The Promotion Of Social Justice In The World Of Health As A Constitutive Dimension And A New Mission Of The Ministers Of The Infirm Philippine Province

PONTIFICIA FACOLTÀ TEOLOGICA TERESIANUM Istituto Internazionale di Teologia Pastorale Sanitaria Camillianum

THE PROMOTION OF SOCIAL JUSTICE IN THE WORLD OF HEALTH AS A CONSTITUTIVE DIMENSION AND A NEW MISSION OF THE MINISTERS OF THE INFIRM PHILIPPINE PROVINCE A Licentiate Dissertation

Student: Aristelo D. Miranda, M.I. Moderator: Luciano Sandrin, M.I.

Roma 2008

TAB LE O F C O NT E N T S pages Acknowledgement

…………………………………………………………

4

Acronyms and Abbreviations ………………………………………………...

5

INTRODUCTION

7

………………………………………………………….

I. A BIRD’S EYE VIEW OF THE PHILIPPINE HEALTH CARE SYSTEM AND THE CAMILLIAN SOCIO-HEALTH INITIATIVES ……………... 10 1.1. Overview of the Health Care Situation in the Philippines ……………. 1.1.1. Geographic and Demographic Characteristics

10

…………………….

10 1.1.2. Health Status ……………………………………………………

11

1.1.3. Organization of Health Care System …………………………....

13

1.1.3.1. Health System Reforms

…………………………………....

14

1.1.3.2. Human and Material Resources for Health ………………….....

18

1.1.4. The Ministers of the Infirm’s Socio-Health Initiatives

………….....

20 1.1.4.1. From Charity to Bureaucracy, the Dilemma of the Institutional Ministry …………………………………….

20

1.1.4.2. Towards a Dynamic and Empowering System of Ministry ……..

21

1.2. The Underview: The Effect of Neo-Liberal Globalization Policies 1.2.1. The Health Reform Agenda of the Government

……..

22

………………….....

23 1.2.2. The WTO as the Front Liner of Neo-Liberal Globalization ………….. 25

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.

1.2.2.1. TRIPS Agreement

…………………………………………....

1.2.2.2. Privatization of Health Services 1.3. General Observation

II.

26

…………………………….

27

…………………………………………………....

29

REDISCOVERING THE FUNDAMENTAL BASIS OF SOCIAL JUSTICE AND ITS IMPLICATIONS TO PASTORAL HEALTHCARE MINISTRY

……………………………...……………………………

32

2.1. The Core Elements of Justice as Constitutive to the Ministry ……………

33

2.1.1. From the Core of our Biblical Faith ..…………………………………. 33 2.1.2. Theological Reflection ………………………………………….... 2.1.3. Our Mission as Church People

36

……………………………………

39 2.2. The Tripod of Social Justice

……………………………………………

43

2.2.1. Human Dignity……………………………………………………

44

2.2.2. Human Rights ……………………………………………………

47

2.2.3. The Common Good

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50 2.2.3.1. The Principle of Universal Destination of Goods …………….

50

2.2.3.2. Health as the Primary Good ……………………………………

51

2.3. Renewing the Camillian Fervor of the Promotion of Social Justice

…….

2.3.1. The Signs of the Time …………………………………………… 2.3.2. The Response to the Urgency: A New School of Charity

53 54

…………….

55 2.3.2.1. Anthropological Vision

……………………………………

2.3.2.2. The Respect for Dignity and Freedom

……………………

56

……………………………………

57

……………………………………………………

58

2.3.2.3. The Prophetic Vocation 2.4. General Observation

55

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III.

TOWARDS A NEW PARADIGM OF WITNESSING THE MERCIFUL LOVE OF CHRIST IN THE WORLD OF HEALTH

…………….

61

3.1. A Justice-Animated Spirituality ……………………………………………

62

3.2. From Competent Love to Prophetic Witnessing

……………………

66

3.2.1. The Camillian Prophetic Vocation ……………………………………

67

3.2.1.1. Characteristics

……………………………………………

67

3.2.1.2. Methods and Forms ……………………………………………

70

3.2.2. Preferential Love for the Poorsick ……………………………………

72

3.2.2.1. The Semantic Problem

……………………………………

72

3.2.2.2. The Demands of the Option ……………………………………

74

3.2.2.3. The Orthopraxy of Preferential Love for the Poorsick ……..….

77

3.3. Solidarity and Social Commitment 3.3.1. Our Point of Departure

……………………………………

79

……………………………………………

80

3.3.2. The Desire for a Hundred Arms

……………………………………

82

3.4. Towards a Developmental Paradigm of Health Ministry ………………….

84

3.4.1. Advocacy as Prophecy

……………………………………………

85

3.4.2. The Imperative of Social Analysis ……………………………………

87

3.5. A New Paradigm For a New Vision of Life

……………………………

90

GENERAL CONCLUSION ……………………………………………………

94

BIBLIOGRAPHY

97

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AC K N OWLE D G M E NT

I wish to acknowledge the persons and communities that made this dissertation possible, thought provoking and inspiring. To my moderator Fr. Luciano Sandrin, M.I. who took time and effort in safeguarding and correcting the ideas and flow of thought of the presentation. To my technical consultant Fr. Eugenio Sapori. M.I. who zealously corrected the arrangement of the schema, footnotes and bibliographies. To my community Blsd. Enrico Rebuschini whose enthusiasm has challenged me to work hard and pursue deadlines expected. To UMANGAT, Migrante and other Filipino migrant communities in Rome who gave me the chance to share in their daily struggles that made me aware of so many brilliant ideas that contributed to the build up of this dissertation. To my confreres, co-workers and friends in St. Camillus Hospital – Calbayog community, who gave me the impetus to translate into writing my experiences and reflections during my two years of stay in that community. To all of my superiors, who shared material and moral support to this endeavor. And above all, to the ever-present God who always strengthened and helped me to find him into those situations where He is least expected, in situations of injustices. Let it be remembered then, that the true promotion for social justice does not end in writings but in translating it into the day-to-day experience with others especially the most vulnerable.

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ACRONYMS & ABBREVIATIONS CA

Centesimus Annus

CBCP

Catholic Bishops Conference of the Philippines

CBEW

Catholic Bishops of England and Wales

CCC

Catechism of the Catholic Church

CD

Documents of the General Chapter

CICL/SAL

Congregation for Institutes of Consecrated Life and Societies of Apostolic Life

CJSWH

Commission for Justice and Solidarity in the World of Health

CL

Christifidelis Laici

CSDC

Compendium of the Social Doctrines of the Church

DCE

Deus Caritas Est

DOH

Department of Health

EJFA

Economic Justice for All

EN

Evangelii Nuntiandi

FABC

Federation of Asian Bishops Conference

GS

Gaudium et Spes

HSRA

Health Sector Reform Agenda

IMF-WB

International Monetary Fund – World Bank

JW

Justice in the World

MI

Ministers of the Infirm (Camillians)

MM

Mater et Magistra

OA

Octogesima Adveniens

PCJP

Pontifical Council for Justice and Peace

PCP II

Second Plenary Council of the Philippines

PP

Populorum Progressio

PT

Pacem in Terris

RA

Republic Act

SAP

Structural Adjustment Plan

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SRS

Sollicitudo Rei Socialis

SS

Spe Salvi

ST

Summa Theologica

UDHR

Universal Declaration of Human Rights

UN

United Nations

USCCB

United States Conference of Catholic Bishops

VAT II Second Vatican Ecumenical Council WHO

World Health Organization

WTO

World Trade Organization

art.cit.

articolo citatum (article cited)

Cf.

Confer

Const.

Constitution

e.g.

exempli gratia (for example)

ed/s

editor/s

et. al.

et alii (and others)

ibidem.

the same place

idem.

the same person

i.e.

id est (that is)

n.

number

nn.

numbers

op.cit.

opus citatum (the work cited)

Php

Philippine Peso currency

trans.

Translation

$

US dollar currency

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INTRODUCTION The present condition of the Philippine health care system reveals two major threats to the growing number of Filipinos who live with less than $2.00 a day. These are the new socio-economic political order infused with neo-liberalist principles, and the revenueoriented (a disguised for profit) health care system that breeds deprivation of health resources and services to the majority poor. These two are characterized by a dynamic relation of cause and effect, and the inherent contradictions that exist within the system itself.

The entry of the neo-liberal globalization policies in the developing nations,

particularly the Philippines, played a major role in the unequal distribution of health resources (human and material), and paved the way towards commercialization of health. From the year 2000, a massive privatization of public tertiary and specialized hospitals had taken place in the major urban centers of the country. This has been carried out by the government in the name of revenue enhancement, and upgrading of standard of services as one of the finest in Asia. But, its net effect is the gross deprivation of the majority of its populace to health services. Coupled with the ailing economy and the commercialization of health services, some health institutions run by religious congregations were forced to adapt certain measures that ended up in a compromise to their ideals of charity, while a good number have closed down their services. The language of marketing and revenue strategies replaces the language of offering to the least without counting the cost of services. The philosophy of health management replaces the classical form of administration of goods in the name of charity. Religious health institutions, as used to be the expression of the great charity and ideals of love and service have turned into profitable institutions for the congregations’ economic sustenance and survival. These changes have taken place not because they want it to be but because the prevailing socio-economic order forces them to move along the line of establishing financial capability and stability. This situation greatly affects the ministry of the Ministers of the Infirm of the Philippine Province. Confronted by this dilemma of administering charity in an environment where profiteering is the name of the game, and the desire for an adequate

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financial stability, the religious are challenged to discern and act according to these signs of the times. The demand of “prudence” of one’s action, and the desire to respond to the urgency as modern day prophets in the world of health raise some problems to be resolved. The issue of “prudence” arises when one fails to distinguish between social activism and active ministry. Thus, there is a need to re-establish the foundational principles and renewing the grounds of witnessing the merciful love of Christ in the ministry. This dissertation will attempt to establish some important foundational principles that will serve as the backbone and parameters of actions (responses) according to the respective and unique social situation. The presentation will follow a systematic and dialectical framework of reference using the method of pastoral theology that elucidates the action of the Church to the urgencies of the time, and the lived experience of the “here” and “now” of the community1. Its dialectical framework follows a certain systematic order. It begins with the perception of the reality. It responds to the question of what is happening here. The second moment is the analysis of the perceived reality. It responds to the question of why is it happening. The third moment is the faith-based reflection of the reality interpreted. It responds to the question of how do we evaluate it. The last moment is the response which is the aim of the method itself. It responds to the question of how do we respond2. The first chapter dedicates to a description and analysis of the Philippine health situation, and its relation to the global socio-economic perspective under the neo-liberal globalization policies. The shift from the question of having resources to the distribution of resources is the main concern when one tackles the problem in the world of health. One of the indicators of the unequal distribution of health resources is the widening gap of the average life expectancy and mortality rates between the north and the south. There is also the problem of the mass production of health professionals, and the mass exodus of these professionals to other countries. These predicaments are the corresponding effects of the government’s health reform agenda as prescribed by its international patrons who are proponents of the neo-liberal globalization policies. Cf. SANDRIN L., Fragile Vita. Lo Sguardo della Teologia Pastorale, Edizioni Camilliane, Torino 2005, p. 33. 2 Cf. Ibidem., pp. 38-39; cf. WIJSEN F. – HENRIOT P. – MEJIA R., (eds.), The Pastoral Circle Revisited: A Critical Quest for Truth and Transformation, Paulines Nairobi 2005, pp. 46-47, 251. 1

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The second chapter attempts to dialogue and reflect with the situation described in the light of scripture, the Catholic Social Teachings, and the documents of the Ministers of the Infirm. It confirms the assumption that the problem in the world of health particularly in the distribution of resources is a problem of social justice. The core elements of our faith, and the anthropological-ontological truths of the human person are the fundamental bases of the administration of social justice in the world of health. The grandeur of science and technology has relativized certain truths of human existence that are foundational, rational and enduring. The notion of progress of human development, which is reduced only to progress of having rather than of being, dissuades the society’s effort to promote authentic and integral human development. It is in this context that the perpetrators of injustice triumph and the defenders of the people’s right and dignity are silenced. The last chapter confers the basic principles of one’s action in the world of health, and proposes concrete forms of witnessing towards a more liberating approach of health care ministry. The appreciation of the prophetic ministry of consecrated life is the key towards promoting a justice-animated spirituality. This is called forth now wherein consecrated life tend to withdraw away from immersing with the situation of the most vulnerable to re-enhancing its identity as an institution. The language of prophecy and preferential love is relativized and left to the voluntary option of the individual rather than being affirmed as a community commitment. Regaining the grounds of one’s commitment and consecration, and clarifying the ultimate ends of all our witnessing are given ample emphasis in this section. A general line of action is presented in order to have a concrete view on what does it mean to commit to the promotion of social justice in the world of health. Thus, the interplay of the concrete situation, its reflection and the proposed actions situate the basis of the promotion of social justice in the world of health. This interaction must be seen within the context of the intricate web of relationship of these factors in order to understand what constitutes the new mission of the Ministers of the Infirm at the present millennium.

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CHAPTER I A BIRD’S-EYE VIEW OF THE PHILIPPINE HEALTH CARE SYSTEM AND THE CAMILLIAN SOCIO-HEALTH INITIATIVES

A better picture of a particular health care system is one that looks into the two sides of a single coin. The front side which represents the overview, i.e., the indicators that are present and measurable, and the flipside which represents the under-view, i.e., the resulting effect of those indicators indicated, or the presenting problem. In order to understand this picture, it is important to scrutinize what makes this picture appears in this way. This is now the point of analysis of the situation. It has to be ordained toward arriving at a particular solution without pretending its absolute certainty as the only solution but maintaining its humble character as contributory to a more comprehensive and collective alternative or recommendable options.

1.1. Overview of the Health Care Situation in the Philippines 1.1.1. Geographic and Demographic Characteristics The Philippines is an archipelago of 7,100 islands located at the western part of the Pacific Ocean off the coast of Southeast Asia. The country has a total land area of 300,000 square kilometers, and is one of the largest island groups in the world 3. It has a total population of 76,504,077 (2000) with an average annual rate of 2.36%. Population has been projected by the year 2010 at 94,013,200. Metro Manila, also known as the National Capital Region (NCR), is the biggest urban center in the country and the most densely populated with a total inhabitants of 9,932,560 (2000). Approximately 52% of the total population lives in the countryside4. The concentration of socio-economic development in

Cf. WURFEL D. – BORLAZA G., “Philippines” in Encyclopædia Britannica 2005 Deluxe Edition CD, Encyclopaedia Britannica Inc, LA, California 2005. 4 This figure was based on the national census reported in May 2000 by the National Statistics Office which can be accessed at http://www.nscb.gov.ph/secstat/d_popn.asp. 3

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key major cities attracts more people to move, and dwell in slum and unsafe areas. Urban migration facilitates the transfer of diseases aggravated by congestion and pollution. The Philippines is generally mountainous with narrow strips of interrupted coastal plains and some broad inland plains. Its forest is endowed also with great biodiversity resources mostly animal species, plants, flora and fauna with a significant medicinal quantity value though remain to be fully tapped5. According to the Center for Environmental Concerns (CEC), an non-government organization (NGO), since 1900, its forest cover has a total of 65% of the land, but in the year 2000 it has only a remaining of 18.1%6. The massive depletion and denudation of these resources is caused by large-scale logging and mining operations causing soil erosion and flash floods. This has a big impact on the recurrent patterns of diseases among Filipinos. The country’s climate is generally hot and humid with a mean annual temperature of 26.6°C and an average monthly relative humidity of 71% - 85%. The Philippines is prone to natural disasters brought about by volcanic eruptions, earthquakes, floods and typhoons. It registered 26 typhoons in the year 2006 with varying intensity. “The tropical temperature favors the existence of disease vectors and parasites”7.

1.1.2. Health Status Generally, the health status of Filipinos in the past decades had shown minimal signs of improvement as far as management of diseases is concerned. It lags behind in providing access to health services as one of the strategies in attaining the ideal standard of human development using the Millennium Development Goals (MDGs)8 as framework. Cf. VILLAVERDE M. – BELTRAN M. – DAVID L. (eds.), National Objectives for Health Philippines 2005-2010, DOH, Manila 2006, p. 1. 6 These figures were presented during a symposium at Christ the King College, Calbayog City on the Philippine Environmental Situation on November 2006 by the Center for Environmental ConcernsPhilippines. 7 VILLAVERDE M. – BELTRAN M. – DAVID L. (eds.), National Objectives ..., op. cit., p. 1. 8 Cf. “The Millennium Development Goals (MDGs) are the world's time-bound and quantified targets for addressing extreme poverty in its many dimensions-income poverty, hunger, disease, lack of adequate shelter, and exclusion-while promoting gender equality, education, and environmental sustainability. They are also basic human rights-the rights of each person on the planet to health, education, shelter, and security.” Cf. http://www.unmillenniumproject.org/goals/index.htm. 5

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The average life expectancy at birth shows an upward trend, i.e., from 61.6 (1980), 64.6 (1990), 69 (2000) and 70.5 (2005). The data vary according to the different 15 regions of the country. It has been noted that regions situated in the far south, particularly among the Muslim regions are having lower average life expectancy (59.3 years) as compared to the regions in the north where the center of power is located9. With respect to the other countries of the Southeast Asian region, the Philippines ranked number 7 out of the 10 countries10. Thus, the upward trend does not guarantee a corresponding equal distribution of health resources and adequate access to the populace because of the differential variation. The infant (IMR) and child (CMR) mortality rates which are measured per 1,000 live births and the maternal (MMR) mortality rate per 100,000 live births showed a decline comparing to the previous years. By looking at the records from the year 1988 – 2003, the IMR tallied from 34 down to 29, the CMR tallied from 19 down to 12 and the MMR tallied from 209 down to 138 deaths. The primary cause of death among infants and children is pneumonia while among mothers are hypertension and postpartum hemorrhage. Variations in terms of rate and causes are noticed in each regions due to socio-economic and demographic factors. It recorded high respectively in the southern regions11. Though it showed some improvements in lowering the number of incidences, the growth is very slow comparing to the other neighboring Asian countries. According to the World Health Organization (WHO), the Philippines has the highest rate of maternal deaths (MMR) which is four times higher than Thailand, and twice higher than Vietnam, and one of the 42 countries that account 90% of global deaths of children under five years old12. Looking at the trends and patterns of the disease for the past decade, the following can be observed. Of the top ten leading of causes of morbidity, eight are communicable diseases and two are non-communicable diseases (1995-2005). Unlike the causes of morbidity, of the top ten leading causes of mortality, seven are non-communicable diseases

Cf. VILLAVERDE M. – BELTRAN M.– DAVID L. (eds.), National Objectives …, op. cit., p. 7. DE LEON L. – THANN M., ASEAN in Figures, ASEAN Secretariat, Indonesia 2004, p.30. 11 VILLAVERDE M. – BELTRAN M. – DAVID L. (Eds.), National Objectives …, op. cit., pp. 10-12. 12 Cf. WORLD HEALTH ORGANIZATION (WHO), World Health Statistics 2007, WHO Press, Geneva 2007, pp.264-266. 9

10

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with diseases of the heart and diseases of the vascular system account for 29.7% of deaths13. Though the statistics reveal a progression in terms of controlling communicable diseases as causes of deaths, their burden as causes of morbidity is still high. Among the communicable diseases, tuberculosis is still gaining high prevalence. Among the southeast Asian countries, Philippines is second to Myanmar with the highest TB death rate of 36.1 per 100,000 population14. The statistics show that there are improvements in the health status of the Filipinos for the past decade. However, the following observations call for an immediate attention to health care providers such as the widening gap in terms of regional differences in statistics particularly in the southern regions, the slow decline of morbidity and mortality rate and its current standing in Asia as it lags behind the other neighboring countries. Much of these problems have something to do with the health care delivery system that the government adheres and promotes. 1.1.3. Organization of Health Care System The organization of health care system in the Philippines has started during the middle of the 16th century upon the arrival of the first Catholic missionaries from Spain particularly the Franciscans (OFM). Historical records showed that when illnesses and epidemics occurred, the friars were the only persons competent to serve as physicians and nurses in their infirmaries. Scientific studies on medicinal properties of some herbs are spearheaded by the friars. This early beginning does not neglect the fact that prior to the Spanish colonization (1521-1898) there were already traces of conventional indigenous health care system. However, there are no substantial records available. Later, in the early 20th century with the occupation of the Americans, health care organization took a big leap with the establishment of the first medical school in the Philippines at University of Sto. Tomas and the first batch of Filipino physicians. “The Philippines has a dual health systems consisting of: the public sector which is largely financed through a tax-based budgeting at national and local Cf. VILLAVERDE M. – BELTRAN M. – DAVID L. (eds.), National Objectives …, op. cit., pp. 12.; PHILIPPINES – DEPARTMENT OF HEALTH (DOH), Field Health Services Information System Annual 13

Report 2006, DOH, Manila 2007, p.4ff. 14 Cf. DE LEON L. – THANN M., ASEAN in …, op. cit., p. 53.

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levels and where health care is generally given free at the point of service (although socialized user charges have been introduced for certain types of services) and the private sector (consisting of for profit and non-profit providers) which is largely market-oriented and where health care is paid through user fees at the point of service”15. However, there is another sector of health care providers which can neither be categorized in any of those two sectors mentioned above. They are called the indigenous or traditional healers in which the government recognized their contribution as health care providers and categorize them as traditional medicine. Most of these healers (commonly called albularyos and manghihilot) attribute their healing capacity to a calling or a mandate from a supernatural being and use prayers, rituals and herbs as modalities of healing. The attempt to institutionalize traditional medicine and alternative health care have met some problems because “these practices are essentially non-formalizable”16. The indigenous “medical” practice is an old tradition as old as the early inhabitants of the country and guided by the laws of nature and tradition which has been handed down normally within the members of the family lineage. Thus, it does not fit into any formal and rigid structure.

