Abstracts for Contributed Papers University of St.

Thomas Catholic Intellectual Tradition Lecture: Self-Body Dualism and the Question of Euthanasia I argue that the advocacy of euthanasia is often based, explicitly or implicitly, on a body-self dualism, that is, on an identification of the self with a consciousness that inhabits or possesses a body. In fact we are animals (albeit of a very special kind, rational, self-determining animals) and so we continue to exist, and have inherent dignity and full moral worth, for as long we exist. I also re-examine the distinction between intentional killing and forgoing extraordinary means to preserve life, and argue that withholding food and water is almost always intentional killing. Dr. Patrick Lee Professor of Philosophy Franciscan University of Steubenville, Steubenville, Ohio

Keynote Address: Palliative Care: European Practice and Perspectives The European Association for Palliative Care (EAPC) project aims to gain knowledge and understanding of the development of programs to promote end of life and palliative care and more effective pain relief across Europe. This project aims to be valuable to governments and policy makers committed to improving national or regional health care systems. The task force is an opportunity to share information and experience with health professionals interested in appropriately approaching end of life care matters in an ever more culturally diverse working environment. Reliable information on the development and provision of palliative care across Europe, however, remains scattered. For this reason, in June 2003, the EAPC Board agreed to the creation of an official Task Force to research palliative care developments in the European region. This session will update on developments mapped to date. Dr. Carlos Centeno Palliative Care Unit, Clnica Universitaria University of Navarre, Pamplona, Spain Board Member of European Association for Palliative Care

Battling and Bearing: Two Metaphors for Courage in Illness Relatively recently people have begun to use a new metaphor to describe courage in illness, that of making a brave fight or battle against illness. This metaphor has to a large extent replaced the older metaphor of bearing illness bravely. The two metaphors seem to represent different attitudes towards the nature of the courage which can be shown by a sick person. Interestingly, the difference between the two metaphors seems to correspond to the difference between the account which Aristotle gives of courage, and that given by St Thomas. This difference is shown by the fact that Aristotle chooses as the prime example of courage the courage of the soldier, while Aquinas chooses the courage of the martyr.

I suggest that the attitude to illness expressed in the bearing metaphor is more basic to courage in illness than that expressed by the battle metaphor. The battle against illness is only to be found in a few cases, while bearing illness and its concomitants is likely to be found at some stage of every illness. To talk exclusively of the battle against illness may leave the patient, the medical care-givers, and the family trapped in Kubler-Rosss stage of anger or even in the stage of denial. But bearing an illness is something that can be done and is of value at all stages of an illness and of ones reactions to it. Dr. Christopher Martin University of St Thomas, Houston

The Medicalization of Death and Dying There are two basic understandings of what it means to be human and a person, and these two concepts underlie two diametrically opposed views on the discipline and practice of medicine, the Hippocratic and the New Medicine. This paper briefly shows these two approaches in understanding death, dying, suicide and despair, euthanasia, killing/letting die, ordinary/extraordinary care, PAS, advanced directives/living wills, PVS, brain and brainstem death and terminal sedation. A gradual change from the Hippocratic to a new model of disease, underlies so many of the conflicts in ethical and moral decision making in our time. Marcella Colbert Respect Life Office, Diocese of Galveston- Houston

Keynote Address Brain Death Criteria and the Organismal Function of Human Beings from Conception to Natural Death Various attempts have been made to define the beginning of human life coincident with the onset of brain activity (i.e. brain life), thereby establishing brain function as the unifying criterion for both human life and human death. Dr. Condic proposes that organismal function is the defining characteristic of human life. She will discuss the relationship of brain function to organismal function, illustrating that loss of brain function is a legitimate criterion for death not because the patient has ceased to think or reason, but rather because in postnatal stages of human development, the brain is required for organismal function. Organismal function is observed from conception onward to natural death by any means. During embryonic development, organismal function both precedes and gives rise to brain function. Thus organismal function provides a unified criterion for defining both the beginning and end of human life. Dr. Maureen Condic Associate Professor, Department of Neurobiology and Anatomy University of Utah, School of Medicine

