a) Space: “The message of Christmas makes us recognize the darkness of a closed world, and thereby no doubt illustrates a reality that we see daily. Yet it also tells us that God does not allow himself to be shut out. He finds a space, even if it means entering through the stable; there are people who see his light and pass it on.”
b) The Stable as Space: “In some Christmas scenes from the late Middle Ages and the early modern period, the stable is depicted as a crumbling palace. It is still possible to recognize its former splendour, but now it has become a ruin, the walls are falling down - in fact, it has become a stable. Although it lacks any historical basis, this metaphorical interpretation nevertheless expresses something of the truth that is hidden in the mystery of Christmas. David's throne, which had been promised to last for ever, stands empty. Others rule over the Holy Land. Joseph, the descendant of David, is a simple artisan; the palace, in fact, has become a hovel. David himself had begun life as a shepherd. When Samuel sought him out in order to anoint him, it seemed impossible and absurd that a shepherd-boy such as he could become the bearer of the promise of Israel. In the stable of Bethlehem, the very town where it had all begun, the Davidic kingship started again in a new way - in that child wrapped in swaddling clothes and laid in a manger. The new throne from which this David will draw the world to himself is the Cross. The new throne - the Cross - corresponds to the new beginning in the stable. Yet this is exactly how the true Davidic palace, the true kingship is being built. This new palace is so different from what people imagine a palace and royal power ought to be like. It is the community of those who allow themselves to be drawn by Christ's love and so become one body with him, a new humanity. The power that comes from the Cross, the power of self-giving goodness - this is the true kingship. The stable becomes a palace - and setting out from this starting-point, Jesus builds the great new community, whose key-word the angels sing at the hour of his birth: "Glory to God in the highest, and peace on earth to those whom he loves" - those who place their will in his, in this way becoming men of God, new men, a new world.”
c) Heaven in the Stable: “Jesus himself is what we call ‘heaven;’ heaven is not a place but a person, the person of him in whom God and man are forever and inseparably one. And we go to heaven and enter into heaven to the extent that we go to Jesus Christ and enter into him.”[1]
“In the stable at Bethlehem, Heaven and Earth meet. Heaven has come down to Earth. For this reason, a light shines from the stable for all times; for this reason joy is enkindled there; for this reason song is born there. At the end of our Christmas meditation I should like to quote a remarkable passage from Saint Augustine. Interpreting the invocation in the Lord's Prayer: 'Our Father who art in Heaven', he asks: what is this - Heaven? And where is Heaven? Then comes a surprising response: '... who art in Heaven' - that means: in the saints and in the just. Yes, the heavens are the highest bodies in the universe, but they are still bodies, which cannot exist except in a given location. Yet if we believe that God is located in the heavens, meaning in the highest parts of the world, then the birds would be more fortunate than we, since they would live closer to God. Yet it is not written: 'The Lord is close to those who dwell on the heights or on the mountains', but rather: 'the Lord is close to the brokenhearted' (Ps 34:18[33:19]), an expression which refers to humility. Just as the sinner is called "Earth", so by contrast the just man can be called "Heaven"' (Sermo in monte II 5, 17). Heaven does not belong to the geography of space, but to the geography of the heart. And the heart of God, during the Holy Night, stooped down to the stable: the humility of God is Heaven. And if we approach this humility, then we touch Heaven. Then the Earth too is made new. With the humility of the shepherds, let us set out, during this Holy Night, towards the Child in the stable! Let us touch God's humility, God's heart! Then his joy will touch us and will make the world more radiant. Amen."
Confronting the Scandal of the Hidden God, Theologians Created "Heaven:"
"Christian theology, which was very soon confronted by this discrepancy between expectation and fulfillment, in the course of time turned the kingdom of God into a kingdom of heaven that is beyond this mortal life; the well-being of men became a salvation of souls, which again comes to pass beyond this life, after death. But theology did not thereby provide an answeer. For what is sublime in this message is precisely that the Lord was talking not just about another life, not just about men's souls, but was addressing the body, the whole man, in his embodied form, with his involvement in history and society; that he promised the kingdom of God to the man who lives bodily with other men in this history. As marvelous as the knowledge is that has been opened up for us by biblical scholarship in our century (that is, that Christ was not just looking forward to another ife, but was talking about real people), it can also disappoint and unsettle us when we look at real history, which is in truth no kingdom of God" (J. Ratzinger, "What It Means to Be a Christian," Ignatius [2006] 28-29).
[1] Dogma and Preaching, Franciscan Herald (1985) 63.
Wednesday, December 26, 2007
Monday, December 24, 2007
Email: "I was reading your blog (the Paul Vitz entry) which echoed past of our last conversation - and was wondering about how the substance (thing) oriented metaphysics of Aristotle/Aquinas (which is the foundation for Transubstantiation) reconciles with the understanding that the fundamental Being of the Trinitarian Persons is Relation. In other words, how does the underlying substance of the bread become (as substance) the Relation of the 2nd Person of the Trinity - both as Son to the Father and the Filioque in relation to the Holy Spirit? Or yet again, "Under" the accidents of bread, is the "substance" of a consecrated not a Thing, but a Relation (or Relations)?
Add to this what Aquinas says in De Ente et Essentia -namely that in God, essence and being are the same, The kind of "Thing" God is is an "Existing Thing". Yet, I am hearing now that God's essence is Relation. I am thinking this is one of those Catholic both/and things (God's essence is somehow both Existence and Relation) but am as of yet not understanding how so.
Response:
The Church doesn't teach philosophy, not even that of Aristotle and Aquinas! Revelation is the Person of Jesus Christ Who is the Word of the Father. Faith is the response of the whole person of the believer to the act of self-gift that the Father makes in the Person of the Son.
"Substance" is a conceptual sign that Aristotle created to formulate a likeness between his experience of being through sensation of particularly organic reality like animals that grow, heal, etc., and the inorganic that perdures in spite of what he perceives to be "accidental" like bigger/smaller, white/black, etc. "Substance" pertains to the experience of internal and external sensation of being and the mode of our abstract knowing through concepts. I would even dare to say that "substance" corresponds to our conceptual way of knowing.
"Substance" as conceptualized by Aristotle is designed to account for and represent "being-in-itself." "Accident" is designed to account for "being-in-another." Neither of these categories could account for reality that is pure self-giving or streaming out of self as revealed concerning the Trinity. Hence, none of the divine Persons could be classified as "substances." And hence again, God could not be called a "substance" because there can be no "accidents" in what we know of God, since "He" is not susceptible of change having nothing that is not totally "Himself."
In a word, "substance" is a useful category to give being, and has been its prime category. But reality has proven larger than "substance." "Communio" that is Magisterial designation of the Trinity transcends substance since it is understood to be integrated by persons whose very "to be" is "to - be - in - relation." This is beyond our sensation, but it is not beyond our experience. You experience this in spousal love (and for that I direct you to JPII's "Love and Responsibility" Ignatius 96).
To shorten this, I include Ratzinger's remarks on the category on "substance." (I also direct you to Wojtyla's "Subjectivity and the Irreducible in the Human Person" in Person and Community Lang (1993) 209-215).
Re: the "essence/esse" duality, you are here in the epistemological horizon of the experience through the senses. Neither Aristotle or Aquinas knew anything of "experience" of the "I" in the moral moment (such as faith as anthropological act. Aquinas understood it in terms of viritue/habit/accident of substance). Vatican II, JPII and Benedict are always dealing with faith as an anthropological act of the entire "I" that is given to the revealing "I" of the Logos. When you talk about the "essence" of God, you are making an abstraction. The existential revelation is "I AM," and Jesus Christ reiterates that He is "I AM" in Jn. 8, 24, 28, 58. See the Greek does not say "I am he," but ego eimi.
With regard to the Eucharist, Ratzinger is at pains to explain that the "body" of Christ is not a substantial -in-itselfness. No human body is, much less Christ's, particularly when dealing with the risen body of Christ, which is what we consume.
“Substance” in Joseph Ratzinger
1) “In this idea of relativity in word and love [that is the person in God], independent of the concept of substance and not to be classified among the ‘accidents,’ Christian thought discovered the kernel of the concept of person, which describes something other and infinitely more than the mere idea of the ‘individual.’ Let us listen once again to St. Augustine: ‘In God there are no accidents, only substance and relation.’ Therein lies concealed a revolution in man’s view of the world: the undivided sway of thinking in terms of substance is ended; relation is discovered as an equally valid primordial mode of reality. It becomes possible to surmount what we call today ‘objectifying thought;’ a new plane of being comes into view”1 (Josef Ratzinger, “Introduction to Christianity,” Ignatius [1990] 132).
2) More recently, he refers to “person” as a “new philosophical category… a concept that has become for us the fundamental concept of the analogy between God and man, the very center of philosophical thought;”2 J. Ratzinger, “The New Covenant,” in Many Religions – One Covenant Ignatius (1999) 76-770).
In the light of this, he remarks:
“The meaning of an already existing category, that of ‘relation,’ was fundamentally changed. In the Aristotelian table of categories, relation belongs to the group of accidents that point to substance and are dependent on it; in God, therefore, there are no accidents. Through the Christian doctrine of the Trinity, relatio moves out of the substance-accident framework. Now God himself is described as a Trinitarian set of relations, as relatio subsistens. When we say that man is the image of God, it means that he is a being designed for relationship; it means that, in and through all his relationships, he seeks that relation which is the ground of his existence”3(Ibid) 3)
“I believe that if one follows this struggle in which human reality had to be brought in, as it were, and affirmed for Jesus, one sees what tremendous effort and intellectual transformation lay behind the working out of this concept of person, which was quite foreign in its inner disposition to the Greek and the Latin mind. It is not conceived in substantialist, but… in existential terms… Remaining on the level of the Greek mind, Boethius defined ‘person’ as naturae rationalis individual substantia, as the individual substance of a rational nature. One sees that the concept of person stands entirely on the level of substance. This cannot clarify anything about the Trinity or about Christology; it is an affirmation that remains on the level of the Greek mind which thinks in substantialist terms.” (J. Ratzinger, “Concerning the Notion of Person in Theology,” Communio 17 [Fall, 1990] 448).
Let me suggest more. If the bread becomes the Body of Christ, and the Body of Christ is His Person, and His Person is an action of self-gift (relation) to the Father, then the Body of Christ is an Action, a divine Act ion. Cartesian dualism would have the body to a substance in itself as “res extensa.”
Let me add re: the Body of Christ is His Person.
From the time of the Council of Chalcedon (451) to Constantinople III, the problem was a kind of “parallelism” of the divine and the human, with the “human” as a kind of “thing-in-itself” as “substance.” Ratzinger had this to say: “In the manuals, the theological development after Chalcedon has ordinarily come to be little considered. The impression thus frequently remains that dogmatic Christology finishes up with a certain parallelism between the two natures of Christ. This impression has also been the cause leading to the divisions since Chalcedon. But in effect the declaration of the true humanity and the true divinity of Christ can retain its significance only when there is a clarification also of the mode of unity of the two natures, which the Council of Chalcedon has defined by the formula of the `one person’ of Christ, at that time not yet fully examined. In fact only that unity of divinity and humanity which in Christ is not parallelism, where one stands alongside the other, but real compenetration, - compenetration between God and man – means salvation for humankind. Only thus in fact does that true `being with God’ take place, without which liberation and freedom do not exist…
“If God joins himself to his creature –man/woman – he does not wound or diminish it: he brings it to its plenitude. But on the other hand (and this is no less important) there remains no trace of that dualism or parallelism of the two natures, which in the course of history was frequently judged necessary to defend the human liberty of Jesus. Such studies forgot that the assumption of the human will into the divine will does not destroy freedom, but on the contrary generates true liberty. The Council of Constantinople has analyzed concretely the problem of the two natures and one person in Christ in view of the problem of the two natures and one person in Christ in view of the problem of the will of Jesus. We are reminded firmly that there exists a specific will of the man Jesus that is not absorbed into the divine will. But this human will follows the divine will and thus becomes a single will with it, not, however, in a forced way but by way of freedom. The metaphysical duplicity of a human will and a divine will is not eliminated, but in the personal sphere, the area of freedom there is accomplished a fusion of the two, so that this becomes not one single natural will but one personal will. This free union – a mode of union created by love – is a union higher and more intimate than a purely natural union. It corresponds to the highest union which can exist, the union of the Trinity…. (I)n Jesus there are not two `I,’ but only one. The Logos speaks of the will and human thought of Jesus using the `I;’ this has become his `I,’ has been assumed into his `I,’ because the human will has become fully one with the will of the Logos, and with it has become pure assent to the will of the Father.”[1]
The Body of Christ is compenetrated with the divinity of the divine Person without losing its autonomy as natural freedom which is perfected as self-gift. The Body is the Body with its natural soul and human intellect and human will exercised by divine Son. St. Thomas said that there was only one Esse for the Body and Soul with its faculties of intellect and will, which was the Esse Personale (S. Th. III, 17 a.2, ad 2). Hence, that Body will be the material action of self-gift as Eucharist and to death on the Cross.
Now, let me add more from Ratzinger’s “God is Near Us:” “What does it mean, to receive the Lord? That is never just a physical bodily act, as when I eat a slice of bread. So it can therefore never be something that happens just in a moment. To receive Christ means: to move toward him, to adore him. For that reason, the reception can stretch out beyond the time of the Eucharistic celebration; indeed, it has to do so. The more the Church grew into the Eucharistic mystery, the more she understood that she could not consummate the celebration of Communion within the limited time available in the Mass. When, thus, the eternal light was lit in the Church, and the tabernacle installed beside the altar, then it was as if the bud of the mystery had opened, and the Church had welcomed the fullness of the Eucharistic mystery. The Lord is always there. The church is not just a space in which something sometimes happens early in the morning, while for the rest of the day it stands empty, ‘unused.’ There is always the ‘Church’ in the church building, because the Lord is always giving himself, because the Eucharistic mystery remains present, and because we, in approaching it, are always included in the worship of the whole believing, praying, and loving Church.
“We all know what a difference there is between a church that is always prayed in and one that has become a museum. There is a great danger today of our churches becoming museums and suffering the fate of museums: if they are not locked, they are looted. They are no longer alive. The measure of life in the Church, the measure of her inner openness, will be seen in that she will be able to keep her doors open, because she is a praying Church. I ask you all therefore from the heart, let us make a new start at this. Let us again recollect that the Church is always alive, that within her evermore t he Lord comes to meet us. The Eucharist, and its fellowship, will be all the more complete, the more we prepare ourselves for him in silent prayer before the Eucharistic presence of the Lord, the more we truly receive Communion. Adoration such as that is always more than just talking with God in a general way. But against that could then rightly be voiced the objection that is always to be heard: I can just as well pray in the forest, in the freedom of nature. Certainly, anyone can. But if it were only a matter of that, then the initiative in prayer would lie entirely with us; then God would be a mental hypothesis – whether he answers, whether he can answer or wants to, would remain open. The Eucharist means, God has answered: The Eucharist is God as an answer, as an answering presence. Now the initiative no longer lies with us, in the God-man relationship, but with him, and it now becomes really serious. That is why, in the sphere of Eucharistic adoration, prayer attains a new level; now it is two-way, and so now it really is a serious business.”[2]
1 Josef Ratzinger, “Introduction to Christianity,” Ignatius (1990) 132.
2 J. Ratzinger, “The New Covenant,” in Many Religions – One Covenant Ignatius (1999) 76-770).
3 Ibid.
4 J. Ratzinger, “Concerning the Notion of Person in Theology,” Communio 17 (Fall, 1990) 448.
[1] J. Ratzinger, “Journey Towards Easter,” Crossroad (198 )
[2] J. Ratzinger, “The Presence of the Lord in the Sacrament,” God is Near Us Ignatius (2003) 89-90.
Add to this what Aquinas says in De Ente et Essentia -namely that in God, essence and being are the same, The kind of "Thing" God is is an "Existing Thing". Yet, I am hearing now that God's essence is Relation. I am thinking this is one of those Catholic both/and things (God's essence is somehow both Existence and Relation) but am as of yet not understanding how so.
Response:
The Church doesn't teach philosophy, not even that of Aristotle and Aquinas! Revelation is the Person of Jesus Christ Who is the Word of the Father. Faith is the response of the whole person of the believer to the act of self-gift that the Father makes in the Person of the Son.
"Substance" is a conceptual sign that Aristotle created to formulate a likeness between his experience of being through sensation of particularly organic reality like animals that grow, heal, etc., and the inorganic that perdures in spite of what he perceives to be "accidental" like bigger/smaller, white/black, etc. "Substance" pertains to the experience of internal and external sensation of being and the mode of our abstract knowing through concepts. I would even dare to say that "substance" corresponds to our conceptual way of knowing.