1.1.3.1. Health System Reforms Beginning in the second half of the 19th century up to the present, several reforms have been enacted in the health care system. This is due to the increasing demand of the constituents for a better and efficient public service and the economic crisis. The main objective of these reforms is the “restructuring for efficient management and effective delivery of service at lower cost, greater involvement of the private sector and decentralization of services to local governments”17. The following reforms have been undertaken in the name of re-structuring the system: 1. Primary Health Care: The Philippines adopted in 1979 the Declaration of Alma Ata by the UN member’s states on September 1978 of using Primary Health Care (PHC) as VILLAVERDE M. – BELTRAN M. – DAVID L. (eds.), National Objectives …, op. cit., pp. 15. Cf. SY P., “Doing Bioethics in the Philippines: Challenges and Intersections of Culture(s) and Medicine(s)”, in FUJIKI N. - MACER D. (Eds.), Bioethics in Asia, Eubios Ethics Institute, Japan 2000, p.106. 17 SIA I, Public Service Reforms and their Impact on Health Sector Personnel in the Philippines, in WHO, Public Service Reforms and Their Impact on Health Sector Personnel, WHO – ILO, Geneva 2001, p.162. 15 16

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an approach and the key to achieving the goal of “Health for All by the Year 2000”18. This approach upholds the principles of full participation, self-reliance and self-determination of the people and the community through delivering promotive, preventive, curative and rehabilitative services. The implementation of the program has been successful despite political turmoil under the dictatorial regime of Pres. Ferdinand Marcos. It made inroads amidst unfavorable situation through the cooperation of NGOs, and the church sector especially the religious. It paves the way towards further reforms in the health system such as the integration of public health and the hospital services and the propagation of a Community-Based Healthcare Program (CBHP). In 1985, the WHO recognized the Philippine model of primary health care as a model for PHC for developing countries19. 2. Republic Act 6675 - Generics Act of 1988: The RA 6675 is “an act to promote, require and ensure the production of an adequate supply, distribution, use and acceptance of drugs and medicines identified by their generic names”. This Generic Act requires all health providers to use generic in importation, manufacture, marketing and prescription of affordable drugs and to make it free as possible to indigent patients20. This was signed into law on September 13, 1988 by the then Pres. Corazon C. Aquino. However, this law is met with non-compliance particularly among medical practitioners who prefer branded drugs over generics due to the enticing offers of pharmaceutical companies who manufacture these drugs. The Undersecretary of Health has even confirmed, “that RA 6675 is defective because he sees it as bearing the mark of the strong pharmaceutical lobby that insisted on the right of doctors to continue prescribing branded medicines. While the law compelled doctors to issue generic prescriptions, it also allowed them to continue prescribing the branded equivalent of their choice, the net effect of which has been to nullify generics altogether"21. 18

“Health For All By The Year 2000” was a famous slogan that promoted the vision of attaining the highest possible level of health for all people during the UN conference at Alma Ata, presently Kazakhstan, in 1978. 19 Cf. JACOBS M., Primary Health Care Review Project Region Specific Report, in http://www.wpro.who.int/NR/rdonlyres/551B008E-6B7F-4C40-9FD7-7C710087D0BB/0/ region_specific_report.pdf. 20 Cf. PHILIPPINE SENATE, Republic Act No. 6675 An Act to Promote, Require and Ensure the Production of An Adequate Supply, Distribution, Use and Acceptance of Drugs and Medicines Identified by their Generic Names, Sec.2. in http://www.supremecourt.gov.ph/gender/laws/health_and_social_ welfare/RA%206675.pdf.

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It is a law that is weak in itself and faces a possible abrogation due to the effect of the Trade-Related Aspects of the Intellectual Property Rights (TRIPS) agreement signed by the World Trade Organization (WTO) members, where Philippine is a member state and a signatory to it in 1995. 3. Republic Act 7160 – The Local Government Code of 1991: This Act is known as the Local Government Code of 199122.

The primary motive of this Code is the

“decentralization which is the transfer of power in planning, management and decisionmaking from the national level to sub-national levels of government”23. This has been implemented through the devolution of basic services such as health. “Local government units shall endeavor to be self-reliant and shall continue exercising the powers and discharging the duties and functions currently vested upon them. They shall also discharge the functions and responsibilities of national agencies and offices devolved to them pursuant to this Code. Local government units shall likewise exercise such other powers and discharge such other functions and responsibilities as are necessary, appropriate, or incidental to efficient and effective provision of the basic services and facilities …”24. However, instead of improving the delivery and effectiveness of health services, the contrary happens. It’s because health management is now taken over by non-health managers (political unit leaders) whose decision-making is constrained by their political interests above social interests25. This becomes the sphere of expanding their political influence and venues of corruption. 4. Health Sector Reform Agenda 1999: The Health Sector Reform Agenda (HSRA) has been undertaken in response to the failure of the devolution of health services under the new local government code of 1991. The program aims to reform the following five major areas of concern: “to provide fiscal autonomy to government hospitals, to secure funding for priority public health programs, to promote the development of local health systems and ensure its effective performance, to strengthen the capacities of PABICO A., New Rx Needed for Generics Movement, in “Philippine Center for Investigative Journalism Online”, 22 September 2006, in http://www.pcij.org/i-report/2066/generics.html. 22 Cf. PHILIPPINE SENATE, Republic Act 7160, The Local Government Code of the Philippines, Sec. 1, in: http://www.chanrobles.com/localgov.htm. 23 GRUNDY J., The Impact of Health System Reform on Remote Health in Cambodia and the Philippines, in “Rural and Remote Health” (online), in: http://www.rrh.org.au/publishedarticles/article_print_84.pdf. 24 PHILIPPINE SENATE, Republic Act 7160…, op. cit., Sec.17a. 25 Cf. GRUNDY J., The Impact of Health …, op.cit., pp.4ff. 21

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health regulatory agencies and to expand the coverage of the National Health Insurance Program (NHIP)”26. The very essence of these reforms is the rationalization of services and revenue generation among public health institutions. These agenda have been responsible for the gross charging of service-user fees to patients, the mass lay-off of health care personnel in government hospitals due to streamlining, the reduction of health expenditure per capita income and the privatization of public tertiary and specialty hospitals. These are just one of the many “conditionalities” that the International Monetary Fund – World Bank (IMFWB) imposed on the government through the “Structural Adjustment Program (SAP)” as prior conditions for the granting of loans27. The HSRA is a strategy conceived in view of mobilizing additional resources for health by increasing the public health institutions revenue generation capacities. This means turning hospitals into a better investment opportunities through charging user fees on personal health care (curative care) and regulatory services 28. A concrete example of this strategy is the introduction of medical tourism as part of the package in maximizing profitability of tertiary and specialized hospitals in the country. “Medical tourism can be broadly defined as provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public”29. The Philippine House of Representatives has proposed a bill to create a special committee that will pave the way to the creation of Philippine Center for Specialized Health Care (PCSHC). This concerns the integration of four tertiary, specialized-care government hospitals in order to deliver a world-class health care delivery services but 26

PHILIPPINES – DOH, The Health Sector Reform Agenda, DOH, Manila 1999, pp. iii-iv.

27

Cf. “Structural Adjustment Policies are economic policies which countries must follow in order to qualify for new World Bank and International Monetary Fund (IMF) loans and help them make debt repayments on the older debts owed to commercial banks, governments and the World Bank. SAPs generally require countries to devalue their currencies against the dollar; lift import and export restrictions; balance their budgets and not overspend; and remove price controls and state subsidies”., in: http://www.whirledbank.org/development/sap.html. 28 Cf. PHILIPPINES – DOH, Formula One for Health, DOH, Manila 2005, p.9. 29 SEN GUPTA A., Medical Tourism, in http://www.health-tourism-india.com/articles-on-medical-tourismindustry.html.

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enormously expensive which is unaffordable to the majority poor. It is called integration but privatization in disguise30. This innovation has made access to health care by the poor more difficult. It’s because the poor has lost their income opportunities and thus, their purchasing power due to massive unemployment in the past decades up to the present.

1.1.3.2. Human and Material Resources for Health According to the Department of Health (DOH), from 1991-2000, it registered a total of 95,016 physicians and 337,939 nurses31. Out of the 95,016 physicians, only 2,955 (3%) are working in public hospitals and the rest (97%) are in the private hospitals. Of those working in public hospitals, 650 (22%) of them are in the National Capital Region (NCR) and the rest are distributed in the other fourteen regions. Of the 337,939 nurses only 4,374 (1%) are working in public hospitals and the rest are in the private hospitals. Of those in public hospitals, 683 (16%) of them are in the NCR. Services in the countryside and remote villages/or barangays (41,793) are normally taken by the 239,397 trained barangay health workers (BHWs) and traditional birth attendants32.

The situation is

worsened by the recent phenomenon of “brain drain”33 of healthcare professionals. According to Dr. Jaime Galvez-Tan, a former Health Secretary, that from 1994-2003 there are already a total of 163,756 nurses and about 2,000 physicians working abroad in 46 countries. But he pointed out a more serious fact, that there are about 3,000 physicians (80% are government physicians) currently enrolled in 45 nursing schools all over the country offering a customized nursing courses. They are called the “nursing medics” who ventured in such a humiliating initiative in order to get a job abroad easily. Thus, majority of the Filipinos died of illness without undue attention by medical personnel particularly in the rural areas where most of the country’s poor live, and where healthcare in many instances non-existent. Cf. MAKILAN A., Gov’t Hiding Real Plans for Proposed Integration - Health Workers, in “Bulatlat” (online) Vol. VI, No. 41 (Nov. 19 - 25, 2006), on: http://www.bulatlat.com/news/6-41/6-41-plan.htm. 31 Cf. PHILIPPINES – DEPARTMENT OF HEALTH (DOH), Statistics, in: http://www.doh.gov.ph/kp/statistics/ health_human_resource. 32 Cf.Idem., Field Health Services…, op. cit., pp. 133-142. 33 Brain drain is a catch phrase which refers to migration of healthcare professionals particularly nurses and doctors to countries which offer a better income and opportunities. 30

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In terms of facilities, as of 2005, there are a total of 359 (36,396 beds) government hospitals and 595 (36,519 beds) private hospitals34. In the past decades, a number of government and private hospitals had closed down due to bankruptcy or debt burden. Some are operating with inadequate funds, thus affecting both the quantity and quality of their services. The supply and availability of affordable drugs is also another cause of alarm among patients and the healthcare providers. The supply of drugs in the Philippines is highly import dependent, which accounts 81.32% of the overall supply. The pharmaceutical market is dominated by the supply of branded drugs, which accounts 96.3% of the total market sales35. According to the Philippine International Trading Corporation (PITC), a government-owned marketing agency, Filipinos are paying drugs forty-five times (45x) higher than in any other countries for exactly the same product and manufacturer36. In fact, Philippines has the highest drug prices in Asia next to Japan. There is no law that supports the supply and purchase of cheaper medicines in the neighboring Asian countries such as India, Pakistan, and others. Most of its drugs are coming from big multinational companies of USA and Europe. By looking at the rate of family expenditures, health is the least among the lists, which takes only about 1%-2%. In 2003, the total expenditure for health amounts to Php. 136 billion in which 44% comes from out of pocket expenditure of individual families and only 34.2% from the government which stands only a 2.9% share of the gross national product (GNP). This figure is way below to the 5% standard set by the WHO for developing countries37. The rate is further declining as compared to the previous decade. According to the WHO in its World Health Report 2000, Philippines ranks 131 st out of 191 countries in terms of public expenditure on health. 1.1.4. The Ministers of the Infirm’s Socio-Health Initiatives

Cf. PHILIPPINES – DOH, Statistics, op.cit., in: http://www2.doh.gov.ph/bhfs/hosp/proveitgovthosp2005.pdf. 35 Cf. Philippine Pharmaceutical Industry Factbook, PHAP, Makati City, Philippines 20036, pp. 6-37. 36 Cf. HABITO C., Medicine Can Be Cheap, in “Philippine Daily Inquirer”, 13 August 2007 (Editorial). 37 Cf. VILLAVERDE M. – BELTRAN M.– DAVID L. (eds.), National Objectives …, op. cit., pp. 26-27; Philippine Pharmaceutical Industry …, op. cit., pp.10-15. 34

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The Ministers of the Sick (Camillians) arrived in the Philippines in 1974 and officially setup their first foundation in March 1975 at Quezon City, Metro Manila. Vocation promotion and religious seminary formation has been the first initiatives. However, the massive poverty in the slums of the metropolis has prompted them to venture immediately into another area of specific ministry. They organized outreach programs, free clinics, nutrition and daycare centers and polyclinics in 198038. At present, the Camillians has established two hospitals, three polyclinics, two physical rehabilitation centers, ambulatories, and community-based health care projects.

1.1.4.1 From Charity to Bureaucracy, the Dilemma of Institutional Ministry All of these socio-health initiatives are borne out of the greatest desires of the Camillians to make charity a concrete manifestation of the gospel of mercy and compassion to the sick. The establishment of these institutions was made possible through foreign donations from generous benefactors, and the various provinces and delegations of the Order. The places that were chosen for these initiatives are strategic and accessible to the low-income sectors of the society. Most of these institutions have been able to give free medical services and medicines to indigent patients during its early years of operation. However, the external factors such as the economic and political crisis of the country and the internal constraints such as the transfer of leadership from the Far East province to the Philippine Province in 2003, and the reduction of subsidy given for formation houses from Taiwan delegation due to juridical restructuring of St. Mary’s Hospital, instigate the rethinking and rationalization of management of these institutions that eventually affected the privileges given to the poor39. Some daycare and nutrition centers were closed. In order to cope with the challenge of the time, the Province has set up the Finance Office, which takes care of assessing and recommending strategies for the management of the institutions of the Province. It aims to increase its capability to generate income,

Cf. FERRI P., Twenty-five Years of Camillian Presence in the Philippines, in “With You” Vol.2 No.5 (2003), pp. 56-63. 39 Cf. ANSELMI I., An Over-all Report on the State of the Philippine Province, in “With You” Vol.3, No.7 (2004), p. 97. 38

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ensures its viability and contributes to the upkeep of formation houses. Quoting the words of the provincial superior: “We are trying to use available corporate systems and strategies in order to carry out the goal stated in our Three-Year Plan: ‘to vitalize the structures, personnel and finances of the Province.’ And in doing so inevitably we mean business – business not for mere monetary profit but for a mission”40. A new direction of the health institutions of the Province has been set towards financial stability through better revenue generation. The management of these institutions is placed under the St. Camillus Polyclinic Charity Foundation of the Camillian Fathers, Inc., except one hospital in the far south. Since most of these institutions are situated in depressed areas and regions, the access of the poor patients has been limited. Looking at its financial report from fiscal years 2004-2006 of the 100% gross income of the hospitals and polyclinics, 85% comes from out of pocket expenditure of the individual patients, 8% comes from government health insurance benefits and 7% from private insurances (HMOs)41. The figures demonstrate the inability of these institutions to deliver health services to the majority poor who live with only less than $2.0 a day. On the other hand, the institutions coped its daily operations through the out of pocket contributions by the patients. Thus, the operation of these institutions is put at a high risk in the future. 1.1.4.2. Towards Dynamic and Empowering System of Ministry The Philippine Province, conscious of its vision and mandate as faithful servants of the sick especially to the least privileged brothers and sisters, pursues its initiatives according to the specific mission of the Province. Its mission states that: “We, the consecrated men of the Order of St. Camillus in the Philippine Province, commit ourselves to a contextualized proclamation of the gospel values by promoting human dignity in our service to the sick”42.

40

Ibidem p.98. (The Three Year Plan 2004-2007 refers to section IV, no.5a/c which states that, we, as a Province, strive to attain a degree of financial stability and self-reliance through concrete courses of action such as a) to improve our health institutions; c) to make St. Camillus Home of Charity and income generating institution.) cf. Three Year Plan (2004-2007), in “With You” Vol. III, No.8 (May-August 2004) p.41. 41 Cf. MINISTERS OF THE INFIRM – PHILIPPINE PROVINCE, Financial Statement 2004-2006 of the St. Camillus Polyclinic Charity Foundation of the Camillian Fathers, Inc. and the St. Camillus Mati Foundation, Inc., Finance Office – Philippine Province 2007. 42 MINISTERS OF THE INFIRM – PHILIPPINE PROVINCE, Vision - Mission of the Philippine Province, in “With You” Vol. III, No.7 (January-April 2004), p. 84.

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Several initiatives has been undertaken along this direction such as the communitybased health care programs for the sick, handicapped and the common people, and the creation of the Justice and Peace commission which underwent a series of litmus test before it was finally approved by the Provincial Council in 2006. The commission, which is now officially called as the Commission on Justice and Solidarity in the World of Health (CJSWH), envisions a “totally healed society where members are active participants in their integral and sustainable well-being.” Its main strategies are: conscientization, community empowerment and advocacy43. The commission is borne out of a constant reading of the signs of the time and reflections in the light of the gospel and the social teachings of the Church. A careful study has been conducted also on the economic arrangements, social formation, and power relations in politics, culture and faith life being the structural determinants of health. At present, the commission is focusing on developing modules for formation on the Church’s social teachings, and a research and study on the latest health reforms that the government is developing and implementing.

1.2. The Underview: The Effect of Neo-Liberal Globalization Policies Before delving into a diagnosis of the ailing health care system, some conceptual ideas need to be clarified. What does it mean by neoliberal globalist policies? Globalization is a buzzword that arouses unimaginable attention and curiosity among the society of the intellectuals and critics down to the community of ordinary workers and farmers. It’s an evolving concept whose origin and meaning is continually debated by its proponents and critics. It can be defined as “a historical process, one being molded and shaped by individual and institutional choices and decisions that are undergirded by particular cultural, theological and social values”44.

MINISTERS OF THE INFIRM – PHILIPPINE PROVINCE, JPIC-OSC Philippine Province, in “With You” Vol.5, No.14 (2006), p.69. 44 PETERS R., In Search of the Good Life: The Ethics of Globalization, The Continuum International, New York 2004, p. 7. 43

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The crucial point of this definition is the decision-maker. What philosophy does the decision-maker/s believes? Most of them are neo-liberalists. David Harvey, a political economist defines neo-liberalism as, “a theory of political economic practices that proposes that human well-being can best be advanced by liberating individual entrepreneurial freedoms and skills within an institutional framework characterized by strong private property rights, free market and free trade”45. Therefore, a neo-liberal globalist policy is a policy that advocates no restrictions, but at the same time regards protection. This is much reflected in the overview, the situation as described above. This will be analyzed further under the following agenda of the government.

1.2.1. The Health Reform Agenda of the Government The HSRA is prompted by the progressive deterioration of the public health institutions and agencies that are supposed to deliver the needed health services. What causes the deterioration? Looking at the macro perspective, several external and internal factors can be deciphered. Examining first the external indicators, the following conclusions can be arrived. First, since Pres. Gloria Macapagal-Arroyo assumed to power in 2001 by people power, the public health expenditure was cut down to 3.4% of the GNP, which means an allocation of Php. 0.40 cents per Filipino per year while the military and debt servicing are getting the biggest share of the pie. For instance, in the 2008 budget proposal, the government’s skewed priorities can be seen in giving more importance on debt interest payments which amounts to Php. 295 billion ($6,339,995,701) or Php. 3,261 ($70.08) per Filipino. Meanwhile, the Department of National Defense will receive P56 billion (($1,203,524,607)-- or more than three times the allocation for the DOH 46 while about 70% of the local health fund is lost to corruption in the previous years. No wonder why the patterns of diseases had not made any significant breakthrough because the government is EMAR T.D. – LIE, A., What is Neoliberalism?, in http://folk.uio.no/daget/What%20is%20NeoLiberalism%20FINAL.pdf. 46 Cf. IBON FOUNDATION, Proposed 2008 Budget Allocates Only P180 per Filipino for Health Services, in http://info.ibon.org/index.php?option=com_frontpage&Itemid=1. 45

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only allocating a meager budget, and the bulk of its health expenditure are more on personal health services (curative) and much less on public health which is contrary to the target of the Millennium Development Goals (MDG). Secondly, is the skyrocketing price of medicines due to the monopoly of multinational (MNC) drug companies, which control the 70% of market sales. Of the 10,000 types of drugs off to the patients based on the sales, only 500 of these were produced locally, and most of these are branded products47. The Philippine pharmaceutical market is import-dependent, and much worse is that even the local manufacturing firm is importing most of its raw materials. Looking at the cost structure of medicines, for every peso of the price of medicines that Filipinos buy, drug companies spend for the following: product transfer price, promotions, sales force expenses, distribution costs, and medical expenses which amounts to Php. 0.92 centavos48. Therefore, the real direct cost of production of a particular medicine is only about 8% of its total selling price. What aggravates the situation is its distribution. Almost 75% of the medicines are sold in the business nerve center while only 25% are in the far-flung areas49. Drugs are meant only for the few elites while the ailing majority has to depend alone on unanswered prayers and false hopes. Thirdly, is the shortage of medical personnel. This is due to the government’s labor export policy. Migration of health personnel has been going on since middle of the 20th century. “Since 1950s, the Philippines has led the world in preparing nurses for export” 50. The migration started during the economic crisis in 1970’s up to the present wherein not only nurses are leaving the country, but physicians as well joining the band in search of a better future. This policy has been institutionalized in 1974 when Pres. Marcos issued a decree directing the Ministry of Labor to create three agencies that would facilitate the export of workers. This gave the government full control of all aspects of overseas

Cf. VILLAVERDE M. – BELTRAN M. – DAVID L. (eds.), National Objectives…, op. cit., pp.19-20. Cf. PABICO A., New Rx Needed for Generics Movement..., art. cit. 49 Cf. KANAVOS P.G. – LIM J. – PASCUAL C., Philippines Health Policy Note: On Improving the Poor’s Access to Affordable Drugs, World Bank, Washington, D.C. 2002, p. 15-18. 50 BRUSH B. – SOCHALSKI J., International Nurse Migration: Lessons From the Philippines, in “Policy, Politics and Nursing Practice,” Vol. 8. No. 1 (2007), p. 39. 47 48

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employment and formalized a labor export policy51. The need for remittances, which fuel the ailing economy, and the lack of employment generation in the domestic labor market, led the Philippines to institutionalize this policy. In fact, migrant workers are honored as the “bagong bayani” (new heroes) of the country. However, the big amount of remittances that enter into the national treasury has never been converted into forms of basic social services, because it has been used for foreign-debt servicing. In short, the IMF-WB benefits the sweat of their labor. Lastly, is the privatization of health institutions. This brings terror to the hopes of poor patients to seek for affordable and efficient health care. The past presidents of the nation up to the present are pushing more to privatize tertiary and specialized public hospitals in the guise of improving services comparable with the world’s standard. Privatization comes in different terminologies such as corporatization, collocation, integration, decentralization, etc. However, they mean the same thing, i.e., sell and let the private sector takes over not mainly for public service but for profit. This is one of the big showcases of the health sector reform agenda of the present government. As one study concludes that, “health system reforms have been undertaken in the name of market reform, globalization, decentralization, devolution, people power, cost recovery, cost effectiveness, community participation and rationalization. But experience to date, would indicate that from rural and remote populations in the developing world, there is more in the rhetoric than the reality”52.

