PASTORAL MEDICINE. – A particular discipline which, by studying the relations existing between m. and morality, aims to provide the priest with those medical («m.») notions that may be useful to him for understanding particular subjects of moral theology and canon law. Here the word m. is taken in its broadest sense, namely as “the science which, from the study of the physical and psychic human being, healthy and ill, and of the environmental circumstances surrounding him, seeks to understand the conditions of biological equilibrium, in order to preserve it in a state of health or restore it in pathological disequilibria.”
The legitimacy of the relations between morality and m. rests on the identity of the material subject, man, though differing in formal aspect: spiritual in order as regards the former, material-immaterial (physical-psychic) in order as regards the latter. Now, to the extent that the union of the spiritual with the material part in us is intimate, in the relation between form and substance, to that extent are the relations between m. and morality close and profound, and the legitimacy of p. m. as a science in its own right, with its own object of study, is established.
From the juridical point of view, the priest’s work takes place in a particular form, apparently more solemn, if not more common, when he acts as a judge in diocesan tribunals or in the apostolic tribunals of the Segnatura and the Rota, or decides administratively certain questions belonging to the competence of the SS. Congregations (Sacraments, Rites, Holy Office, etc.), in order to resolve problems whose aspects connected with medical subjects he will fully understand and judge accurately only if he possesses the medical component of the matter (e.g., in cases before the Rota concerning declarations of the nullity of marriage; before the Congregation of the Sacraments regarding dispensation “super rato”; before the Congregation of Rites in determining the miraculous character of a cure in canonization proceedings). In
such cases, the judge makes use of the work of technical experts in the corresponding subjects; but he always also requires specific knowledge, even if only of a general nature, in order to weigh the value of the arguments, accepting or rejecting them.
Apart from this juridical activity, the priest is more commonly a judge when, in the tribunal of Penance, he weighs guilt by assessing its gravity in terms of the degree of responsibility or, even in the external forum, must resolve cases of conscience involving medical subjects, or establish a norm for new social activities connected with developments in biological science (e.g., concerning the practical applications of eugenics, artificial insemination, the treatment of mental illnesses by means of psychoanalysis, narcoanalysis, and destructive operations on the cerebral hemispheres); questions which the moralist priest must study and know well from the medical point of view before passing judgment.
From the educational point of view, the priest is particularly the one who points out the path and the means of virtue. It must not be forgotten that essentially his work takes place on a supernatural plane, and that, in guiding souls along the paths of perfection, the means at his disposal are grounded in the action of Grace v (A. Gemelli, La direzione spirituale e le anomalie mentali, in Rio del clero, 31 [1950], p. 278); nevertheless, the natural contributions which pedagogy and m., human sciences, can provide must not be neglected. Nor can he, in practice, draw a sharp boundary between the normal and the abnormal; and in the infinite variety of individual types to whom the priest educator directs his work, it is not uncommon to encounter latent abnormality, which also requires the contribution of m. It may be observed that priest and physician alike require, by different paths, an arduous and lengthy preparation, such as cannot be mastered thoroughly by the same person except in exceptional cases; it is not meant, however, that the spiritual director should diagnose an abnormality or mental illness—every physician knows well how arduous this is—but rather that he should suspect, in the individual case under examination and guidance, that the person is on the borderline of, or already beyond, normality, refer him to a psychiatrist, and proceed in association with the latter in concerted action; and the priest will be able to do this only if p. m. forms part of his general education.
The priest educator also requires knowledge concerning questions relating to the procreative function, both from the standpoint of the activity of the individual and that of the mutual activity within the marital relationship, namely, the problems of education in chastity and the physical exercise of Christian marriage. Now the priest who is prudently but sufficiently well versed in such subjects will be able, in confession or outside it, to penetrate more readily and clearly the meaning of what is said or requested of him; with greater accuracy and delicacy he will know how to ask questions, and with greater effectiveness how to admonish or advise.
It may be said that, in the beginning, p. m. had origins in common with legal medicine, with which it has here and there followed a parallel course. Legal medicine, in fact, makes collaboration in the search for truth for the purposes of justice its object; in certain biological fields it seeks to resolve problems of juridical capacity and responsibility; and it deals with more specifically social problems of welfare and assistance (the prevention and insurance of workplace accidents and occupational diseases, forms of assistance for the disabled and the elderly, tuberculosis patients, and the sick in general). Apart from this sector of legal medicine, which is of a more distinctly social nature, it is clear how great the similarity of subject is between legal medicine and p. m.: the human act in the service of justice in the former, and in the service of morality in the latter; juridical capacity and responsibility in one, moral capacity and responsibility in the other; the vision of perfect individual and social justice for legal medicine, and of ever greater individual and collective moral perfection for p. m. Indeed, this parallelism of subjects is demonstrated by the overlapping of certain fields of their studies: knowledge of the individual in his somatic and psychic characteristics at the different ages of life; circumstances and states of physical and particularly mental impairment, the latter being capable of modifying the faculty of understanding and willing and, correspondingly, juridical and moral responsibility, or capable of determining the act in a vicious direction.
It is therefore not surprising that the two sciences had a common historical development at first, then a contemporaneous one, and subsequently a collateral one. Indeed, while in the first centuries after the year one thousand the first formal relations between m. and law, and confusedly between m. and morality, can be seen to have been established, one subsequently witnesses the clear emergence of medical-canonical-moral collaboration. In the Decretals of Gregory IX (1234), under the title De probationibus, medical findings concerning matrimonial nullity are discussed; and Giovanni XXII (1316–24), while definitively reorganizing the tribunal that came to be called the S. Rota, speaks in the decretal Ratio iuris exigit (1331) of medical expert opinions to assist the work of the tribunal.
But a scholar of pastoral medicine appears only in the first half of the seventeenth century, when the Roman P. Zacchia (v.) sets forth in the Quaestiones medico-legales (3 vols., Lyon 1701) an ordered body of doctrines, not only medico-legal and hygienic, but also pastoral-medical. Zacchia’s work remained authoritative until the beginning of the nineteenth century, both because of its undisputed value and because medicine still remained anchored in old positions of scientific dogmatism. Apart from this, during this interval the union between medicine and morality also became widely established. For example, in the Teologia morale of St. Alfonso Maria de Liguori (1748), the entire treatment of morality «de sexto» and that concerning marriage rests upon medical knowledge and upon knowledge of pastoral medicine. Likewise, among others, this is the case in the monographs of P. Florentinus (De hominibus dubiis baptizandis, Lyon 1658) and F. E. Cangiamila (Sacra embryologia, Palermo 1758) on the questions of fetal animation and the intrauterine Baptism of the fetus. In the latter part of the nineteenth century, systematic works with a more modern approach began to appear, drawing upon the ever-greater progress of pastoral medicine—for example, Von Olivers’s Pastoral-medicine (Freiburg 1892) and C. Capellmann’s Medicina pastoralis (Paris 1893). In the course of recent years, a considerable number of works have been published on the subject (v. BIBLICA), largely of value; they take account of the most recent advances in medicine and have been enriched by the most recent medico-moral questions. These matters are now discussed publicly in specialized or general journals, at conferences, congresses, and so forth.