"Substance" as conceptualized by Aristotle is designed to account for and represent "being-in-itself." "Accident" is designed to account for "being-in-another." Neither of these categories could account for reality that is pure self-giving or streaming out of self as revealed concerning the Trinity. Hence, none of the divine Persons could be classified as "substances." And hence again, God could not be called a "substance" because there can be no "accidents" in what we know of God, since "He" is not susceptible of change having nothing that is not totally "Himself."
In a word, "substance" is a useful category to give being, and has been its prime category. But reality has proven larger than "substance." "Communio" that is Magisterial designation of the Trinity transcends substance since it is understood to be integrated by persons whose very "to be" is "to - be - in - relation." This is beyond our sensation, but it is not beyond our experience. You experience this in spousal love (and for that I direct you to JPII's "Love and Responsibility" Ignatius 96).
To shorten this, I include Ratzinger's remarks on the category on "substance." (I also direct you to Wojtyla's "Subjectivity and the Irreducible in the Human Person" in Person and Community Lang (1993) 209-215).
Re: the "essence/esse" duality, you are here in the epistemological horizon of the experience through the senses. Neither Aristotle or Aquinas knew anything of "experience" of the "I" in the moral moment (such as faith as anthropological act. Aquinas understood it in terms of viritue/habit/accident of substance). Vatican II, JPII and Benedict are always dealing with faith as an anthropological act of the entire "I" that is given to the revealing "I" of the Logos. When you talk about the "essence" of God, you are making an abstraction. The existential revelation is "I AM," and Jesus Christ reiterates that He is "I AM" in Jn. 8, 24, 28, 58. See the Greek does not say "I am he," but ego eimi.
With regard to the Eucharist, Ratzinger is at pains to explain that the "body" of Christ is not a substantial -in-itselfness. No human body is, much less Christ's, particularly when dealing with the risen body of Christ, which is what we consume.
"The body is not just 'there,' having a merely external relationship to the spirit; rather, the body is the self-expression and 'image' of the spirit. In the human being, what constitutues biological life also constitutes the person. The person actualizes itself in the body and the body is, therefore, its expression. In the body we may see what is invisible as spirit. Because the body is the person become visible, and the person is an image of God, the body, taken in its full network of relationships, is also the space where the divine becomes imaged, expressed, seen" J. Ratzinger, "The Paschal Mystery as Core and Foundation of Devotion to the Sacred Heart," in Towards the Civilization of Love" Ignatius (1985) 149.
“Substance” in Joseph Ratzinger
1) “In this idea of relativity in word and love [that is the person in God], independent of the concept of substance and not to be classified among the ‘accidents,’ Christian thought discovered the kernel of the concept of person, which describes something other and infinitely more than the mere idea of the ‘individual.’ Let us listen once again to St. Augustine: ‘In God there are no accidents, only substance and relation.’ Therein lies concealed a revolution in man’s view of the world: the undivided sway of thinking in terms of substance is ended; relation is discovered as an equally valid primordial mode of reality. It becomes possible to surmount what we call today ‘objectifying thought;’ a new plane of being comes into view”1 (Josef Ratzinger, “Introduction to Christianity,” Ignatius [1990] 132).
2) More recently, he refers to “person” as a “new philosophical category… a concept that has become for us the fundamental concept of the analogy between God and man, the very center of philosophical thought;”2 J. Ratzinger, “The New Covenant,” in Many Religions – One Covenant Ignatius (1999) 76-770).
In the light of this, he remarks:
“The meaning of an already existing category, that of ‘relation,’ was fundamentally changed. In the Aristotelian table of categories, relation belongs to the group of accidents that point to substance and are dependent on it; in God, therefore, there are no accidents. Through the Christian doctrine of the Trinity, relatio moves out of the substance-accident framework. Now God himself is described as a Trinitarian set of relations, as relatio subsistens. When we say that man is the image of God, it means that he is a being designed for relationship; it means that, in and through all his relationships, he seeks that relation which is the ground of his existence”3(Ibid) 3)
“I believe that if one follows this struggle in which human reality had to be brought in, as it were, and affirmed for Jesus, one sees what tremendous effort and intellectual transformation lay behind the working out of this concept of person, which was quite foreign in its inner disposition to the Greek and the Latin mind. It is not conceived in substantialist, but… in existential terms… Remaining on the level of the Greek mind, Boethius defined ‘person’ as naturae rationalis individual substantia, as the individual substance of a rational nature. One sees that the concept of person stands entirely on the level of substance. This cannot clarify anything about the Trinity or about Christology; it is an affirmation that remains on the level of the Greek mind which thinks in substantialist terms.” (J. Ratzinger, “Concerning the Notion of Person in Theology,” Communio 17 [Fall, 1990] 448).
Let me suggest more. If the bread becomes the Body of Christ, and the Body of Christ is His Person, and His Person is an action of self-gift (relation) to the Father, then the Body of Christ is an Action, a divine Act ion. Cartesian dualism would have the body to a substance in itself as “res extensa.”
Let me add re: the Body of Christ is His Person.
From the time of the Council of Chalcedon (451) to Constantinople III, the problem was a kind of “parallelism” of the divine and the human, with the “human” as a kind of “thing-in-itself” as “substance.” Ratzinger had this to say: “In the manuals, the theological development after Chalcedon has ordinarily come to be little considered. The impression thus frequently remains that dogmatic Christology finishes up with a certain parallelism between the two natures of Christ. This impression has also been the cause leading to the divisions since Chalcedon. But in effect the declaration of the true humanity and the true divinity of Christ can retain its significance only when there is a clarification also of the mode of unity of the two natures, which the Council of Chalcedon has defined by the formula of the `one person’ of Christ, at that time not yet fully examined. In fact only that unity of divinity and humanity which in Christ is not parallelism, where one stands alongside the other, but real compenetration, - compenetration between God and man – means salvation for humankind. Only thus in fact does that true `being with God’ take place, without which liberation and freedom do not exist…
“If God joins himself to his creature –man/woman – he does not wound or diminish it: he brings it to its plenitude. But on the other hand (and this is no less important) there remains no trace of that dualism or parallelism of the two natures, which in the course of history was frequently judged necessary to defend the human liberty of Jesus. Such studies forgot that the assumption of the human will into the divine will does not destroy freedom, but on the contrary generates true liberty. The Council of Constantinople has analyzed concretely the problem of the two natures and one person in Christ in view of the problem of the two natures and one person in Christ in view of the problem of the will of Jesus. We are reminded firmly that there exists a specific will of the man Jesus that is not absorbed into the divine will. But this human will follows the divine will and thus becomes a single will with it, not, however, in a forced way but by way of freedom. The metaphysical duplicity of a human will and a divine will is not eliminated, but in the personal sphere, the area of freedom there is accomplished a fusion of the two, so that this becomes not one single natural will but one personal will. This free union – a mode of union created by love – is a union higher and more intimate than a purely natural union. It corresponds to the highest union which can exist, the union of the Trinity…. (I)n Jesus there are not two `I,’ but only one. The Logos speaks of the will and human thought of Jesus using the `I;’ this has become his `I,’ has been assumed into his `I,’ because the human will has become fully one with the will of the Logos, and with it has become pure assent to the will of the Father.”[1]
The Body of Christ is compenetrated with the divinity of the divine Person without losing its autonomy as natural freedom which is perfected as self-gift. The Body is the Body with its natural soul and human intellect and human will exercised by divine Son. St. Thomas said that there was only one Esse for the Body and Soul with its faculties of intellect and will, which was the Esse Personale (S. Th. III, 17 a.2, ad 2). Hence, that Body will be the material action of self-gift as Eucharist and to death on the Cross.
Now, let me add more from Ratzinger’s “God is Near Us:” “What does it mean, to receive the Lord? That is never just a physical bodily act, as when I eat a slice of bread. So it can therefore never be something that happens just in a moment. To receive Christ means: to move toward him, to adore him. For that reason, the reception can stretch out beyond the time of the Eucharistic celebration; indeed, it has to do so. The more the Church grew into the Eucharistic mystery, the more she understood that she could not consummate the celebration of Communion within the limited time available in the Mass. When, thus, the eternal light was lit in the Church, and the tabernacle installed beside the altar, then it was as if the bud of the mystery had opened, and the Church had welcomed the fullness of the Eucharistic mystery. The Lord is always there. The church is not just a space in which something sometimes happens early in the morning, while for the rest of the day it stands empty, ‘unused.’ There is always the ‘Church’ in the church building, because the Lord is always giving himself, because the Eucharistic mystery remains present, and because we, in approaching it, are always included in the worship of the whole believing, praying, and loving Church.
“We all know what a difference there is between a church that is always prayed in and one that has become a museum. There is a great danger today of our churches becoming museums and suffering the fate of museums: if they are not locked, they are looted. They are no longer alive. The measure of life in the Church, the measure of her inner openness, will be seen in that she will be able to keep her doors open, because she is a praying Church. I ask you all therefore from the heart, let us make a new start at this. Let us again recollect that the Church is always alive, that within her evermore t he Lord comes to meet us. The Eucharist, and its fellowship, will be all the more complete, the more we prepare ourselves for him in silent prayer before the Eucharistic presence of the Lord, the more we truly receive Communion. Adoration such as that is always more than just talking with God in a general way. But against that could then rightly be voiced the objection that is always to be heard: I can just as well pray in the forest, in the freedom of nature. Certainly, anyone can. But if it were only a matter of that, then the initiative in prayer would lie entirely with us; then God would be a mental hypothesis – whether he answers, whether he can answer or wants to, would remain open. The Eucharist means, God has answered: The Eucharist is God as an answer, as an answering presence. Now the initiative no longer lies with us, in the God-man relationship, but with him, and it now becomes really serious. That is why, in the sphere of Eucharistic adoration, prayer attains a new level; now it is two-way, and so now it really is a serious business.”[2]
1 Josef Ratzinger, “Introduction to Christianity,” Ignatius (1990) 132.
2 J. Ratzinger, “The New Covenant,” in Many Religions – One Covenant Ignatius (1999) 76-770).
3 Ibid.
4 J. Ratzinger, “Concerning the Notion of Person in Theology,” Communio 17 (Fall, 1990) 448.
[1] J. Ratzinger, “Journey Towards Easter,” Crossroad (198 )
[2] J. Ratzinger, “The Presence of the Lord in the Sacrament,” God is Near Us Ignatius (2003) 89-90.
Sunday, December 23, 2007
The Blueprint to Benedict XVI's Magisterium: The New Evangelization
Human life cannot be realized by itself. Our life is an open question, an incomplete project, still to be brought to fruition and realized. Each man´s fundamental question is: How will this be realized -- becoming man? How does one learn the art of living? Which is the path toward happiness?
To evangelize means: to show this path -- to teach the art of living. At the beginning of his public life Jesus says: I have come to evangelize the poor (Luke 4:18); this means: I have the response to your fundamental question; I will show you the path of life, the path toward happiness -- rather: I am that path.
The deepest poverty is the inability of joy, the tediousness of a life considered absurd and contradictory. This poverty is widespread today, in very different forms in the materially rich as well as the poor countries. The inability of joy presupposes and produces the inability to love, produces jealousy, avarice -- all defects that devastate the life of individuals and of the world.
This is why we are in need of a new evangelization -- if the art of living remains an unknown, nothing else works. But this art is not the object of a science -- this art can only be communicated by [one] who has life -- he who is the Gospel personified.
I. Structure and method in new evangelization
1. The structure
Before speaking about the fundamental contents of new evangelization, I would like to say a few words about its structure and on the correct method.
The Church always evangelizes and has never interrupted the path of evangelization. She celebrates the eucharistic mystery every day, administers the sacraments, proclaims the word of life -- the Word of God, and commits herself to the causes of justice and charity. And this evangelization bears fruit: It gives light and joy, it gives the path of life to many people; many others live, often unknowingly, of the light and the warmth that radiate from this permanent evangelization.
However, we can see a progressive process of de-Christianization and a loss of the essential human values, which is worrisome. A large part of today´s humanity does not find the Gospel in the permanent evangelization of the Church: That is to say, the convincing response to the question: How to live?
This is why we are searching for, along with permanent and uninterrupted and never to be interrupted evangelization, a new evangelization, capable of being heard by that world that does not find access to "classic" evangelization. Everyone needs the Gospel; the Gospel is destined to all and not only to a specific circle and this is why we are obliged to look for new ways of bringing the Gospel to all.
Yet another temptation lies hidden beneath this -- the temptation of impatience, the temptation of immediately finding the great success, in finding large numbers. But this is not God´s way. For the Kingdom of God as well as for evangelization, the instrument and vehicle of the Kingdom of God, the parable of the grain of mustard seed is always valid (see Mark 4:31-32).
The Kingdom of God always starts anew under this sign. New evangelization cannot mean: immediately attracting the large masses that have distanced themselves from the Church by using new and more refined methods. No -- this is not what new evangelization promises.
New evangelization means: never being satisfied with the fact that from the grain of mustard seed, the great tree of the Universal Church grew; never thinking that the fact that different birds may find place among its branches can suffice -- rather, it means to dare, once again and with the humility of the small grain, to leave up to God the when and how it will grow (Mark 4:26-29).
Large things always begin from the small seed, and the mass movements are always ephemeral. In his vision of the evolutionary process, Teilhard de Chardin mentions the "white of the origins" (le blanc des origines): The beginning of a new species is invisible and cannot be found by scientific research. The sources are hidden -- they are too small. In other words: The large realities begin in humility.
Let us put to one side whether Teilhard is right in his evolutionary theories; the law on invisible origins does say a truth -- a truth present in the very actions of God in history: "The Lord did not set his affection on you and choose you because you were more numerous than other peoples, for you were the fewest of all peoples. But it was because the Lord loved you." God says [this] to the People of Israel in the Old Testament and thus expresses the fundamental paradox of the history of salvation: certainly, God does not count in large numbers; exterior power is not the sign of his presence.
Most of Jesus´ parables indicate this structure of divine intervention and thus answer the disciples´ worries, who were expecting other kinds of success and signs from the Messiah -- successes of the kind offered by Satan to the Lord: All these -- the kingdoms of the world -- I will give to you ... (Matthew 4:9).
Of course, at the end of his life Paul believed that he had proclaimed the Gospel to the very ends of the earth, but the Christians were small communities dispersed throughout the world, insignificant according to the secular criteria. In reality, they were the leaven that penetrates the meal from within and they carried within themselves the future of the world (see Matthew 13:33).
An old proverb says: "Success is not one of the names of God." New evangelization must surrender to the mystery of the grain of mustard seed and not be so pretentious as to believe to immediately produce a large tree. We either live too much in the security of the already existing large tree or in the impatience of having a greater, more vital tree -- instead we must accept the mystery that the Church is at the same time a large tree and a very small grain. In the history of salvation it is always Good Friday and Easter Sunday at the same time ....
2. The method
The correct method derives from this structure of new evangelization. Of course we must use the modern methods of making ourselves be heard in a reasonable way -- or better yet: of making the voice of the Lord accessible and comprehensible. ... We are not looking for listening for ourselves -- we do not want to increase the power and the spreading of our institutions, but we wish to serve for the good of the people and humanity giving room to he who is Life.
This expropriation of one´s person, offering it to Christ for the salvation of men, is the fundamental condition of the true commitment for the Gospel. "I have come in my Father´s name, and you do not receive me; if another comes in his own name, him you will receive," says the Lord (John 5:43). The mark of the Antichrist is the fact that he speaks in his own name.
The sign of the Son is his communion with the Father. The Son introduces us into the Trinitarian communion, into the circle of eternal love, whose persons are "pure relations," the pure act of giving oneself and of welcome. The Trinitarian plan -- visible in the Son, who does not speak in his name -- shows the form of life of the true evangelizer -- rather, evangelizing is not merely a way of speaking, but a form of living: living in the listening and giving voice to the Father. "He will not speak on his own authority, but whatever he hears he will speak," says the Lord about the Holy Spirit (John 16:13).
This Christological and pneumatological form of evangelization is also, at the same time, an ecclesiological form: The Lord and the Spirit build the Church, communicate through the Church. The proclamation of Christ, the proclamation of the Kingdom of God presupposes listening to his voice in the voice of the Church. "Not speak on his own authority" means: to speak in the mission of the Church ....