1.2.2. The WTO as the Front Liner of Neo-Liberal Globalization Those external factors mentioned above are just necessary consequences of the internal machinery that moves within. This is the World Trade Organization (WTO), “a negotiating forum by member governments (151 nations) that set the rules of trade among nations at a global or near-global level”53. Philippines is a member government of WTO since its creation in January 1995. Even prior to WTO days, Philippines has been RUIZ N. G., The Emigration State: Labor Export as Development Policy, (1 September 2007), in http://web.mit.edu/polisci/students/nruiz/Documents/Ruiz_APSA%202007%20 Paper_The%20Emigration%20State.pdf. 52 GRUNDY J., The Impact of Health System Reform …, art. cit. 53 Cf. World Trade Organization, in http://www.wto.org/english/thewto_e/whatis_e/tif_e/fact1_e.htm 51

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practicing already a subservient political and economic policies to the big capitalist nation, which dates back to the Spanish colonization. Its outstanding foreign debt reaches to $54.4 billion US dollars as of 2007. With this big foreign borrowing, the country owes to the conditionalities imposed by its patron, the IMF-WB through the so-called Structural Adjustment Program (SAP). These adjustments in the economic policies of the nation ranges from devaluation of currency, budget austerity, the application of user fees in health and education, trade liberalization and deregulation, elimination of minimum wage legislation, etc54. The following controls are worth examining:

1.2.2.1. TRIPS agreement The Trade-Related Aspects of the Intellectual Property Rights (TRIPS) agreement on health is a mechanism that prohibits reproduction of a particular medicine for a minimum period of 20 years by virtue of the patent right protection. Although recently the WTO made some ramifications of the rule by introducing flexibilities such as “compulsory licensing” and “parallel importation”55 in low and middle income countries (LMIC) that is in dire need of such particular medicine, still it did not make any significant impact in the access of medicines by the poor56. The conditions by which the granting of these flexibilities for easy access to medicines are just enough to add more burden for the LMIC to comply. Moreover, at the behest of the influential pharmaceutical lobby, developed nations would threaten sanctions on countries that attempted to take advantage of those flexibilities as it happened in South Africa in 1997 that was threatened with trade sanction by the United States government57. When the Philippines attempted to promote expanded use of generic for off-patented drugs, the US government intervened by putting the country in the Special 301 Watch List58. Though capitalism promotes free market, and free competition, it is at the same time engaging the market in an unfair competition. Cf. GALLAGHER V., The True Cost of Low Prices, The Violence of Globalization, Orbis Books, Maryknoll NY 2006, p.88. 55 Compulsory licensing is an intervention to restricted patent monopolies and provide access to generic drugs. Parallel importation is the bringing in cheaper drugs from another country without prior permission from the patent holder ., in Understanding Global Trade and Human Rights, p. 4., in http://www.fidh.org/spip.php?article2592. 56 Cf. SUBHAN J., Scrutinized: The TRIPS Agreement and Public Health, in “McGill Journal of Medicine,” Vol. 9, No. 2 (2006), pp. 153-154. 57 Cf. Ibid. 54

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Respect for intellectual property rights is morally right. But when this protection is motivated by amassing huge profit, and applying it to essential drugs or life saving products, then, it is morally wrong and unjust to deprive the people especially the marginalized sectors in the society. It is also a violation of respect of the cultural heritage of indigenous communities who developed and nurtured the raw materials and knowledge for several generations that where appropriated by private sector researchers and pharmaceutical corporations. This is bio-colonialism, the monopoly, control and commodification over life itself under the WTO-TRIPS agreement59. All in the name of profit. This creates the “crisis of neglected diseases”60. This means focusing researches on profitable diseases rather than the common diseases of poor people such as tuberculosis, malaria, AIDS, etc. This policy hinders the production and access to essential drugs in the market of the developing countries. On the other hand, if ever these drugs are available, they are sold at exorbitant prices. This policy is very much evident in the Philippine pharmaceutical industry. “In an increasingly global economy, maintaining one’s standing as a trading partner committed to intellectual property right protection has so far taken precedence over access to medicines”61. Thus, this collective and organized neglect of public health maintains the vicious cycle of poor health and underdevelopment. 1.2.2.2. Privatization of Health Services “Privatization refers to the provision of public-funded services and activities by non-governmental entities”62. This strategy, which in turn applied by the government as a policy is meant to curb financial difficulty, and to improve revenue-generating capacity. Under the neo-liberal globalist policy, privatization is one among the many prescriptions that the big international financial institutions such as the WB-IMF imposed on the government through the structural adjustment programs (SAP). The big problem here is Cf. MATTSON J. E., 1999 Collaboration Between the US Government and Pharmaceutical Industry to Oppose Philippine Government Effort to Promote Expanded Use of Generics for Off-Patented Drugs, (9 February 2005), in http://www.cptech.org/ip/health/c/phil/philtimeline.html. 59 Cf. CHOUDRY A., Neoliberal Globalization: Cancun and Beyond, ASEJ Vermont, USA 2003, p. 11-13. 60 Understanding Global Trade…, art. cit. 61 KERRY V. – LEE K., TRIPS, The Doha Declaration and Paragraph 6 Decision: What Are The Remaining Steps For Protecting Access To Medicines?, in “Globalization and Health ” Vol.3, No.3, (24 May 2007), pp. 2-3. 62 NIGHTINGALE D. S. – PINDUS N. M., Privatization of Public Social Services, “Urban Institute 15 October 1997, in http://www.urban.org/url.cfm?ID=407023. 58

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not so much the transfer of responsibility to private enterprise on the provision of social services such as health, but the introduction of competition as an underlying mechanism in order to increase efficiency, reduce costs, improve quality and above all the maximization of profit63. The effect of this policy of privatization is highlighted in the latest survey made by the World Bank in 2000 on pro-poor services. It has been found out that the non-poor uses health facilities more than the majority poor, that the median expenditures for health of the 60% poorest is only one tenth that of the 40% richest, that the prices of medicines is the highest in Asia and that almost 50% of the physicians, and 75% of the dentists are in Metro Manila, the capital64. This shows that the most vulnerable population to diseases is the one that is most deprived of the needed public intervention. The continuous integration, which is a disguise for privatization, of the tertiary and specialty hospitals endangers accessibility to the most needed services by the public. These five government specialty hospitals, namely, East Avenue Medical Center, Philippine Heart Center, National Kidney and Transplant Institute, Lung Center of the Philippines and the Philippine Children’s Medical Center are among the top priority hospitals of the government’s privatization scheme through the medical tourism strategy since 1999. Health then becomes a commodity and a source for revenue and profit. What use to be a public good whereby the people has exercised its domain and right freely through the administration by the state, is now alienated from its right beneficent. The commodification of health eliminates the people’s claim to it by virtue of their right and replaces it with money as the only means to attain it. Privatization weakens the people’s ability to assert their collective interests, and participation in the government in the administration and protection of public good. In addition, even the government ceases to be the right entity to protect and deliver it to its constituents because the market forces, which are the capital and the owners of the capital, have overtaken it65.

63

Cf. Ibid. Philippines – Filipino Report Card on Pro-Poor Services, World Bank, Washington D.C. 2001, pp. 10-29. 65 Cf.The Policy Roots of Economic Crisis and Poverty: A Multi-Country Participatory Assessment of Structural Adjustment, SAPRIN Washington, D.C. 2002, p. 149. 64

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1.3. General Observation The very opening statement of the Church’s pastoral constitution Gaudium et Spes states: “The joys and the hopes, the griefs and the anxieties of the men of this age, especially those who are poor or in any way afflicted these are the joys and hopes, the griefs and anxieties of the followers of Christ” (GS No.1)66. This mirrors the Church real sentiments to the plight of her people and her challenge to all the disciples of Christ. The griefs and anxieties that the Church pointed out are the same griefs and anxieties of the poor sick and marginalized who are being trapped and pushed to the wall due to the injustices present in the world of health today. There is a need to examine carefully what are these injustices, where is it coming from and how to confront it. Indeed, the situation poses us a serious pastoral problem that needs pastoral answers in the light of the gospel and the teachings of the Church. It is then an imperative of the Church to do her contribution to the vast field of work, which concerns the whole person. The concrete health situation of the Philippines manifests three major problems, namely, access to health care services, distribution of health resources and the neo-liberal globalization policies. Health is considered a public good and a necessary condition for man to attain the fulfillment of his life. It is therefore a common good, which is the “sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily (CSDC 164)”67. The sum total of social conditions means the mere absence of one condition affects the whole project of life. This presupposed that no one should be deprived of it because of its indispensability. The lack of access to this good as described above, presupposes the good’s existence in real terms but in reality it is withheld to its right beneficent unless one is willing to pay for it. As an Indian economist, Amet Sen Gupta holds that “its (health) benefits cannot be individually

SECOND VATICAN ECUMENICAL COUNCIL, (VAT. II) Pastoral Constitution Gaudium et Spes, in FLANNERY A., (ed.), Vatican Council II The Conciliar and Post-Conciliar Documents, Paulines, New 66

Delhi 2001, n. 1, p. 794. 67 PONTIFICAL COUNCIL FOR JUSTICE AND PEACE (PCJP), Compendium of the Social Doctrine of the Church, Libreria Editrice Vaticana, Vatican City 2004, No. 164, p. 93.

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appropriated or computed but have to be seen in the context of benefits that accrue to the public”68. Thus, all deserves health care regardless of color, creed and ideology. The equal distribution of health resources has remained up to the present a slogan that resonates in the four corners of the world. The widening gap between the rich and the poor in terms of providing equal health opportunities and benefits, and the differential state of the life expectancy between the north center and the far south of the Philippines are enough proofs that indeed there is an unjust distribution of resources. Again, the Church held the principle of the universal destination of goods which means: “God destined the earth and all it contains for all men and all peoples so that all created things would be shared fairly by all mankind under the guidance of justice tempered by charity (CSDC 171)”69. All these are ordained towards man’s attainment of the highest possible good to whom he is called. No one has the right to monopolize health but everyone is a rightful steward to it. The government has the special vocation to administer and protect it for the people. Lastly, the entry of free market forces bearing the neo-liberal globalist ideology into field of welfare services especially on health, facilitates the growing imbalance and unjust distribution of the goods of this earth. The market forces have no right to determine the nature and extent of service provision, and must respect the social value of health, which surpasses beyond the economic-efficiency equation70. Health is not a commodity that carries only a monetary value but a primary good. Thus, it cannot be subjected for profit sake. “In the economic and social realms, too, the dignity and complete vocation of the human person and the welfare of the society as a whole are to be respected and promoted. For man is the source, the center and the purpose of all economic and social life (CSDC 331)”71. Any economic principles and endeavors are essentially ordained towards a creation of a social condition that facilitates man’s growth towards his fullness. The neo-liberal

68 69 70 71

SEN GUPTA A., The Big Squeeze, in: http://www.infochangeindia.org/agenda2_02.jsp. Cf. PCJP, CSDC , n. 171, p. 96. Cf. The Policy Roots of Economic Crisis …, art. cit., p. 149. PCJP, CSDC, n. 331, p.188.

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globalist policy did not only hamper the creation of a favorable social condition but it also destroys socio-cultural systems and worldviews. “It replaces the common good, cooperation, the sense of community, spiritualism, respect for life, compassion, tolerance and love with cross economist values that put a premium on individualism, competition, survival of the strongest, disdain for the weak and the losers, materialism, compulsive consumption and arrogant secularism”72. Therefore, it becomes a deterrent to our cultural and Christian values. It is recognized then, that the worsening health crisis, which is not simply an epidemic but a humanitarian crisis begging for global attention, is a social justice issue. The complexity of this crisis demands a clear foundation of the fundamental principles in bringing the good news of justice to the world of health. It is against this background that the succeeding chapter will try to scrutinize this pastoral concern, the under-view that surfaces from below and read it critically in the light of scripture, Church tradition and the congregational values and principles of preaching the gospel and healing the sick. The situation of the world of health today poses a great challenge and even mandates us Camillians in conscience to confront these structural sins that pin down the hopes of “the least of our brothers” (Mt. 25:40) and sisters to a life in its fullness. Naturally, it needs a careful study and a critical heart to evaluate this situation. Certainly it warns us also to pay attention to the value of prudence in dealing with this heinous human predicament. Thus, it calls us to define well our point of departure but at the same time to purify our inner attitudes of timidity, reservation, numbness, hardness of hearts, etc., as we confront these evils that reign in the world of health today.

HONG E., Globalization and the Impact on Health: A Third World View, Third World Network, Penang, Malaysia 2000, p. 11. 72

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CHAPTER II REDISCOVERING THE FUNDAMENTAL BASIS OF SOCIAL JUSTICE AND ITS IMPLICATIONS TO PASTORAL HEALTHCARE MINISTRY

The recently concluded 56th General Chapter of the Ministers of the Infirm (2007) has this to say in one of the responses to the challenges of the time in the world of health marred by various forms of institutional violence and injustices as expressed in their Operative Guidelines. “We should make our charism and our spirituality the preferential subject of personal and communal study and investigation, and not only during the formative stages, so as to make ourselves more aware of our rooting in the merciful Christ, from whom all the initiatives for justice and solidarity draw meaning and vigor (CD 2007, 4.1)”73. This guideline points to us to the complexity of the situation of the world of health. A careful, personal, and communal study, and investigation means rediscovering the fundamental basis for our reflection on the situation presented. This chapter will attempt to investigate the foundational concepts that enshrine and protect the very subject and object (the sick person) of our ministry of witnessing the merciful love of Christ using the very sources of our faith (scripture and Tradition), the tradition of the Ministers of the Infirm (M.I.) and valuable studies and reflections of progressive theologians and scholars. Following the pastoral framework of reference, this chapter will attempt to enter the dialogue between the context presented (reality) and the text (truths) of Revelations as shown in the Scripture and Tradition. The reality is seeking light in order to transform it according to its original purpose, and thus overcoming its barriers.

2.1. The Core Elements of Justice as Constitutive to the Ministry MINISTERS OF THE INFIRM (CAMILLIANS), Acts of the 56th General Chapter United for Justice and Solidarity in the World of Health, 2-18 May 2007, Ariccia, Art. 4, Sec. 1,in “Documents”. 20 (2008), p. 734. 73

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Justice is defined and categorized as a moral virtue. It is “the moral virtue that consists in the constant and firm will to give their due to God and neighbor” (CCC 1807)74. As a moral virtue, it is something innate or natural in the person as he or she is created in the “image and likeness of God” and “as male and female” (Gen. 1:26-27). This revealed truth helps us to realize that man and woman by nature is just and at the same time must be treated justly. Secondly, it reveals also man’s inter-relational identity, i.e., in justice he is bound to render what is due to others and to God, a relationship that is always defined by the triad of the “I – God – Others”. Thirdly, this quasi-trinitarian (Trinity-liked relation) is mediated by what is “due” to each of them, i.e., the common good.75 These truths are deeply rooted and founded in the roots of our historic faith conviction, which is the biblical faith, the faith-experience of our ancestors as handed down to us through the so-called Judeo-Christian tradition76. This faith-experience is well kept in the book of God’s ever-present desire to be with his people, and to bring justice to the oppressed and the outcasts. 2.1.1. From the Core of our Biblical Faith The biblical concept of justice is always contextualized in a communal relationship between Yahweh and his people77. This communal character of justice is “based on the covenant and not on the relationship between absolute laws and the concrete activities of the people and the individual”78. It is more of a personal relationship between two individuals engaged and bonded by a covenant and not by a contract sealed with specific conditions. Thus, justice refers more to man’s attitude of sincerity and fidelity to the demands of a relationship79. (cf. Ex. 23:3; Lev. 19:15; Deut. 32:4). This was particularly lived by Israel after she experienced God’s decisive intervention in her history.

74

Catechism of the Catholic Church, 19972, in PRO-LIFE CD Library, Human Life International, USA 2005. Ibid. 76 Cf. ABESAMIS C., Exploring the Core of Biblical Faith, Claretian Publication, Quezon City, Philippines 1986, p. 8. 77 Cf. FUCEK I., Justice, in LATOURELLE R. – FISICHELLA R (eds.) “Dictionary of Fundamental Theology”, The Crossroad Publishing Co., New York 1994, p.562a. 78 Ibid. 79 Cf. BURGHARDT W., Justice: A Global Adventure, Orbis Books, Maryknoll, NY, USA 2004, p.7. 75

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“The Exodus was not simply liberation from slavery; it was the formation of a new social order, in sharp contrast to the Egypt of their experience. Freedom from yes; but equally or more important, freedom for the formation of a community that would live under a covenant with God”80. This justice is mandated strongly among relations of unequals such as between the rich and the poor (cf. Lev. 19:9-10; 25:35-37), between male and female (cf. Ex. 21:7-11; 22:21-23), and between citizens and strangers (cf. Ex. 23:9; Deut.10:17-18) 81. Among these unequals, they are not simply bound by treating others equally but primarily rendering to each other what is due to each of them. For instance, the rich is not simply bound to give half of his riches to the poor so that both of them will be on equal footing. Rather, by virtue of justice the rich is bound to render what exactly belongs or due to him or her, that could be less or more than what he possessed. It means also a relationship that pays more attention to those who are weak, the disadvantage, and the powerless in the community (cf. EJFA 38)82. The justice of Yahweh refers to “right relationship”83 and failure to sustain it would mean an injustice. (cf. Ps. 31:2; 52; 71). It is then, an affront against Yahweh who offered the covenant and a corruption of justice that He establishes and inhabits in it84. The various forms of injustices committed against the weak and the powerless give birth to the vocation and mission of the prophets of Israel. Yahweh never stops in calling the patriarchs, the liberator and the kings but He sends prophets to speak to his people on his behalf. "Is not this the fast that I choose: to loose the bonds of wickedness, to undo the thongs of the yoke, to let the oppressed go free, and to break every yoke? Is it not to share your bread with the hungry, and bring the homeless poor into your house; when you see the naked, to cover him, and not to hide yourself from your own flesh? Then shall your light break forth like the dawn, and your healing shall spring up speedily; your righteousness shall go before you, the glory of the LORD shall be your rear guard. Then you shall call, and the LORD will answer; you shall cry, and he will say, Here I am” (Is.58:6-9).

80

Ibidem, p. 13. Cf. Ibidem. p. 14. 82 Cf. UNITED STATES. CONFERENCE OF CATHOLIC BISHOPS (USCCB), Pastoral Letter Economic Justice for All, 13 November 1986, in O’BRIEN D. – SHANNON T., (eds.), Catholic Social Thought, The Documentary Heritage, Orbis Books, Maryknoll, NY 2005, n. 38, p. 587. 83 BURGHARDT W., op.cit., p. 8. 84 Cf. FUCEK I., Justice, art.cit., 563a. 81

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In the words of the prophet Isaiah, God expresses to his people what he wants. He wants freedom, abundance, security, and the poor be restored to their rightful place and right relationship85. Prophets act as the “critical conscience” to the rulers of the time and their administration of public goods86. (cf. also Amos 4:4-5; 5:21-27). These events reveal the true identity of Yahweh, the God of Israel who is always partisan and bias on the side of the poor, the oppressed and the needy87. This attitude does not make Him unfair nor unjust to his people. Yahweh wanted to reveal his real nature to his people, i.e., one who desires right relationship and vindicates the victims of injustices. In the New Testament, justice is understood in the very mission of Jesus to the people of Israel. Jesus is not proposing a new meaning of what has been founded by his Father in the ancient Israel. Rather, he brings to fulfillment what has been established through His salvific words and deeds in this programmatic speech. "The Spirit of the Lord is upon me, because he has anointed me to preach good news to the poor. He has sent me to proclaim release to the captives and recovering of sight to the blind, to set at liberty those who are oppressed, to proclaim the acceptable year of the Lord (Luke 4:18-19)." This sets the tone of his mission and ministry. In this passage, Jesus projects the finality of His Kingdom mission, which is the goodness and right order of creation; a responsible shepherding of this creation; the right conduct of the covenant community, which must be characterized by sharing of the goods and giving privilege to the least especially the sick88. What is more interesting here is when he exercises his preferential love to the poor (outcasts, marginalized, sick), he dares to cross the social and legal boundaries of the time, notwithstanding the criticisms and plots against his life89. (cf. Matthew 12:1-5; Mark 2:7-8; Luke 10:25-37). He does not simply defend what is due to the poor but even identifies with them as one of them (cf. Matthew 25:31-46). “He reveals himself now as the center of a Cf. KAMMER F., Doing Faithjustice: An Introduction to Catholic Social Teaching, Paulist Press, New York 2004, pp.31-32. 86 Cf. PASQUETTO V., Solidarieta e Giustizia: Fondazione Biblico-Teologica, in SANDRIN L., (ed.) Solidarieta e Giustizia in Sanita, Atti di Convegno Camillianum, Roma 21-22 Novembre 2006, Edizione Camilliane, Torino 2006, p.26. 87 Cf. FUCEK I., Justice, art. cit., p. 564ab. 88 Cf. KAMMER F., Doing Faithjustice …, op.cit., p. 47. 89 Cf. Ibidem., pp.45ff. 85

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new web of relationship between God and us, a new covenant of kinship with the anawim as its privileged locus”90. This new web of relation reveals a two-edged relation: “the God who wills to be helped in the poor because what is done to the poor is done to him”91. The preferential love of Jesus to the poor is not an assault to the gospel value of equality and justice. Rather, it strengthens and gives new meaning to it. For equality is not founded in the principle of equal treatment but on justice, i.e., giving what is due to each one that suffices man’s equality in dignity and destiny92. From the core of our biblical faith, three salient points are pointed out here in relation to the discourse on justice. The justice of God is always understood in the context of a] the covenant relationship between b] Israel/people of God and Yahweh/Jesus, the son of God, as subjects, and c] its objective which is to establish right order, right relationship that will culminate in the final coming of His Kingdom. This truth is founded from the moment of creation wherein God created man and woman in His image and likeness. 2.1.2. Theological Reflection The biblical concept of justice has been affirmed by our catechism when it categorizes justice as one of the four cardinal virtues wherein all other virtues depend (cf. CCC 1805-1809); wherein all other virtues operate to establish a right relationship. This concept leads us to the Thomistic concept of justice, i.e., “rendering each one his right (ST, II,II, Q.58.1)”93. He defines justice as a voluntary act, which is known, chosen for a specific end, and decisive, thus it renders such an act as virtuous 94. This definition reveals four essential aspects, namely, the moral agent, the recipient of the act, the content (what is due), and the relation of the thing that is due to its recipient95. The interplay of these elements is indispensable to render the act as just or right. For instance, a sick person (recipient) needs health care (due), and as a health care provider (moral agent), he is bound 90

Ibidem., p.54 FUCEK I., Justice, art. cit., p.566a. 92 Cf. PASQUETTO V., Solidarieta e giustizia ..., art. cit., p.28. 93 Cf. AQUINAS T., Summa Theologica II,II, Q.58, Art.1, (trans.), in PRO-LIFE CD Library, Human Life International, USA 2005. 94 Ibid. 95 Cf. WILLIAMS T., Who is My Neighbor? Personalism and the Foundations of Human Rights, The Catholic University of America Press, Washington, D.C. 2005, p. 265. 91

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in justice to provide because health belongs to him by reason of natural law principles. Thus, an undue regard to this truth will result to injustice because as Heinrich Rommen, in his essay on natural law, “one’s own, in fact, is an extension of the self”96. A just order of things and conduct will establish indeed just relation and thus harmony. However, since this relation is always situated in the context of complex society of individuals with various legitimate needs, then a moral obligation and duties are called forth. The exercise of this obligation must be always guided by justice; may it be “commutative, distributive, and contributive”97. In other words, all forms of human relation are essentially an interaction of these three types of justice: from an individual to another individual (commutative), from an individual to the society (contributive), and from the society to the individual (distributive). This triadic relation forms the dynamic of the social order in the human community. This dynamic of human relation in society aims towards a higher vision which is much in accord with man’s original nature (cf. Gen.1,2628). “Christian revelation shines a new light on the identity, the vocation and the ultimate destiny of the human person and the human race. Every person is created by God, love and saved in Jesus Christ, and fulfils himself by creating a network of multiple relationships of love, justice and solidarity with other persons while he goes about his various activities in the world (CSDC 35)”98. However, the finality of human vocation will not be guaranteed if the conditions to attain it are not present. These conditions are what we call the common good which is defined as “the sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily (GS 26)”99. These conditions are essential and indispensable for an integral human development and the vocation to the fullness of life (cf. Jn.10:10). “Belonging to everyone and to each person, it 96

Ibidem., 268. Cf. AQUINAS T., S.T., II,II, q.6, .art.1, “[… ]commutative justice, which is concerned about the mutual dealings between two persons. In the second place there is the order […] directed by distributive justice, which distributes common goods proportionately”; cf. USCCB, Pastoral Letter Economic …, art. cit., n. 71, “Contributive justice stresses the duty of all who are able to help create the goods, services, and other nonmaterial or spiritual values necessary for the welfare of the whole community”. 98 PONTIFICAL COMMISSION FOR JUSTICE AND PEACE (PCJP), Compendium of the Social Doctrine of the Church, Libreria Editrice Vaticana, Vatican City 2004, n.35, p. 20. 99 SECOND VATICAN ECUMENICAL COUNCIL, (VAT. II) Pastoral Constitution Gaudium et Spes on the Church in the Modern World, 7 December 1965, in FLANNERY A., (ed.), Vatican Council II, The Conciliar and Post-Conciliar Documents, St. Pauls, New Delhi 2001, n. 26, p. 815. 97

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is and remains ‘common’, because it is indivisible and because only together is it possible to attain it, increase it, and safeguard its effectiveness, with regard also to the future (CSDC 164)”100. Its indivisible character (common) assures each individual person in the community to develop and achieve their potential according to his original design. Thus, it is in accord and rooted in the person’s dignity and equality with others101. The common good is guaranteed to a person by virtue of his nature and dignity, which endow him the right to have all those conditions necessary for his development. This includes the “right to fulfillment of materials needs, the guarantee of fundamental freedoms, and the protection of relationships that are essential to participation in the life of the society (EJFA 79)”102. The key element here is the right to participate into the life of the society. The society exists because of and for the person. Whenever a person is denied of this basic demand of justice, he ends up being marginalized (cf. EJFA 77)103. This is exactly what is happening today where health ceases to be a basic human right but a basic human commodity wherein its access, is mediated by money that is simply unaffordable to the majority who lives at less than US$2.00 a day. Thus, injustice comes when one fails to recognize this fundamental right of the persons to determine their own destiny by depriving them of the means to achieve their ends104. While it is true that injustices happen also among personal-individual relations, but we cannot hide the fact that the most vivid and brutal forms of injustices are coming from a sinful social structure. It is the one that “destroys life, violate human dignity, facilitate selfishness and greed, perpetuate inequality and fragment the human community105”. Social structure is an interdisciplinary concept, meaning its uses are varied and complex. In general, it refers to the mechanism or system that mediates, facilitates, and arranges human interaction in the society. For instance, Catholic institutions (schools, hospitals, centers for human development, etc.) are established primarily for delivering services to the least 100 101

PCJP, CSDC, op.cit., n.164, p. 93. CORKERY P., Companion to the Compendium of the Social Doctrine of the Church, Veritas Publications,

Dublin 2007, p. 73. 102 USCCB, Pastoral Letter Economic ..., art. cit., n. 79. 103 Cf. Ibidem., n. 77. 104 Cf. DORR D., Option for the Poor, A Hundred Years of Catholic Social Teaching, Orbis Books, Maryknoll, NY 20036 , p. 233. 105 KAMMER F., Doing Faithjustice …, op.cit., p. 205.

