesus to others” (Evangelii Gaudium, 127). To be able to bring Jesus’ love to others, we need to possess his love and for this to happen, we need to be repentant. Lent is the appropriate time to be deeply sorry for our sins, to receive the pardon and love of God and, in turn, to give to others our pardon and Jesus’ love.

Saint John XXIII writes in his diary: There are two paths to paradise: innocence and penance. We have lost our innocence, so the path open to us is penance. Lent is the journey of penance to the celebration of the great mystery of our faith. Pope Francis tells us in his Lenten Message (2020) that Lent is “a favorable time to prepare to celebrate with renewed hearts the great mystery of the Death and Resurrection of Jesus.” The virtue of penance renews our hearts, our loves.

Connected with the cardinal virtue of justice, penance is a great virtue: a success in self-realization, a good operative habit or strong disposition of the soul that inclines the possessor to perform acts of penance. Penance is ordered to the destruction of sin as an offense against God, neighbor, and creation.

The virtue of penance is a permanent attitude of Christian life. Lent is the season of penance. Through 40 days Christians are asked by their faith, by Mother Church to practice in a deeper way the good habit of penance, which is mainly interior penance centered on repentance: a firm disposition of the soul to renounce sin and return to God, a permanent inclination to change our lives following the way of Christ, the way of his life, death and resurrection.  

The basic penance is greater fidelity to our vocation and mission. “If you just are what you ought to be, you will set the whole world on fire” (St. Catherine of Siena). The Constitution of the Dominicans says: Imitating St. Dominic…, the brothers should practice the virtue of penance especially by observing faithfully all that belongs to our life. For the Dominican family, for all the Disciples of Christ really, the principal forms of penance are: the performance of spiritual exercises, works of mortification or self-denial, and works of benefit to the community. This is really another way of saying: prayer, fasting and almsgiving.

PRAYER, FASTING AND ALMSGIVING

Interior penance, “the habit of the heart,” inclines us to perform external penances that in turn, deepen penance in our hearts. The virtue of penance as continuing conversion disposes us to practice in particular the traditional penances of prayer, fasting and almsgiving. These penances help us re-establish and fortify our relationship with God through prayer, with ourselves through fasting and abstinence, and with others through almsgiving or mercy.

The Fathers of the Church (from first to eighth centuries), pre-eminent representatives of Christian Tradition, speak powerfully of the three classical expressions of penance, namely, prayer, fasting and almsgiving. For the Fathers of the Church prayer is presented as directed to fasting and almsgiving. St Cyprian (200-250) speaks of fruitful and fruitless prayer. Prayers that produce no fruits are prayers without good deeds: “Prayer with no good works is not effective. Prayer is good with fasting and almsgiving. For he who on the day of the last judgment will reward good works and almsgiving, today also listens favorably to prayers which come from good deeds.” Fasting to be a good deed must be accompanied by almsgiving or mercy. Fasting without almsgiving is useless on the way to heaven; it is insufficient as John Chrysostom, Ambrose and Augustine tell us. St. Peter Chrysologus (406-450) writes: “Prayer, mercy and fasting constitute one thing only, and they fertilize reciprocally. Fasting is the soul of prayer, mercy is the lifeblood of fasting… They cannot be separated. So if you pray, fast; if you fast, show mercy; if you want your petitions to be heard, hear the petitions of others… He who does not fast for the poor fools God. Give to the poor and you give to yourself.”

Today we need a new expression of fasting: technological fasting to fight technological addition. This needed kind of fasting contributes to having more interior silence, “prayer in secret”- as Jesus recommends to us. In silence, we may hear God’s voice.

We are pilgrims on the way to eternal life. On the way to happiness, to holiness, to the joy of Easter, three things are essential, namely, prayer, fasting and almsgiving. Fray Luis de Granada (1504-1588) explains that we do need the three in our lives: Prayer because it connects us with God; fasting or mortification because it puts order in our lives (St. Augustine’s saying - “The body under the spirit, and the spirit under God”); and almsgiving because it connects us with our neighbors, in the first place with the needy and poor. Penance, we may add, also connects us with God’s creation that we have to care and cultivate and not exploit or destroy.