Many practical consequences come from this law of expropriation. All reasonable and morally acceptable methods should be studied -- to use these possibilities of communication is a duty. But words and the whole art of communication cannot reach the human person to such depths as the Gospel must reach.
A few years ago, I was reading the biography of a very good priest of our century, Don Didimo, the parish priest of Bassano del Grappa. In his notes, golden words can be found, the fruit of a life of prayer and of meditation. About us, Don Didimo says, for example: "Jesus preached by day, by night he prayed."
With these few words, he wished to say: Jesus had to acquire the disciples from God. The same is always true. We ourselves cannot gather men. We must acquire them by God for God. All methods are empty without the foundation of prayer. The word of the announcement must always be drenched in an intense life of prayer.
We must add another step. Jesus preached by day, by night he prayed -- this is not all. His entire life was -- as demonstrated in a beautiful way by the Gospel according to St. Luke -- a path toward the cross, ascension toward Jerusalem. Jesus did not redeem the world with beautiful words but with his suffering and his death. His Passion is the inexhaustible source of life for the world; the Passion gives power to his words.
The Lord himself -- extending and amplifying the parable of the grain of mustard seed -- formulated this law of fruitfulness in the word of the grain of seed that dies, fallen to earth (John 12:24). This law too is valid until the end of the world and is -- along with the mystery of the grain of seed -- fundamental for new evangelization. All of history demonstrates this.
It is very easy to demonstrate this in the history of Christianity. Here, I would like to recall only the beginning of evangelization in the life of St. Paul. The success of his mission was not the fruit of great rhetorical art or pastoral prudence; the fruitfulness was tied to the suffering, to the communion in the passion with Christ (see 1 Corinthians 2:1-5; ... 2 Corinthians 11:30; Galatians 4:12-14).
"But none will be given it except the sign of the prophet Jonah," said the Lord. The sign of Jonah is the crucified Christ -- they are the witnesses that complete "what is lacking in Christ´s afflictions" (Colossians 1:24). Throughout all the periods of history, the words of Tertullian have always been verified: The blood of martyrs is a seed.
St. Augustine says the same thing in a much more beautiful way, interpreting John 21, where the prophesy of Peter´s martyrdom and the mandate to tend, that is to say, the institution of his primacy, are intimately connected.
St. Augustine comments [on] the text John 21:16 in the following way: "Tend my sheep," this means suffer for my sheep.... A mother cannot give life to a child without suffering. Each birth requires suffering, is suffering, and becoming a Christian is a birth. Let us say this once again in the words of the Lord: The Kingdom of heaven has suffered violence (Matthew 11:12; Luke 16:16), but the violence of God is suffering, it is the cross. We cannot give life to others without giving up our own lives.
The process of expropriation indicated above is the concrete form (expressed in many different ways) of giving one´s life. And let us think about the words of the Savior: "Whoever loses his life for my sake and the Gospel´s will save it" (Mark 8:35).
II. The contents essential for new evangelization [to achieve joy]
1. Conversion [to self-gift]
As for the contents of new evangelization, first of all we must keep in mind the inseparability of the Old and the New Testaments. The fundamental content of the Old Testament is summarized in the message by John the Baptist: metanoeìte -- Convert! There is no access to Jesus without the Baptist; there is no possibility of reaching Jesus without answering the call of the precursor, rather: Jesus took up the message of John in the synthesis of his own preaching: metanoeìte kaì pisteúete èn tù eùaggelíu (Mark 1:15).
The Greek word for converting means: to rethink -- to question one´s own and common way of living; to allow God to enter into the criteria of one´s life; to not merely judge according to the current opinions. Thereby, to convert means: not to live as all the others live, not do what all do, not feel justified in dubious, ambiguous, evil actions just because others do the same; begin to see one´s life through the eyes of God; thereby looking for the good, even if uncomfortable; not aiming at the judgment of the majority, of men, but on the justice of God -- in other words: to look for a new style of life, a new life.
All of this does not imply moralism; reducing Christianity to morality loses sight of the essence of Christ´s message: the gift of a new friendship, the gift of communion with Jesus and thereby with God. Whoever converts to Christ does not mean to create his own moral autarchy for himself, does not intend to build his own goodness through his own strengths.
"Conversion" (metanoia) means exactly the opposite: to come out of self-sufficiency to discover and accept our indigence -- the indigence of others and of the Other, his forgiveness, his friendship. Unconverted life is self-justification (I am not worse than the others); conversion is humility in entrusting oneself to the love of the Other, a love that becomes the measure and the criteria of my own life.
Here we must also bear in mind the social aspect of conversion. Certainly, conversion is above all a very personal act, it is personalization. I separate myself from the formula "to live as all others" (I do not feel justified anymore by the fact that everyone does what I do) and I find my own person in front of God, my own personal responsibility.
But true personalization is always also a new and more profound socialization. The "I" opens itself once again to the "you," in all its depths, and thus a new "We" is born. If the lifestyle spread throughout the world implies the danger of de-personalization, of not living one´s own life but the life of all the others, in conversion a new "We," of the common path of God, must be achieved.
In proclaiming conversion we must also offer a community of life, a common space for the new style of life. We cannot evangelize with words alone; the Gospel creates life, creates communities of progress; a merely individual conversion has no consistency....
2. The Kingdom of God [is the Person of Jesus of Nazareth: R Mi #18]
In the appeal to conversion the proclamation of the Living God is implicit -- as its fundamental condition. Theocentrism is fundamental in the message of Jesus and must also be at the heart of new evangelization.
The keyword of the proclamation of Jesus is: the Kingdom of God. But the Kingdom of God is not a thing, a social or political structure, a utopia. The Kingdom of God is God. Kingdom of God means: God exists. God is alive. God is present and acts in the world, in our -- in my life.
God is not a faraway "ultimate cause," God is not the "great architect" of deism, who created the machine of the world and is no longer part of it -- on the contrary: God is the most present and decisive reality in each and every act of my life, in each and every moment of history.
In his conference when leaving the University of Münster, the theologian J.B. Metz said some unexpected things for him. In the past, Metz taught us anthropocentrism -- the true occurrence of Christianity was the anthropological turning point, the secularization, the discovery of the secularity of the world. Then he taught us political theology -- the political characteristic of faith; then the "dangerous memory"; and finally narrative theology.
After this long and difficult path, today he tells us: The true problem of our times is the "Crisis of God," the absence of God, disguised by an empty religiosity. Theology must go back to being truly theo-logy, speaking about and with God.
Metz is right: the "unum necessarium" to man is God. Everything changes, whether God exists or not. Unfortunately -- we Christians also often live as if God did not exist ("si Deus non daretur"). We live according to the slogan: God does not exist, and if he exists, he does not belong.
Therefore, evangelization must, first of all, speak about God, proclaim the only true God: the Creator -- the Sanctifier -- the Judge (see Catechism of the Catholic Church).
Here too we must keep the practical aspect in mind. God cannot be made known with words alone. One does not really know a person if one knows about this person secondhandedly. To proclaim God is to introduce to the relation with God: to teach how to pray. Prayer is faith in action. And only by experiencing life with God does the evidence of his existence appear.
This is why schools of prayer, communities of prayer, are so important. There is a complementarity between personal prayer ("in one´s room," alone in front of God´s eyes), "para-liturgical" prayer in common ("popular religiosity") and liturgical prayer.
Yes, the liturgy is, first of all, prayer; its specificity consists in the fact that its primary project is not ourselves (as in private prayer and in popular religiosity), but God himself -- the liturgy is actio divina, God acts and we respond to this divine action.
Speaking about God and speaking with God must always go together. The proclamation of God is the guide to communion with God in fraternal communion, founded and vivified by Christ. This is why the liturgy (the sacraments) are not a secondary theme next to the preaching of the living God, but the realization of our relationship with God.
While on this subject, may I be allowed to make a general observation on the liturgical question. Our way of celebrating the liturgy is very often too rationalistic. The liturgy becomes teaching, whose criteria is: making ourselves understood -- often the consequence of this is making the mystery a banality, the prevalence of our words, the repetition of phrases that might seem more accessible and more pleasant for the people.
But this is not only a theological error but also a psychological and pastoral one. The wave of esoterism, the spreading of Asian techniques of relaxation and self-emptying demonstrate that something is lacking in our liturgies. It is in our world of today that we are in need of silence, of the super-individual mystery, of beauty.
The liturgy is not an invention of the celebrating priest or of a group of specialists; the liturgy (the "rite") came about via an organic process throughout the centuries, it bears with it the fruit of the experience of faith of all the generations.
Even if the participants do not perhaps understand each single word, they perceive the profound meaning, the presence of the mystery, which transcends all words. The celebrant is not the center of liturgical action; the celebrant is not in front of the people in his own name -- he does not speak by himself or for himself, but "in persona Christi." The personal abilities of the celebrant do not count, only his faith counts, by which Christ becomes transparent. "He must increase, but I must decrease" (John 3:30).
3. Jesus Christ
With this reflection, the theme of God has already expanded and been achieved in the theme of Jesus Christ: Only in Christ and through Christ does the theme God become truly concrete: Christ is Emmanuel, the God-with-us -- the concretization of the "I am," the response to Deism.
Today, the temptation is great to diminish Jesus Christ, the Son of God, into a merely historical Jesus, into a pure man. One does not necessarily deny the divinity of Jesus, but by using certain methods one distills from the Bible a Jesus to our size, a Jesus possible and comprehensible within the parameters of our historiography.
But this "historical Jesus" is an artifact, the image of his authors rather than the image of the living God (see 2 Corinthians 4:4ff; Colossians 1:15). The Christ of faith is not a myth; the so-called historical Jesus is a mythological figure, self-invented by various interpreters. The 200 years of history of the "historical Jesus" faithfully reflect the history of philosophies and ideologies of this period.
Within the limits of this conference, I cannot go into the contents of the proclamation of the Savior. I would only like to briefly mention two important aspects.
The first one is the Sequela of Christ -- Christ offers himself as the path of my life. Sequela of Christ does not mean: imitating the man Jesus. This type of attempt would necessarily fail -- it would be an anachronism. The Sequela of Christ has a much higher goal: to be assimilated into Christ, that is to attain union with God. Such a word might sound strange to the ears of modern man. But, in truth, we all thirst for the infinite: for an infinite freedom, for happiness without limits.
The entire history of revolutions during the last two centuries can only be explained this way. Drugs can only be explained this way. Man is not satisfied with solutions beneath the level of divinization. But all the roads offered by the "serpent" (Genesis 3:5), that is to say, by mundane knowledge, fail. The only path is communion with Christ, achieved in sacramental life. The Sequela of Christ is not a question of morality, but a "mysteric" theme -- an ensemble of divine action and our response.
Thus, in the theme on the sequela we find the presence of the other center of Christology, which I wished to mention: the Paschal Mystery -- the cross and the Resurrection. In the reconstruction of the "historical Jesus," usually the theme of the cross is without meaning. In a bourgeois interpretation it becomes an incident per se evitable, without theological value; in a revolutionary interpretation it becomes the heroic death of a rebel.
The truth is quite different. The cross belongs to the divine mystery -- it is the expression of his love to the end (John 13:1). The Sequela of Christ is participation in the cross, uniting oneself to his love, to the transformation of our life, which becomes the birth of the new man, created according to God (see Ephesians 4:24). Whoever omits the cross, omits the essence of Christianity (see 1 Corinthians 2:2).
4. Eternal life
A last central element of every true evangelization is eternal life. Today we must proclaim our faith with new vigor in daily life. Here, I would only like to mention one aspect of the preaching Jesus, which is often omitted today: The proclamation of the Kingdom of God is the proclamation of the God present, the God that knows us, listen to us; the God that enters into history to do justice. Therefore, this preaching is also the proclamation of justice, the proclamation of our responsibility.
Man cannot do or avoid doing what he wants to. He will be judged. He must account for things. This certitude is of value both for the powerful as well as the simple ones. Where this is honored, the limitations of every power in this world are traced. God renders justice, and only he may ultimately do this.
We will be able to do this better the more we are able to live under the eyes of God and to communicate the truth of justice to the world. Thus the article of faith in justice, its force in the formation of consciences, is a central theme of the Gospel and is truly good news. It is for all those suffering the injustices of the world and who are looking for justice.
This is also how we can understand the connection between the Kingdom of God and the "poor," the suffering and all those spoken about in the Beatitudes in the Speech on the Mountain. They are protected by the certainty of judgment, by the certitude, that there is a justice.
This is the true content of the article on justice, about God as judge: Justice exists. The injustices of the world are not the final word of history. Justice exists. Only whoever does not want there to be justice can oppose this truth.
If we seriously consider the judgment and the seriousness of the responsibility for us that emerges from this, we will be able to understand full well the other aspect of this proclamation, that is redemption, the fact that Jesus, in the cross, takes on our sins; God himself, in the passion of the Son, becomes the advocate for us sinners, and thus making penance possible, the hope for the repentant sinner, hope expressed in a marvelous way by the words of St. John: Before God, we will reassure our heart, whatever he reproves us for.
"For God is greater than our hearts, and he knows everything" (1 John 3:19ff). God´s goodness is infinite, but we should not diminish this to goodness to mawkish affectation without truth. Only by believing in the just judgment of God, only by hungering and thirsting for justice (see Matthew 5:6) will we open up our hearts, our life to divine mercy.
This can be seen: It isn´t true that faith in eternal life makes earthly life insignificant. To the contrary: only if the measure of our life is eternity, then also this life of ours on earth is great and its value immense. God is not the competitor in our life, but the guarantor of our greatness.
This way we return to the starting point: God.
If we take the Christian message into well-thought-out consideration, we are not speaking about a whole lot of things. In reality, the Christian message is very simple: We speak about God and man, and this way we say everything.
To evangelize means: to show this path -- to teach the art of living. At the beginning of his public life Jesus says: I have come to evangelize the poor (Luke 4:18); this means: I have the response to your fundamental question; I will show you the path of life, the path toward happiness -- rather: I am that path.
[The topic of Happiness and Joy Means "Hope"]
The deepest poverty is the inability of joy, the tediousness of a life considered absurd and contradictory. This poverty is widespread today, in very different forms in the materially rich as well as the poor countries. The inability of joy presupposes and produces the inability to love, produces jealousy, avarice -- all defects that devastate the life of individuals and of the world.
This is why we are in need of a new evangelization -- if the art of living remains an unknown, nothing else works. But this art is not the object of a science -- this art can only be communicated by [one] who has life -- he who is the Gospel personified.
I. Structure and method in new evangelization
1. The structure
Before speaking about the fundamental contents of new evangelization, I would like to say a few words about its structure and on the correct method.
The Church always evangelizes and has never interrupted the path of evangelization. She celebrates the eucharistic mystery every day, administers the sacraments, proclaims the word of life -- the Word of God, and commits herself to the causes of justice and charity. And this evangelization bears fruit: It gives light and joy, it gives the path of life to many people; many others live, often unknowingly, of the light and the warmth that radiate from this permanent evangelization.
However, we can see a progressive process of de-Christianization and a loss of the essential human values, which is worrisome. A large part of today´s humanity does not find the Gospel in the permanent evangelization of the Church: That is to say, the convincing response to the question: How to live?
This is why we are searching for, along with permanent and uninterrupted and never to be interrupted evangelization, a new evangelization, capable of being heard by that world that does not find access to "classic" evangelization. Everyone needs the Gospel; the Gospel is destined to all and not only to a specific circle and this is why we are obliged to look for new ways of bringing the Gospel to all.
Yet another temptation lies hidden beneath this -- the temptation of impatience, the temptation of immediately finding the great success, in finding large numbers. But this is not God´s way. For the Kingdom of God as well as for evangelization, the instrument and vehicle of the Kingdom of God, the parable of the grain of mustard seed is always valid (see Mark 4:31-32).
The Kingdom of God always starts anew under this sign. New evangelization cannot mean: immediately attracting the large masses that have distanced themselves from the Church by using new and more refined methods. No -- this is not what new evangelization promises.
New evangelization means: never being satisfied with the fact that from the grain of mustard seed, the great tree of the Universal Church grew; never thinking that the fact that different birds may find place among its branches can suffice -- rather, it means to dare, once again and with the humility of the small grain, to leave up to God the when and how it will grow (Mark 4:26-29).
Large things always begin from the small seed, and the mass movements are always ephemeral. In his vision of the evolutionary process, Teilhard de Chardin mentions the "white of the origins" (le blanc des origines): The beginning of a new species is invisible and cannot be found by scientific research. The sources are hidden -- they are too small. In other words: The large realities begin in humility.