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fortunate. Nowadays, with the entry of the neo-liberal globalization policies in almost all aspects of life, that primary intent has been unrecognized. “Institution tends to take on a life of their own. Rather than to care for the true needs of the people for which it was founded, the institution serves its own needs especially the needs of its own bureaucracy. In this process, right relationships are undermined, the balance of justice tilted and the common good forgotten”106 Donald Gelpi describes it in his article The Converting Jesuit, as a “conspiracy with the institutional injustice”107. No doubt, that there must be some legitimate or practical reasons to it, but it should be further based on what is morally a sound decision, which oftentimes runs counter to the institutional operative values. 2.1.3. Our Mission as Church People The initial statement of the Pastoral Constitution “Gaudium et Spes” affirms clearly the role and mission of the Church to humanity especially to the suffering humanity. “The joys and the hopes, the griefs and the anxieties of the men of this age, especially those who are poor or in any way afflicted these are the joys and hopes, the grief and anxieties of the followers of Christ (GS 1)”108. As followers of Christ, they are our absolute responsibility to bring them onwards to the fullness of His Kingdom, the fullness of their lives as sons and daughters of God. Moreover, the Church is called to intervene into their history wherein such condition does not guarantee anymore to the full attainment of their Christian vocation, as God did once with Moses to his oppressed people of Israel (cf. Ex. 3, 7-10). “Action on behalf of justice and participation in the transformation of the world fully appear to us as a constitutive dimension of the preaching of the Gospel, or, in other words, of the Church's mission for the redemption of the human race and its liberation from every oppressive situation (JW 6)”109. HEALY S., Justice in a Changing World, in MINISTERS OF THE INFIRM – “Documents”, n. 20 (2008), p.448. 107 KAMMER F., Doing Faithjustice ..., op.cit, p. 215. This was quoted by the author from the article of Gelpi, D., The Converting Jesuit, in Studies in the Spirituality of the Jesuits, Vol. 18, No. 1, January 1986, p.28. 108 VAT. II, GS, n. 1, p. 794. 109 SYNOD OF CATHOLIC BISHOPS, Justice in the World, 30 November 1971, in O’BRIEN D. – SHANNON T., (eds.), Catholic Social Thought …, op. cit., p. 289. 106

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This affirmation has been provoked by the Church’s continuous task of reading the signs of the times (cf. GS 4)110 wherein a great number of her disciples are deprived of the means for integral human development and ignored of their rights to full participation and determination of their own destiny according to their original design. The statement strongly affirms the centrality of justice in the gospel and to the Church’s evangelizing mission. The Church is task to liberate humanity from the bondage of slavery from all structures and forms of relation that hinder the person’s attainment of his vocation111. The Church is called to offer, not a new social ideology marcotted from the social message of the gospel, but a new basis and a motivation for action (cf. CA, 57) 112. It is her right and a duty “to develop a social doctrine of her own and to influence society and societal structures with it by means of the responsibility and tasks to which it gives rise (CSDC, 69)”113. As a praxis, there is nothing new since these principles has been lived out and proven right in the early years of Christianity (cf. Acts 4:32-37) and the succeeding centuries. Anything that matters for integral development of persons (cf. PP, 14)114 are the same matters that need to be evangelized, which means to be injected by the gospel values as the vital principles of development. It is in this context that evangelization must begin with as its point of departure. “But since the human person who is to be evangelized does not live in a vacuum, but is constantly barraged by social and economic and political problems, since redemption must touch the very concrete situation of injustice to be combated and of justice to be restored, since the new commandment of love cannot be proclaimed without promoting in justice and in peace the true,

Cf. VAT. II, GS, n. 4, p. 796. Cf. KAMMER J., Doing Faithjustice ..., op. cit., p. 134. 112 Cf. JOHN PAUL II, Encyclical Letter Centesimus Annus, 1 May 1991, in O’BRIEN D. – SHANNON T., (eds.), Catholic Social Thought …, op. cit., n.57, p. 481. 113 PCJP, CSDC, n. 69, p. 38. 114 PAUL VI, Encyclical Letter Populorum Progressio, 26 March 1967, in O’BRIEN D. – SHANNON T., (eds.), Catholic Social Thought …, op. cit., n. 4, p. 240. “Development cannot be limited to mere economic growth. In order to be authentic, it must be complete: integral, that is, it has to promote the good of every man and of the whole man. As an eminent specialist has very rightly and emphatically declared: We do not believe in separating the economic from the human, nor development from the civilizations in which it exists. What we hold important is man, each man and each group of men, and we even include the whole of humanity”. 110 111

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authentic development of the human person, evangelization is not complete without temporal liberation (PCP II, 243)”115. The great economic disparity wherein wealth is concentrated into the hands of the few rich people in the world, the injustice of poor distribution of resources necessary for human development, and the basic social institutions that are designed to deliver basic services to the people that became now centers for profit and power brokers are the very concerns that evangelizers must pay attention. As the famous archbishop Dom Helder Camarra says, “You cannot feed the word of God to a hungry stomach.” These are the very concerns that the great saints of charity wasted much of their time and effort even at the risk of their own lives. “Christian love of neighbor and justice cannot be separated. For love implies an absolute demand for justice, namely, a recognition of the dignity and right of one’s neighbor (JW, 34)”116. Love is the apex and reason for justice. Love begins and emanates from God, and our neighbor is the visible sign of this love. Anything that is deprived of him is deprived of God. (cf. Mt. 25, 31-46). Since the dignity of persons rests in the truth of being created in the image and likeness of God, then anything that violates, must be overcome and it is in the realm of the Church’s mission. Thus, the Church turns to be a “judge and a defender of the unrecognized and violated rights especially those of the poor, the least and the weak (CSDC, 81)”117. While it is true that the provision of all those fundamental needs for human development does not fall under the primary responsibility of the Church because she cannot replace the State, but when the person’s right to have these necessary means is violated then she has right to fight for it in justice. (cf. DCE, 28)118. At the same time, the commandment of love obliges her to act in charity to provide these needs within the bounds of her competence and the “opus proprium” which the task entrusted to her (cf.

CATHOLIC BISHOPS CONFERENCE OF THE PHILIPPINES (CBCP), Acts and Decrees of the Second Plenary Council of the Philippines, Manila, 17 February 1991, Paulines Publishing House, Pasay City 1992, n. 243, p. 87. 116 WSCB, JW, n. 34, p. 293. 117 Cf. PCJP, CSDC, n. 81, p.45. 118 Cf. BENEDICT XVI, Encyclical Letter Deus Caritas Est, 25 December 2005, n. 28, in http://www.vatican.va/holy_father/benedict_xvi/encyclicals/documents/hf_ben-xvi_enc_20051225_deuscaritas-est_en.html 115

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DCE, 29)119. For it is through this way that our presence be known and felt by our least fortunate brothers and sisters. As St. John says, “By this we know love, that he laid down his life for us; and we ought to lay down our lives for the brethren. But if any one has the world's goods and sees his brother in need, yet closes his heart against him, how does God's love abide in him? Little children, let us not love in word or speech but in deed and in truth (1John 3:16-18)”. When love is taken as the vital principle of justice then it becomes a real impetus for us Christians to build a better, humane and just world120. This spurs from the belief that injustices are caused by the destruction of right relationship and social order. He who works for justice should aim at re-ordering this chaos manifested in the various sinful social structures. This entails enormous passion and determination on the part of the workers of the vineyard of our Lord, and the capacity to embrace the greatest form of love, i.e., “to lay down one’s life for his friend” (Jn. 15:13). Confronted by this sinful social structure, we are challenged, “to unmask the realities lurking behind the legitimized structure or institution. When the realities of harm done to the human community are exposed, their demise begins”121. It is indeed an arduous task that entails serious commitment and creative minds. It is not simply by being armed with uncontestable principles but most of all a full resolution to dedicate oneself with the oppressed people. As Peter Henroit S.J., reflected his experience in working and fighting for justice has this to say: “It can’t be only ideology or politics that drives me to challenge the unjust structures of society, for that would fall too quickly become stale and sterile. People with names and faces make the difference”122. Love for others, and especially for the poor, is made concrete by promoting justice (cf. CA, 58)123. By establishing the intrinsic link between justice and charity as part of the Church’s mission of evangelization, we have affirmed that confronted with the menace of social structures that are detrimental to full human development; we are bound to uphold the 119

Cf. Ibidem., n. 29. Cf. KAMMER I., Doing Faithjustice ..., op. cit., p.193. 121 Ibidem., p. 214. 122 Ibidem., p.227. This was quoted by the author from the article of Henroit P., Lessons of Seventeen Years…, in Center Focus, Issue 88, January 1989, p.6. 123 Cf. JOHN PAUL II, CA, n. 58, p. 482. 120

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natural principles of dignity and rights of the person. Thus, it is within the competence of the Church to offer a rational and ethical formation for the promotion of justice in the society, the community of persons (cf. DCE, 28)124. She is called to witnessing in words and at the same time preaching the word by witnessing in action. This is where her credibility lies. (cf. EN 21-22; 41-42)125.

2.2. The Tripod of Social Justice It is clear that at the heart of the Church’s social mission is the promotion of integral human development whose subject and aim is the human person, an individual and a social being endowed with intrinsic dignity, freedom, responsibility, human rights, and transcendent nature126. This further affirms that all persons are unique and irreplaceable and cannot be reduced to a mere entity, which can be interchanged or disposed as instruments for another purpose. As a social being, the person is always in relationship whose well-being is attainable only through entering into the fabric of various forms of human relationships in the society127. As a transcendent being, his life is ordained towards the highest good, the fullness of life. He is destined for a higher state of perfection, which surpasses his nature and bestows new fullness of life (cf. PP 16)128. These intelligible truths are founded in human nature, the original design of God as created in His image and likeness which confers him/her the dignity and the rights to have all the basic conditions (common good) for integral human development. 2.2.1. Human Dignity

Cf. BENEDICT XVI, DCE, n. 28. Cf. DORR D., Option for the Poor…, op.cit., p.243. 126 Cf. CBCP, Pastoral Exhortation on the Philippine Economy, Tagaytay City, July 10, 1998, in http://www.cbcponline.net/documents/1990s/1998-philippine_economy.html; cf. CORKERY P., Companion to the Compendium…, op. cit., pp.44-47. 127 Cf. CATHOLIC BISHOPS OF ENGLAND AND WALES (CBEW), Human Rights and the Catholic Church, Reflections on the Jubilee of the Universal Declaration of Human Rights, 1998. http://www.catholicchurch.org.uk/index.php/ccb/catholic_church/catholic_bishops_conference_of_england_a nd_wales/publications 128 cf. PAUL VI, PP, n. 16, pp. 243-244. 124 125

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God created human being both body and soul, a unitotality of both substances, which are inseparable (cf. GS 14)129. This truth points to the primordial nature of man as a being relating to the world through his body as well as a spiritual being open to transcendence, the original project of his life (cf. CSDC 127/129)130. However, this reality does not negate man’s limitations in spite of his freedom and faculties for selfdetermination. Aided by reason and conscience, man is able to conduct himself towards the perfection of his transcendent nature, which is evident in the very dignity that he is endowed with (cf. GS, 15-16)131. This openness to transcendence brings man to the unlimited horizon of his existence, which compensates his faculties for self-understanding and self-determination. Man’s consciousness is aware that his life is ordained towards the fullness of his dignity and identity (cf. CSDC, 131)132. Moreover, this personal dignity of man demands that he should be treated always as an end and never as a means, which is an absolute violation of his dignity133. The dignity of person opens another light into human existence that from the classical down to the post-modern concepts of person affirmed that a person is always a person-in-relationship, whose becoming at the level of the pursuit of his well-being cannot be simply attained alone134. In the process of relating to others, when persons meet together they form into a community or what we have seen now a bigger society. This conforms exactly to man’s social nature, which is ordained towards the well-being of the individual and the society. “The social nature of man shows that there is an interdependence between persons’ betterment and the improvement of society. In so far as man by his very nature stands completely in need of life in society, he is and he ought to be the beginning, the subject and the object of every social organization”135. The interdependent nature of man reveals to us three important aspects in the dignity conformed to man by virtue of his creation. First, the other is a reflection of the Cf. VAT II, GS, n. 14, p. 804. Cf. PCJP, CSDC, nn. 127.129, pp. 71-72. 131 Cf. VAT II, GS, nn. 15-16, pp.805-806. 132 Cf. PCJP, CSDC, n. 131, p. 73. 133 Cf. WILLIAMS T., Rights and the Person: An Inquiry into the Foundation of Human Rights in the Light of Thomistic Personalism, Atheneum Pontificium Regina Apostolorum, Roma 2001, p. 80. 134 Cf.CBEW, Human Rights and the Catholic Church…, art. cit. 135 VAT II, GS, n. 25, p. 814. 129 130

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realization of his potentialities towards the fullness of meaning and transcendence through the establishment of his well-being in the community. The strong desire of the post-modern man for belongingness reveals this kind of reflection. Second, the interdependence of persons reveals the truth that all persons are equal in dignity. This equality demands that no person should be discriminated in all aspects and everyone is ought to protect and respect that dignity (cf. also GS 29)136. This aspect of human dignity is founded in its ontological identity, which means because of its nature, it is common and equal to everybody 137. This is a pre-condition for a just and healthy society138. Third, the society is ought to recognize the worth and needs of each one, and thus assure the presence of the fundamental social conditions for human integral development (cf. also PP 76)139. These conditions is what the Magesterium described as the common good which is “the sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily (GS 26)”140. The presence of the common good which should not be simply construed as the sum of all the basic necessities of person as to the fact that these conditions are common to all and due to all by virtue of the person’s dignity. These are necessary conditions for the person to live with dignity. (cf. GS 27)141. The threat of the person’s well-being today are the visible economic disparity among citizens, the liberal imperialist philosophies that give the backbone to the liberal but protective profit-oriented economic policies, and the deaths of many without receiving any medical attention while tons of medicines and unused equipments are kept inaccessible to the common people. These are the real menace to human dignity, and thus contrary to God’s plan in history. Society is created by persons in order to facilitate their well-being and not the other way around. Human dignity affirms the truth that man is always in the process of becoming. He is always expected to do something in accordance with his primordial nature and original Cf. CREPALDI G. – COLOM E., Dignità Umana, in Dizionario di Dottrina Sociale della Chiesa, Libreria Ateneo Salesiano, Roma 2005, pp. 197-198. 137 Cf. WILLIAMS T., Rights and the Person ..., op. cit., p. 157. 138 Cf. EVANS B., Lazarus at the Table: Catholics and Social Justice, Liturgical Press, Minnesota, USA 2006, p. 23. 139 Cf. CREPALDI G. – COLOM E., Dignità Umana, art. cit., p. 197. 140 VAT II, GS, n. 26, p. 815. 141 Cf. Ibidem., n. 27, p. 816. 136

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intent, freely as a moral agent142. His excellence demands respect, not for him to boast of himself or glorify himself above all others but to remind himself of his transcendent purpose, i.e., to be united finally with his Creator in His Kingdom. All his efforts must be oriented towards that noble purpose of life. He must be conscious also that the final test of his act is his capacity to do a sincere gift of himself through interpersonal communion with others and to God, the finality of all things. Thus, any human activity should promote always the integral dignity and vocation of the person as God himself wills all men, and the commitment to justice and solidarity is embedded in it (cf. CDSC 35-40)143. Therefore, human dignity is what makes the person is, which means, “it has as much to do with who we are and where we are headed as it does with how we relate to other people along the way”144. Since, man is ordained towards the fulfillment of his human vocation (cf. also PP, 15), the protection of his dignity must always be the primary concern. This can only be assured, if the social conditions that is due to him by natural right, the rights that are inherent in his dignity, are guaranteed by the State which is ordained for the protection and promotion of the rights and dignity of persons (cf. CSDC 165)145. The State by virtue of its nature and purpose is obliged to render any good necessary for man’s project of life. 2.2.2. Human Rights Human dignity is recognized and the common good is promoted only if the person can freely exercise his responsibilities and claim to all these goods by virtue of a right that is inherent to him. It is only through the exercise of these fundamental rights that man will be able to attain authentic development. If these rights are inherent, where did it emanate from? According to the Scholastic thought, every human being is a person with dignity that is endowed with intelligence and free will and from this truth, flows the rights of the person, which is granted and assured from his very nature (cf. also PT, 9)146. From man’s Cf. WILLIAMS T., Rights and the Person ..., op. cit., pp. 151-2. Cf. PCJP, CSDC, nn. 35-40, pp. 20-22. 144 EVANS B., Lazarus at the Table…, op.cit., p. 14. 145 Cf. PCJP, CSDC, n. 165, p. 94. 146 Cf. WILLIAMS T., Rights and the Person ... , op. cit., p. 66. 142 143

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personal dignity, there arises his rights. This right comes not as a tangible possession but as a faculty of the will to exercise what the person is ought and not ought to be. The stability of that right does not depend on the exercise or the non-exercise of it; rather, it depends on man’s nature. It remains forever in man as long as he exists147. Aside from its inherent character, rights bear some fundamental characteristics, namely, universal, inviolable and inalienable. “Universal because they are present in all human beings, without exception of time, place or subject. Inviolable in so far as ‘they are inherent in the human person and in human dignity’ and because ‘it would be vain to proclaim rights, if at the same time everything where not done to ensure the duty of respecting them by all people, everywhere, and for all people’. Inalienable insofar as ‘no one can legitimately deprive another person, whoever they may be, of these rights, since this would do violence to their nature’(CSDC 153) ”148. As St. James in his letter to the people in diaspora, (cf. Jas. 2), clearly bring out the very intention of God to protect the least fortunate in the community who happens always to be the victims of injustices and violation of their inherent rights. Not even by the force of a legitimate law such as the privatization and liberalization of health care can deprive the person of access to the necessary goods for protection and promotion of his health because it would mean a violation to his very nature. Thus, its force is drawn from natural law (cf. PT 30)149. In the context of the exercise of the rights of an individual, aided by justice, it demands certain duties and responsibilities from every individuals of the society. The moral imperative to respect the fundamental rights of person is universally binding on our consciences wherein everyone is directed to provide it by any legitimate means (cf. CL 38)150. The respect and the promotion of human rights are the necessary condition for an integral development of man and humanity (SRS 44)151. Thus, it presupposes a concrete legal structure or organization that will handle the responsibility of its protection and Cf. Idem., Who is My Neighbor? …, op. cit., pp. 4-6. PCJP, CSDC, n. 153, p. 85. 149 Cf. JOHN XXIII, PT, n. 30, p. 135. 150 Cf. JOHN PAUL II, Apostolic Exhortation Christifideles Laici, 30 December 1988, n. 38, in http://www.vatican.va/holy_father/john_paul_ii/apost_exhortations/documents/hf_jp-ii_exh_ 30121988_christifideles-laici_en.html. 151 Cf. Idem, Encyclical Letter Sollicitudo Rei Socialis, 30 December 1987, in O’BRIEN D. – SHANNON T., (eds.), Catholic Social Thought …, op. cit., n. 44, p. 427. 147 148

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assurance152. This is where the role of the State comes into play specifically in the distribution of resources as a necessary condition for development. Furthermore, the promotion of human rights is a constitutive element of the mission of the Church because this emanates from the natural and divine law, and it is designed for the fulfillment of man’s transcendent vocation153. The pastoral commitment of the Church towards the promotion of human rights evolves in two spheres of commitment, namely, the “proclamation of the foundations of rights and the denunciation of the violations of these rights (CSDC 159)”154. This commitment even demands in cases when the poor are being subjected to massive discrimination, continuous exploitation, and the legal rules have no more power to sanction the situation, to instruct those who have abundant resources to renounce their rights over it, in the name of charity, so that those goods will be at the disposal of the most needy (cf. OA 23)155. It shows that respect and recognition of these rights are not enough but one must secure and defend them with concrete actions for the simple reason that “they are statements of normative moral principles, regardless of whether they are legally codified”156. Thus, in conscience one is obliged to defend it. What are these fundamental rights? There is a hierarchy of rights wherein all other rights depend and operate. It serves as the fundamental basis that without which all other rights are unattainable, and an authentic human development is inconceivable. These are the right to life which is the primary and indispensable to all, the civil right which is necessary for the individual’s public life, the political right which assures the individual’s participation into the life of the society, and the cultural right which gives due respect to one’s identity157. The right to life is the most fundamental and indispensable because of the sacredness of human life. Each and every life is a gift from God. To deny the person of this fundamental right is a clear obstruction for the realization of his/her dignity. The Cf. CREPALDI G. – COLOM E., Diritti della Persona, in Dizionario di Dottrina Sociale della Chiesa, Libreria Ateneo Salesiano, Roma 2005, p. 224. 153 Cf. TOSO M., Verso Quale Società? La Dottrina Sociale della Chiesa per una Nuova Progettualita, Libreria Ateneo Salesiano, Roma 2000, p. 181-180. 154 PCJP, CSDC, n. 159, p. 89. 155 Cf. PAUL VI, Apostolic Letter Octogesima Adveniens, 14 May 1971, in O’BRIEN D. – SHANNON T., (eds.), Catholic Social Thought …, op. cit., n. 23, p. 273. 156 WILLIAMS T., Who is my Neighbor …, op. cit., p. 18. 157 Cf. CREPALDI G. – COLOM E., Diritti della Persona ..., art. cit., p. 225ff. 152