Ethical Considerations for the Treatment of those in a Vegetative State This paper deals with a number of problems related to the treatment of comatose patients. A study of the cases of Karen Ann Quinlan, Nancy Cruzan and, most recently, that of Terri Schindler Schiavo reveals a pronounced change of juridical attitude in regard to the legal status of such patients. In each of these cases, American courts ruled that life support systems could be removed from these patients in the conscious expectation that their deaths would result. With judicial approval, Karen was removed from ventilator support so as to bring about her death. In the Cruzan and Schiavo cases, the courts ordered that feeding

tubes be removed so that they would die of starvation and dehydration. The paper will explore the philosophical issues involved in such decisions. An action that, in another context, would be labeled murder and/or euthanasia now has been given legal sanction. In the case of Nancy Cruzan, the Supreme Court of the United States has established the legality of the practice for the entire country. The author aims to answer fundamental questions that are raised by the general acceptance of this practice. Is the comatose patient still a living human person despite her being apparently unaware of her surroundings, being unable to care for herself, and being unable to communicate with other humans? Can one human being or whatever reason, act so as to terminate the life of another human being guiltless of any crime? Can a second party act in such fashion so as to cause the death of another human person even if requested to do so? In answering these questions the author draws upon the philosophy of the human person and human worth articulated by Aristotle and by Thomas Aquinas. Declared teachings of the Catholic Church on these subjects are also explored. The recently promulgated statement of Pope John Paul II on the matter of appropriated care for the comatose is proposed as providing wise guidance for all, especially for Catholic hospitals and hospices that must face these problems almost daily. Dr. Joseph Graham University of St Thomas, Houston

The Hospitality of Hospice: Forming Temporary Communities for the Sick or the Dying The earliest type of hospice, like the one established by St. Basil in Caesarea for those displaced from their communities by disease and poverty, was a natural outgrowth of the hospitality conventions in the ancient world, the practice of which marked a people as civilized. These conventions were part of a carefully articulated process for the temporary absorption of the stranger into the community. Someone with authority in the community is alerted to the coming of a stranger and must make the decision to lead the stranger over the threshold and admit him into all of the privileges, provisions, and protection the community affords to its members. Hospice, whether a place apart or taking place in the home of the sick or dying person, recognizes the displacement caused by disease and the crucial need to relocate the person within a new community constituted precisely for the persons care. An examination of hospitality practices of ancient and early Christian cultures suggests ways of understanding the needs of those in care and their caregivers. Dr. Mary Catherine Sommers University of St Thomas, Houston

Keynote Address Palliative Care in North America Modern palliative care emerged in the United Kingdom in the late 1960s as a response to the unmet need of terminally ill patients and their families. This originally British movement soon became global and the first North American palliative care programs emerged in Canada in the late 1970s. The purpose of this presentation is to discuss the different components of palliative care programs in North America. This presentation will address some of the most important problems faced by patients and their families and how North American palliative care programs attempt to address these needs. The presentation will discuss the different components of an interdisciplinary palliative care program and the different settings where care takes place including inpatient acute care facilities, palliative care units, consult teams, home care, and inpatient hospice care.

The mechanism for coordination of these different components and areas where a major cultural change is required will all be discussed. Dr. Eduardo Bruera Director, Department of Palliative Care and Rehabilitation Medicine University of Texas M.D. Anderson Cancer Center

The Human Person as the Subject of Suffering Why does it tell us about human beings that we generally have a negative response to suffering; we usually think it is unfair? Why do we experience a need to make sense of suffering? Why is it that those who spend a year of their life fighting cancer often find that year to be the richest and most meaningful year of their lives? In Evangelium Vitae, Pope John Paul II states that the modern age has a distorted attachment to the values of doing and having over those of being. This talk explains what the values of being are, why they are to be preferred over doing and having, and why suffering is a predictable doorway to the discovery of the values of being. Dr. Janet Smith Fr. Michael J. McGivney Chair of Life Issues Sacred Heart Major Seminary, Detroit

Aquinas and the Cry of Rachel I examine Jacques Maritains critique of a Thomistic explanation of suffering from his 1942 Marquette Aquinas Lecture, St. Thomas and the Problem of Evil. At Summa Theologiae I, 48, 2c Aquinas explains that evil results from corruptible things that are in turn necessary for the perfection of the universe. Using the Biblical personage of Rachel, who has lost her children to the soldiers of King Herod, Maritain poignantly observes that Aquinas reason would never satisfy a mother suffering the loss of her child. What can be the value of the perfection of the universe in comparison to the loss of a young and innocent human being? And so, according to Maritain, one must balance 48, 2, with Summa Contra Gentiles III, 112, in which Aquinas describes the rational creature as a person. This description means that the rational creature is more like a whole than a part thereof. Hence, Martian concludes that human suffering is better understood as the unfortunate result of the rational creatures free refusal of divine love, i.e., as a result of original sin. In my opinion, neither of Maritains two reasons hold. First, SCG III, 112, never ascribes to humans the exalted sense of person used by Maritain. Rather, Aquinas characterizes the rational nature as: a principle part, closest to a whole, closest to existing always. Also, the chapter concludes with Aquinas insisting that the rational creature is still divinely ordered to the perfection of the universe, the very context of 48, 2. Moreover, at SCG IV, 52, natural and spiritual defects are so much natural defects following upon matter that they, contra Maritain, are no sure sign of original sin. Consequently, second, Maritains Rachel is basically demanding a supernatural assistance that God is not obliged to provide. God could preserve humans from all harm as he did our first parents in the state of innocence; God could protect the will from all sin as he did the will of the Blessed Mother; God could create food in the bellies of beasts so the devouring of other animals and humans would be avoided; finally God could continually created matter so that its taking up into the divinely protected higher species would not bring the universe to a grinding halt. But all of these scenarios are expressly supernatural and so are not demanded by our natural condition. In conclusion, I think that Rachel would be dissatisfied with 48, 2, but not for the reason that Maritain gives. Closely considered, 48, 2, only shows how evil is possible not why evil is actual. But Rachel is