Let us put to one side whether Teilhard is right in his evolutionary theories; the law on invisible origins does say a truth -- a truth present in the very actions of God in history: "The Lord did not set his affection on you and choose you because you were more numerous than other peoples, for you were the fewest of all peoples. But it was because the Lord loved you." God says [this] to the People of Israel in the Old Testament and thus expresses the fundamental paradox of the history of salvation: certainly, God does not count in large numbers; exterior power is not the sign of his presence.
Most of Jesus´ parables indicate this structure of divine intervention and thus answer the disciples´ worries, who were expecting other kinds of success and signs from the Messiah -- successes of the kind offered by Satan to the Lord: All these -- the kingdoms of the world -- I will give to you ... (Matthew 4:9).
Of course, at the end of his life Paul believed that he had proclaimed the Gospel to the very ends of the earth, but the Christians were small communities dispersed throughout the world, insignificant according to the secular criteria. In reality, they were the leaven that penetrates the meal from within and they carried within themselves the future of the world (see Matthew 13:33).
An old proverb says: "Success is not one of the names of God." New evangelization must surrender to the mystery of the grain of mustard seed and not be so pretentious as to believe to immediately produce a large tree. We either live too much in the security of the already existing large tree or in the impatience of having a greater, more vital tree -- instead we must accept the mystery that the Church is at the same time a large tree and a very small grain. In the history of salvation it is always Good Friday and Easter Sunday at the same time ....
2. The method
The correct method derives from this structure of new evangelization. Of course we must use the modern methods of making ourselves be heard in a reasonable way -- or better yet: of making the voice of the Lord accessible and comprehensible. ... We are not looking for listening for ourselves -- we do not want to increase the power and the spreading of our institutions, but we wish to serve for the good of the people and humanity giving room to he who is Life.
This expropriation of one´s person, offering it to Christ for the salvation of men, is the fundamental condition of the true commitment for the Gospel. "I have come in my Father´s name, and you do not receive me; if another comes in his own name, him you will receive," says the Lord (John 5:43). The mark of the Antichrist is the fact that he speaks in his own name.
The sign of the Son is his communion with the Father. The Son introduces us into the Trinitarian communion, into the circle of eternal love, whose persons are "pure relations," the pure act of giving oneself and of welcome. The Trinitarian plan -- visible in the Son, who does not speak in his name -- shows the form of life of the true evangelizer -- rather, evangelizing is not merely a way of speaking, but a form of living: living in the listening and giving voice to the Father. "He will not speak on his own authority, but whatever he hears he will speak," says the Lord about the Holy Spirit (John 16:13).
This Christological and pneumatological form of evangelization is also, at the same time, an ecclesiological form: The Lord and the Spirit build the Church, communicate through the Church. The proclamation of Christ, the proclamation of the Kingdom of God presupposes listening to his voice in the voice of the Church. "Not speak on his own authority" means: to speak in the mission of the Church ....
Many practical consequences come from this law of expropriation. All reasonable and morally acceptable methods should be studied -- to use these possibilities of communication is a duty. But words and the whole art of communication cannot reach the human person to such depths as the Gospel must reach.
A few years ago, I was reading the biography of a very good priest of our century, Don Didimo, the parish priest of Bassano del Grappa. In his notes, golden words can be found, the fruit of a life of prayer and of meditation. About us, Don Didimo says, for example: "Jesus preached by day, by night he prayed."
With these few words, he wished to say: Jesus had to acquire the disciples from God. The same is always true. We ourselves cannot gather men. We must acquire them by God for God. All methods are empty without the foundation of prayer. The word of the announcement must always be drenched in an intense life of prayer.
We must add another step. Jesus preached by day, by night he prayed -- this is not all. His entire life was -- as demonstrated in a beautiful way by the Gospel according to St. Luke -- a path toward the cross, ascension toward Jerusalem. Jesus did not redeem the world with beautiful words but with his suffering and his death. His Passion is the inexhaustible source of life for the world; the Passion gives power to his words.
The Lord himself -- extending and amplifying the parable of the grain of mustard seed -- formulated this law of fruitfulness in the word of the grain of seed that dies, fallen to earth (John 12:24). This law too is valid until the end of the world and is -- along with the mystery of the grain of seed -- fundamental for new evangelization. All of history demonstrates this.
It is very easy to demonstrate this in the history of Christianity. Here, I would like to recall only the beginning of evangelization in the life of St. Paul. The success of his mission was not the fruit of great rhetorical art or pastoral prudence; the fruitfulness was tied to the suffering, to the communion in the passion with Christ (see 1 Corinthians 2:1-5; ... 2 Corinthians 11:30; Galatians 4:12-14).
"But none will be given it except the sign of the prophet Jonah," said the Lord. The sign of Jonah is the crucified Christ -- they are the witnesses that complete "what is lacking in Christ´s afflictions" (Colossians 1:24). Throughout all the periods of history, the words of Tertullian have always been verified: The blood of martyrs is a seed.
St. Augustine says the same thing in a much more beautiful way, interpreting John 21, where the prophesy of Peter´s martyrdom and the mandate to tend, that is to say, the institution of his primacy, are intimately connected.
St. Augustine comments [on] the text John 21:16 in the following way: "Tend my sheep," this means suffer for my sheep.... A mother cannot give life to a child without suffering. Each birth requires suffering, is suffering, and becoming a Christian is a birth. Let us say this once again in the words of the Lord: The Kingdom of heaven has suffered violence (Matthew 11:12; Luke 16:16), but the violence of God is suffering, it is the cross. We cannot give life to others without giving up our own lives.
The process of expropriation indicated above is the concrete form (expressed in many different ways) of giving one´s life. And let us think about the words of the Savior: "Whoever loses his life for my sake and the Gospel´s will save it" (Mark 8:35).
II. The contents essential for new evangelization [to achieve joy]
1. Conversion [to self-gift]
As for the contents of new evangelization, first of all we must keep in mind the inseparability of the Old and the New Testaments. The fundamental content of the Old Testament is summarized in the message by John the Baptist: metanoeìte -- Convert! There is no access to Jesus without the Baptist; there is no possibility of reaching Jesus without answering the call of the precursor, rather: Jesus took up the message of John in the synthesis of his own preaching: metanoeìte kaì pisteúete èn tù eùaggelíu (Mark 1:15).
The Greek word for converting means: to rethink -- to question one´s own and common way of living; to allow God to enter into the criteria of one´s life; to not merely judge according to the current opinions. Thereby, to convert means: not to live as all the others live, not do what all do, not feel justified in dubious, ambiguous, evil actions just because others do the same; begin to see one´s life through the eyes of God; thereby looking for the good, even if uncomfortable; not aiming at the judgment of the majority, of men, but on the justice of God -- in other words: to look for a new style of life, a new life.
All of this does not imply moralism; reducing Christianity to morality loses sight of the essence of Christ´s message: the gift of a new friendship, the gift of communion with Jesus and thereby with God. Whoever converts to Christ does not mean to create his own moral autarchy for himself, does not intend to build his own goodness through his own strengths.
"Conversion" (metanoia) means exactly the opposite: to come out of self-sufficiency to discover and accept our indigence -- the indigence of others and of the Other, his forgiveness, his friendship. Unconverted life is self-justification (I am not worse than the others); conversion is humility in entrusting oneself to the love of the Other, a love that becomes the measure and the criteria of my own life.
Here we must also bear in mind the social aspect of conversion. Certainly, conversion is above all a very personal act, it is personalization. I separate myself from the formula "to live as all others" (I do not feel justified anymore by the fact that everyone does what I do) and I find my own person in front of God, my own personal responsibility.
But true personalization is always also a new and more profound socialization. The "I" opens itself once again to the "you," in all its depths, and thus a new "We" is born. If the lifestyle spread throughout the world implies the danger of de-personalization, of not living one´s own life but the life of all the others, in conversion a new "We," of the common path of God, must be achieved.
In proclaiming conversion we must also offer a community of life, a common space for the new style of life. We cannot evangelize with words alone; the Gospel creates life, creates communities of progress; a merely individual conversion has no consistency....
2. The Kingdom of God [is the Person of Jesus of Nazareth: R Mi #18]
In the appeal to conversion the proclamation of the Living God is implicit -- as its fundamental condition. Theocentrism is fundamental in the message of Jesus and must also be at the heart of new evangelization.
The keyword of the proclamation of Jesus is: the Kingdom of God. But the Kingdom of God is not a thing, a social or political structure, a utopia. The Kingdom of God is God. Kingdom of God means: God exists. God is alive. God is present and acts in the world, in our -- in my life.
God is not a faraway "ultimate cause," God is not the "great architect" of deism, who created the machine of the world and is no longer part of it -- on the contrary: God is the most present and decisive reality in each and every act of my life, in each and every moment of history.
In his conference when leaving the University of Münster, the theologian J.B. Metz said some unexpected things for him. In the past, Metz taught us anthropocentrism -- the true occurrence of Christianity was the anthropological turning point, the secularization, the discovery of the secularity of the world. Then he taught us political theology -- the political characteristic of faith; then the "dangerous memory"; and finally narrative theology.
After this long and difficult path, today he tells us: The true problem of our times is the "Crisis of God," the absence of God, disguised by an empty religiosity. Theology must go back to being truly theo-logy, speaking about and with God.
Metz is right: the "unum necessarium" to man is God. Everything changes, whether God exists or not. Unfortunately -- we Christians also often live as if God did not exist ("si Deus non daretur"). We live according to the slogan: God does not exist, and if he exists, he does not belong.
Therefore, evangelization must, first of all, speak about God, proclaim the only true God: the Creator -- the Sanctifier -- the Judge (see Catechism of the Catholic Church).
Here too we must keep the practical aspect in mind. God cannot be made known with words alone. One does not really know a person if one knows about this person secondhandedly. To proclaim God is to introduce to the relation with God: to teach how to pray. Prayer is faith in action. And only by experiencing life with God does the evidence of his existence appear.
This is why schools of prayer, communities of prayer, are so important. There is a complementarity between personal prayer ("in one´s room," alone in front of God´s eyes), "para-liturgical" prayer in common ("popular religiosity") and liturgical prayer.
Yes, the liturgy is, first of all, prayer; its specificity consists in the fact that its primary project is not ourselves (as in private prayer and in popular religiosity), but God himself -- the liturgy is actio divina, God acts and we respond to this divine action.
Speaking about God and speaking with God must always go together. The proclamation of God is the guide to communion with God in fraternal communion, founded and vivified by Christ. This is why the liturgy (the sacraments) are not a secondary theme next to the preaching of the living God, but the realization of our relationship with God.
While on this subject, may I be allowed to make a general observation on the liturgical question. Our way of celebrating the liturgy is very often too rationalistic. The liturgy becomes teaching, whose criteria is: making ourselves understood -- often the consequence of this is making the mystery a banality, the prevalence of our words, the repetition of phrases that might seem more accessible and more pleasant for the people.
But this is not only a theological error but also a psychological and pastoral one. The wave of esoterism, the spreading of Asian techniques of relaxation and self-emptying demonstrate that something is lacking in our liturgies. It is in our world of today that we are in need of silence, of the super-individual mystery, of beauty.
The liturgy is not an invention of the celebrating priest or of a group of specialists; the liturgy (the "rite") came about via an organic process throughout the centuries, it bears with it the fruit of the experience of faith of all the generations.
Even if the participants do not perhaps understand each single word, they perceive the profound meaning, the presence of the mystery, which transcends all words. The celebrant is not the center of liturgical action; the celebrant is not in front of the people in his own name -- he does not speak by himself or for himself, but "in persona Christi." The personal abilities of the celebrant do not count, only his faith counts, by which Christ becomes transparent. "He must increase, but I must decrease" (John 3:30).
3. Jesus Christ
With this reflection, the theme of God has already expanded and been achieved in the theme of Jesus Christ: Only in Christ and through Christ does the theme God become truly concrete: Christ is Emmanuel, the God-with-us -- the concretization of the "I am," the response to Deism.
Today, the temptation is great to diminish Jesus Christ, the Son of God, into a merely historical Jesus, into a pure man. One does not necessarily deny the divinity of Jesus, but by using certain methods one distills from the Bible a Jesus to our size, a Jesus possible and comprehensible within the parameters of our historiography.
But this "historical Jesus" is an artifact, the image of his authors rather than the image of the living God (see 2 Corinthians 4:4ff; Colossians 1:15). The Christ of faith is not a myth; the so-called historical Jesus is a mythological figure, self-invented by various interpreters. The 200 years of history of the "historical Jesus" faithfully reflect the history of philosophies and ideologies of this period.
Within the limits of this conference, I cannot go into the contents of the proclamation of the Savior. I would only like to briefly mention two important aspects.
The first one is the Sequela of Christ -- Christ offers himself as the path of my life. Sequela of Christ does not mean: imitating the man Jesus. This type of attempt would necessarily fail -- it would be an anachronism. The Sequela of Christ has a much higher goal: to be assimilated into Christ, that is to attain union with God. Such a word might sound strange to the ears of modern man. But, in truth, we all thirst for the infinite: for an infinite freedom, for happiness without limits.
The entire history of revolutions during the last two centuries can only be explained this way. Drugs can only be explained this way. Man is not satisfied with solutions beneath the level of divinization. But all the roads offered by the "serpent" (Genesis 3:5), that is to say, by mundane knowledge, fail. The only path is communion with Christ, achieved in sacramental life. The Sequela of Christ is not a question of morality, but a "mysteric" theme -- an ensemble of divine action and our response.
Thus, in the theme on the sequela we find the presence of the other center of Christology, which I wished to mention: the Paschal Mystery -- the cross and the Resurrection. In the reconstruction of the "historical Jesus," usually the theme of the cross is without meaning. In a bourgeois interpretation it becomes an incident per se evitable, without theological value; in a revolutionary interpretation it becomes the heroic death of a rebel.
The truth is quite different. The cross belongs to the divine mystery -- it is the expression of his love to the end (John 13:1). The Sequela of Christ is participation in the cross, uniting oneself to his love, to the transformation of our life, which becomes the birth of the new man, created according to God (see Ephesians 4:24). Whoever omits the cross, omits the essence of Christianity (see 1 Corinthians 2:2).
4. Eternal life
A last central element of every true evangelization is eternal life. Today we must proclaim our faith with new vigor in daily life. Here, I would only like to mention one aspect of the preaching Jesus, which is often omitted today: The proclamation of the Kingdom of God is the proclamation of the God present, the God that knows us, listen to us; the God that enters into history to do justice. Therefore, this preaching is also the proclamation of justice, the proclamation of our responsibility.
Man cannot do or avoid doing what he wants to. He will be judged. He must account for things. This certitude is of value both for the powerful as well as the simple ones. Where this is honored, the limitations of every power in this world are traced. God renders justice, and only he may ultimately do this.
We will be able to do this better the more we are able to live under the eyes of God and to communicate the truth of justice to the world. Thus the article of faith in justice, its force in the formation of consciences, is a central theme of the Gospel and is truly good news. It is for all those suffering the injustices of the world and who are looking for justice.
This is also how we can understand the connection between the Kingdom of God and the "poor," the suffering and all those spoken about in the Beatitudes in the Speech on the Mountain. They are protected by the certainty of judgment, by the certitude, that there is a justice.
This is the true content of the article on justice, about God as judge: Justice exists. The injustices of the world are not the final word of history. Justice exists. Only whoever does not want there to be justice can oppose this truth.
If we seriously consider the judgment and the seriousness of the responsibility for us that emerges from this, we will be able to understand full well the other aspect of this proclamation, that is redemption, the fact that Jesus, in the cross, takes on our sins; God himself, in the passion of the Son, becomes the advocate for us sinners, and thus making penance possible, the hope for the repentant sinner, hope expressed in a marvelous way by the words of St. John: Before God, we will reassure our heart, whatever he reproves us for.
"For God is greater than our hearts, and he knows everything" (1 John 3:19ff). God´s goodness is infinite, but we should not diminish this to goodness to mawkish affectation without truth. Only by believing in the just judgment of God, only by hungering and thirsting for justice (see Matthew 5:6) will we open up our hearts, our life to divine mercy.
This can be seen: It isn´t true that faith in eternal life makes earthly life insignificant. To the contrary: only if the measure of our life is eternity, then also this life of ours on earth is great and its value immense. God is not the competitor in our life, but the guarantor of our greatness.
This way we return to the starting point: God.
If we take the Christian message into well-thought-out consideration, we are not speaking about a whole lot of things. In reality, the Christian message is very simple: We speak about God and man, and this way we say everything.