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universality and objectivity of this right is recognized by the heads of the State in the Universal Declaration of Human Rights (UDHR) in 1948 which states that, “Everyone has the right to life, liberty and security of person (Art. 3). Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control (Art. 25.1)”158. The recognition and assurance of the basic human rights of the person depends solely on an integral vision of the person. The ontological and natural truths of the human person are the keys to the understanding of the dynamism of human life, which is necessary for the fulfillment of his original vocation. These truths are not something abstract, but are realized within a concrete socio-historical context159. It the end, the question of human rights is a question of what is due to the person, thus, a question of justice. But true justice will be realized if man achieves what is due to him but at the same time fulfills what is being asked of him, i.e., his obligation (personal and social). 2.2.3. The Common Good While it is true that “common good” is irreducible to the sum of the particular goods on earth such as food, housing, health care, etc., and it refers primarily to a social condition that can guarantee the men and women of today to the realization of the integral vision of human development according to his original project of life, it is in the nature of the common good that everyone has the right to it especially to those who are deprived of it (cf. PT 56)160. It is in this context, the State is given the primary responsibility to facilitate the establishment of this condition because it constitute the raison d’être of its existence (cf. CCC 1910)161. Thus, the State must be guided by natural principles in order UNITED NATIONS, Universal Declaration of Human Rights, Adopted and proclaimed by General Assembly Resolution 217 A (III) of 10 December 1948, in http://www.un.org/Overview/rights.html. 159 Cf. TOSO M., Verso Quale Società?..., op. cit., pp. 191ff. 160 Cf. JOHN XXIII, PT, n. 56, pp. 140. 161 Cf. CCC, n. 1910. 158

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to maintain its integrity by respecting always the right and dignity of all persons or constituents. In addition, primary among all these principles is the universal destination of goods. 2.2.3.1. The Principle of Universal Destination of Goods The principle of universal destination of earthly goods states that, “God destined the earth and all it contains for all men and all peoples, so that all created things would be shared fairly by all mankind under the guidance of justice tempered by charity (GS 69)” 162. It finds its basis in Genesis. "Be fruitful and multiply, and fill the earth and subdue it; and have dominion over the fish of the sea and over the birds of the air and over every living thing that moves upon the earth." And God said, "Behold, I have given you every plant yielding seed which is upon the face of all the earth, and every tree with seed in its fruit; you shall have them for food (Gen. 1:28-29)”. From this principle, the following elements can be delineated. First, every man has the right to use the earth’s goods. This means that all things are at the disposal of man to be used in view of fulfilling his vocation in life. This also implies that he is responsible for shepherding (developing and protecting) all these things not only for his own sake but also for others. Second, this right is natural, and thus inherent in every person (cf. CSDC 172)163. This is even guaranteed in cases of extreme necessity such as in imminent danger and no other possible recourse, that he may exercise this right by succoring his needs through the properties of others openly or secretly, which is not robbery at all, since it is his right (cf. Summa Theol. II-II, q.66, a.7; cf. GS 69)164. This, further implies that those who are least fortunate should be given preferential attention, which is a social responsibility (cf. CSDC 182)165. Third, above all, this right is exercised not just simply to have the things due to the person but to fulfill the original purpose of life. Now at age of globalization where technology and knowledge are fast developing, the goods that were initially construed as the material goods extend itself to the “new goods which are the result of knowledge, technology and know-how (CSDC 179; cf. CA VAT II., GS, n. 69, p. 857. Cf. PCJP, CSDC, n. 172, p. 97. 164 Cf. AQUINAS T., ST, II-II, q. 66, a.7. 165 Cf. PCJP, CSDC, n. 182, p. 102. 162 163

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32)166”. The right over these “new goods” must be given emphasis especially in the world of health wherein the “intellectual property rights law”, as described in the previous chapter, allows patenting of medicines and technology even to the detriment of inaccessibility to the world’s poor population and developing nations. These goods are in reality are part of the human patrimony and indigenous property, thus, inherited and should be made available to succeeding generations167. Therefore, the use of these created goods should be marked with freedom guided by reason. 2.2.3.2. Health as the Primary Good As the common good is understood as the sum of all social conditions, it finds its concrete expression in the primary good, which is called health. The late John Paul II defined health as, “the tension towards harmony at the physical, psychological, spiritual and social level and not mere absence of illness and which enables man to fulfill his Godgiven mission in the stages of life he finds himself”168. Moreover, his successor defined it as “the sign chosen by Christ to manifest God’s closeness, his merciful love, which heals the mind, the soul and the body”169. These definitions bring to consciousness the following essential elements of health. First, it is a state of integral well-being, which finds its proper place as a gift of God and as a responsibility of all individuals, which is the attainment of harmony. Second, it is dynamic which means oriented towards a specific purpose, the gradual fulfillment of the vocation of man to holiness. Third, it is a sacrament, which means an external sign of God’s gratuitous act of his merciful love that is efficacious or that brings healing. Thus, health is a primary good wherein all other fundamental needs of man presupposed170. Looking at it (health) at the phenomenological level, it can be described as “a new quality of life” or “new health”. 166

Ibidem., n. 179, p. 72. Cf. CORKERY P., Companion to …, op.cit., p. 72. 168 JOHN PAUL II, Message for the World Day of the Sick for the Year 2000, in Dolentium Hominum, No. 42 (2000), p. 9. 169 BENEDICT XVI, Address to the Plenary Assembly of the Pontifical Council for Health Pastoral Care, 22 March 2007, in Dolentium Hominum, No. 65 (2007), p.55. 170 GIANNINO P, Giustizia–Diritti Umani e Salute, in CINA G, et.al. (eds.) Dizionario di Teologia Pastorale Sanitaria, Edizioni Camilliane, Torino, Italy 1997, p. 529°. 167

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“[…] that gives a new quality of existence: communities that live and propose models of solidarity, freed from slavery of possession and from an unhealthy relationship with things, and from the obsession of health that makes a cult of the body; men and women that place their humanity, educated in the school of the Good Samaritan, at the service of other people, who have discovered the meaning of life, the value of the essential, who live a relationship with God capable of meeting the deepest aspirations of man” (CD 2007, n. 66)171. From this description, health is presented as a new mode of being that is promoting right relationship with the eternal source of health and its beneficiaries, and is conscious of its social responsibility to care for the weakest in the society. In other words, it is a state or a condition of life that promotes justice, recognizes individual rights and respects the individual’s responsibility for self-determination and self-fulfillment. Health then, as a social condition, and a project of life is realized through the provision of the fundamental means for its attainment which is health care, a more concrete created good. This idea is founded on the two criteria of justice as regards to the person’s right to health. The first one is that all persons have the right to equal treatment as to the provision of the fundamental goods such as health care, food, housing, etc. The other one is, that the equal distribution of the resources is founded on the recognition of the value of solidarity of all persons, thus, recognizing the interrelation of the various project of life 172. The general comment on the International Covenant on Economic, Social and Cultural Rights expresses that “health is a fundamental human right indispensable for the exercise of other human rights”173. The recognition and respect of the exercise of the right to health is a moral imperative for the protection of human dignity. Therefore, the denial of this right means obstructing the people from responding to God’s call of shepherding his creation (cf. Gen. 1:28-29) where stands the core of our biblical faith. As Church ministers, we partake in her the “indisputable competence to decide whether the bases of a given social

M.I., (CAMILLIANS), Acts of the 56th General Chapter…, art. cit., n. 66, p. 733. GIANNINO P, Giustizia–Diritti..., op. cit., p. 529ff. 173 UNITED NATIONS, Substantive Issues Arising in the Implementation of the International Covenant on 171 172

Economic, Social and Cultural Rights, General Comment No. 14 (2000), The right to the highest attainable standard of health (Art. 12, International Covenant on Economic, Social and Cultural Rights) 11 August 2000, in http://193.194.138.190/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En?OpenDocument

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system are in accord with the unchangeable order which God our creator and Redeemer has shown us through Natural law and Revelation (MM 42)174”.

2.3. Renewing the Camillian Fervor of the Promotion of Social Justice Fr. Carlo Colafranceschi, M.I. has entitled his article at Camillians Today (1986), Camillus de Lellis, The Saint of our Times. This is a most accurate historical description of St. Camillus de Lellis, the great model saint of charity as also confirmed by Pope Benedict XVI in his inaugural encyclical letter Deus Caritas Est (cf. DCE 40 ). The reforms that St. Camillus instituted in his time (16th-17th cent.) in health care ministry are the very concerns that post-modern servants of the sick are pre-occupied with. His method of work and ministry portrayed already what the liberation theologians had articulated: see –judge – act or what we call now the pastoral spiral. This is evident on those three occasions that he had been in and out of St. James of the Incurables (see). This experience marked the starting point of his reflection of the situation (judge). Then, finally, when he organized the first group of dedicated men who served the sick with love and charity (act). 2.3.1. The Signs of the Time The beginning of the Italian Renaissance period (16th c.) is characterized by religious crisis due to the Reformation, the institutional and social crisis due to war and epidemics where urgent and drastic reforms were a necessity175. In the field of health care in particular, the hospitals became refuge of the desperate, abandoned sick people, vagrands and vagabonds while the rich are served in their private houses. For instance, the St. James of the Incurable, which was called Arcispedale (the head of all hospitals for the incurable), was instituted primarily for the poorest sick with incurable sores and ulcers coming from the various parts of Italy176. Oftentimes, medical assistance were rendered by JOHN XXIII, Encyclical Letter Mater et Magistra, in O’BRIEN D. – SHANNON T., (eds.), Catholic Social Thought …, op. cit., n. 42, p. 90. 175 Cf. SPOGLI E., The Diakonia of Charity of the Camillian Order, (trans.), St. Camillus Study House, Bangalore, India, p. 5; cf. BRUSCO A – ALVAREZ F., La Spiritualità Camilliana, Itinerari e Prospettive, Edizioni Camilliane, Torino 2001, pp. 63-64. 176 Cf. SANNAZZARO P., I Primi Cinque Capitoli Generali dei Ministri degli Infermi, Curia Generalizia, Roma 1979, pp. 21ff. 174

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medical personnel for a pay or at the minimum possible, including mercenaries who gambled their service even at the lowest salary, and only few rendered it with charity and dedication177. This inhuman and unjust socio-health condition of the poorest of the sick sparked the desire of St. Camillus to dedicate himself at the service of the sick even in danger to his own life. He was determined to institute reforms in the hospital even if it means going against the current of the time and endangering his tranquility and honor after he has been appointed as administrator, only for the sake of defending the dignity of the poor sick 178. As Cicatelli, his biographer described it, that “he served the sick with grandest zeal and charity that no man has ever known like him”179. Though we could not deny the fact that this zeal was partly influenced by his experience of the sore on his right foot and the gratuitousness of God, his vocation was deeply rooted from the historical condition of the time. His consciousness of the lived experience and the historical situation of the time made him see face of God among the sufferings and hear His voice in the clamor of the abandoned sick people and most vulnerable members of the society.

2.3.2. The Response to the Urgency: A New School of Charity In the Bull of Benedict XIV Misericordiae studium, (29 June 1746), on the canonization of St. Camillus, he defined him as the initiator of the new school of charity. (cf. also Const., 9). This recognition reveals to us the three essential features of his ministry with the sick in his time. This is worth examining closely for it will serve later as the fundamental principles of the promotion of justice in the world of health.

2.3.2.1. Anthropological Vision The sick is a person in his indivisible nature (body and soul), where his needs (corporal and spiritual) as a whole are interdependent180 (cf. also Const. 43). The very intention of St. Camillus in establishing a group of men is to serve the sick in his totality Cf. BERGAMI E., La situazione sanitaria nella Roma del ‘500, in “Camillianum”, 6, 1992, pp. 394-399. Cf. SPOGLI E., S. Camillo de Lellis e La Sua Compangnia: Il Coraggio di Osare, in “Camillianum”, 6, 1992, pp. 413-415. 179 SANNAZZARO P., I Primi Cinque..., op. cit., p. 35. 177 178

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(body and spirit) as revealed to him by God through the promptings of the Holy Spirit felt by him in the urgency of the time. In the official documents of the Holy See that were addressed to Camillus and his companions, the complete service to the sick is given prime importance. In the Brief Ex Omnibus of Sixtus V, the “officium caritatis” points to the attention of the physical and spiritual needs of the poor and the sick. The Bull Illius Qui Pro Pregis of Gregory XIV emphasized the indistinctive role of priests and brothers as regards to giving holistic service to the sick181. The Bull Superna Dispositione of Clement VIII defined clearly the “ratio ordinis” which is the corporal and spiritual works of mercy182. This is far reflected in the first three General Chapters (1596 – 1602), wherein the issue of complete service to the sick was the most controversial topic 183. Lastly, the Formula of Life (1599) which states that, “If someone inspired by our Lord would like to exercise the works of mercy, physical and spiritual, according to the spirit of our Institute…”184. The anthropological vision of man as the mainline basis of Camillian ministry reflects the same vision that the entire corpus of the social doctrines of the Church aim at. The Church always acts “at the service of the full truth about man (CSDC, 13)”185. As followers of Christ, we are called to promote, defend and uphold always the dignity of the person. Thus, when the dignity of the sick person is violated the Camillian could not just simply remain at side in silence because he is meant to be the defender of the indignified sick person. 2.3.2.2. The Respect for Dignity and Freedom The sick person is endowed with dignity and freedom, and equal to all persons regardless of race, condition of life, religious and cultural beliefs186. Camillus rendered Cf. SPOGLI E., S. Camillo de Lellis..., art. cit., p. 418; cf. MINISTERS OF THE INFIRM (CAMILLIANS), Constitution and General Statutes, Ministers of the Infirm, (Eng. trans.) Generalate, Rome 1988, n. 43, p. 33. 181 Cf. SPOGLI E., The Diakonia of Charity…, op. cit., pp.90ff. 182 Cf. SANNAZZARO P., I Primi Cinque..., op. cit., p.263. 183 Cf. VEZZANI F., Compendium of the History of the Camillian Order, (trans.), Order of St. Camillus Philippine Province, Manila 2005, pp. 13ff. 184 M.I., (CAMILLIANS), Constitution and General…, op. cit., p.1 185 PCJP, CSDC, n. 13, p. 6. 186 Cf. SPOGLI E., S. Camillo de Lellis e La Sua Compangnia ..., art. cit., p. 420. 180

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service to the sick especially those who are most abandoned, the poorest and the strangers (pilgrims in Rome) who came from other places outside Italy. He began at St. James of the Incurables wherein the wretched in the society and the most marginalized were found because they could not just simply afford to avail of the services of the physician of his time. In his time, the classical rule before admitting the sick in the hospital was that, the patient has first to do confession of sins. However, Camillus reversed the norm by admitting first the patient and giving him all necessary accommodation and then discreetly asked the patient if he desires to confess. This attitude was described as revolutionary in his time187. In Rule IX of the rules of the servants of the sick, even excuses the minister of the sick to attend mass if he is attending to an important and urgent need of the patient, which in his judgment it is more pleasing to the Lord188. St. Camillus is deeply convinced that the sick person is a sacrament of Christ, which is recognizable only through the eyes of faith189. As Cicatelli described him; “So vividly did he see the person of Christ in them that often when helping them to eat […] he showed them such reverence as of he were in the very presence of our Lord often serving them on his knees with head uncovered”190. The sacramentality of the sick is also an efficacious sign that it opens our hearts and mind to the truth of our Christian radical vocation that we are the bearers of Christ to those who are afflicted and violated of their dignity. In this way, we become the Good Samaritan. This is particularly expressed in the twofold nature of Camillian spirituality, which is to be Jesus to the sick and to serve Jesus in the sick191. The choice of St. Camillus to live in poverty that one “should know that he has to die to all the things of this world […] in order to live solely for the crucified Jesus […]”192. They lived by the generosity of others, so that, they will not be distracted from focusing their time and effort in the service to the sick. The vow of poverty was and is a necessary condition for ones fidelity to the service of 187

Cf. Ibidem., p. 421. Cf. SOMMARUGA G., The Writings of St. Camillus (1584-1614), (Eng. trans.), St. Camillus College Seminary, Manila 1992, p. 13. 189 Cf. SPOGLI E., The Diakonia of Charity …, op. cit., p. 23. 190 Ibid. 191 Cf. VENDRAME C., Carisma e Spiritualità dei Camiliani, in “Camilliani Oggi” 1986-1987, Casa Generalizia, Roma 1987, pp. 27-29. 192 M.I., (CAMILLIANS), Constitution and General…., op. cit., p.1. 188

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the sick193. The person is ever and always the image and likeness of God regardless of his human condition, and this conforms the dignity proper to him, which is inherent and inviolable. Thus, a sick who is most vulnerable and powerless must be helped and defended in his struggle to regain his dignity as a person. This is justice. 2.3.2.3. The Prophetic Vocation The Ministers of the Infirm are called to consecrate their lives to the sick even at the risk of their own lives. “Therefore, following the example of our Holy Father Camillus, we commit ourselves to esteem evermore, to love with all our heart and to practice with all our strength the ministry to the sick, even at the risk to our life (Const. 12)”194. When he took over the hospitals of St. James of the Incurables, and the Holy Spirit, he instituted reforms that were perhaps unthinkable in his time such as the animation and humanization of hospital personnel by initiating a group of dedicated men, men with virtues195. He pursued in spite of the objections from the civil and ecclesiastical authorities, much more with his venerable spiritual father St. Philip of Neri. In the letter of St. Camillus to the Chapter of the General Hospital of Milan in 1594 expressed in strong words that “should a plague happen to strike the city, they are obliged to nurse the plague-stricken by the solemn vow they take”196. He sent 17 religious to Piedmont upon the request of the Pontiff to serve the people in the midst of pestilence197. Today, this prophetic vocation is challenged by the unjust situation in the world of health especially in developing nations. The spread of heinous forms of diseases, the epidemics, the scarcity of medical human and material resources, and the politics of health. The absence of solidarity among nations in putting together their resources in order to combat diseases is very much evident by the great disparity of mortality rates and life expectancy between the rich and poor nations. This vocation challenges the Camillians to

193

Cf. SPOGLI E., La Bola Illius Qui Pro Gregis, Presentazione e Commento, in “Camillianum” n. 5, (1992), p. 49. 194 M.I., (CAMILLIANS), Constitution and General …, op. cit., n. 12, p. 14. 195 Cf. SPOGLI E., S. Camillo de Lellis e La Sua Compangnia..., art. cit., p. 414. 196 SOMMARUGA G., The Writings of …, op. cit., p. 121. 197 Cf. SANNAZZARO P., op. cit, pp. 172-173.

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struggle with the most affected in eliminating the social and political causes of sickness198. To be a prophet then, one must be attentive to the signs of the times and be sensible to the pains and groaning of the suffering people. However, this sensitivity demands that one must live with the poor and by the poor as Christ himself who began his ministry in Galilee, in his region where the unwanted are settled. Though, it must begin from within (interior conversion) but it has to be manifested in the actual and grows out there. 2.4. General Observation The promotion of social justice in the world of health is a constitutive element in the mission of witnessing the merciful love of Christ to the sick person. It finds its root and expression in the very core of our biblical faith, in the font of the deposits of our faith, and especially in the very tradition of the Order. This very rich culture of evangelizing and advocating for social justice can only be accessed through “radicalism” which means going into the very root, the circumstances and the philosophies behind this culture. At the very foot of all these treatises and reflections is the human person who is created in the image and likeness of God. He is a person who is endowed with dignity, rights and freedom to conduct himself according to the very design of his original designer. He is a person who has been lavished by God with all the necessary conditions that he needs to fulfill his vocation in life, that is, the fullness of life, the completion of the joy that Christ has begun in us (cf. John 15:11). No other creature in this world, that God endowed with this gift of life. This gift entails also a responsibility. Responsibility is the true exercise of real freedom, when the person conducts and orients himself towards a personal and integral development. He is given the capacity to determine himself in gratitude. However, when the social condition does not favor the growth and development of his vocation, he is called to be responsible for the restoration of such condition. This is where social responsibility comes to the fore. Social responsibility demands us to be our brothers’ keeper (cf. Gen. 4:9) or to invite Lazarus at our table (cf. Luke 16:19-31). It demands us to put into practice the two great commandments of love (cf. Mark 12:30-31). It is only in this way, we will know that Cf. BRUSCO A., (ed.), The Constitution of the Order of the Ministers of the Sick (Camillians), Edizioni Camilliane, Torino 1998, p. 92. 198

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we are His disciples. Thus, our vocation to discipleship recalls us to the very promptings of the Holy Spirit revealed in a very concrete historical condition wherein we are called and challenged to respond with ability (responsibility) to the cries of the poor. This is where the mission of justice made more evident and appeared to us, as inevitable. If the object and subject of our ministry is the person regardless of his condition, then the inevitability of the justice mission is well-cited. How much more when these injustices are present in the very fundamental or the prerequisite condition for man’s total integral development which is health, the primary good, the cardinal of all other goods. The fundamental concepts and principles of social justice serve as an impetus for one who dedicates his life at the service of the sick, to move forward and deepened this noble vocation. The foundation indeed, is very important but it is useless when no one attempts to furnish the structure. Otherwise, it remains a skeleton and thus has no life. The ground is well established and is prepared to support the structure that we intend to build, a just social structure in the society. However, before delving into the very task that is assigned to us, we need first to prepare ourselves not only psychologically but also spiritually where we find the fountain of strength and stability. The following chapter then will deal this matter comprehensively.

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CHAPTER III TOWARDS A NEW PARADIGM OF WITNESSING THE MERCIFUL LOVE OF CHRIST IN THE WORLD OF HEALTH

The preceding chapter has established the foundational principles of witnessing the merciful love of Christ to the poor sick through promoting and advocating for social justice in the world of health. The world of health “provides the specification, for a Camillian, of his radical self-donation to the Absolute, to the Kingdom”199. It is in this context, wherein one who is called to serve the sick even in danger to his own life is called to realize the fullness of his consecration and in so doing contributes to the full realization of the Kingdom promised to humanity. To carry out this mission, one must be imbued with the real spirit of discipleship, and his life must be animated by passion for justice. This is a necessary pre-condition in setting up to the structural principles of the promotion of social justice in the world of health. As the gospel says, "Every one then who hears these words of mine and does them will be like a wise man who built his house upon the rock; and the rain fell, and the floods came, and the winds blew and beat upon that house, but it did not fall, because it had been founded on the rock”. (Mt. 7:24-25). Now the question is; how does one develop the mission of advocating for the dignity and rights of the poorsick? How does one live and dedicate himself to the promotion of social justice? Neglecting these fundamental questions of one’s consecration is like “a noisy gong and a clanging cymbal” (1Cor. 13:1), whose sound is dull and void of sense. Thus, anyone who believes in justice must be first just in the eyes of others (JW 40)200.

