PASTORAL MEDICINE. - A particular discipline which, through the study of the relationships existing between medicine and morality, seeks to provide the priest with that knowledge of medicine which can be useful to him for the understanding of particular subjects of moral theology and canon law. And here the word medicine is taken in its broadest sense, that is, as «the science which, from the study of physical and psychic man, healthy and sick, and from the environmental circumstances surrounding him, seeks to know the conditions of biological equilibrium, in order to preserve it in the state of health or restore it in morbid imbalances».
The legitimacy of the relationships between morality and medicine is founded on the identity of the material subject, man, albeit different from the formal standpoint, of a spiritual order as regards the former, of a material-immaterial (physical-psychic) order as regards the latter. Now, to the extent that the union of the spiritual part with the material part in us is intimate, in the relationship of form and substance, to that same extent are the relationships between medicine and morality close and profound, and the legitimacy of pastoral medicine as a science in its own right, with its own object of study, is marked out.
From the juridical point of view the priest's work is carried out in a particular form, apparently more solemn, if not more common, when he acts as judge in diocesan tribunals or in the apostolic tribunals of the Segnatura and the Rota, or decides administratively certain questions belonging to the Sacred Congregations (Sacraments, Rites, Holy Office, etc.), in order to resolve problems of which those connected with subjects of a medical nature will be fully grasped by him, so as to arrive at an exact judgment of them, only if he is in possession of the medical part of the subject (for example, in the cases of the Rota for declarations of nullity of marriage; of the Congregation of the Sacraments on the subject of the dispensation «super rato»; of the Congregation of Rites for determining the character of miraculousness of a healing in canonization processes). The judge, in such cases, avails himself of the work of technical experts in the corresponding subjects; but a specific knowledge, even if only of a general order, is nonetheless always necessary for him in order to weigh the value of the arguments, to accept or reject them.
Apart from such juridical activity, the priest, more commonly, is a judge when in the tribunal of Penance he weighs the fault, assessing its gravity in the degree of responsibility, or, even in the external forum, must resolve cases of conscience bearing on matters of a medical nature, or lay down a norm for new social activities connected with the developments of biological science (for example, concerning the practical applications of eugenics, artificial insemination, the treatment of mental illnesses by means of psychoanalysis, narcoanalysis, destructive operations on the cerebral hemispheres); questions which the priest as moralist, before pronouncing judgment, must study and know well from the medical standpoint.
From the educational point of view, the priest is in particular the one who points out the way and the means of virtue. It must not be forgotten that essentially his work is carried out on a supernatural plane and that in guiding souls along the ways of perfection the means at his disposal rest on the action of Grace v (A. Gemelli, La direzione spirituale e le anomalie mentali, in Riv. del clero, 31 [1950], p. 278); but nonetheless the natural contributions that pedagogy and medicine, the human sciences, can provide must not be neglected. Nor can he, in practice, draw a clear boundary between normal and abnormal, and in the infinite variety of individual types to whom the priest as educator directs his work, it is not rare to encounter latent abnormality, which also requires the contribution of medicine. It may be observed that priest and physician both require, along different paths, a laborious and lengthy preparation, such as not to allow itself to be mastered thoroughly by the same man except in exceptional cases; it is not meant here, however, that the spiritual director should make a diagnosis — and every physician knows well how arduous this is — of mental anomaly or infirmity; but rather that he should suspect that in the individual case the person under examination and guidance is on the limits or already beyond the limits of normality, and direct him to the psychiatrist and proceed together with him in concordant action; and this the priest will be able to do only if pastoral medicine forms part of his general culture.
Also necessary for the priest as educator is knowledge concerning questions regarding the procreative function, both from the standpoint of the activity of the individual and of the mutual activity in the marital relationship, that is, the problems of the education of chastity and of the physical exercise of Christian marriage. Now the priest, prudently but sufficiently erudite on such subjects, will more readily and clearly be able, in confession or outside it, to penetrate the meaning of what is said or asked of him, will know how to question with greater exactness and delicacy, and will more effectively rebuke or counsel.
It may be said that at the outset pastoral medicine has origins in common with legal medicine, with which it here and there has a parallel course. Legal medicine, in fact, sets as its object collaboration in the search for truth for the purposes of justice; in certain biological fields it seeks to resolve the problems of juridical capacity and responsibility; it deals with problems more particularly social of welfare and assistance (prevention and insurance of accidents at work, of occupational diseases, forms of assistance for the disabled and the aged, the tubercular and the sick in general). Apart from this sector of legal medicine, of a more exquisitely social order, one sees clearly how great is the similarity of object between legal medicine and pastoral medicine: the human act in function of justice for the former, in function of morality for the latter; juridical capacity and responsibility for the one, moral capacity and responsibility for the other; the aim of a perfect individual and social justice for legal medicine, of an ever greater moral perfection, individual and collective, for pastoral medicine. And indeed such a parallelism of objects is demonstrated by the overlapping of certain fields of their studies: knowledge of the individual in his somato-psychic characteristics at the different ages of life; circumstances and states of physical and particularly mental impairment, the latter capable of modifiing the faculty of understanding and willing and correspondingly juridical and moral responsibility, or capable of determining the act in a vicious direction.
It is not surprising, therefore, that the historical development of the two sciences was first common, then contemporary and collateral. In fact, while in the first centuries after the year 1000 one sees the first formal relationships established between medicine and law and confusedly between medicine and morality, subsequently one witnesses the very clear affirmation of a medico-canonical-moral collaboration. In the Decretals of Gregory IX (1234) under the title De probationibus there is talk of medical examinations in matters of matrimonial nullity, and John XXII (1316-24), definitively reorganizing that tribunal which took the name of the Sacred Rota, in the decretal Ratio iuris exigit (1331) speaks of medical expert reports, which flank 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 out in the Quaestiones medico-legales (3 vols., Lyon 1701) an orderly body of doctrines, not only medico-legal and hygienic, but also medico-pastoral. Zacchia's work remained authoritative until the early nineteenth century, both because of its undisputed value and because pastoral medicine still remained anchored to old positions of scientific dogmatism. Apart from this, even in this interval of time the union between medicine and morality is widely affirmed. For example, in the Teologia morale of St. Alphonsus Maria de Liguori (1748) the entire moral treatment "de sexto" and that on marriage rests on medical knowledge and on knowledge of pastoral medicine. Likewise, among others, in the monographs of P. Florentinus (De hominibus dubiis baptizandis, Lyon 1658) and of F. E. Cangiamila (Sacra embryologia, Palermo 1758) on the questions of fetal animation and the intrauterine Baptism of the fetus. In the last part of the nineteenth century there appear systematic works with a more modern approach, which avail themselves of the ever greater progress of medicine, for example, the Pastoral-medicine of Von Olivers (Freiburg 1892) and the Medicina pastoralis of C. Capellmann (Paris 1893). In the course of recent years there are not a few works published on the subject (v. bibl.), for the most part of value, which take into account the most recent advances of medicine and have been enriched by the most recent medico-moral questions. These are now treated publicly in specialized or general journals, in conferences, in congresses, etc.