Saturday, December 22, 2007
A Clue to "Spe Salvi"
I offer this as a teaser toward a clue to interpreting “Spe Salvi.” When Benedict talks about “hope,” he is not talking about a virtue as an accident of a substance. He is talking about the being of the person. And since the person is relational, he is talking about the being of the person as going out of self toward the Other, i.e. God, and others. I submit that this is what he is always talking about, including the first encyclical “Deus Charitas Est.” He is always talking about God. He talks about man in so far as he images God. Since God is three Persons who are One (Communio) because they are intrinsically and constitutively in relation to each other, each Person can only be relation: the Father is the act of engendering Son; the Son is act of obeying and glorifying the Father; the Spirit is the Personification of these two opposing relations.
God is “joyful” in the fullness of each Person as pure relation or relativity (in our abstract way of thinking). God is a triple joy. The imaging of that joy is “hope.” One is hopeful in that one is tending toward a fuller joy than that which is partially possessed at the moment. The secret that lies hidden in the bowels of our very God-like being is that hope is present and increases the more we act-imaging the obedience and glory-giving of the Son to the Father.
Notice that Benedict immediately identifies “faith” and “hope.” As virtues they are not the same. But as the being of the human person they are. Faith and hope and Love (Agape) are distinct angles of perceiving the same reality of the Person as Self-transcending.
Benedict’s thesis in 1954 starts this whole train of thinking off. What is probably the deepest ground of his thinking is the clarification from Bonaventure (and therefore from the Fathers of the Church, especially Gregory of Nyssa (c. 350) that Revelation is not a series of concepts of propositional thinking (like dogmas) but a Person. The Person of Jesus Christ.
Concomitantly, faith is not an acceptance of concepts, but the ontological act of the whole person who proportions himself to be self-gift to the revealing Christ ("Milestones," Ignatius [1997] 108-109) Benedict early on says: “Christianity was not only ‘good news’ – the communication of a hitherto known content. In our language we would say: the Christian message was not only ‘informative’ but ‘performative.’" That means: “the Gospel is not merely a communication of things that can be known – it is one that makes things happen and is life changing. The dark door of time, of the future, has been thrown open. The one who has hope lives differently; the one who hopes has been granted the gift of a new life” (3). Notice, again, that “the one who hopes lives differently” and experiences “a new life.” The living differently is the giving of the self. And the “new life” is “to be” outside of oneself. This is Trinitarian life lived in the flesh.
Knowing, then, is not an “informative” act but “performative.” If, as it turns out, that the relational Person of the Son becomes flesh, then what we observe Him to be in our world is prayer. Jesus Christ reveals His most intimate being as the performative action of prayer. And since knowledge is a becoming of the subject known – like is known by like - , in order to know the Person of the Son, one must become the Son by becoming the action that constitutes His most inmost Being: prayer (such as “Abba”).
Again, right after the above, in #3 of the “Spe Salvi,” Benedict relaties that the Ephesians did not have hope because they did not have “God in the world.” Keep in mind, “to have God in the world” is to incarnate that giftedness of self in daily, humdrum activity. “To have God in the world” is to turn every activity into service and to think about others and forget about self. The conceptual “knowledge” of a pagan god is not to make the act of faith which is to transcend the self as gift to the revealing God. Hence, the pagan cannot have hope because he cannot experience – mysteriously – the joy of going out of himself and living for others. Only the one who does this is joyful, and begins to experience hope for definitive joy.
God is “joyful” in the fullness of each Person as pure relation or relativity (in our abstract way of thinking). God is a triple joy. The imaging of that joy is “hope.” One is hopeful in that one is tending toward a fuller joy than that which is partially possessed at the moment. The secret that lies hidden in the bowels of our very God-like being is that hope is present and increases the more we act-imaging the obedience and glory-giving of the Son to the Father.
Notice that Benedict immediately identifies “faith” and “hope.” As virtues they are not the same. But as the being of the human person they are. Faith and hope and Love (Agape) are distinct angles of perceiving the same reality of the Person as Self-transcending.
Benedict’s thesis in 1954 starts this whole train of thinking off. What is probably the deepest ground of his thinking is the clarification from Bonaventure (and therefore from the Fathers of the Church, especially Gregory of Nyssa (c. 350) that Revelation is not a series of concepts of propositional thinking (like dogmas) but a Person. The Person of Jesus Christ.
Concomitantly, faith is not an acceptance of concepts, but the ontological act of the whole person who proportions himself to be self-gift to the revealing Christ ("Milestones," Ignatius [1997] 108-109) Benedict early on says: “Christianity was not only ‘good news’ – the communication of a hitherto known content. In our language we would say: the Christian message was not only ‘informative’ but ‘performative.’" That means: “the Gospel is not merely a communication of things that can be known – it is one that makes things happen and is life changing. The dark door of time, of the future, has been thrown open. The one who has hope lives differently; the one who hopes has been granted the gift of a new life” (3). Notice, again, that “the one who hopes lives differently” and experiences “a new life.” The living differently is the giving of the self. And the “new life” is “to be” outside of oneself. This is Trinitarian life lived in the flesh.
Knowing, then, is not an “informative” act but “performative.” If, as it turns out, that the relational Person of the Son becomes flesh, then what we observe Him to be in our world is prayer. Jesus Christ reveals His most intimate being as the performative action of prayer. And since knowledge is a becoming of the subject known – like is known by like - , in order to know the Person of the Son, one must become the Son by becoming the action that constitutes His most inmost Being: prayer (such as “Abba”).
Again, right after the above, in #3 of the “Spe Salvi,” Benedict relaties that the Ephesians did not have hope because they did not have “God in the world.” Keep in mind, “to have God in the world” is to incarnate that giftedness of self in daily, humdrum activity. “To have God in the world” is to turn every activity into service and to think about others and forget about self. The conceptual “knowledge” of a pagan god is not to make the act of faith which is to transcend the self as gift to the revealing God. Hence, the pagan cannot have hope because he cannot experience – mysteriously – the joy of going out of himself and living for others. Only the one who does this is joyful, and begins to experience hope for definitive joy.
Thursday, December 20, 2007
Address of John Paul II on Brain Death 2000
In the Address of John Paul II below, you will find the designation of brain death as the sign that is purported to give “moral certainty” that a person has, indeed, died. Death is understood in this papal address as “the total disintegration of that unitary and integrated whole that is the personal self.” Brain death as criterion “for ascertaining death used by medicine today should not be understood as the technical-scientific determination of the exact moment of a person’s death, but as a scientifically secure means of identifying the biological signs that a person has indeed died.”
The decisive center of the papal address is the supposition that the scientific community has ascertained that “the total disintegration of that unitary and integrated whole that is the personal self” takes place when there is “the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity.”
In a word, the irreversible cessation of all brain activity signifies that the body no longer has the ability to be an integrated organism. The previous posting of Dr. Alan Shewmon purports to clinically show the exact opposite. And since “the Church does not make technical decisions,” it is important for every informed mind to be open to the clinical facts concerning the relation between complete and irreversible “brain death” and the somatic integration as organism. The latter is the undisputed “sign” of “that unitary and integrated whole that is the personal self.”
ADDRESS OF THE HOLY FATHER JOHN PAUL II TO THE 18th INTERNATIONAL CONGRESS OF THE TRANSPLANTATION SOCIETY
Tuesday 29 August 2000
Distinguished Ladies and Gentlemen,
1. I am happy to greet all of you at this International Congress, which has brought you together for a reflection on the complex and delicate theme of transplants. I thank Professor Raffaello Cortesini and Professor Oscar Salvatierra for their kind words, and I extend a special greeting to the Italian Authorities present.
To all of you I express my gratitude for your kind invitation to take part in this meeting and I very much appreciate the serious consideration you are giving to the moral teaching of the Church. With respect for science and being attentive above all to the law of God, the Church has no other aim but the integral good of the human person.
Transplants are a great step forward in science's service of man, and not a few people today owe their lives to an organ transplant. Increasingly, the technique of transplants has proven to be a valid means of attaining the primary goal of all medicine - the service of human life. That is why in the Encyclical Letter Evangelium Vitae I suggested that one way of nurturing a genuine culture of life "is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope" (No. 86).
2.As with all human advancement, this particular field of medical science, for all the hope of health and life it offers to many, also presents certain critical issues that need to be examined in the light of a discerning anthropological and ethical reflection.
In this area of medical science too the fundamental criterion must be the defence and promotion of the integral good of the human person, in keeping with that unique dignity which is ours by virtue of our humanity. Consequently, it is evident that every medical procedure performed on the human person is subject to limits: not just the limits of what it is technically possible, but also limits determined by respect for human nature itself, understood in its fullness: "what is technically possible is not for that reason alone morally admissible" (Congregation for the Doctrine of the Faith, Donum Vitae, 4).
3. It must first be emphasized, as I observed on another occasion, that every organ transplant has its source in a decision of great ethical value: "the decision to offer without reward a part of one's own body for the health and well-being of another person" (Address to the Participants in a Congress on Organ Transplants, 20 June 1991, No. 3). Here precisely lies the nobility of the gesture, a gesture which is a genuine act of love. It is not just a matter of giving away something that belongs to us but of giving something of ourselves, for "by virtue of its substantial union with a spiritual soul, the human body cannot be considered as a mere complex of tissues, organs and functions . . . rather it is a constitutive part of the person who manifests and expresses himself through it" (Congregation for the Doctrine of the Faith, Donum Vitae, 3).
Accordingly, any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an "object" is to violate the dignity of the human person.
This first point has an immediate consequence of great ethical import: the need for informed consent. The human "authenticity" of such a decisive gesture requires that individuals be properly informed about the processes involved, in order to be in a position to consent or decline in a free and conscientious manner. The consent of relatives has its own ethical validity in the absence of a decision on the part of the donor. Naturally, an analogous consent should be given by the recipients of donated organs.
4. Acknowledgement of the unique dignity of the human person has a further underlying consequence: vital organs which occur singly in the body can be removed only after death, that is from the body of someone who is certainly dead. This requirement is self-evident, since to act otherwise would mean intentionally to cause the death of the donor in disposing of his organs. This gives rise to one of the most debated issues in contemporary bioethics, as well as to serious concerns in the minds of ordinary people. I refer to the problem of ascertaining the fact of death. When can a person be considered dead with complete certainty?
In this regard, it is helpful to recall that the death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self. It results from the separation of the life-principle (or soul) from the corporal reality of the person. The death of the person, understood in this primary sense, is an event which no scientific technique or empirical method can identify directly.
Yet human experience shows that once death occurs certain biological signs inevitably follow, which medicine has learnt to recognize with increasing precision. In this sense, the "criteria" for ascertaining death used by medicine today should not be understood as the technical-scientific determination of the exact moment of a person's death, but as a scientifically secure means of identifying the biological signs that a person has indeed died.
5. It is a well-known fact that for some time certain scientific approaches to ascertaining death have shifted the emphasis from the traditional cardio-respiratory signs to the so-called "neurological" criterion. Specifically, this consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity. [This is the point of contention with regard to the findings of Dr. Shewmon]
With regard to the parameters used today for ascertaining death - whether the "encephalic" signs or the more traditional cardio-respiratory signs - the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity.
Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology. Therefore a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgement which moral teaching describes as "moral certainty". This moral certainty is considered the necessary and sufficient basis for an ethically correct course of action. Only where such certainty exists, and where informed consent has already been given by the donor or the donor's legitimate representatives, is it morally right to initiate the technical procedures required for the removal of organs for transplant.
6. Another question of great ethical significance is that of the allocation of donated organs through waiting-lists and the assignment of priorities. Despite efforts to promote the practice of organ-donation, the resources available in many countries are currently insufficient to meet medical needs. Hence there is a need to compile waiting-lists for transplants on the basis of clear and properly reasoned criteria.
From the moral standpoint, an obvious principle of justice requires that the criteria for assigning donated organs should in no way be "discriminatory" (i.e. based on age, sex, race, religion, social standing, etc.) or "utilitarian" (i.e. based on work capacity, social usefulness, etc.). Instead, in determining who should have precedence in receiving an organ, judgements should be made on the basis of immunological and clinical factors.Any other criterion would prove wholly arbitrary and subjective, and would fail to recognize the intrinsic value of each human person as such, a value that is independent of any external circumstances.
7. A final issue concerns a possible alternative solution to the problem of finding human organs for transplantion, something still very much in the experimental stage, namely xenotransplants, that is, organ transplants from other animal species.
It is not my intention to explore in detail the problems connected with this form of intervention. I would merely recall that already in 1956 Pope Pius XII raised the question of their legitimacy. He did so when commenting on the scientific possibility, then being presaged, of transplanting animal corneas to humans. His response is still enlightening for us today: in principle, he stated, for a xenotransplant to be licit, the transplanted organ must not impair the integrity of the psychological or genetic identity of the person receiving it; and there must also be a proven biological possibility that the transplant will be successful and will not expose the recipient to inordinate risk (cf. Address to the Italian Association of Cornea Donors and to Clinical Oculists and Legal Medical Practitioners, 14 May 1956).
8. In concluding, I express the hope that, thanks to the work of so many generous and highly-trained people, scientific and technological research in the field of transplants will continue to progress, and extend to experimentation with new therapies which can replace organ transplants, as some recent developments in prosthetics seem to promise. In any event, methods that fail to respect the dignity and value of the person must always be avoided. I am thinking in particular of attempts at human cloning with a view to obtaining organs for transplants: these techniques, insofar as they involve the manipulation and destruction of human embryos, are not morally acceptable, even when their proposed goal is good in itself. Science itself points to other forms of therapeutic intervention which would not involve cloning or the use of embryonic cells, but rather would make use of stem cells taken from adults. This is the direction that research must follow if it wishes to respect the dignity of each and every human being, even at the embryonic stage.
In addressing these varied issues, the contribution of philosophers and theologians is important. Their careful and competent reflection on the ethical problems associated with transplant therapy can help to clarify the criteria for assessing what kinds of transplants are morally acceptable and under what conditions, especially with regard to the protection of each individual's personal identity.
I am confident that social, political and educational leaders will renew their commitment to fostering a genuine culture of generosity and solidarity. There is a need to instil in people's hearts, especially in the hearts of the young, a genuine and deep appreciation of the need for brotherly love, a love that can find expression in the decision to become an organ donor.
May the Lord sustain each one of you in your work, and guide you in the service of authentic human progress. I accompany this wish with my Blessing.
The decisive center of the papal address is the supposition that the scientific community has ascertained that “the total disintegration of that unitary and integrated whole that is the personal self” takes place when there is “the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity.”
In a word, the irreversible cessation of all brain activity signifies that the body no longer has the ability to be an integrated organism. The previous posting of Dr. Alan Shewmon purports to clinically show the exact opposite. And since “the Church does not make technical decisions,” it is important for every informed mind to be open to the clinical facts concerning the relation between complete and irreversible “brain death” and the somatic integration as organism. The latter is the undisputed “sign” of “that unitary and integrated whole that is the personal self.”
ADDRESS OF THE HOLY FATHER JOHN PAUL II TO THE 18th INTERNATIONAL CONGRESS OF THE TRANSPLANTATION SOCIETY
Tuesday 29 August 2000
Distinguished Ladies and Gentlemen,
1. I am happy to greet all of you at this International Congress, which has brought you together for a reflection on the complex and delicate theme of transplants. I thank Professor Raffaello Cortesini and Professor Oscar Salvatierra for their kind words, and I extend a special greeting to the Italian Authorities present.
To all of you I express my gratitude for your kind invitation to take part in this meeting and I very much appreciate the serious consideration you are giving to the moral teaching of the Church. With respect for science and being attentive above all to the law of God, the Church has no other aim but the integral good of the human person.
Transplants are a great step forward in science's service of man, and not a few people today owe their lives to an organ transplant. Increasingly, the technique of transplants has proven to be a valid means of attaining the primary goal of all medicine - the service of human life. That is why in the Encyclical Letter Evangelium Vitae I suggested that one way of nurturing a genuine culture of life "is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope" (No. 86).
2.As with all human advancement, this particular field of medical science, for all the hope of health and life it offers to many, also presents certain critical issues that need to be examined in the light of a discerning anthropological and ethical reflection.
In this area of medical science too the fundamental criterion must be the defence and promotion of the integral good of the human person, in keeping with that unique dignity which is ours by virtue of our humanity. Consequently, it is evident that every medical procedure performed on the human person is subject to limits: not just the limits of what it is technically possible, but also limits determined by respect for human nature itself, understood in its fullness: "what is technically possible is not for that reason alone morally admissible" (Congregation for the Doctrine of the Faith, Donum Vitae, 4).