3.1. A Justice-Animated Spirituality

Cf. ALVAREZ F., Community, in BRUSCO A., (ed.), The Constitution of the Order of the Ministers of the Sick (Camillians), Edizioni Camilliane, Torino, Italy 1998, p. 107. 200 SYNOD OF BISHOPS, Justice in the World, 1971, in O’BRIEN D. – SHANNON T., (eds.), Catholic Social Thought, The Documentary Heritage, Orbis Books, Maryknoll, NY 2005, n. 40, p. 295. 199

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One of the serious errors that man or a Christian in particular, confronts in our era of today is the divorce between faith (orthodoxy) and its correct practice (orthopraxy) in his daily existence (cf. GS 43)201. A consecrated person is called to witness the Word of God in his concrete life, both personal and social. His proclamation must always be an interplay of the Gospel and the dynamism of his life (cf. EN 29)202. This is not an exclusive mission but of the entire People of God. This is our spirituality, the privileged place of encounter in which God speaks to us (the Word) […] and the school of thoughts and actions that fashions and motivates us203. Living therefore this spirituality, “is like walking on a razor’s edge. It is an uncomfortable challenge. Yet a sustaining and stimulating spirituality requires an effort from us to walk that thin line and to live in creative tension with what is on both sides of the razor’s edge”204. A justice-animated spirituality is exactly like “walking on the razor’s edge” where one feels always the tension to maintain himself on the line without falling into the one side. The tension is brought about by one’s passion to justice that hopes a “new heaven and a new earth” (Rev. 21:1) amidst chaos and turbulence; the desire for a new health as salvation amidst complex personal and societal illnesses; and the desire for integral development through just distribution of the earths goods amidst a global imperialist capitalist economic system that solely aims for profit and greed of power. It is also a rejection of the way of theologizing that completely blindfolds itself from the very concrete situation of sufferings, its structural causes, and from the hopes of the suffering humanity that can be transformed into a transformative power for liberation205. In other words, it is allowing the in-breaking and making inroads of the primary mission of Jesus Christ, i.e., the proclamation of the Kingdom of God, to bring health, justice, glad tidings to the poor, etc. (cf. Lk. 4:18-19)206. Cf. SECOND VATICAN ECUMENICAL COUNCIL (VAT. II), Pastoral Constitution Gaudium et Spes, 7 December 1965, in FLANNERY A., (ed.), Vatican Council II, The Conciliar and Post Conciliar Documents, Paulines, New Delhi 2001, n. 43, p. 829. 202 Cf. PAUL VI, Apostolic Exhortation Evangelii Nuntiandi, 8 December 1975, in O’BRIEN D. – SHANNON T., (eds.), Catholic Social…, op. cit., n. 29, p. 313. 203 Cf. WALSH J., Integral Justice, Changing People Changing Structures, Orbis Books, Maryknoll, NY 1990, p. 56. 204 Ibidem, p. 63. 205 Cf. GUTIERREZ G., On Job, God-Talk and the Suffering of the Innocent, (trans.), Orbis Books, Maryknoll, NY 1987, p. 29. 206 Cf. WALSH J., Integral Justice …, op. cit., p. 6. 201

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The struggle for justice for a Christian is the fountain of religious experience and the mark of the climate of spiritual life207. The interior life of a Christian expresses itself in the practice of justice, which is an expression of authentic love in the world marred by injustices. It is only in the context of the inhuman situation where the orphans, widows, and strangers lived, is the justice of God, his uprightness (sedaqah) can be experienced208. Here, the nature of human salvation is brought into light which is an integral human liberation from all that violates and alienates his dignity and freedom including illnesses caused by structural injustices that breed extreme poverty. What then is the role of the Church and her disciples to further these forms of liberation? The role of the Church is clearly stated in John Paul II’s encyclical letter Redemptoris Missio, which states that, “Through the gospel message, the Church offers a force for liberation which promotes development precisely because it leads to conversion of heart and of ways of thinking, fosters the recognition of each person's dignity, encourages solidarity, commitment and service of one's neighbor, and gives everyone a place in God's plan, which is the building of his kingdom of peace and justice, beginning already in this life […] That is why there is a close connection between the proclamation of the Gospel and human promotion” (RM 59)209. The Holy Scripture elucidates the importance of this mission. In the Old Testament, God is known to the people as the liberator of the oppressed (cf. Ex. 14). God saw and heard the cry of the poor and the oppressed. In the New Testament, God is known to be the father of all, whose justice echoes the whole world in behalf of the needy, the sick, the outcast and the marginalized (cf. Lk. 6:21-23). The whole of Christian life is summed up in faith, which is characterized by the observance of the two great commandments of love, which involve the fulfillment of the demands for justice (cf. JW 30-34)210. Thus, the Church is called to defend and promote the dignity and fundamental rights of the human person. She is called not to propose concrete solutions to the socio-political and economic 207

Cf. “La lucha por la justicia para un cristiano es fuente de experiencia religiosa y marca el clima de la vida espiritual” (original text), in ACOSTA J.J.T., Hacia la Comunidad, La Marginacion Lugar Social de los Cristianos, Editorial Trotta, Madrid 19952, p. 47. 208 Cf. GUTIERREZ G., On Job …, op. cit., p. 40. 209 JOHN PAUL II, Encyclical Letter Redemptoris Missio, 7 December 1990, in http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/hf_jp-ii_enc_07121990_redemptorismissio_en.html. 210 Cf. SYNOD OF BISHOPS, JW, 1971, op. cit., nn. 30-34, pp. 293-294.

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problems but to remind and give light to the State as to the basic natural principles of human existence that are inviolable and inalienable (cf. JW 37)211. This truth bears the fact that all men and women are called to fulfill their social responsibility towards full, integral human development both personal and communitarian levels. This vocation becomes the ground of the individual’s participation into the civil and political affairs of the society for the promotion and protection of human dignity212. “For Christian witness to be effective […] one must focus on interpreting and defending the values rooted in the very nature of the human person” 213. As consecrated persons, we are entrusted with the gift of intelligence to read and interpret the signs of the times. In the midst of the medicalization and commercialization of health, and the abuse of the fundamental rights of the person, especially the right to life and the deprivation of the necessary conditions for integral human development. We are bound in conscience to take the side of the victims that might put them directly against the perpetrators of injustice. This particular mission requires a personal conversion and a deeper transformation of oneself. This demands a re-rooting of oneself into the very gift, the charism of witnessing the merciful love of Christ to the sick, which St. Camillus received from the Holy Spirit and is handed down to his followers. “The charism helps us conform to Christ as we contemplate Him as the divine Samaritan of souls and bodies and as the promoter of health”(CD 2001, n. 14)214. This conformity to Christ as the Good Samaritan marks the very identity of the servant’s being and acting. The mercy and compassion of Christ will always be the inner strength and motivation of an authentic Camillian witnessing. The motivation will always remain the same but its form of witnessing changes according to the specific historical circumstances (cf. Const., 58)215. This requires creative fidelity which is “an invitation to propose anew the enterprising initiative, creativity and 211

Cf. Ibidem., n. 37, p. 294. Cf. CREPALDI G. – COLOM E., Impegno Sociale, in Dizionario di Dottrina Sociale della Chiesa, Libreria Ateneo Salesiano, Roma 2005, p. 401. 213 CONGREGATION FOR INSTITUTES OF CONSECRATED LIFE AND SOCIETIES OF APOSTOLIC LIFE, Starting Afresh from Christ: A Renewed Commitment to Consecrated Life in the 3rd Millenium, 19 May 2002, n. 38, in http://www.vatican.va/roman_curia/congregations/ccscrlife/documents/. 214 MINISTERS OF THE INFIRM (CAMILLIANS), Documents of the 55th General Chapter Witnesses of the Merciful Love of Christ, Promoters of Health, Mottinello, 2001, Generalate, Rome 2002, n. 14, p. 138. 215 Cf. Idem., The Constitution and General Statutes Ministers of the Infirm, Generalate, Rome 1988, n. 58, p. 39. 212

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holiness of their founders and foundresses in response to the signs of the times emerging in today’s world”216. Nowadays, this creative fidelity is no longer limited to the so-called pluriformity of expression of one’s ministry but importantly to a more collaborative effort and sharing of resources of the various charisms of the Church. This new form of witnessing particularly in the world of health calls for a “new creativity of charity”. This means the ability to identify with the suffering humanity and to be able to live in communion with them (poor sick and the agents of charity) and stirs in them the gift and strength of each one in order to effect a change in an unjust situation in the world of health (cf. SA, n. 33)217. Since the “promotion of health is part of the salvation process” (CD 2001, n. 5)218, one must broaden his horizon in approaching and dealing with the problems of health, and its delivery of services in view of that integral notion of health. The world of health embraces broader concerns such as structures, legislations, ethics, disciplines, policies, governance, investments, etc. Anything that aims toward the promotion of the quality of life is the concern of health. The condition of health is the mirror of the society’s state and condition and its capacity to fulfill its primary vision, which is for the well-being of the person (CD 2001, n. 8)219. Thus, the Camillian presence will become an authentic witnessing if it responds to the urgencies and necessities of the society and acts on it accordingly regardless of the cost it entails. As a former Superior General says, “we must be present for the people and with the people […] it must be such that as we work and build with them, they must grow to help themselves”220

3.2. From Competent Love to Prophetic Witnessing Competent love has been the slogan among the Camillians especially in the late 1970’s up to the present. This has been prompted by the complex situation of the world of JOHN PAUL II, Apostolic Exhortation Vita Consecrata, 25 March 1996, n. 37, in http://www.vatican.va/holy_father/john_paul_ii/apost_exhortations/documents/hf_jp-ii_exh_25031996_vitaconsecrata_en.html. 217 Cf. CICL/SAL, Starting Afresh …, art. cit., n. 33. 218 M.I., (CAMILLIANS), Documents of the 55th General Chapter…, op. cit., n. 5, p. 134. 219 Cf. Ibidem., n. 8, p. 135; STEFFAN M., Pastoral Actions to Defend and Promote the Right to Health, in “Dolentium Hominum”, 63 (2006), pp. 37. 220 VENDRAME C., Letters and Writings to the Order, (trans.), Camillian Generalate, Rome 1983, p. 97. 216

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health. Fr. Calisto Vendrame said once; “In competence, I see love that is in search of an understanding of the technical, and science in order to be able to serve better to really serve”221. This is not just mere professionalism of our services but making charity an effective kind of love to those who are suffering. It is a chemistry of compassion plus competence and vice versa, that results to competent love. It is like making “charity at the service of intelligence” (SA n. 38)222 and intelligence making charity efficient and effective. However, if charity is modeled before the Good Samaritan, as the Camillians are called to conform to, competent love is not enough. As it happens today with so much professionalization of services, it ends up in a highly institutionalized form of ministry, which is inaccessible to the poorsick, and makes the servant himself distant from the real drama of suffering. Sometimes these institutions (polyclinics, hospitals, etc.) unknowingly share in a subtle way the sinful structures of the society. Charity must grow from a real “formation of the heart” which will lead to an encounter in faith the real love of God to others. It must make love present in the here and now so that it will become a “credible witness to Christ” at all times in all circumstances because this is man’s very nature (DCE 31)223. Since the world of health is slowly co-opted by the sinful structures of the society that create systematic injustices against the poorsick, then, competent love must be reenforced with authentic prophetic witnessing. 3.2.1. The Camillian Prophetic Vocation 3.2.1.1. Characteristics The term prophet comes from the Greek word pro (on behalf of) femi (to speak in the name of). This presupposes an intimate relationship between the resource person and the spokesperson (God – prophet)224. This bond arises from the gift of prophetic vocation, 221

Ibidem., p. 96. CICL/SAL, Starting Afresh …, art. cit., n. 38. 223 BENEDICT XVI, Encyclical Letter Deus Caritas Est, 25 December 2005, n. 31, in http://www.vatican.va/holy_father/benedict_xvi/encyclicals/documents/hf_ben-xvi_enc_20051225_deuscaritas-est_en.html. 224 Cf. MESTERS C., Prophecy in the Bible, Inspiring Source of Religious Life, in UNIONE SUPERIORI GENERALI (USG), Religious Life: Prophecy in the Cultures Today?, 690 Conventus Semestralis, Litos, Rome 2007, pp. 8-9. 222

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which is a mystery (no exact criterion of choice), and at the same time a historical reality (the calling happens in a specific situation of injustices). This is God’s gratuitousness and freedom. This presupposes also an attentive listening to God who continuously speaks in the daily events of history (cf. VC 84)225. Listening then, requires not merely our five senses but most of all the eyes of faith that has the capacity to decipher the signs of the time. At present, the people perceived the seeming silence of God in the midst of gross injustices and violations of the persons’ fundamental rights; in the movements of history from the so-called Third World to the least developing countries (LDCs), where development is extremely biased only to the few rich, and the great majority is impoverished. Is God really silent or absent in the suffering humanity? Just like the experience of the prophet Elijah, (cf. 1 Kgs. 19:11-16) who longs for God’s presence through the classical theophanies (storms, earthquakes, thunder, fire, etc.), who is perplexed by the silence of God. But God indeed appears to Elijah in a new way in “a still small voice” (1Kgs. 19:12), in a gentle breeze that clasps his face, in an imperceptible way that brings him a radical conversion226. God continues to manifest himself today in situations where we least expect him to be, in the midst of hopelessness and sufferings, in the deprivation of the majority, and the exploitation by the few. One, who is sensitive to his presence, and dispose to listen to his words articulated by the events of life, could not help himself but be converted, and thus become a prophet. If a person is deeply touched by the situation of the poorsick, and feels the commotion from within, his radical conversion is making inroads in himself that will allow him to respond with great compassion to the urgency of the time even at the risk of his life. This is a true Camillian prophetic vocation, one that is in conformity with Christ, the Good Samaritan. “Prophecy is connatural to consecrated life”227. It is a substantial element to consecration. It is inalienable and irresistible. In the midst of the worsening health condition of the poor people in the developing nations, the inaccessibility of medical resources both material and human while on the one hand, the continuous growth and big Cf. JOHN PAUL II, V.C., op. cit., n. 84; CARVALHO J.O., Prophecy and the Religious Community, in USG, Religious Life …, op. cit., p. 67. 226 Cf. Ibidem., pp. 16-17. 227 ABELLA J., Introduction to Dialogue Based on Experiences, in USG, Religious Life …, op. cit., p. 35. 225

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revenues of the global pharmaceutical market (US$ 534.8 billion in 2005)228 and the new breakthroughs in the frontiers of science and medicine are indeed imminent dangers to the world of health. The modern prophets are then called to respond with appropriateness and creativity of their actions into this situation because they are called to promote and defend integral development of person and to the entire humanity. This could mean using all available justifiable means without even excluding that of the secular or profane 229. “[…] the Camillian grasps the meaning of the urgent, of the necessary, of priorities, and of the short and long waves of charity. His greatest sin would be the loss of this sensitivity” (CD 2007, n. 51)230. The late John Paul II, on the occasion of the 450th birthday of St. Camillus, has reminded the Camillians that the option to stay at the side of the poor promoting health for all and witnessing the love of the Church to the least, is becoming urgent in the least developing countries, where the situation of indigence worsens the health condition of the population favoring the spread of new forms social diseases […] and social injustices […]231. Due to the vastness and complexity of the injustices in the world of health, there might be a tendency to be messianic in our action rather than prophetic. The situation must be confronted with no pretension of exhausting all means to counter the situation, means that are beyond one’s capacity and resources. This is a clear and present danger in consecrated life. One must be guided by “prophetic realism”, i.e., the capacity to act within the bounds of one’s charismatic capacity (personal resources) but at the same time exploring all possibilities of the gift received (charismatic potentialities)232. This realistic attitude must be assisted by “prophetic imagination, i.e., the gift of wisdom that sees 228

Cf. World Pharmaceutical Market (2007), in http://www.rncos.com/Report/IM085.htm. Cf. FEDERATION OF ASIAN BISHOPS’ CONFERENCES (FABC), BISA III: Final Reflections, Kuala Lumpur, 3 November 1975, in ROSALES G. – AREVALO C.G., For All the Peoples of Asia, FABC Documents from 1970-1991, Claretian Publications, Quezon City, Philippines 1992., p. 208. 230 Cf. MINISTERS OF THE INFIRM (CAMILLIANS), Acts of the 56th General Chapter United for Justice and Solidarity in the World of Health, 2-18 May 2007, Ariccia, in “Documents”, 20 (2008), n. 51, p727. 231 Cf. “L’opzione di stare accanto ai poveri promuovendo la salute comunitaria e testimoniando l’amore della Chiesa verso gli ultimi, risulta particolarmente urgente nei paesi in via di sviluppo, dove la situazione di indigenza aggrava le condizioni di salute della popolazione, favorendo la diffusione delle nuove malattie sociali [...] e di ingiustizie sociali [...]” (original text), in JOHN PAUL II, Ai Chierici Regolari Ministri degli Infirmi, in “Camilliani”. 5 (2001), Casa Generalizia, Roma, 2001, p. 232. 232 PAREDES J.C.R., Prophecy of Religious Life Today, New Paths, Challenges and Opportunities, Sources of Prophecy, in USG, Religious Life …, art. cit., p. 51. 229

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alternatives there where apparently there are none; discovers life where apparently there is only death”233. This wisdom brings creativity instead of monotony. It operates with a dynamic vision rather than with dogmatism. It is more assertive than aggressive. It is more radical in character rather than fundamentalist. It is animated by courage rather than with bravery. Thus, the prophetic ministry is more apt and opportune in the present situation of injustices that operate subtly not only in the fundamental structures of society such as the bureaucracy but in the mind of the leaders of the society. The consecrated person is tasked “to nurture, nourish and evoke a consciousness and perception alternative to the consciousness and perception of the dominant culture around us (Brueggemann, 1978)”234. He is called to offer an alternative, and sometimes this alternative goes against the status quo, which might not be acceptable. However, its acceptability does not rely so much on how the concepts are developed but, on how its developer involves himself into the process of transforming reality. He needs to be a credible witness, a true “expert in humanity”, one who is capable of seeing what others failed to see (cf. CD 2007, 49)235. He is the one who keeps his services “authentically human”, i.e., upholding always the dignity and the rights of the sick 236 even if it shaken the prevailing socio-political order. “Concern for stability is important, but stability is not the only social value, or even the highest. Justice ranks higher. There may be times when the value of justice calls the Christian community and its leaders to take a risky stand on political, social and economic issues”237. Though the statement refers directly to situation of extreme socio-economic disorder, it has its strong bearing on the socio-health situation wherein health is no longer regarded as a right but as a commodity. Thus, this conviction must be reflected in the dialectical prophetic pathway of the Camillians, i.e., “commitment to the Word (preaching) and commitment to charity (witnessing)” (CD 2007, n. 5)238.

233

Ibidem., p. 55. HEALY S., Justice in a Changing World, in M.I (CAMILLIANS), “Camilliani-Camillians”, 3 (2007) p. 247. This was quoted by the author from W. Brueggemann, 1978. 235 Cf. M.I., (CAMILLIANS), Acts of the 56th General Chapter …, art. cit., n. 49, p. 727. 236 Cf. BRUSCO A. – MONKS F., Ministry, in BRUSCO A., (ed.), The Constitution of the Order of the Ministers of the Sick , Edizioni Camilliane, Torino, Italy 1998, p. 214. 237 DORR D., Option for the Poor: A Hundred Years of Vatican Social Teaching, Orbis Books, Maryknoll, NY 2003, p. 93. 238 M.I., (CAMILLIANS), Acts of the 56th General Chapter …, art. cit., n. 5, p. 707. 234

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3.2.1.2. Methods and Forms The prophetic ministry of consecrated is often mistaken as the ministry of denouncing the evils or structures of sin in the society. This reductive view of prophecy becomes prominent in the Church during the early 1970s, during the period of various dictatorial, and the post-colonial imperialist regimes particularly in the developing nations. The influence of liberation theology with all its various expressions has somehow added to such outlook, which was also taken advantage by the perpetrators of injustice, by making it as a black propaganda against such a kind of theologizing. This inherent ministry of the consecrated person comes in a dialectical relationship of to announce and to denounce. Both methods are interdependent and inseparable. These are necessary modes since the Church desires an integral and total development of the person, the fullness of his vocation to holiness, and thus, “necessarily extend her religious mission to the various fields in which men and women expend their efforts in search of the always relative happiness which is possible in this world, in line with their dignity as persons” (SRS 41)239. The announcement consists of the anthropological truths of the person as a creature endowed with highest dignity and ordained to relate with others and to his Creator, and the truths that Christ proclaimed that He came to save man and lead him to the fullness of life. It is always directed towards formation of conscience of the people rather than a simplistic criticism of the denial of those truths. This aim towards the establishment and reaffirmation of the non-negotiable and global vision of the person. On the other hand, the denunciation consists in the awakening of the consciousness of the people to the reality of sin, and the sinful structures that hinder human integral liberation. All are obliged to denounce all structures, institutions and attitudes that offend the dignity of persons240. “The condemnation of evils and injustices is also part of that ministry of evangelization in the social field which is an aspect of the Church’s prophetic role. But it should be made clear that the proclamation is always more important than condemnation, and the latter cannot ignore the former, which gives it true solidity and the force of higher motivation” (SRS 41)241.

JOHN PAUL II, Encyclical Letter Sollicitudo Rei Socialis, 30 December 1987, in O’BRIEN D. – SHANNON T., (eds.) Catholic Social Thought …, op. cit., n. 41, p. 424. 240 Cf. CREPALDI G. – COLOM E., Annuncio e Denuncia, in Dizionario di Dottrina ..., art. cit., pp. 46-48. 241 JOHN PAUL II, SRS 41, op. cit., p. 425. 239

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Both are interdependent though the announcement occupies the primary post since it serves as the ground for denunciation. In other words, it makes the denunciation credible and weightier. Though in reality, what is more visible is the latter since announcement departs itself and deepen from the very experience of injustices and the faith-experience of the people who untiringly struggled to restore the dignity of persons. Thus, the content of denunciation validates further the truth of the announcement, it makes its content more understandable and meaningful that prompts concrete expressions or actions. In the concrete, “the prophetic mission of the Camillian […] involves condemning all the surrogates of life and health, the attacks on the dignity and the integrity of the weakest, the unjust distribution of health-care resources, the mechanisms and the structures that impede the poorest from reaching the table of life and health” (CD 2007, 68)242. Nowadays, the problem of the world of health reaches to the level of an institutional violence. The market-oriented health vision that influences the public and private (sectarian and non-sectarian) health institutions becomes the great blunders to a service-oriented health vision. It turns health institutions into lucrative ventures. This affects many religious-run health institutions that in the name of sustenance and survival in this highly competitive world, they fall into the trap of making services into an entrepreneur. Sometimes their administrators are tempted to shift their attention from giving services to the least to making services profitable and sustainable for the institution. Thus, one must be reminded that it is only in “opting for the most abandoned that religious institutes fulfill the prophetic dimension inherent in religious life. This is accomplished by defending the rights of the weak, cooperating in the promotion of political thought, and in exposing injustice”243. In order not to get lost of the rationale of such a kind of approach (to announce-to denounce), one must be guided by the virtue of prudence. “Prudence shapes and informs our ability to deliberate over available alternatives, to determine what is most fitting to a specific context and to act decisively” (FCFC 19; cf. CCC 1806)244. It is acting on right 242 243

M.I., (CAMILLIANS), Acts of the 56th General Chapter …, art. cit., n. 68, p. 733. MONKS F., What We Might Bear in Mind in Any Response, in “SEDOS Bulletin 2007”, Vol. 39, Nos.