ALMSGIVING AND FORGIVING

The Lord says: “Forgive, and you will be forgiven; give, and it will be given to you” (Lk 6:37-38). Compassion or mercy – an effect of charity with peace and joy - is the most important virtue in relation to others. Mercy comprises not only the corporal work of mercy but also the spiritual work of mercy. Thus, St. Isidore of Seville (c. 560-636) speaks of two kinds of mercy: corporal, or to give to the needy all you can; and spiritual, or forgiving the one who offended you. St. Isidore comments: the first, that is the corporal work of almsgiving, is practiced with the indigent; and the second, that is the spiritual work of forgiving others, is practiced with sinners. Thus, he ends, “you will always be able to give something: if not money, at least forgiveness.” Another meaningful comment from St. Augustine (354-430): “Let us give graciously and fervently perform these two types of almsgiving, that is, giving and forgiving, for we, in turn, pray the Lord to give us good things and not to requite our evil deeds

What is the kind of penance, of fasting that the Lord wants us to do? The Lord keeps answering us through his prophet Isaiah: God wants a fasting that breaks the fetters of injustice, that shares food with the hungry, that brings to your house the unsheltered needy, that clothes the man you see naked, and does not turns away from your own kin (cf. Is 58:6-7). In this context, we remember Jesus’s parables of the rich man and poor Lazarus (cf. Lk 16:19-31) and of the last judgment (cf. Mt 25:31-46).

What do the three traditional forms of penance mean to you, to me? It is my Lenten responsibility to practice them. Regarding prayer, I will seriously try to pray better: more attentively, more devoutly and, perhaps, add one new prayer to remind me of Lent. Concerning fasting, I will attempt at mortifying my senses and my passions, live a simple life style, and give up something to be able to share what I did not spent with the poor and, of course, fulfill the norms of fast and abstinence. Checking my mercy (almsgiving), I shall share, hopefully, a percentage of my monthly allowance or salary with the poor around and/or beyond me.

May prayer, fasting and almsgiving deepen the virtue of penance in our hearts and lead us to approach, if possible, the Sacrament of Penance or Reconciliation. The virtue of penance entails “The will to receive the Sacrament of the forgiveness of sins” (K. Rahner), including, our sins against God, neighbors, the poor neighbor and creation

Through God’s gift of Lent, let us continue striving to pray better, fasting to be temperate and sharing through almsgiving and forgiving. Lent reminds us that we are dust and in dust we shall return. Yes, but more importantly, Lent leads us to Easter through the passion, death and resurrection of Christ. Through Lent, we do not forget that we are Easter people and alleluia is our song!

Mary, our Mother of mercy, pray for us!

By F. Fausto Gómez, OP.

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One of the favorite themes of Pope Francis, especially in all his visits, is the elderly and their essential importance in the Christian community and in society. His latest message on the topic came on January 31, 2020 at the Vatican.

            The First International Congress on the Pastoral Care of the Elderly took place on January 29-31, 2020, at theAugustinianum Congress Center in Rome. The concrete theme of the congress was “The Richness of Many Years.”The pace-setting congress was organized by the Vatican Dicastery for the Laity, Family and Life. Ascending Life, the association and movement of the Elderly in the Church helped prepare the Congress. We are told that about 550 experts and pastoral agents from 60 countries participated in the international encounter.

            On the last day of the congress, January 31, Pope Francis received the participants in audience at the Vatican.  The Pope’s remarks then have been described as “dramatic.” They are part of the love story of the Argentine Pope with the elderly. Let me present its highlights and add other teachings from Pope Francis.

            THE ELDERS ARE MANY

            Old age is “one of the distinctive features of humanity in our days.” The elderly are many worldwide, to the point of having inverted the so-called “demographic pyramid”: once this pyramid rested upon a large number of children and young people and had at the top just a few elderly people. Currently, it is the opposite. Thus, the “enormous presence” of elderly persons “constitutes a novelty for every social and geographic environment worldwide.”

            The elderly have to be taken seriously and responsibly by society and the Church.  As part of humanity, the old persons have an “irreplaceable role.” Pope Francis tells his audience: “God has a large population of grandparents throughout the world.”