3. It must first be emphasized, as I observed on another occasion, that every organ transplant has its source in a decision of great ethical value: "the decision to offer without reward a part of one's own body for the health and well-being of another person" (Address to the Participants in a Congress on Organ Transplants, 20 June 1991, No. 3). Here precisely lies the nobility of the gesture, a gesture which is a genuine act of love. It is not just a matter of giving away something that belongs to us but of giving something of ourselves, for "by virtue of its substantial union with a spiritual soul, the human body cannot be considered as a mere complex of tissues, organs and functions . . . rather it is a constitutive part of the person who manifests and expresses himself through it" (Congregation for the Doctrine of the Faith, Donum Vitae, 3).
Accordingly, any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an "object" is to violate the dignity of the human person.
This first point has an immediate consequence of great ethical import: the need for informed consent. The human "authenticity" of such a decisive gesture requires that individuals be properly informed about the processes involved, in order to be in a position to consent or decline in a free and conscientious manner. The consent of relatives has its own ethical validity in the absence of a decision on the part of the donor. Naturally, an analogous consent should be given by the recipients of donated organs.
4. Acknowledgement of the unique dignity of the human person has a further underlying consequence: vital organs which occur singly in the body can be removed only after death, that is from the body of someone who is certainly dead. This requirement is self-evident, since to act otherwise would mean intentionally to cause the death of the donor in disposing of his organs. This gives rise to one of the most debated issues in contemporary bioethics, as well as to serious concerns in the minds of ordinary people. I refer to the problem of ascertaining the fact of death. When can a person be considered dead with complete certainty?
In this regard, it is helpful to recall that the death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self. It results from the separation of the life-principle (or soul) from the corporal reality of the person. The death of the person, understood in this primary sense, is an event which no scientific technique or empirical method can identify directly.
Yet human experience shows that once death occurs certain biological signs inevitably follow, which medicine has learnt to recognize with increasing precision. In this sense, the "criteria" for ascertaining death used by medicine today should not be understood as the technical-scientific determination of the exact moment of a person's death, but as a scientifically secure means of identifying the biological signs that a person has indeed died.
5. It is a well-known fact that for some time certain scientific approaches to ascertaining death have shifted the emphasis from the traditional cardio-respiratory signs to the so-called "neurological" criterion. Specifically, this consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity. [This is the point of contention with regard to the findings of Dr. Shewmon]
With regard to the parameters used today for ascertaining death - whether the "encephalic" signs or the more traditional cardio-respiratory signs - the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity.
Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology. Therefore a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgement which moral teaching describes as "moral certainty". This moral certainty is considered the necessary and sufficient basis for an ethically correct course of action. Only where such certainty exists, and where informed consent has already been given by the donor or the donor's legitimate representatives, is it morally right to initiate the technical procedures required for the removal of organs for transplant.
6. Another question of great ethical significance is that of the allocation of donated organs through waiting-lists and the assignment of priorities. Despite efforts to promote the practice of organ-donation, the resources available in many countries are currently insufficient to meet medical needs. Hence there is a need to compile waiting-lists for transplants on the basis of clear and properly reasoned criteria.
From the moral standpoint, an obvious principle of justice requires that the criteria for assigning donated organs should in no way be "discriminatory" (i.e. based on age, sex, race, religion, social standing, etc.) or "utilitarian" (i.e. based on work capacity, social usefulness, etc.). Instead, in determining who should have precedence in receiving an organ, judgements should be made on the basis of immunological and clinical factors.Any other criterion would prove wholly arbitrary and subjective, and would fail to recognize the intrinsic value of each human person as such, a value that is independent of any external circumstances.
7. A final issue concerns a possible alternative solution to the problem of finding human organs for transplantion, something still very much in the experimental stage, namely xenotransplants, that is, organ transplants from other animal species.
It is not my intention to explore in detail the problems connected with this form of intervention. I would merely recall that already in 1956 Pope Pius XII raised the question of their legitimacy. He did so when commenting on the scientific possibility, then being presaged, of transplanting animal corneas to humans. His response is still enlightening for us today: in principle, he stated, for a xenotransplant to be licit, the transplanted organ must not impair the integrity of the psychological or genetic identity of the person receiving it; and there must also be a proven biological possibility that the transplant will be successful and will not expose the recipient to inordinate risk (cf. Address to the Italian Association of Cornea Donors and to Clinical Oculists and Legal Medical Practitioners, 14 May 1956).
8. In concluding, I express the hope that, thanks to the work of so many generous and highly-trained people, scientific and technological research in the field of transplants will continue to progress, and extend to experimentation with new therapies which can replace organ transplants, as some recent developments in prosthetics seem to promise. In any event, methods that fail to respect the dignity and value of the person must always be avoided. I am thinking in particular of attempts at human cloning with a view to obtaining organs for transplants: these techniques, insofar as they involve the manipulation and destruction of human embryos, are not morally acceptable, even when their proposed goal is good in itself. Science itself points to other forms of therapeutic intervention which would not involve cloning or the use of embryonic cells, but rather would make use of stem cells taken from adults. This is the direction that research must follow if it wishes to respect the dignity of each and every human being, even at the embryonic stage.
In addressing these varied issues, the contribution of philosophers and theologians is important. Their careful and competent reflection on the ethical problems associated with transplant therapy can help to clarify the criteria for assessing what kinds of transplants are morally acceptable and under what conditions, especially with regard to the protection of each individual's personal identity.
I am confident that social, political and educational leaders will renew their commitment to fostering a genuine culture of generosity and solidarity. There is a need to instil in people's hearts, especially in the hearts of the young, a genuine and deep appreciation of the need for brotherly love, a love that can find expression in the decision to become an organ donor.
May the Lord sustain each one of you in your work, and guide you in the service of authentic human progress. I accompany this wish with my Blessing.
Tuesday, December 18, 2007
"Brain Death:" True or False Criterion
The President’s Council on Bioethics: Session 5: Response to the Council’s White paper, “Controversies in the Determination of Death” D. Alan Shewmon, Olive View – UCLA Medical Center
The Conclusion of Dr. Shewmon: If there is somatic integration, i.e. a physical organism that is an “organism” working as a biological unity, there is a living person even if there is no consciousness or environmental/social response or interaction.
The details of Shewmon's world-class example - T.K. - of both "brain death" and surviving somatic integration are below. Suffice it to say at this point that T.K. was clearly "brain dead." He had no identifiable brain structures (including brain stem structures). Crainial autopsy showed his brain to be a mass of disorganized fluids, membranes and calcifications of a brownish, gritty material with no microscopic evidence of neurons.
Nevertheless, his body was a functioning, integrated organism: homeostasis of fluid balance, electrolytes, energy balance, low but steady body temperature, body growth with proper proportions, wound healing from surgery, abrasions and infections, cardiovascular and autonomic regulation, weaned off pressor medication, self sustained blood pressure. He could tolerate a sitting position without blood pooling into legs, fever response to infections, recovered from various medical crises...
These are holistic properties of the organism. He reacts to environmental stressors in a coordinated manner. "I pinch his shoulder and his leg will move evidencing integration across levels of spinal chord. When he is uncovered he gets goose bumps."
Theological evaluation: "The body is not just 'there,' having a merely external relationship to the spirit; rather, the body is the self-expression and 'image' of the spirit. In the human being, what constitutes biological life also constitutes the person. The person actualizes itself in the body and the body is, therefore, its expression. In the body we may see what is invisible as spirit. Because the body is the person become visible, and the person is an image of God, the body, taken in its full network of elationships, is also the space where the divine becomes imaged, expressed, seen. This is why, from the very beginning, the Bible portrays the mystery of God in images of the body and of the world that is ordered to that 'body'" (Joseph Ratzinger, "The Paschale Mystery as Core and Foundationa of Devot ion to the Sacred Heart," Civilization of Love Ignatius [1985] 149).
The Standing Public Criterion:
Harvard Ad Hoc Committee on Brain Death (1968)
In 1968, this committee of the Harvard Medical School published a report describing the following characteristics of a permanently nonfunctioning brain, a condition it referred to as "irreversible coma," now known as brain death: Unreceptively and unresponsitivity--patient shows total unawareness to external stimuli and unresponsiveness to painful stimuli;
No movements or breathing--all spontaneous muscular movement, spontaneous respiration and response to stimuli are absent; No reflexes--fixed, dilated pupils; lack of eye movement even when hit or turned, or ice water is placed in the ear; lack of response to noxious stimuli; unelicitable tendon reflexes. In addition to these criteria, a flat electroencephalogram (EEG) was recommended. The committee also noted that drug intoxication and hypothermia which can both cause reversible loss of brain functions should be excluded as causes. The report was used in determining patient care issues and organ transplants. The condition of irreversible coma, i.e., brain death, needs to be distinguished from the persistent vegetative state, in which clinical presentations are similar but in which patients manifest cycles of sleep and wakefulness. [See President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death (Washington, DC: U.S. Government Printing Office, 1981)].
No movements or breathing--all spontaneous muscular movement, spontaneous respiration and response to stimuli are absent; No reflexes--fixed, dilated pupils; lack of eye movement even when hit or turned, or ice water is placed in the ear; lack of response to noxious stimuli; unelicitable tendon reflexes. In addition to these criteria, a flat electroencephalogram (EEG) was recommended. The committee also noted that drug intoxication and hypothermia which can both cause reversible loss of brain functions should be excluded as causes. The report was used in determining patient care issues and organ transplants. The condition of irreversible coma, i.e., brain death, needs to be distinguished from the persistent vegetative state, in which clinical presentations are similar but in which patients manifest cycles of sleep and wakefulness. [See President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death (Washington, DC: U.S. Government Printing Office, 1981)].
Shewmon:
“Looking back over the almost 40 years of the history of this topic [“brain death”], I still see it as a conclusion in search of a justification” [the desire for “live” organs for transplantation seeking a justifiable rationale]. And throughout the literature on determination of death, there are three categories of justifications that have been proposed.
1) “One is loss of conferred membership in human society. This is a sociological concept of death. It is society specific. Some advocates of higher brain death [as opposed to “lower brain” or brain stem] appeal to this rationale. Other advocates of whole brain death appeal to this rationale. The Harvard committee implicitly appealed to this rationale.
2) “The second is loss of essential human properties or personhood. [Me: personhood is considered identical with consciousness. As Shewmon will say below, “this is the implicit rationale of many, if not most, today]. This is a psychological species-specific definition of death, which is pretty much restricted to those who are called the "higher brain death" advocates or "neocortical death" advocates.
“I would say, in having discussions with many colleagues about this, that this is the implicit rationale of many advocates of whole brain death today. When you pin them down and ask, "Why do you really think brain death is death," this is what you'll get: "Because there's no person in there, because there's permanent unconsciousness."
3) “Third is a biological kind of rationale, loss of somatic integrative unity or, if you will, the loss of the organism as a whole. This is a biological species-nonspecific concept. It's the concept that corresponds to the mainstream whole brain death view and also the British brain stem death view. It was the rationale of the President's Commission of 1981, and evidently it's the rationale of this Council in its White Paper. It's also my rationale. I think this is a correct concept of death. But what I will try to convince you of in what follows is that brain destruction does not fulfill this concept….
“There's always some loose logic hidden in there somewhere, and those who are coherent usually end up with the psychological rationale, that this is no longer a human person even if it may be a human organism.
“Youngner and colleagues did some very interesting surveys in 1985 and 1989, which I'm sure you're all aware of, looking at the attitudes towards brain death and found out a surprisingly high incidence of lack of coherent concepts among people involved in transplantation, incoherence whether the donors are really dead or not.
“Japan, Germany, and Denmark are interesting countries to look at their history on this topic because it was only recently that Japan passed a brain-death law, and that law is incoherent insofar as you're legally dead if you're going to become an organ donor, but if you're not going to become an organ donor, then brain death doesn't make you dead.
“In Germany, also very recently, the law was changed about this. And there you are legally allowed to extract organs from brain-dead patients, but the law does not explicitly say brain death is death. It's kind of implied, but they just can't quite bring themselves to say that.
“Denmark, the Danish Council of Ethics for many years came out with a series of statements reiterating their conviction that brain death is not death and that organ transplantation needs to be justified by some other way. So even on the international scene, this is not a settled issue.
“There have been increasing publications of critiques of neurologic determinations of death, and I think very significantly the establishment—and by that I mean relevant medical associations like the American Academy of Neurology, the AMA, and so on—the establishment ignores the conceptual critiques and focuses rather on how to diagnose global brain infarction.
“There has been a rejection of the mainstream rationale by an increasing number of high-profile experts, particularly advocates of higher brain death, but also people from the mainstream sort of jumping ship from the biological rationale to the psychological personhood rationale. And I have seen this at conferences a number of times.
“And then there are some very interesting Freudian slips by those who certainly know what they're talking about. Here's from the American Medical News: "Brain-dead woman ordered kept alive." Here's from Neurology Today, more recently: "Dr. Ropper"—this is Allan Ropper, a famous neurologist in intensive care neurology who has published a great deal about brain death—"Dr. Ropper added that it has been suggested that children who are brain dead can be kept alive by artificial means for a long period of time."
“Now, maybe that was a medical reporter putting words into his mouth, but these are his own words in his own very recent textbook: "In exceptional cases [of brain death], however, the provision of adequate fluid, vasopressor, and respiratory support allows preservation of the somatic organism in a comatose state for longer periods." So here he actually comes out and asserts that this is an organism and it's clearly a living organism because corpses are not comatose.
“This is from a neurosurgeon in a textbook on transcranial Doppler sonography. He says, "The findings were obtained in 15 patients who fulfilled the clinical criteria for brain death. All of the patients died within 24 hours or upon discontinuation of the mechanical ventilation."
“I think this one is even more significant. This is from a chapter written by Fred Plum, who is one of the major figures in American neurology who has written extensively about issues of coma and brain death. And in this table he lists some cases of prolonged visceral survival after brain death. And look at that column that is circled called "Mode of Death." And the modes of death are "spontaneous cardiac arrest" and "respirator discontinued." So obviously Dr. Plum does not consider these people dead by virtue of their brain being destroyed, but they died as organisms when the respirator was discontinued or they had a spontaneous cardiac arrest.
“And this is from Dr. Ron Cranford, another very famous neurologist who has written extensively on brain death. And this is in an article about vegetative state, but what he says about brain death is revealing: "It seems, then, that permanently unconscious patients have characteristics of both the living and the dead. It would be tempting to call them dead and then retrospectively apply the principles of death as society has done with brain death."
“These are not lay people who are naive about this topic. These are the experts in the field who kind of indirectly are revealing the degree of conceptual confusion underlying the superficial consensus.
“Now, my own conceptual itinerary on this is quite circuitous. As many of you know, I have at one time or another in my life held every possible position on brain death. So I think I understand all the positions quite well and am able to think outside the box, if you will.
From 1981 to '89, I supported the notion of neocortical death and wrote to that effect. I was forced to change my analysis when I came across some hydranencephalic children who in principle ought to have been in a vegetative state, but they were actually conscious, yet they had no cerebral cortex.
From 1981 to '89, I supported the notion of neocortical death and wrote to that effect. I was forced to change my analysis when I came across some hydranencephalic children who in principle ought to have been in a vegetative state, but they were actually conscious, yet they had no cerebral cortex.
"So the whole idea of neocortical death had to go out the window, and I reverted to a variation on the theme of whole brain death, which I presented at the Pontifical Academy of Sciences in 1989, and continued to write accordingly up until 1992, when I came across a case of a 14-year-old boy on whom I was consulted in California.
He had jumped onto the hood of a slowly moving car, fallen off, hit his head against the concrete, and within four days was brain dead, certified by a full neuro exam and an apnea test. Parents refused to accept that this was death and insisted with the doctors to continue life support.
Well, since they knew that there is imminent cardiac arrest in this condition of brain death, they thought, "Okay, we'll humor the parents for a few days, and then nature will take its course, and then we don't have to have this ugly confrontation with them."
So they continued for a few days and finally made an agreement with the parents that they would withdraw all support except for the ventilator and basic fluids for 48 hours and if the child passed away, then that was an indication of what God's will was. And if the child survived, then that would be an indication of what God's will was, because the parents were very deeply religious and insisted on doing what they considered to be God's will. But nobody could agree on what God's will was.
Well, since they knew that there is imminent cardiac arrest in this condition of brain death, they thought, "Okay, we'll humor the parents for a few days, and then nature will take its course, and then we don't have to have this ugly confrontation with them."