11/12 (2007), p. 285. 244 UNITED STATES CONFERENCE OF CATHOLIC BISHOPS (USCCB), Pastoral Letter Forming Consciences for Faithful Citizenship A Call to Political Responsibility, 14 November 2007, n. 19, in

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judgment based on ones conscience. It is acting not out of a particular fixated ideology, nor of any political or institutional interest. It is putting reason in the light of faith so that it will function at the service of a moral imperative. This is a very important aspect since the primary goal of these prophetic approaches is the liberation of the person by transforming relationships that are oppressive and structures in society that prejudices human dignity and human rights245. 3.2.2. Preferential Love For the Poorsick 3.2.2.1. The Semantic Problem The application of the methods of to announce and to denounce in the filed of health care ministry presupposes a very vital mode of living, i.e., the capacity to demonstrate a preferential love for the poorsick. Before delving into the nature and characteristics of this type of love, let us clarify first the semantic problem which rests on the term poorsick. The term poor sick is deliberately superseded by the term poorsick. The former refers to all sick people regardless of status and condition of life. The sick is the subject and the term poor is an adjective or a qualifier that gives further information about the subject. However such information cannot stand by itself because it can be interpreted with various meaning (powerlessness, helplessness, economically deprived, dull, ignorant, poor in spirit, etc.), which are relative and subjective. The latter refers to a specific human subject who is literally exploited, deprived of his rights, and stripped of his dignity that render him powerless, and at the mercy of others. This is an undeniable fact in the age of neo-liberal socio-economic order. Ours is no longer a dehumanization perpetrated by the use of modern technology but of the invisible hand (the market forces) whose ultimate end is profit and global monopoly even at the expense of innocent human lives. A typical example of this, are the wars that profited not so much of the strong and powerful States but of the market players (war profiteers). Another example is the TRIPS agreement of the WTO that prohibits reproduction of cheaper medicines in the LDCs. Thus, the poorsick is understood and taken as the primary subject of this preferential love. http://www.usccb.org/faithfulcitizenship/FCStatement.pdf. 245 Cf. GROODY D., Globalization, Spirituality and Justice, Orbis Books, Maryknoll, NY 2007, p. 185.

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Another problematic term is the poor. For the sake of clarity and consistency, the poor refers to the “overwhelming majority who are deprived of access to the material goods they need for a truly human life, and even access to the resources they need to produce these goods for themselves […] deprived of the goods and opportunities to which they have a right because they are oppressed”. (BISA I, 2)246. The accent is placed on the situation of being deprived and oppressed. They are the new anawims of the present. The 53rd Camillian General Chapter, 1989 has affirmed this clearly, that economic deprivation leads to the decline of the quality of being especially in the case of illness247. Their situation of deprivation did not happen by chance nor by sheer misfortunes, as most of them believed, but it is caused by human action that breeds institutional violence to the toiling and ailing masses. This type of violence, that creates a devious pattern of behavior particularly among those powerful elites, breeds oppression wherein the poorsick are stripped of their rights and dignity (cf. Medellin 1968, n. 2)248. Last is the term “preferential”. This refers to a choice of the individual (and the community of consecrated persons) to work with the poor and not exclusively for the poor. This does not mean dissociating and distancing with those who are affluent and powerful, the power brokers and stakeholders of the society, but influencing them and stirring in them their vocation in life to share with our concern to make the poor people (the poorsick in particular) participate in the vital decisions that affect their lives (cf. BISA I, 4-5) 249. Thus, the objective and reason of this preference is to be with the poorsick in all our endeavors in the vineyard of our Lord because of the conviction that, in them we encounter Christ and learn His way. As Albert Nolan says, “the more we are exposed to the sufferings of the poor, the deeper and more lasting does our compassion become” 250. Just like St. Camillus, he always believed that the poorsick are sacraments for us. 246 247

FABC, BISA I: Final Reflections, op. cit., n. 2, p. 199. Cf. MINISTERS OF THE INFIRM (CAMILLIANS), The 53rd General Chapter Towards the Poor and the

Third World, Bucchianico1989, in BRUSCO A., Walking Together in Hope, Camillian Generalate, Rome 1992, n. 26, p. 107. 248 DORR D., Option for ..., op. cit., pp. 206-207. The mainline thought of these ideas are coming from the Document of the Latin American Bishops Conference (CELAM) in Medellin, 1968. 249 Cf. FABC, BISA I…, op. cit., nn. 4-5, pp. 199-200; GROODY D., Globalization …, op. cit., p. 196. 250 KAMMER F., Doing Faithjustice: An Introduction to Catholic Social Thought, Paulist Press, New York 20043, p. 174. (This was quoted by the author from the article of Albert Nolan, Spiritual Growth and the Option for the Poor, in “Church”, Vol. 1, 1 Spring 1985, p. 45.)

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3.2.2.2. The Demands of the Option The preferential love for the poorsick is not a social ideology with a religious mask rather it is “a commitment in which one assumes voluntarily and lovingly the condition of the needy of this world in order to bear witness to the evil which it represents and to spiritual liberty […] after Christ’s example” (cf. Medellin 1968, 14)251. As a voluntary commitment, it entails a profound challenge aimed at a metanoia, a change of mind and heart. The voluntariness springs from ones primary consecration to the evangelical counsels. It is a necessary consequence of its profession. It is nourished by constant listening and engaging into the cry of the poor, the cry of misery and for compassion. It is the cry that made God intervened into the history of the Israelite (cf. Ex. 3:7). “That cry must, first of all, bar you from whatever would be a compromise with any form of social injustice. It obliges you also to awaken consciences to the drama of misery and to the demands of social justice made by the Gospel and the Church” (ET 18)252. This preference becomes more credible if it demonstrates external proofs of authentic poverty. It is not canonizing poverty but exalting the vow of simplicity, a life lived with full conviction of the divine Providence as the sole refuge of all our strength. “Simplicity of life, deep faith and unfeigned love for all, especially the poor and the outcast are luminous signs of the gospel in action” (EA 34)253. Such external proofs must realistically emanate from the true poverty of being than having, which is more liberating and convincing. In the midst of strong consumerist mentality, our poverty will be an exact counter-mentality that will liberate us from inordinate human want. It seeks more of the “quality of one’s heart rather than the quantity of one’s possession”254. It is a way of promoting the culture of life than the culture of death. As declared by the Catholic Bishops’

251 252

DORR D., Option for ..., op. cit., p. 207. PAUL VI, Apostolic Exhortation Evangelica Testificatio, 29 June 1971, n. 18, in

http://www.vatican.va/holy_ father/paul_vi/apost_exhortations/documents/hf_pvi_exh_19710629_evangelica-testificatio_en.html. 253 JOHN PAUL II, Apostolic Exhortation Ecclesia In Asia, 6 November 1999, n. 34, in http://www.vatican.va/holy_ father/john_paul_ii/apost_exhortations/documents/hf_jp-ii_exh_06111999 _ecclesia-in-asia_en.html. 254 GROODY D., Globalization …, op. cit., p. 258.

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Conference of the Philippines (CBCP), that the radical authenticity of our discipleship consists in our poverty. “Poverty witnesses against the exploitation of material resources, against the greed that leads to the impoverishment of millions, by demonstrating responsible stewardship in a finite universe, by its detachment from material possessions and its call for simplicity, poverty urges the Church to trust entirely in God and to place all its resources in the service of the Kingdom” (PCP II, 461)255. Nowadays, with the emerging techno-mentality, and its accessibility and affordability brought about by the new global economic order, the temptation to shun away from a life of simplicity is more enticing and palatable to ones human desire. Consecrated persons are even hooked to it unconsciously using the slogan of “poverty but not misery”256. The slogan becomes an excuse not to embrace evangelical simplicity, that of, Christ. But, what does it really profit for a person to live in evangelical poverty? St. Camillus de Lellis believed that the life of poverty, i.e., the lifestyle of mendicancy, is a necessary condition to maintain one’s dedication of service to the sick at all times regardless of circumstances. This was clearly expressed in the Formula of Life, which is up to the present remained in the very first pages of the Constitution and General Statutes257. Poverty (the condition of the poorsick) reveals an ambivalent faces, i.e., the face of misery and the face of virtue. The former is self-explanatory while the latter demands the eyes of faith to recognize it. The virtue of poverty lies in its inherent contradiction, which is a negation of the non-essentials of life, and the affirmation of living alone on what is essential, i.e., simplicity, an antidote to consumerist mentality. It is also an occasion for a deeper renewal of fraternity and solidarity with the suffering humanity.

CATHOLIC BISHOPS CONFERENCE OF THE PHILIPPINES (CBCP), Acts and Decrees of the Second Plenary Council of the Philippines, 17 February 1991, Paulines Publishing House, Pasay City, Philippines 1992, n. 461, p. 159. 256 This slogan is the most abuse reason whenever a discussion on what simplicity of lifestyle in religious life consists of. Though nothing is wrong with it but more often it presents only a one-sided focus, i.e., on misery. The accent is given more on misery as synonymous to scarcity of the bare necessities of life. It is on the definition of “necessities” that remains to be relative and oftentimes is left to the personal interpretation rather than embracing a corporate or collective interpretation. It is just like saying that it is not against the vow of poverty to have the most expensive things in the religious community as long as you use it wisely. 257 Cf. SPOGLI E., The Formula of Life, the Basic Document of the Ministers of the Sick, in BRUSCO A., (ed.), The Constitution ..., op. cit., pp. 47-48. 255

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Lastly, it is the path towards Christian maturity wherein one realizes, in the midst of deprivation and limitation, the basic answer to the anthropological question – who am I?258. Embracing evangelical simplicity and manifesting it in our day-to-day existence is a kenotic choice, an emptying of oneself (cf. Ph. 2:3-8). It is a radical, and an existential option to live only for Jesus alone through an unconditional service to the poorsick even at the risk of one’s life259. A Christ-centered life is necessarily a poorsick-centered existence, a true poverty of being manifested in one’s complete trust to God in a “simple, sober and austere lifestyle” (CD 1989, 39)260. This is only possible if one allows himself to be confronted by the misery and suffering of the poorsick with one’s commitment, lifestyle and response. An interior dialogue then, is required in order to arrive at the real fruit of the process, which is a self-transformation and radical commitment to dismantle the forces of injustice and its structures. 3.2.2.3. The Orthopraxy of Preferential Love For the Poorsick The preferential love for the poorsick is a theological truth, that is founded in the mystery of God who takes the side of the oppressed (cf. Ex. 22:20-22) and the mystery of incarnation, the Emmanuel who came to proclaim the glad tidings to the poor (cf. Lk. 4:16ff)261. This truth becomes normative in our mission of proclaiming the Kingdom of God as Jesus himself lived in his life of preaching the good news and healing the sick. He made his life as counter proposal to the prevailing mode of living grounded on the letters of the Law and customs of the time, by choosing to live at the margin of the society with the marginalized262. On our part, it means a commitment to be with and work with the poorsick, not claiming superiority to them, but with them to learn from them, their needs and aspirations and together striving to effect a change into those structures and situations that impede integral human development. It is therefore making the poorsick as responsible Cf. M.I., (CAMILLIANS), The 53rd General Chapter Towards the Poor and the Third World, Bucchianico 1989, in BRUSCO A., Walking…, art. cit., n. 30, p. 108; DI MENNA R., The Evangelical Counsels, in BRUSCO A., (ed.), The Constitution ..., op. cit., pp. 159-163. 259 Cf. VENDRAME C., Letters and Writings …, op. cit., p. 16. 260 M.I., (CAMILLIANS), The 53rd General Chapter Towards the Poor and the Third World, Bucchianico1989, in BRUSCO A., Walking …, art. cit., n. 39, p. 111; cf. CICATELLI S., St. Camillus de Lellis, Patron Saint of Hospitals, (trans.), Camillian Publications, Manila 1980, pp. 285-286; GROODY D., Globalization …, op. cit., p. 196. 261 Cf. ACOSTA J.J.T., Hacia la Comunidad …, op. cit., p. 19. 262 Cf. Ibidem., p. 23. 258

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stakeholders of their own health, development, and destiny, the fullness of their original vocation in life (cf. PP 15, 20, 65, 70)263. This preferential love means taking on an active stance, a definite choice, and a decision as to how the society is organized, and how does it affect to the day-to-day life of the poorsick264. This decision is embedded itself in our social responsibility especially to the vulnerable in the society. To overlook this responsibility is liken to the “rich man” who pretended not to notice the ailing and starving Lazarus at his gate (cf. Lk. 16:19-31; SRS 42)265. As consecrated persons animated by a specific charism, we are invited to review and renew our traditional expressions of our ministry in order to respond to the emerging pastoral needs, particularly in the areas of social justice and transformation of society, the world of health in particular. This renewal is urgent and necessary (cf. PCP II, 478, 481)266. Charitable acts are the common expressions of our ministry. However when not evaluated properly, instead of helping the sick persons, we are just making them “parasites”, always at the mercy of our help. Such actions though noble are not enough. We need to change institutions, laws and policies so that the poorsick may be less dependent upon our charity267. This is making the poorsick the subjects and actors in their own struggle for liberation. One of the most effective ventures in such a kind of ministry is the building of, and formation of “healthy and healing communities” (CD 2001, n. 47)268. An example of this type of initiative is the Community-Based Health Programs (CBHP). This program was recommended by the Declaration of the Alma Ata in 1978269. It aims towards empowerment, participation and self-reliance of the community. It seeks also to eliminate the social and political causes of sickness, which affect also the ethical, spiritual and Cf. DORR D., Option for ..., op. cit., p. 208. Cf. KAMMER F., Doing Faithjustice:.., op. cit., pp. 146ff. 265 Cf. JOHN PAUL II, SRS, n. 42, p. 425. 266 Cf. CBCP, Acts and Decrees …, op. cit., nn. 478, 481, pp. 164-165. 267 Cf. EVANS B., Lazarus at the Table: Catholics and Social Justice, Liturgical Press, Minnesota, USA 2006, p. 68. 268 M.I., (CAMILLIANS), Documents of the 55th General Chapter…, op. cit., n. 47, p. 147. 269 This was a declaration by the heads of the States during the International Conference on Primary Health Care, at Alma-Ata on September 12, 1978, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, through primary health care. Cf. www.who.int/hpr/NPH/docs/declaration_almaata.pdf. 263 264

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human dimensions of the person, by advocating structures that opens wider participation from the grassroots. This is what we call now social advocacy, e.g., Commission on Justice and Solidarity in the World of Health (CJSWH). Moving on to new forms of ministry will always be an uncomfortable process especially if it touches certain ground (structure) that needs to be changed in order to respond intelligently to the pressing pastoral needs of the time. This indeed, requires enough courage to plunge into the new streams (movement) of our ministry. “There will be times when the message that needs to be heard will come from within the community, from one of our own confreres. While their proposals and new initiatives must be evaluated through community discernment, we must also bear in mind the admonition of the Apostle: ‘never try to suppress the spirit, or treat the gift of prophecy with contempt; think before you do anything – hold on to what is good (1Thes. 5:2)”. (CD 1989, n. 51)270. Because of its decisive and provocative character, one’s desire to translate this into action is a pure gift of God (cf. Const. 51). Let one hang on to his conviction that there is nothing else to do in this world, but to be busy with the affairs of God. Thus, the work for social justice must be situated within the framework of God’s gratuitous love, and it is only in this way we understand better why God chooses to take the sides of the poor271. The ultimate objective of this preferential love for the poorsick is the establishment of the so-called “Church of the Poor”, which is a new way of being Church in Asia particularly in the Philippines. “It means a Church that embraces and practices the evangelical spirit of poverty which combines detachment from possessions with a profound trust in the Lord as the sole source of salvation. While the Lord does not want anyone to be materially poor, he wants all his followers to be poor in spirit” (PCP II, n. 125)272. Our contribution then to the new way of being Church is to give attention to those who are most vulnerable and to share our own resources (human and material) in order to let them feel the love of God to them despite impoverishment and scarcity. This could mean also going against the rich and powerful but in the name of love and justice, we have to accept it. Therefore, this is an excellent opportunity to exercise authentic charity that 270

M.I., (CAMILLIANS), The 53rd General Chapter Towards the Poor and the Third World,

Bucchianico1989, in BRUSCO A., Walking…, art. cit., n. 51, p. 114. 271 Cf. GUTIERREZ G., On Job …, op. cit., p. 88. 272 CBCP, Acts and Decrees …, op. cit., n. 125, p. 48.

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respects and promotes justice to those who have the right to it. The struggle for justice is love; it is a minimum requirement of charity (cf. CSDC nn. 4-6)273.

3.3. Solidarity and Social Commitment The basic question that one must reflect in order to understand the vision of solidarity, and social commitment is Cain’s question, “Am I my brother’s keeper?” Looking at the text, it was not really a question but rather a response to God’s question, “Where is your brother Abel?” (Gen. 4:9). This section does not intend to do an exegesis of the text but to establish our point of departure in scrutinizing the theological foundation of solidarity. Cain’s response to God echoes into the very situation of injustices in the world of health today. Do we feel responsible to it? It is then, a question that seeks a collective and innovative response to the situation. 3.3.1. Our Point of Departure There are already great signs of solidarity in the world today. Some expressions of these global solidarities are the various world organizations for human development, the different annual world day celebrations of the Church, the international solidarity movements for the promotion of rights, justice and peace, etc. However, we could not deny the fact that there are shadows also into these formations particularly those organizations that are tainted with political and economic interest. Nonetheless, the concept and quest for solidarity is no longer an alien thing to this world but a necessary expression of one’s “beingness” as a social or relational being. What does it really matters to us consecrated persons this vision? John Paul II defines solidarity as a “firm and persevering determination to commit oneself to the common good; that is to say to the good of all and of each individual, because we are really responsible for all” (SRS 38)274. Solidarity is the handmaid of the common good. Its natural function or better mission is the guaranteeing of the common good, which is “the sum total of social conditions which allow people, either as groups or Cf. PONTIFICAL COMMISSION FOR JUSTICE AND PEACE, (PCJP),Compendium of the Social Doctrine of the Church, Libreria Editrice Vaticana, Vatican City 2004, nn. 4-6, pp. 2-3. 274 JOHN PAUL II, SRS, n. 38, art. cit., p. 421. 273

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as individuals, to reach their fulfillment more fully and more easily” (CSDC 164) 275. This broad sense of the common good should not be confused with sum total of individual goods or created goods necessary for integral development of person. Rather, it should be understood as the whole condition (sum total of social conditions) that guarantees, facilitates, and enables the person or the human community to reach fulfillment of their original vocation rooted in their being an image and likeness of God. Therefore, solidarity has a historical mission of establishing those social conditions, which could be liken to a fiber that makes up the cloth, which are essential and inseparable for the fullness of meaning of the human person. Solidarity is actualized in a form of commitment, which is an exercise of social responsibility, by an individual or the community of persons. This commitment emanates from “the intrinsic social nature of the human persons, the equality of all in dignity and rights and the common path of individuals and peoples towards an ever more committed unity” (CSDC 192)276. It is recognition of man’s intersubjectivity or interdependence. Such interdependence is a humble recognition of the truth of human existence that man cannot attain happiness or fulfillment by himself. He needs others not in a sense of using others for his own good but together realizing their full capacity for self-donation, the greatest form of love that assures true happiness. Much of these ideal needs to be reclaimed today, wherein the resurgence of individualism and utilitarianism is gaining ground and prominence in the society. Thus, it is a call towards communion of persons. This co-existential nature and communion of the human persons is further enhanced and perfected by the participation of individuals in the building up of the human community. Participation is allowing and respecting the individual’s responsibility for his or her own destiny277. This responsibility arises from the fact of human existence that whatever one does has a concurrent impact whether explicitly or implicitly on the lives of others and similarly its impact on others has affected the one who initiates the act278. For instance, if an entrepreneur would deprive his workers of a just wage and a just working condition, the production will likely be diminished and in return, it will have a 275

PCJP, CSDC n. 164, p. 93.

276

Ibidem., n. 192, p. 109. Cf. DORR D., Option for the Poor …, op. cit., p. 302. 278 Cf. OPONGO E.O. – OROBATOR A., Faith Doing Justice …, op. cit., p. 36. 277

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corresponding loses of income on the part of the entrepreneur, that in the end if it would reach bankruptcy that would affect both of them. If the conditions are good, all will benefit the good outcome of it and this can only be assured if everybody participates in the creation of such good. Applying it to the society, it means encouraging the people to contribute to the cultural, economic, political, and social life of the particular community to which he belongs (cf. CSDC 189)279. This responsibility is assumed now by the civil society groups particularly among the middle class citizens and the peoples’ organizations from the grassroots level. At this point, it should have been made clear that the natural responsibility of the human person for solidarity emanates from his intrinsic social nature and his basic responsibility to promote the common good. Solidarity is one of the principal signs of a Christian identity. This sign is based on our belief and conviction that all the goods of this earth belong to the Creator, which was entrusted to us to shepherd, and administer for the good of all. Thus, all must participate and share the fruits of these goods for the fulfillment of all280. 3.3.2. The Desire For a Hundred Arms From the very beginning when St. Camillus felt the precariousness of the situation at St. James of the Incurable and the Holy Spirit Hospital in Rome, he deemed it worthy to organize a group of dedicated men that will serve the sick with great diligence and with no vested interest nor for any profit or gain. He chose these men not among from those who have been into big careers in life but from his fellow laborers in the same hospital281. This initiative continues to grow up to the present and his dream of having a hundred arms came to be realized. His exclamation of – ‘I would like to have one hundred arms’ “is emblematic of the desire to associate all persons of goodwill to his cause” (Inst. Lab., 2007, n. 11)282.This is a concrete act of solidarity. It is going down into the very situation of the poorsick, into the world of health, and awakens the consciousness of the people to Cf. PCJP, CSDC n. 189, p. 107. Cf. ACOSTA J.J.T., Hacia la Comunidad …, op. cit., p. 26. 281 Cf. CICATELLI S., St. Camillus de Lellis, op. cit., pp. 36-38. 282 M.I. (CAMILLIANS), Instrumentum Laboris, in “Documents” 20 (2008), p. 626. 279 280

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bring health into their hands, which means to exercise and to organize their responsibility towards an action with vision, i.e., witnessing the merciful love of Christ in healing the poorsick. His solidarity with the poorsick is in a way of “cultivating relationship with the poor that are marked by mutual receptivity and reciprocity”283, that is, by giving example of disinterested service. Solidarity with the poorsick has a historic mission, i.e., a mission that is faithful to its calling, and provokes a transformative action in history284. It is not a one-time deal initiative but a long-term struggle of being with the poorsick, respectful to its process of developing into a fully integrated healthy community. Crucial to this mission is the democratization of the process, i.e., encouraging people’s participation, and developing their capacities for involvement. This is commonly called empowerment of the people. It is returning the power into the hands of the people, the power to decide for their own destiny with freedom. However, such decision will never be materialized if not done in the context of the community of persons where he belongs. His autonomy is always condition by others because such autonomy is not absolute nor relative but responsible. This is the paradox of the intrinsic social nature of man. A misunderstanding of this truth would amount to the dissolution of human community, and a denial of the value of equality and unity of all beings. Its transformative act could inevitably create tension as we engage with the structures of sin, which perpetuate injustice and dominate relationships among people rather than animate. However, if it is done, not out of any personal motive, but out of one’s moral obligation, then the structures of sin will be turned into “structures of solidarity” which will open up to a transformation of certain systems that impede integral development of persons (cf. CSDC 193)285. For instance, the problem of access to health care, which affects not only the developing nations, but also even the highly developed nations, is not a question of scarcity of resources but of a just distribution. How come that health investments is one of the most profitable and lucrative venture in the world market today? The advancement of medicine today is beyond our imagination. But why is it that in 283

GROODY D., Globalization, Spirituality …, op. cit., p. 255.

284

Cf. Ibidem., p. 193. Cf. PCJP, CSDC n. 193, p. 110.