            Old age is perceived in different ways: “For many, it is the age in which productive efforts cease, strength declines and the signs of illness, the need for help, and social isolation appear; but for many, it is the beginning of a long period of psycho-physical well-being and freedom from work commitments.” The weak and vulnerable are to be treated – like every human being, young or old - as end and not as means: not to be exploited, ostracized, abandoned, or disposed of by a culture of waste (cf. Pope Francis, Amoris Laetitia, AL, 51, 128).

MISSION OF THE ELDERLY

            Pope Francis proclaims: “The richness of many years is a richness of people, of each individual person who has many years of life, experience, and history behind them.” The Pope adds: “It is the treasure that takes form in the journey of life of each man and woman, whatever their origins, provenance, and economic and social conditions. Life is a gift, and when it is long it is a privilege, for oneself and for others.”

            How to live well the final stages of life? The Bible, Pope Francis tells u, helps us answer the question. It considers old age as a blessing for the family and the community. For believers – and for many others adhering to traditional religions and cultures -, old age is a blessing from God and a time given by Him “to deepen our knowledge of Him, our intimacy with Him,” and our surrender to Him. It is a time to prepare for the final lap of the race of life “with childlike trust.” Moreover, old age is “a time of renewal and fruitfulness” – as it was for old Abraham and Sarah, for Zechariah and Elizabeth, for Simeon and Anna. “The elderly person, even when he is weak, can become an instrument of salvation history.”

            An innovative idea: Pope Francis speaks of the important role of the elderly in society and the Christian community today and tomorrow: the elderly not only have a past, but also a present and a future. He invites us all “to change the tenses of the verbs a little.” The seniors “are also the present and the future of the Church.” In the Christian community, the Lord wants the elderly to write with him “new pages of holiness, of service, of prayers…”

            THE OLD AND THE YOUNG

            Pope Francis calls all, young and old, “to learn to grasp and to appreciate the value of old age.” States“must learn to face the new demographic situation on the economic level.” Civil society “needs values and meaning for the third and fourth ages.” It has to make a room for the elderly, and hear their cry (cf. AL, 191-192) – and not abandon them: “The gravest sickness of the elderly is their abandonment” (Evangelii Gaudium, EG, 75). 

The Church has to expand the pastoral horizons of the elderly: giving them not only pastoral care, but also providing a “substantial presence in our parishes and societies.” In this aspect, “we need to change our pastoral habits in order to respond to the presence of so many elderly people in families and communities.” The elderly are “actors in a pastoral evangelizing ministry, privileged witnesses of God’s faithful love.”

The Pope said to the participants in the congress – and to all evangelizers: “I ask you not to spare yourselves in proclaiming the Gospel to grandparents and elders. Go to them with a smile on your face and the Gospel in your hands. Go out into the streets of your parishes and seek out the elderly who live alone. Old age is not an illness, it is a privilege! Loneliness can be an illness, but with charity, closeness and spiritual comfort we can heal it.”

One idea that is recurring in the writings and addresses of the Holy Father is intergenerational dialogue. In the Message to the Congress, Pope Francis underlines “Intergenerational sharing.” It is really important that the elderly and the young speak to each other, and prophecy and dream together. In this secularized world in which we live, grandparents pass to their grandchildren “Christian formation and living faith.”

Pope Francis says to the elders: “Young people need you, you are essential, so talk to your grandchildren” (Pope Francis, Address, October 17, 2016). All persons have to listen to the elderly: they “bring us memory, the wisdom of experience – and hope” (EG, 108).

CONCLUSION

Pope Francis closes his message on pastoral care of the elderly and by the elderly encouraging the participants of the congress to continue working with others to widen the positive perception of the elders as active citizens and evangelizers in our world: “I hope that what is today the sensitivity of the few will become the patrimony of every ecclesial community. Do not be afraid, take initiatives, and help your bishops and your dioceses to promote pastoral service to and with older people. Do not be discouraged, keep going!”

As usual, the Holy Father asked the participants to pray for him. I remember what Pope Francis, an elderly person himself, had said on another occasion: “Pray that my old age is tranquil, religious and fruitful - and also joyful.” We all join him in praying for the elderly in our midst – and for one another. And to the Lord: “In my old age, do not abandon me; do not forsake me when my strength is spent” (Ps 71, 9).

By Fr. Fausto Gómez, OP.

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