So they continued for a few days and finally made an agreement with the parents that they would withdraw all support except for the ventilator and basic fluids for 48 hours and if the child passed away, then that was an indication of what God's will was. And if the child survived, then that would be an indication of what God's will was, because the parents were very deeply religious and insisted on doing what they considered to be God's will. But nobody could agree on what God's will was.
"So the doctors thought this would be a good way to come to a closure on this. Well, he survived the 48 hours of simple fluids and ventilator support, and now they were in an awkward position to continue support, and they actually transferred him to a skilled nursing facility with the diagnosis of brain death.
"And in California, of course, he was legally dead, and the nursing facility was very confused by this. They had never received a patient who was legally a corpse. And they consulted me about this, and I came up. I examined the boy, and lo and behold, I concurred with the diagnosis of brain death. He had no brain functions, and the records supported the apnea test. So he, while in this condition, began pubertal changes and passed away at 63 days from an untreated pneumonia.
"So this case flew in the face of everything that I had been taught by my mentors and by the literature regarding the imminence of somatic demise and brain death, and it made me rethink the whole thing. And the coup de grace was an analogy with high spinal cord transection, which I'll go into in just a minute. This forced me to reject neurological criteria for death altogether.
So since 1992 I've been an advocate that death is not neurological, and there have been various things that have supported my conviction about that: the series of prolonged survivors in this state which have been published and I'm sure you're familiar with, the evidence of somatic integration and holistic properties in many of these patients, which we'll talk about.
So since 1992 I've been an advocate that death is not neurological, and there have been various things that have supported my conviction about that: the series of prolonged survivors in this state which have been published and I'm sure you're familiar with, the evidence of somatic integration and holistic properties in many of these patients, which we'll talk about.
Also, I've become more and more conscious of conceptual disconnections between the concept, the criterion, and the test of death in the mainstream. And the latest stage in my conceptual itinerary is insights from linguistics. My wife is a linguist, and so we've had very fruitful interchanges over dinner and came out with a couple of publications on the linguistics of death and how the language that we grow up in may influence our conceptual frameworks, including about death concepts. I'm not going to talk about that today.
"So let's look at the spinal cord issue, because if you think about it, the effect on the body should be the same for brain destruction as for brain disconnection. Does that make sense? Okay. As far as the body's physiology is concerned, if the body needs brain control to be a unified organism, then it shouldn't matter to the body whether that is lost through brain destruction or brain disconnection. Either way, the body loses that control.
"So that's what occurred to me in 1992, and I thought, "Huh, that's interesting. Let's go to the literature on high spinal cord transection and see what the physiology of that is like." And I was very surprised to discover that in the spinal cord literature the somatic pathophysiology of high spinal cord transection is absolutely identical to that of brain death. In fact, you could take a chapter on the ICU maintenance of brain-dead organ donors and you can take a chapter on the ICU management of high spinal cord injury victims and interpose the words "spinal cord injury" and "brain death" and the chapters would be almost identical. They have the same kind of somatic instabilities, complications, and so on.
"And if you want to make the analogy really identical, you could add disconnection of the vagus nerve. There's no vagal functioning in brain death, and there is in high spinal cord injury. But sometimes we pharmacologically ablate the vagus nerve to treat cardiac arrhythmias in spinal injury. So if you did that, then there wouldn't even be the vagus nerve functioning that is a difference between the two. Not all brain-dead patients have diabetes insipidus, so that is not necessarily a difference between the two conditions.
“So based on this, we have to conclude that if brain death is death on the basis of loss of the organism as a whole, then so does high spinal cord transection equal death of the organism as a whole. Now, the difference is — and the only difference is — there is preservation of consciousness in the high spinal cord injury. So if we maintain the standard rationale for brain death, we would have to say that the spinal cord injury victim is a consciousness in a non-organism, which doesn't make a whole lot of sense.
“And if we accept that spinal cord injury patients are living organisms, then whether brain death is a deep coma or death depends on the philosophy of personhood, not on any biomedical aspects. And if brain death is death on [that] basis..., then so are all other forms of permanent unconsciousness if we want to be logically consistent. And this is why so many experts today implicitly favor the personhood rationale and have abandoned the biological rationale.
“Now, let's go into three cases. These are three instructive cases. Two of them are from my published series. One was recently published in Japanese, but I had the opportunity to personally examine him, and I've been working with his doctor in Japan, so I have all the clinical data.
Shewmon’s Major Example: T.K, “Brain Dead” But a Very Alive Body
“So first of all is the world-record survivor in the state of brain death, whom I call "T.K." in other articles. He was a previously normal boy who contracted Haemophilus influenzae meningitis at age four and a half years. He had a very rapidly downhill course so that by the second hospital day he had lost all brain function and was apneic. A neurological consultation opined that the child was clinically dead. Now, he did not have a formal apnea test, and the reason for that is that this was before any diagnostic standards for childhood brain death had come out. And the only diagnostic standard was the President's Commission guidelines, which said you cannot make the diagnosis under age five. And he was under age five. So nobody gave him a formal diagnosis of brain death, yet clearly he was brain dead.
“Now, I want to elaborate a little bit on the evidence for brain death because one of the critiques of my work is that I'm presenting misdiagnoses, and I want to assure you that there was superabundant evidence of the correctness of the diagnosis here. So for the rest of his life in this state he had no cranial nerve reflexes, no spontaneous respiration, including off of the ventilator for up to a minute for purposes of changing tracheostomy and so on.
“On day two he had sudden onset of hypothermia, profound hypothermia, also, sudden onset of diabetes insipidus. Both of these are complications of brain death, and there's no other reason that he would have had these symptoms on day two. He has had four EEGs on brain death day zero, which I'm calling the day of onset of brain death, again, the next day, on day 841, and on day 4,202. All four EEGs were absolutely flat at maximal sensitivity.
“He had a CT scan on brain death day nine, which showed extensive subarachnoid hemorrhage, diffuse, severe cerebral edema with obliteration of the ventricles and cisterns. And he had splitting of the cranial sutures. The intracranial pressure was so high that his already fused cranial sutures at age four split apart. So that tells you how high the intracranial pressure was at that time.
“Multiple independent neurology consults reiterated the lack of neurological function, including my own exam, which I videotaped and will show you in a second, on brain death day 4,969. A few months after that exam when he was 13 and a half years into the state of brain death, they did an MRI scan, which I'll show you, also, an MR angiogram and multi-modality evoked potentials, which I'll show you.
“Finally, if anybody still had any doubts, he passed away a couple of years ago, and an autopsy was performed—a brain-only autopsy, which showed no identifiable brain structures, including brain stem structures, and I will show you that, as well. So there's no question that this child was brain dead. He was transferred from the ICU to a regular pediatric ward on day 504, and he was discharged after seven and a half years in this condition. He was discharged to a rehab facility and then to home, and he had four brief hospitalizations during the rest of his time in this condition. He expired after 20 and a half years in the state of brain death. Thirty-seven percent of that time he was in the hospital, 53 percent was at home, and 10 percent was in a rehab facility or skilled nursing facility.
“Here's his brain stem auditory evoked potential [referencing projected PowerPoint slide], which shows stimulus artifact and no intracranial potentials. Here's a somatosensory evoked potential, which shows Erb's point at the brachial plexus and no intracranial potentials after that. Here's his visual evoked potential, which shows no response to visual flashes. Here's his MRI scan, a sagittal section, which shows an incredibly thickened skull. Radiologists have never seen such a thickened skull that I've shown this to. And this is due to the failure of the brain to grow during normal childhood, and the skull grows in compensation to that. It's a well-known phenomenon.
“But, more importantly, there's no identifiable brain structure in there. There's just a collection of disorganized fluids and membranes and calcifications, including no brain stem. Here's some axial views of the same thing. And here's the autopsy, the outer aspect of the brain, which was totally calcified, and inside was this brownish, gritty material, plus a lot of calcifications. And on microscopic analysis, they were unable to find any neurons. So there's no question that this child was brain dead for 20 and a half years.
“Now, upon examining him and going over his records during this time, there are a number of holistic properties that his body demonstrated. First of all, homeostasis of fluid balance, electrolytes, energy balance, and so on, without monitoring and without frequent adjustment based on that monitoring. So he was just given G-tube feedings and liquids day after day after day, and his body made whatever adjustments were needed to keep that homeostasis.
“Temperature maintenance—of course, all these patients tend to have subnormal temperatures, but with a few extra blankets he maintained his temperature just fine. Proportional growth—I call it proportional because he did not grow like a cancer. He grew with the normal body proportions, and we'll see his growth chart. Teleological wound healing from surgical procedures or from minor abrasions or from infections. Cardiovascular and autonomic regulation.
“So he and all the other patients were very unstable in the beginning. They required pressor medications. But they were able to wean off the pressor medications, and he remained stable in terms of self-sustained blood pressure on his own. He could tolerate a sitting position, which indicates some degree of autonomic control of the blood pressure. So his blood pressure didn't plummet from blood pooling into the legs upon sitting.
“And there was a coordinated response to stress in terms of blood pressure, heart rate, and capillary skin changes. He had a febrile response to infections and sometimes mottling of the skin with that. And, I think very importantly, he recovered from various medical crises. Once he had congestive heart failure, got through that. He had hypotensive shock at one point, got through that. He had various infections, pneumonia, urinary tract infection, sinusitis, and with ordinary antibiotics got through all of that.
“So I consider these to be holistic properties because they're not properties of any one organ or organ system, but they're properties of the organism as a whole. Here's his growth chart, and his weight eventually ended up at 75 kilograms. And here is evidence of his autonomic reactivity. It's a little kind of a busy slide, but the point is, these spikes in systolic and diastolic blood pressure usually correspond with spikes in the heart rate, and they coincide, the big ones, with environmental stressors like suctioning or turning or so on. So the organism reacts to these environmental stressors in a coordinated manner. Let me now show you his video. He has hyperactive reflexes. He has what we call a triple flexion response where you elicit this Babinski reflex, and the entire legs at hip, knee, and ankle will withdraw.
“And what I think is quite interesting in a few other segments that will briefly come is when I pinch his shoulder the leg will move. So there's integration within the spinal cord across levels of spinal cord. I don't think such movements have any survival value, but it's a sign that the spinal cord is doing a lot of integration there, including autonomic integration, and that's what's important in the somatic organism. So when he's uncovered he did get goose bumps, and he had mottling of the skin. These are the caregivers that took care of him at home during all of this time.
Third Case: Girl
"Another case is a 12-year-old girl with a malignant brain tumor diagnosed at age 12. It progressed despite surgery, radiation, and chemotherapy. At age 15 she was already moribund. She was apneic and on a ventilator, had almost no neurological function by that time. She was in the hospital, and they thought she was brain dead at this point, and they did an apnea test which was positive. Nevertheless, she could not be declared brain dead because of a right corneal reflex and a weak cough to tracheal suctioning. These were the only residual brain stem functions that she had.
"I would have to say that on the basis of the proposed concept of apneic coma in the White Paper, she would have to be declared dead, although using the mainstream diagnostic criteria, she could not be declared dead because of a right corneal reflex and a weak cough reflex. So they sent her home on a ventilator, and while at home she probably became brain dead on what I'm calling brain death day minus 28. Nobody knows quite when she became brain dead because she was just lying there on a ventilator all the time. Then she had a crisis with obstruction of the ventilator and was brought to the emergency room and admitted where she was formally diagnosed as brain dead, which is what I'm calling brain death day zero.
She had no brain stem reflexes, a positive repeat apnea test, a flat EEG, and no blood flow on radionuclide scan. She was reconfirmed to be brain dead on day 312 by a neurosurgeon, although he did not repeat the apnea test, and she had another flat EEG at that time. The parents took her home because they were convinced that she was not dead, that brain death was not death. They didn't accept what the doctors told them, and the doctors, rather than making a big legal show about it, just discharged her home.
She had no brain stem reflexes, a positive repeat apnea test, a flat EEG, and no blood flow on radionuclide scan. She was reconfirmed to be brain dead on day 312 by a neurosurgeon, although he did not repeat the apnea test, and she had another flat EEG at that time. The parents took her home because they were convinced that she was not dead, that brain death was not death. They didn't accept what the doctors told them, and the doctors, rather than making a big legal show about it, just discharged her home.
"She had a CT scan, which I'll show you, and she expired on 410 days into brain death, officially, which I think was actually 438 days into brain death, 98 percent of which was at home on a ventilator and only 2 percent of which was in the hospital.
"Here's her radionuclide scan showing no blood flow into the brain, and here's her CT scan on day 312, and notice that there's total obliteration of brain contents. There's some residual islands of some kind of tissue but not enough to make any brain waves on EEG. There's calcifications in there, and here is an epidural residual of her malignant brain tumor, which has grown out of the skull defect into an excrescence on her forehead.
"She exhibited many holistic properties, also, again, homeostasis, again, temperature maintenance, again, teleological wound healing, again, cardiovascular and autonomic regulation. She had a relative paucity of complications. She had one pneumonial, which resolved at home with enteral antibiotics. And I think of great interest is to compare the growth of that tumor with how the multiplication and turnover of her own cells throughout her own body was teleological and unified.
"Here's a graph, a scatter plot of her temperatures. Notice here is brain death day zero, what I'm calling that, when it was formally diagnosed. And up till then she had relatively normal temperatures. And then on this day, minus 28, the temperature plummeted and then gradually maintained in this range with the help of blankets. Also notice that she is able to generate some fevers, too.
"Here's a scatter plot of her blood pressure and heart rate on the same time axis, and notice that these increased during the days prior to onset of brain death, and this is no doubt from intracranial pressure building up. And then they plummet, corresponding to when the temperature plummeted. And so the conjunction of all of this is what led me to say that she became brain dead at home on that day. Importantly, it gradually stabilizes. She came off of pressor medications during the first hospitalization, which was very brief, right here, and then all of this was spontaneously maintained blood pressure. This is a scatter plot of mean blood pressure versus heart rate, and what it shows is there's coordination between the two with stress responses. So the blood pressure goes up and the heart rate goes up, which doesn't necessarily follow if there was just an uncoordinated group of organs."
Japanese Boy
"Okay, third case. Do you want me to stop or show the third case? Show the third case. I thought so.
"So this is a Japanese boy who became brain dead at age 13 months from a necrotizing encephalopathy of presumed viral etiology. He has now been brain dead for seven years, 78 percent of which has been in the hospital and 22 percent at home. He's had three EEGs on day one, day 297, and day 1,617, all of them isoelectric. He's had three brain stem auditory evoked responses, all of them showing no response. He had a SPECT scan, which shows no intracranial blood flow. He's had a total of five CTs and four MRI scans, all of which show progressive disintegration of the brain to disorganized fluids and membranes without identifiable brain structures.
"Here's his MRI scan. You can see just what I described. Here's a sagittal view showing no brain stem structures. Here's an absent response to auditory evoked potential. Here's his radionuclide scan showing no intracranial blood flow and SPECT scan showing no intracranial profusion. He also has homeostasis, temperature maintenance, proportional growth, teleological wound healing, cardiovascular autonomic regulation, and recovery from various medical crises.
Here's his growth chart, and here he is. And I'm going to show you him at different ages. Here he is at three years old, at four years old, at five years, eight months old. That's when I saw him and did my own independent exam and confirmed the lack of brain functions. And here he is at eight years old. And I think you would agree with me that if any biologist were put in front of this boy and not primed about any brain death debate but simply asked to examine this and tell us is this a living organism or not, any biologist would say, "Well, of course this is a living organism. This is a comatose apneic living organism."
Here's his growth chart, and here he is. And I'm going to show you him at different ages. Here he is at three years old, at four years old, at five years, eight months old. That's when I saw him and did my own independent exam and confirmed the lack of brain functions. And here he is at eight years old. And I think you would agree with me that if any biologist were put in front of this boy and not primed about any brain death debate but simply asked to examine this and tell us is this a living organism or not, any biologist would say, "Well, of course this is a living organism. This is a comatose apneic living organism."
"So I think for the interest of time I will have to forego the other points that I wanted to make, but maybe they'll come out in the question-and-answer session. But I thought these were very important for you to see because a big criticism of my work has been that a lot of this is undocumented. It is not undocumented. It's just that the critics haven't seen the documentation yet. So I'll stop here and be very happy to answer questions.
CHAIRMAN PELLEGRINO: Thank you very much, Dr. Shewmon. I'm going to ask Dr. Floyd Bloom, a member of the Council, to open the discussion.