285

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every 30 seconds, one child died of malaria, and all other litany of agonies of the ailing masses. It is then, a question of social justice that one and the entire humanity must confront through globalizing solidarity (cf. CSDC 321)286. This globalizing task is not simply a creation of alternative structures in society independent that of the State but primarily putting in order the hierarchy of values of the society so, that society will always be at the service of the common good, the reason for its existence. Solidarity will always remain as a challenge, which the people must grapple with everyday. It must be a very taxing moral imperative and might not be sustainable in the end, knowing man’s limitations and imperfections. However, if it is exercised and grounded in a real belief in God then it will become a lasting and persevering commitment. It’s because “real belief in God entails solidarity with the poor so as to ease their undeserved suffering by establishing ‘uprightness’ (sedaqah) and ‘judgment’ (misphat)”287. Therefore, the mission of building solidarity of peoples is a concrete act of faith and at the same time a gift of faith. 3.4. Towards a Developmental Paradigm of Health Ministry Confronted with the new signs of the times in the world of health, and the challenges it pose to us as bearers of the merciful love of Christ to the poorsick, the compassionate, competent and critical heart is ever awaken in listening, and seeking the “new gaze” of the Spirit in order to respond to the pastoral urgencies of the time. This heart bears in it the authentic love of the Good Samaritan, the love incarnated in action with great diligence and skills, and the attentiveness and readiness to announce the gospel of life and denounce the forces that impede its growth. Taking into consideration the above premises and the condition of the time, there is an inner cry to seek a new paradigm of announcing the good news and healing the sick, a paradigm that deems to awaken the individual “charisms” (spiritual gifts) of the people from the grassroots level up to its leaders. It is a paradigm that believes on the value of solidarity and participation in the promotion of social justice in the world of health. Cf. PCJP, CSDC n. 321, p. 182. (The global development of solidarity is used in the context of creating job opportunities in the less-advantaged regions at the same time creating conditions for the survival of the least fortunate members of the human community.) 287 GUTIERREZ G., On Job …, op. cit., p. 48. 286

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3.4.1. Advocacy as Prophecy One of these paradigms is the social work for advocacy. This paradigm seemingly emanates from the world of the laity (not to be understood as separate but distinct from the ecclesiastical world) incarnated and practice in the various solidarity networks and peoples’ organizations which are popularly known as non-governmental organizations (NGOs). The term advocacy comes from the root verb to advocate which means “one who speaks on behalf of another person, especially in a legal context”288. It has also the same root from the Latin term “vocare” (vocation), a call. In simple terms, it means to be a voice for others especially the voiceless. The Federation of Asian Bishop Conference (FABC) defines advocacy as the “ability to articulate the Good News of Jesus in an audible and credible way today to the people of this generation and age and brings with it a message that gives more humanizing meaning to their lives”289. The definition presents to us the four essential elements of advocacy. The first one is the proclamation of the Word of God in an intelligible, comprehensible and creative way. Secondly, it is communicating in a language that touches the very experience of the people especially the hopeless and marginalized. It is a language from the heart. Thirdly, it has to be made credible by our involvement290 into the lives of the people by doing initiatives that promote the common good. Lastly, this proclamation aims at transforming society into a healthy and healing community that regards always the primacy of the dignity of the human person. Theologically speaking, advocacy finds its root from the very mission and ministry of Jesus (cf. Lk. 4:18-19; 6:20,24; 12:16-21) of proclaiming the Kingdom of God. It is a proclamation that calls for an inner transformation among us advocates in order for us to be awaken to the truths that the Good News is bringing to us291. This ministry of advocacy is being continued by the presence of the Holy Spirit, the great advocate (cf. Jn. 14:15) in 288

Wikipedia English Dictionary, in http://www.babylon.com/define/112/Latin-Dictionary.html. FABC, The Prophetic Path to the New Millenium Through Social Advocacy, in EILERS, F.J, For All the Peoples of Asia, FABC Documents from 1997-2001, Vol. 3, Claretian Publications, Quezon City, Philippines 1992, p. 49. 290 Cf. MONKS F., Credibility Through Involvement, in “SEDOS Bulletin 2007”, Vol. 39, Nos. 11/12 (2007), pp. 289. 291 Cf. FABC, The Prophetic Path …, op. cit., pp. 48-49. 289

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the Church at present. The Spirit that enlightens her members to read the signs of the times, and respond to emerging pastoral urgencies. Even earlier than the time of Jesus, the prophets had advanced themselves into this type of proclamation. Thus, advocacy itself is grounded in the very faith experience of the people of God and in the very mission of Jesus. In the concrete situation of injustices, advocacy is exercised as “influencing the decision-makers with a commitment in the pursuit of Truth and thus bring changes to social policy or to enforce laws or to repeal them if they violate norms of universal human rights”292. Pope Benedict XVI himself, like his predecessors, leads the entire Church in influencing the decision-makers and heads of the States during his first appearance at the assembly of the United Nations in April 2008 at USA. At present, the various congregations of religious has shared seat in the big international formations or organizations of world governments. In the local setting, several initiatives has been ongoing in line with influencing bodies of leaders in the society through advocating and promoting human developmental projects. Sometimes these initiatives may come in, in a form of confrontation and dialogue by getting the poor and the marginalized organized. This is a way of encouraging and empowering the voiceless to make their voice audible and credible293 especially in fighting against the oppressive and exploitation tendencies of the neo-liberal economic policies and competitive global market economy particularly in the field of health care industry. Advocacy means advocating for cultural innovation in the field of formation and education of the masses that is accessible to them in places where there is a real need of education294. Analogically, it means bringing the classroom into the courtyards of the marginalized people. It is democratizing education or formation allowing greater participation of the masses into the struggle for health, justice and peace. It is just like restoring health into the hands of the people or shepherding health. This is a way of making credible and intelligible the sign of the good news of the Gospel and making our prophetic role as consecrated people revitalized295. 292

Ibidem., p. 60. DORR D., Option for ..., op. cit., p. 202. 294 Cf. FABC, The Prophetic Path …, op. cit., p. 42. 295 Cf. Ibid. 293

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During the 56th General Chapter of the Camillians, the point of advocacy is well spelled in its Operative Guidelines, which states: “A Committee for Justice and Solidarity in the World of Health at the central level of the Order and where possible at the level of the Provinces, Viceprovinces and Delegations, should be created: ‘Love thus needs to be organized if it is to be an ordered service to the community’ (DCE 20)” (CD 2007, IV, n. 7)296. This commission has the primary task of forming and sensibilizing the Camillian religious, and all its collaborators to the promotion of justice and solidarity; the promotion and defense of the fundamental rights of person to health; and the advocacy of those who struggle for a just and caring society through developing a culture of solidarity 297. The formation of the commission was a positive and a decisive leap of the Ministers of the Infirm after several Chapters of founding and establishing its principles of actions. It is a way of making charity organized, and not just a mere effort of generosity and benevolence. It is democratizing charity by opening possible avenues of cooperation and collaboration with various groups and organizations of the same interest, the field of health care ministry. This a new way of revitalizing one’s prophetic vocation, and thus a new mode of making our presence felt by the poorsick. Nonetheless, this should not be easily understood as scrapping away of the classical form of one’s presence in the world of health but it is strengthening it. 3.4.2. The Imperative of Social Analysis Since the primary function of social advocacy is an attentive listening to the signs of the times, it needs certain tool of analysis that will help it in understanding the very condition of the world of health. As the social teachings of the Church claims that, “Compassion is not sufficient because to transform the world implies that we know something about the world and that we know what has to be transformed. Every involvement in any action for justice has to recognize the systematic injustice which is the cause of much of the hunger in the world, of the situation of the homeless, of the violence, and the destruction of the environment […] ” (CD 2007, n. 16)298. 296

M.I., (CAMILLIANS), Acts of the 56th General Chapter …, art. cit., n. 7, p. 735.

297

This is part of the action plan and strategies of the said commission (Commission on Justice and Solidarity in the World of Health - CJSWH) which was drawn out during the first convocation of the members of the generalate commission on the 15th – 16th of January 2008 in Rome. 298 M.I., (CAMILLIANS), Acts of the 56th …, art. cit., n. 16, p. 713.

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This assumption is necessary in any forms of ministry that aim towards the elimination of structures of injustice and institutional violence. It demands a critical consciousness and reading of the situation in order to arrive at an efficient and effective intervention or pastoral response. This consciousness can be enhanced by the methods of social analysis. The tool of social analysis has came in to the arena of the ecclesiastical endeavors, and become popular during the reforms done in the second Vatican ecumenical council particularly in the overall framework of the Pastoral Constitution Gaudium et Spes using the formula of see-judge-act. However, traces of this type of framework have been noticed as early as 1740s in the various social encyclicals of the previous popes. Beginning at this time, the formula of see-judge-act was used, and after the second Vatican council, it was well articulated and publicized up to the present. It became known as a pastoral methodology bearing in it with different names such as pastoral spiral, pastoral cycle, pastoral circle, social discernment, social analysis etc299. What then is social analysis? “It is about constructing and seeing a bigger picture or collage of a social reality. This simply means that each element or aspect of the social reality belongs to an intricate web of relationships”300. The essential point here is not the construction of the entire picture but the recognition of an intricate web of relationships of the various problems found in a specific social reality. This implies that any form of systemic injustice is not simply a by-product of historical events or misfortunes but of “conscious choices, decisions and actions”301 of its perpetrators. That is why it is called systemic or structural. Failure to recognize this will not render any good fruits to ones pastoral endeavors. For instance, the problem of patenting of medicines is not just simply the assertion of ones right guaranteed by the law on intellectual property rights and the protection it entails. A much bigger injustice here is found in the way such intellectual property has been obtained by its recognized inventor or developer, which is a gross violation and disrespect of the indigenous culture and tradition that had originally Cf. HOLLAND J., Roots of the Pastoral Circle in Personal Experiences and Catholic Social Tradition, in WIJSEN F. – HENRIOT P. – MEJIA R., (eds.), The Pastoral Circle Revisited: A Critical Quest for Truth and Transformation, Paulines Nairobi 2005, pp. 23-34. 300 OPONGO E.O. – OROBATOR A., Faith Doing Justice …, op. cit., p. 18. 301 Ibid. 299

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discovered and used it in their respective communities. So, a sound social analysis should always establish this web of relationships in order to develop with a better picture of the social reality. Another important element of social analysis, which could serve as its backbone in identifying the principles of action and strategies, is the identification of the constants. “Constants are the interrelated elements always found in the differing expressions of the faith”302. These refer to the truths of our faith that is contextualized in a specific situation and place. These are often embedded in the actual practice of Christian life. It may appear at times in a form of higher values that make sense to one’s praxis. For example, the famous theologian Edward Schillebeeckx identifies four structural constants in theology, namely, God saves human beings in and through history; Jesus is the definitive revelation of God; the way of being Church and discipleship today; and the salvation of God finds it fullness in the future (the not yet)303.These are the basic truths of our faith that are incarnated and dynamically contextualized in the various epochs of history. Thus, the analysis of a particular social reality should always take into consideration to look into its various expressions. In the actual practice of social analysis, there are four tasks that one must respond in order to arrive at a sound social discernment. First is the establishment of contact with the most vulnerable members of the human community in order to see the situation through the spectacle of their experiences. At this level, one would initiate by asking, what is happening? Second is the analysis of the experience/s. This goes into the details by looking at the causes and its intricate web of relations. This will respond to the question why such condition exists. Third is the reflection of the condition analyzed. This will respond to the question; what does it imply to our faith? The last is the response, which are the decisions, plan of actions, strategies for growth, program of implementations, etc that will resolve the problem presented304. These tasks normally follow the same order for a more systematic approach but at the same time can be explored further depending upon the specific social DE MESA J., Theological Constants and Theological Reflections, in WIJSEN F. – HENRIOT P. – MEJIA R., (eds.), op. cit., p. 114. 303 Cf. Ibidem., p. 116-117. 304 Cf. HENRIOT P., Social Discernment and the Pastoral Circle, in WIJSEN F. – HENRIOT P. – MEJIA R., (eds.), op. cit., pp. 44-45. 302

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condition. It presupposes a wider participation and involvement of the people themselves as active agents for transformation.

3.5. A New Paradigm For a New Vision of Life The witnessing of the merciful love of Christ in the world of health is not completed in the renewal and re-establishment of a new world order. It is a mission that is intrinsically incomplete and unsatisfactory. Nonetheless, it is necessary and a responsibility as created human beings. Why? There are two reasons why such mission of promotion of social justice is an incomplete mission but at the same time necessary for its completion. The first reason has something to do with the reality of man’s authentic and transcendent vocation. The second reason is the real nature of suffering particularly brought about by illness, which is an “undefeatable” human experience. The former refers to man’s original project of life which has been contemplated from the very moment of his creation, i.e., he is called to the fullness of life (cf. Jn. 10:10), the perfection of his dignity which is beyond the bounds of the earth. “The human person in himself and his vocation transcends the limits of the created universe, of society and of history: his ultimate end is God himself, who has revealed himself to men in order to invite them and receive them into communion with himself” (CSDC 47)305. That is why no matter what human efforts and interventions are being done in order to restore the social order in justice, man and the human community continue to live in “tension” between good and evil, between harmony and discord, and between justice and injustice. Man lives in constant struggle and toil in this world. But this tension is relevant and productive because it makes man realized his nature and ultimate end – transcendence, final union with the Creator. It is necessary because his faith in God must produce changes in his life. As Pope Benedict XVI says, “the Christian message was not only ‘informative but performative’ […]; the Gospel is not merely a communication of things that can be known – it is one that makes things happen and is life-changing” (SS 2)306. This transformation is possible only if

305 306

PCJP, CSDC n. 47, p. 25. BENEDICT XVI, Encyclical Letter Spe Salvi, 30 November 2007, Libreria Editrice Vaticana, Vatican

2007, n. 2, pp. 5-6.

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it is anchored in hope, a hope that has been shown to us in the Paschal mystery of Christ. Thus, it is a hope that is fertile and real (cf. SS 4)307. The former refers to man’s imperfect nature that made him always empowerless and impotent before suffering. Suffering is an indispensable element of man’s finitude and the society’s imperfect nature brought about by gross transgressions against man and God (cf. SS 36)308. Man lives in tension between joy and suffering. But this tension is something that is desirable because it makes sense to human existence. Just like a battery, it has two opposite poles, the positive and negative, constantly in tension in order to produce current. In other words, without such interaction there would be no life. This affirms the pedagogical and positive value of suffering. To a certain extent, Karl Marx’s principle of inherent contradiction in all things that exists is correct, but it falls short to identify the definitive end of such contradiction, which is beyond the material world. Failure to recognize the reality of human suffering would mean a defeat of man’s struggle for perfection. This will make all his efforts futile and inutile. This is one of the reasons why man wanted to end his life in order to stop suffering but only to find out that in this way the more he will suffer. Recognizing suffering in our life means overcoming suffering. “It is an obligation both in justice and in love, and they are included among the fundamental requirements of the Christian life and every truly human life” (SS 39)309. This is the paradox of an authentic Christian living. One the hand, one must overcome suffering but on the other hand, one must live with it. This means that it is only in hoping for the completion of human suffering which is totally dependent on the grace God, one will have the courage to face it and find meaning in it. It is only this way, that man befriends suffering and determines to live until the perfection of his dignity, which is the eternal life as promised to him by God from the beginning of time. This implies also that overcoming it, means to suffer with others out of love and justice just as Jesus did to us, a true expression and embodiment of love. It is in the context of human suffering, that we are called to promote social justice in the world of health. We are in conscience bound to do something in order to reduce the 307

Cf. Ibidem., n. 4, p. 10. Cf. Ibidem, n. 36, p. 68. 309 Ibid. 308

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suffering of humanity. We are tasked to transform structures of sin into structures of solidarity wherein the promotion of the common good and the respect for human dignity are upheld. However, one should not have an illusion that an end of all sufferings is the establishment of a new social order. No amount of human effort can contain and order everything according to its ultimate purpose in this world as science and reason try to assert and insist. It is because, “every cultural, social, economic, and political accomplishment in which the social nature of the person and his activity of transforming the universe are brought about in history, must always be considered also in the context of its relative and provisional reality, because ‘the form of this world is passing away (1Cor. 7:31)’ (CSDC 48)”310. Its relative and provisional nature of any social order conforms to the endowment of man which is freedom. Man’s freedom could not be defined by social structures, otherwise, he is unfree311. This is true with totalitarian regime wherein man’s freedom is subjugated to the collective interest. “The right state of human affairs, the moral wellbeing of the world can never be guaranteed simply through structures alone, however good they are. Such structures are not only important but necessary; yet they cannot, and must not marginalize human freedom” (SS 24)312. Though man is totally free, his freedom is always prone to be abused. This is evident in our society today where freedom is exercised without responsibility. For instance, the commodification or commercialization of health is system that denies health as a primary good, and an inalienable right to all persons. Thus, in the name of justice one must “create convincing structures of freedom and of good” that will protect the integrity and enhance man’s effort to the perfection of his original vocation ( SS 25)313. If the definitive completion of a new order of things, “the new heaven and the new earth” (2 Pt. 3:13) depends solely on the free gift of God (grace) which is completely a transcendent reality (cf. CSDC 58)314, then what sense does the promotion of social justice has in this earthly reality? Indeed, it is very difficult to understand this truth, if it is not PCJP, CDSC, n. 48, p. 26. Cf. SCHALL J.V., The Encyclical on Hope: On the "De-immanentizing" of the Christian Eschaton, 3 December 2007, in http://www.ignatiusinsight.com/features2007/schall_onspesalvi_dec07.asp. 312 BENEDICT XVI, SS, n. 24, pp. 48-49. 313 Ibidem., n. 25, p. 50. 314 Cf. PCJP, CDSC, n. 58, p. 31. 310 311

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seen in the light of faith. “Faith gives us even now something of the reality we are waiting for, and this present reality constitutes for us a ‘proof’ of the things that are still unseen” (SS 7)315. The mission of promotion of social justice as a constitutive dimension of the proclamation of the gospel “has a saving and eschatological purpose which can be fully attained only in the next life” (GS 40)316. The Camillian mission of healing and curing the sick portrays in the same way its eschatological end. The promotion of health is indeed a salvific act which means promoting wholeness of being, life to the fullest (cf. CD 2001, n. 5)317. Thus, it is an important act that one must commit here and now. Therefore our action in behalf of justice is a very significant commitment because it makes our hope salvific and real, i.e., will come to its completion. Hope to those who are suffering has to be demonstrated in our actions because it is only in our commitment to action that one finds hope amidst pain and afflictions, a hope that gives courage and perseverance (cf. SS 35)318. St. Camillus was fully convinced of this hope, that he did not even feared of losing his life in serving the sick, because he knew well that it is not his work but God’s and thus its completion will come in his time, when His Kingdom is fully established in the end of time.

BENEDICT XVI, SS, n. 7, p. 19. VAT. II, GS, n. 40, p. 825. 317 Cf. M.I., (CAMILLIANS), Documents 55th General Chapter…, op. cit., n. 5, p. 134. 318 Cf. BENEDICT XVI, SS, n. 35, pp. 66-68. 315 316

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GENERAL CONCLUSION

The promotion of social justice in the world of health is, indeed a constitutive dimension and a new mission of the Ministers of the Infirm, not only in the Philippine Province but also to its global presence particularly in the least developing nations. This is not simply warranted by the situation though it must depart from a concrete reality, but foremostly demanded by the very consecration of each individual religious according to the spirit of the holy founder Camillus de Lellis. However, this task is not only limited to those consecrated or the members of the Order itself, but it extends beyond its confines to the greater participation of the majority members of the Body of Christ, the faithful. Thus, it is a mission of the Church. As the Synod of Bishops in 1971 upheld in the document Justice in the World that, “Action on behalf of justice and participation in the transformation of the world fully appear to us as a constitutive dimension of the preaching of the Gospel, or, in other words, of the Church’s mission for the redemption of the human race and its liberation from every oppressive situation” (JW, p. 289). Furthermore, recalling Pope Paul VI in his apostolic letter Octogesima Adveniens states that, “In the social sphere, the Church has always wished to assume a double function: first to enlighten minds in order to assist them to discover the truth and to find the right path to follow amid the different teachings that call for their attention; and secondly to take part in action and to spread, with a real care for service and effectiveness, the energies of the Gospel” (OA, n. 48, p. 283). The accent of these prophetic messages is found in its “constitutionality” or constitutiveness, which means its cause of existence. A mission will always be a mission of the promotion of social justice. The richness of the Good News is found in the proclamation of the truths and beauty of human existence, which are inviolable and inalienable for the full completion of man’s original vocation to fullness of life. This is what makes human existence meaningful and hopeful amidst cries and chaos of the human situation. This is what gives man real happiness, which is more than the worth of all the

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material blessings that God has endowed with freedom and gratuitousness. How much more if the basic conditions, the common good of people are denied and superseded by selfish desire for greed and power of certain individuals that made the people to turn into their knees and beg for their “mercy”. Let us remember what St. Paul says, that the new community, the new body of Christ no longer constitutes the slaves or free, Gentiles or Jews, woman or man. We all partake in the same bread in the same body (cf. 1 Cor. 10). The highest respect that man deserves must be given and protected. The proclamation of the Word carries in it a social responsibility which cannot be simply relegated to the State as its prime mover and purpose. That social responsibility remains always the property of every created human beings and each one must safeguard it in order to promote integral human liberation. This is a necessary passage towards the full completion of man’s original vocation, i.e., called to holiness and fullness of life in final communion with his Father in the new heaven and the new earth, His Kingdom. This form of liberation is not therefore definitive because everything depends on God’s grace. However, it is necessary that without it man will never find the courage and perseverance to continue his journey in this world. It is what makes hope real and present. Action on behalf of justice awakens us also to affirm the great value of human dignity and freedom. Oftentimes, the quest for justice is confined only within the realm of politics. That is why, when the Church speaks of injustices and intervenes in concrete specific situations, she is always condemned as meddling in politics and the truth about the separation between the Church and the State is obscured. This is what paralyzes the Church’s people to actively participate in the transformation of the world especially in overcoming oppressive situations. This participation then is grounded in the very proclamation of the Good News, which is the Church’s primary responsibility. Action on behalf of justice overcomes also the dualism of our Christian spirituality and mission. This classical principle has great influence in today’s world, in the perspective of man and the mission and ministry of the Church. The recovery of the ontological truths of man as a uni-totality of body and soul and its inherent social nature are given much emphasis in the social justice ministry of the Church. Applying it to the situation of the sick, wherein the various faces of dehumanization and corporatization of health services

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happen, it emanates from the denial of these anthropological-ontological truths of the human person. As consecrated persons, we are called to serve the sick who is a human person created both in union of body and soul. Whatever that affects the body affects the soul and vice versa. Whenever a person is sick, what is at stake is not simply his body but his dignity that is ought to be protected. Action in behalf of justice authenticates one’s witnessing to the gospel values and the “sequela Christi”. It makes the values of compassion, mercy, love and simplicity incarnate in the life of a disciple. For anyone one who believes in justice must be just first in himself. It is in the configuration to the person of Christ as the Good Samaritan that a consecrated Camillian becomes true and faithful to his choice of vocation in life. This configuration to Christ as the Good Samaritan demands the person to live his prophetic identity of announcing the good news at all situations and denouncing the evils that hamper even at the risk of his own life. It also necessitates the person to show preference of his love for the poorsick without neglecting the other sick persons but conscious and aware of their specific condition. It gives the person the capacity to see beyond what others normally don’t see and to read words and events and its message beyond what is actually presented. Finally, action in behalf of justice gives the person the capacity to demonstrate real hope of the suffering masses particularly the poorsick. Such commitment demonstrates at present what seems to be known as the “not yet”. It makes the proclamation of the Kingdom of God a real foretaste of the new heaven and a new earth. It makes the poorsick not only as recipients of the kingdom-blessings of integral health, but also as active and responsible agents of transformation of the world of health. It helps us to realize that though the redemption of the world is truly a pure gift of God, it is also at the same time a human responsibility, a true exercise of the gift of one’s freedom and dignity as persons created in the image and likeness of God. It is here where health as a human project finds its concrete expression and hope of what is to be fulfilled and experienced in the Kingdom of God.

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