mourning an actual evil the slaughter of her children. Aquinas cannot show why evil is actual, not because of a dearth of explanations, but because of a plethora of explanations. Evil may exist because it is a natural defect, or because it is punishment for an original transgression, or because it is a crucible to another and supernatural life, etc. On the philosophical level all of these explanations for actual evil, even the supernatural ones, are able to be seen as possible. Hence, what the Thomistic philosopher should do is to refer Rachel to a consideration of religions. In the religious domain decisive claims are made in respect to an explanation of the actuality of evil. That is where Thomistic philosophy must leave it. Dr. J. F. X. Knasas University of St Thomas, Houston

Suffering and Transcendence Women witness much suffering that they cannot eliminate but can alleviate through their belief in transcendence. Although there are various types of transcendence, only the belief in immortality makes suffering bearable, while only love makes suffering a joy. Women must therefore become witnesses to hope in order to alleviate inescapable suffering. Dr. R. M. Lemmons University of St. Thomas, St Paul MN

Suffering & Evil Arguments for euthanasia and assisted suicide often begin with the proposition that suffering is an evil. The argument then quickly turns to other matters. On this initial point, I will examine two questions that are often passed over: first, how should we understand evil in general?, and what sort of evil is human suffering? In De Malo, Thomas Aquinas distinguishes several ways in which something might be an evil. I will use this discussion as a framework for attempting to answer the questions above. In closing, I will argue that this same framework can illuminate the shift that often occurs from an argument for euthanasia based on the evil of suffering to an argument for euthanasia based on the evil of limited rationality. Dr. C. Deavel University of St. Thomas, St Paul MN

The Theology of Grace & the Ground of Hope Hope is an expectation that a good end would emerge from a situation that would not usually warrant such expectation. Given that such good ends can only follow from the actual possibilities within a given situation, genuine hope must be based on our knowledge of the possibilities within a particular situation. One must employ the particular disciplines that are pertinent to understanding the nature and intrinsic possibilities of some given situation; thus a political question must employ political science, situations regarding challenges to ones health must rely on medical investigations, and so on. What, then, would the discipline of theology have to offer in any given situation? Thomas Aquinas and those who follow in his footsteps would assert that one could employ the appropriate sciences and arrive and a pretty good understanding about the possibilities of a given situation; man can use reason to investigate our plight and to distinguish genuine hope from wishful thinking. Theology speaks of possibilities that emerge, not merely from the nature of things, but from the possibilities of divine action. In this paper I wish to follow in the footsteps of Thomas Aquinas and explore how a hope in such possibilities that might emerge as a result of divine action are is not to be derided as an unfounded reliance

upon miracles. Thomass doctrine of divine grace lays out an understanding of the nature of Gods action on our behalf, and in doing so presents a framework for distinguishing between the genuine hope that we might have in our reliance on God, as well as the genuine limits to what we might expect out of divine action on our behalf. Whatever limits there might be to what we might hope for will be understood through an account of divine grace as the ground for such hope.