DR. BLOOM: I was going to respond first to your letter to us, having read our White Paper in its last draft and then talk about your concept of the organism as a whole or your view that unless the organism as a whole is dead the subject is not dead.
You first said in your letter that you didn't like our concept of total brain failure, which we defined as a documented history of injury due to either trauma, stroke, or prolonged hypoxia. You didn't like that because it missed the concept of irreversibility. However, it's hard for me to believe that you actually read the draft since irreversibility was defined in the second paragraph and at least 50 more times throughout the document. So irreversibility is a major part of the state that we call total brain failure.
DR. SHEWMON: May I say something to that?
DR. BLOOM: Well, I have a lot more further, but I wouldn't want it to get lost.
(After conferring with Chairman Pellegrino, Dr. Shewmon agreed to hold his comments until after Dr. Bloom finished his response.)
(After conferring with Chairman Pellegrino, Dr. Shewmon agreed to hold his comments until after Dr. Bloom finished his response.)
So we defined total brain failure as a medical diagnosis which represents the neurological standard of death to try to separate out the physical findings and the history of the subject from the actual diagnosis and call it death. You then created several what you called "devil's advocate" positions to try to distinguish those from how we define total brain failure.
And you talked about the locked-in patient on a ventilator simulating these causes. You talked about bilateral injury to the phrenic nerves that would simulate some of the loss of respiratory function and look like pseudo apnea. You talked about deep general anesthesia with no brain activity.
And you talked about the locked-in patient on a ventilator simulating these causes. You talked about bilateral injury to the phrenic nerves that would simulate some of the loss of respiratory function and look like pseudo apnea. You talked about deep general anesthesia with no brain activity.
Now, I would submit to you that while those are perfectly good in debating points as devil's advocate positions, they totally miss the prime concept that this is a documented history of injury due to trauma, stroke, or prolonged hypoxia. And so even though some aspects of those physical findings could be reproduced by your hypothetical examples, they do not really counter the position that we chose to create in order to eliminate some of the confusion.
We defined total brain failure as a body that has irreversibly lost the fundamental openness to the surrounding environmental and the capacity and drive to act on that environment in its own behalf. It seems to me that's a very clear-cut description of the loss of consciousness, the inability to acquire and consume for itself the necessary components of life, such as breathing, such as food and water.
And just to make it very clear if you had any doubts, I belong to that reductionistic biological group of people such as the ones you quote, starting with our beloved, distinguished Fred Plum and ending with Dr. Cranford, all of whom will take the position that a person in that state without the capacity for consciousness may have a living body but is not a person.
Now, if I could turn to the document that you sent us, starting on page 308 where you cite Dr. Ropper, Dr. Plum, and Dr. Cranford, you end up with the statement, more or less what I just stated, which is that these bodies are biologically living organisms, which is your central tenet. "But that's irrelevant," he said, "because they are still dead as human beings."
I don't understand why that is not correct. The fact that the brainless or headless body in your example of physiological decapitation is alive because autonomic functions persist is exactly why it's called the autonomic nervous system. It exists to be able to act locally and globally to defend the body before the brain is aware of what's wrong and can send commands to integrate that. But the fact that their body may be alive in some aspects in no way eliminates the fact that they are still dead as human beings.
If we go to page 308, "Everyone who saw the video agreed that the patient met all the clinical criteria for brain death short of a formal apnea test which could not be ethically performed because there would have been no benefit to outweigh the risks." This is referring to your patient, T.K. It strikes me that the decision to keep this body alive for 20 years in the total absence of any surviving brain tissue could not have been morally defensible when he reached the age of five years when a death by brain death could have been declared. And to have seen two more examples of this kind of muddled thinking to keep a corpse alive just strikes me as medically unacceptable.
Let me finish by going to two more places in your paper before the Pontifical Academy. Page 320, you talk about—the preceding page defines the human soul with spiritual dimensions that cannot be reduced to physical brain activity, and you list as the properties of that human soul reflective self-awareness, abstract concept formation, and volition. But, in fact, all of those have been reduced to physical brain activity, both with brain imaging and computer brain interfaces.
Your example of the locked-in patient does not meet our criteria because those patients, fitted with the appropriate computer interfaces, can, in fact, escape their locked-in position by moving cursors on keyboards, on computer screens that they can see.
Your example of the locked-in patient does not meet our criteria because those patients, fitted with the appropriate computer interfaces, can, in fact, escape their locked-in position by moving cursors on keyboards, on computer screens that they can see.
So you go on to say, then, that the key difference between Catholic anthropology and person mind/brain reductionism, of which I would happily agree to be known as a member, "The former admits of such a notion as a permanently unconscious person, while the latter does not."
And I would say that's accurate for my position.
And you go on to say for the Catholic, "As long as there is evidence that the body is alive, an organism of the whole," as you have called it, "then the soul and person are present even if rendered permanently unconscious by a brain lesion. Since mental functions presumably continue to be mediated by the isolated brain"—and maybe you would tell us how you know that—"the soul must be informing the brain or the head with the brain, depending on which version of the thought experiment one wishes to follow."
And I'll just end by referring to page 322, which summarizes this entire thought experiment: "...for the reductionist, the brain-dead body is a living 'humanoid organism' but no longer the body of a person... For those who accept an Aristotelian-Thomistic type of spiritual soul, some brain-dead bodies are indeed dead by virtue of supracritical multisystem damage, whereas others (with pathology relatively limited to the brain) are permanently comatose, severely disabled, still living human beings; in either case, death of the brain, per se, does not constitute human death."
So let me ask you, then, really as the question, is this view of organism as a whole the holistic—what was the word you used?—the holistic question, if the organism as a whole is still functioning can the body of that person be dead? Is this really primarily a religiously motivated point of view? A philosophical point of view and not a medical scientific point of view?
CHAIRMAN PELLEGRINO: Thank you, Floyd.
Dr Shewmon: "So I think it's very interesting that you say that you are in the camp with Dr. Plum and Cranford and so on because this is exactly the point I was making in my talk, that more and more people who understand this issue very thoroughly have gotten away from the mainstream biological rationale for brain death and admit that the only coherent rationale is, indeed, this philosophical position regarding the relationship between personhood and consciousness.
So there was no meeting of the minds once this philosophical divide was clarified. But what I found very interesting was there was general agreement that the biological rationale didn't hold water anymore. And so I considered my presentation a success because I wasn't there to argue philosophy but to present this biological evidence, which was new at the time and I think now seems to be generally accepted. But the view that you explained in line with Plum and Cranford I don't see adopted in the White Paper. That's very interesting that you say that because the White Paper doesn't reflect that at all.
Now, regarding keeping these people alive—
Now, regarding keeping these people alive—
DR. BLOOM: Excuse me, but I don't see how you can say that. The exact phrase that I quoted a moment ago, "Total brain failure is a body that has irreversibly lost the fundamental openness to the surrounding environment and the capacity and drive to act on that environment in its own behalf"—that's consciousness. That's conscious interaction with the environment.
DR. SHEWMON: "Okay. Well, it's interesting that you say that. That was one of my questions to the Council about the White Paper. What exactly is this drive? Are we talking about a physiological drive, or are we talking about a subjective personal conscious drive? That was not clear in the way the paper was worded. I assumed that you were talking about a physiological drive because elsewhere in the paper you reject the higher brain death camp as a rationale for equating it with death. So what you're saying now seems to accept the higher brain death camp rather than reject it. So I'm a little confused by that.
DR. BLOOM: I guess we have to agree to disagree on whether—
DR. SHEWMON: "Okay. Regarding keeping these patients alive at home and so on as being morally unacceptable, by presenting these cases, I certainly did not want to go on record as advocating that we keep all these patients alive. That's not my purpose. I strongly believe that this is morally way extraordinary means that can be legitimately foregone and could have been a long time ago. They were not my patients. So I cannot defend for you the fact that they were kept going all this time. I have simply used them as a point for learning about the physiology of this condition. That's all I can [do].
And regarding the reduction of mind-to-brain activity, well, I don't think the fMRI studies and PET studies and so on justify a reduction of mind to physical brain activity. There's certainly a very important fascinating strong correlation between the two. It certainly doesn't prove any reductionism. But what I have to present here I think is more for the secular audience. The paper that I presented for Rome that you're quoting obviously had some theological aspects because it was for a meeting in Rome.
I don't think that our understanding of death needs to be based on any kind of religious notion of soul. Certainly not. So I definitely respect the differences of view regarding that. I don't think it affects one way or the other the biological arguments regarding the unity of the organism.
CHAIRMAN PELLEGRINO: Thank you very much. I will invoke the Chairman's privilege and extend the discussion to 10:30 and now invite Council members, usual fashion indicating you wish to speak, in order.
DR. GAZZANIGA: Dr. Shewmon, your presentation at the Vatican Council was sent in. I realize you weren't able to be there. But it was not uniformly welcomed in that setting, and other neurologists present—for instance, Dr. Jerry Posner is on record in that book, as well. I think he might be called the senior neurologist in the United States. He simply said that death is a process and "brain death" is a lousy term. Brain death is death, and that furthermore he doesn't know of a single case—a single case—where properly clinically defined brain death led to anything other than death very quickly.
So in my explorations of this and in my friends in the neurologic community, they subscribe to that rather strongly, and they become annoyed when people start to tamper with the definition of brain death. So I'm a little bit mystified. Either you're hanging out with a different group of neurologists than I am—but I'm a little bit mystified when you say the neurologic community is split on this. I don't see it that way at all, and I'd just like to have you comment on that.
DR. SHEWMON: What they're split on is under the surface. I mean, there's a huge widespread consensus that brain death is death. Or use some other term if you don't like brain death.
DR. GAZZANIGA: And follows—let's give you .0001 percent. And follows as described and known by professional neurologists on schedule.
DR. SHEWMON: Yeah. And a slide that I didn't have time to show states, "Why are these cases so rare?" And the slide says that the kind of case that I'm showing you is extraordinary and that certainly 99.99 percent of cases of brain death have somatic death, if you will, within a few days. Now, why is that? Now, I would answer that the reason that is — and the reason Dr. Posner hasn't seen cases like this is — that the diagnosis is a self-fulfilling prophecy. In this day and age and for many decades, as soon as that diagnosis is made, the patient either becomes an organ donor or ventilation is discontinued. So there has been all along no motivation whatsoever to try to maintain those patients. So these cases are rare because the motivation to maintain them is exceedingly rare.
Now, where there is motivation the prolonged survival is not so rare. Okay? So we're talking about the rare cases where there is motivation to push through the acute phase of instability. What are those motivations? Pregnant women who are brain dead is one kind of motivation, personal beliefs like in these cases I showed you—they're rare, but we see them—and cultural or societal reasons, like in Japan. Many of the cases of prolonged survival are in Japan where that society is less open to these ideas.
So to find these cases, one just keeps an eye out, and I had to pay with my own money to fly halfway across the country to make this video of T.K. So I think, rather than say, "Well, this just doesn't occur in my experience; therefore, it doesn't occur anywhere," is not quite fair. These are very well documented cases now, and just because Dr. Posner hasn't seen the documentation, which I will be submitting hopefully soon for publication, doesn't mean they didn't exist. And I think it behooves us to learn everything we can from them.
CHAIRMAN PELLEGRINO: Dr. Carson?
DR. CARSON: I'm sure as a neurologist you've had an opportunity to deal with many neurosurgeons, and as one I generally like neurologists. But as you know, we have a tendency to pretty much cut to the point without endless discussions. And a couple of things that you said I wonder about the basis for.
You indicated that the high spinal cord transection was equivalent, essentially, to brain death, and even though you did mention the vagus nerve, you didn't mention the influences of the vagus nerve on the gastrointestinal tract. You did mention that you could perhaps block some of the effects of the vagus nerve on the heart. I'm not sure that anyone has done the requisite experimentations to say that those two things are equivalent.
Another question I had for you was regarding T.K., who spent two decades in a supported system. You didn't mention whether, in fact, he had undergone puberty during that time, so that's just a question that I had.
And then a century ago what we're talking about here today would essentially have been irrelevant because we didn't have the ability to maintain a brain-dead individual. A century from now we might be able to indefinitely maintain such individuals as we continue to learn more and be able to do more. If we can, in fact, maintain them indefinitely, are you saying that we should simply because of the existence of integrative physiological functions because we can maintain them, because there is a life there? What are the implications of what you're saying?
That's one question.
And, also, is it possible that human life consists of more than just the ability to maintain integrative physiological functions?
DR. SHEWMON: Well, thank you for these questions. Let me answer the last two first. I think I already said I don't think we should maintain indefinitely these patients. I think it's clearly an extraordinary disproportionate means that is not morally obligatory and most of the time is not morally appropriate. The point in these cases—first of all, they weren't my patients, so I had nothing to do in maintaining them, but I just am learning from them.
DR. CARSON: No, what I'm saying is what is your point? If, in fact, you're not advocating that we go through these extraordinary mechanisms of maintaining such individuals if they're brain dead—if we're saying that and if the general neurological community is saying that, what is the point of what you're talking about today?
DR. SHEWMON: Well, the point is whether they are living, comatose human beings or whether they are corpses, and that point makes all the difference in the world for how transplantation of unpaired vital organs is done. So it doesn't make any difference about withdrawing support, but it does make a difference about transplantation of organs. Then what was the fourth question? I forgot already.
DR. CARSON: The fourth question is is it possible that human life consists of more than just the maintenance of integrative physiological functions?
DR. SHEWMON: Oh, yeah. Of course, normal human life does consist of much more than that. The question here is whether these patients are comatose, severely disabled human beings or are they nonorganisms, corpses. So there are many, many disabled people and many comatose people in ICUs whose lives are very incomplete but they're still living. So I think our issue is not whether they have the fullness of human functions or not. Clearly, they don't. But are they living, severely disabled, comatose people, or are they dead people? That's the question.
T.K. did not go through puberty, and most of the children in my series did not go through puberty. Two of them did. I told you about one of them. And regarding the vagus nerve, whether you pharmacologically ablate the vagus nerve or surgically cut it in some hypothetical thought experiment — if you want to be sure you could do this thought experiment and surgically cut it — and then that would be absolutely the same physiologically as the destruction of the vagus centers in the brain stem.
DR. CARSON: In theory, but what I was asking you is are you aware of the work that has been done to prove that, or is this just a theory? Because as you know, historically, many times we have assumed that we knew all there was to know about a particular function of the brain only to discover later on that there was more.
DR. SHEWMON: Well, all I can say is that reading the literature about high spinal cord injury, the intensive care thereof, there's all kinds of autonomic dysfunction, including in the GI tract, and often they give pharmacologic ablation of the vagal nerve to treat cardiac arrhythmias. So there was so much similarity between the ICU treatment of brain death and the ICU treatment of high spinal cord injury that I thought that comparison was quite instructive.
CHAIRMAN PELLEGRINO: Next I have Professor Gómez-Lobo, then Dr. Hurlbut.
PROF. GÓMEZ-LOBO: Thank you very much for your presentation. First, a general remark. I think it's really fascinating when one sees someone challenging the consensus. I think that culture, science, humanities advance in that way. So if there is empirical evidence, for instance, to challenge a view, I think we should look at it and accept the consequences, wherever that may take us.
Now, I would like to ask a specifically ethical question now. Supposing you're right and these are not dead patients, what would be the consequences for transplantation? In other words, it seems to me that the whole legal system in the United States would have to be revised in order to determine when it would be legitimate to obtain organs for transplantation. Could you please comment on that?
DR. SHEWMON: Yeah. The last slide that I was going to show you was two columns of the ideal and the actual with regard to major socio-legal medical changes in a society. And I propose that the ideal sequence of events is that there's a new concept that's introduced. It's studied. It's agreed upon. Then you have the medical community establish diagnostic standards for it. Then you revise the statutory laws accordingly, and then you put it into practice.
And so the actual history of brain death has followed exactly the opposite sequence of events that ought to characterize an ideal major socio-legal medical change. So I think at this point in time it's going to be very hard to change how transplantation is done because it's already so ingrained.
But if we accept that these are comatose living patients, then we need to look for ways of transplanting unpaired vital organs that do not cause the death of those donors. And in some of my writings over the last few years, I proposed a variation on the non-heart-beating donor approach that would allow for recovery of such organs in an ethical way, even on the assumption that these patients are not dead.
And I think the ones with total brain failure or total brain destruction or whatever you want to call it are prime candidates for such an approach to organ retrieval, as well as patients with less-than-total brain failure but who are ventilatory-dependent and in whom it has been agreed independently that it's ethical to withdraw the ventilator because it's an extraordinary means."
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