Dr. R. J. Barry Providence College, Providence RI

Did Jesus Have Hope? An established component of palliative care is the importance of hope. Christians consider their hope in God to be critical in coping with illness, emotional distress and spiritual well-being. They believe that the Bible is a valuable resource in helping outline practices of hope such as prayer and fellowship. However, how should we think about Jesus own hope? What do we make of the fact that while the Gospels refer to Jesus trust, there is very little, if any, direct reference to his hope? Is trust the same as hope? Moreover, traditional Christological formulations of Jesus humanity do not make pay enough attention to the emotions of Jesus and thus believers are not given all of the resources they might need to cope with suffering. This paper proposes these formulations be reconsidered so that they reflect in a more precise way the experiences of those who are suffering. This can be done so by building a Christology that gives an increased priority to the role of hope in the life of Jesus. Dr. A. Sutherland Loyola College in Maryland

The Role of the Suffering Mystagogue The spiritual relationship between God, self and others is an important emerging dynamic that is being better understood in the theological discipline. In this context, theological inquiry takes on the responsibility of answering questions about relationships between people and with God. Suffering can no longer be understood as either merely a philosophical subject of inquiry or a purely subjective experience of individuals. Suffering is always contextual, relational and communal, and because it is so, those who suffer play an important role in leading their community closer to God, whether they know it or not. I describe this role or vocation as that of the suffering mystagogue. The role of the suffering mystagogue is to lead others to conversion, help them to find meaning in their lives, and ultimately to mediate Gods divine love, which is the only source of meaning in suffering. For Christians, the life, death, and resurrection of Christ are what give meaning to their experiences of suffering. Jesus Christ is the paradigmatic and preeminent suffering mystagogue because he leads us into the mystery of suffering, shows us the meaning of it, and mediates Gods love to us. The role of the suffering mystagogue can be understood by using the mystery of faith stated in the memorial acclamation of the liturgy of the Eucharist in the Roman Missal (Christ has Died, Christ is Risen, Christ Will Come Again) as a framework.

Mr. C. Whelan Saint Marys University, San Antonio

Letting Go Is Not Giving Up

End of life care in the United States can be characterized by zealous belief that we have the power to keep someone alive. This belief is played out by families, patients and caregivers on the battleground of giving up versus letting go. These two are distinctly different medical, psychological and spiritual paths that lead to a common end. Giving up is characterized by struggle, dread, fear, defeat, unyielding and a fear of God while letting go is the antithesis of these things. How each of the three groups involved, the patient, family and caregivers, reaches their own level of acceptance is heavily influenced by individual prejudices and cultural pressures. Personal awareness of preconceptions and the ability to articulate them facilitate ultimate acceptance. Acceptance is letting go. Rev. D. Garvis Hospice Chaplain Houston Hospice Critical Care Center

Palliative Care for the Professional Caregiver -- Focusing the Lens on Ourselves As Palliative Care professionals we are accustomed to attending to our patients as whole persons and identifying their understandings of life, suffering and hope in relation to their clinical condition. We spend much of our time in close proximity to physical and emotional suffering. However, we seldom attend to ourselves as whole persons or apply the philosophy and goals of palliative care to ourselves or our professional relationships. This paper will draw parallels between our professional and spiritual journeys and discuss the importance of integrating crisis points on those trajectories, toward a goal of nurturing the life affirming passion of the caregiver-patient relationship. Rev. Ms. S. E. Kelly, MDiv Spiritual Care Coordinator Blanchard Valley Health Association, Findlay, OH

Communicating Bad News to Patients in Circumstances Where There Is No Protocol In the eyes of the medical field communicating bad news to a patient is strategically formulated as a plan of action that must be learned to enable a physician to be properly trained and emotionally equipped to support his or her patient through a difficult situation. In the eyes of a patient it is much more simplified. They want from their doctor an honest and empathetic evaluation of their condition. Physicians should give information on which patients can build their hope. They should be adaptable, recognizing the fact that every patient is different and realize that they can never be 100% right all the time in communicating something as imponderable as death. Physicians must be honest to themselves and deliver the message as if they were the recipient. The results of this study are ongoing. Dr. M. MacLeod Kasetsart University, Bangkok

Keynote Address The Supreme Court and Oregons Death with Dignity Act Oregon is the only state in the union that permits physician assisted suicide. Attorney General Ashcroft determined that physicians who use federally controlled substances to induce death in their patients would be violating the Controlled Substance Act, and risk loss of their prescribing privileges. The Attorney General of Oregon challenged that conclusion in

federal court, arguing that patient autonomy and the right of states to define medical practice trumped the federal government's interest in a consistent national drug policy. The position of Oregon challenges the historical consensus that assisting suicide is not a "legitimate medical purpose." The federal government argued that assisting suicide is antithetical to the proper conduct of a physician in the "usual course of his professional practice." Medical treatment has as its ultimate end the restoration or preservation of the patient's health and the relief of suffering, not the termination of the patient's life. During oral argument, members of the Supreme Court were troubled by the "either/or" nature of the choice the case seemed to present - either recognize the traditional role of the states in defining medical practice or recognize the federal government's right to establish a national drug policy.

Dr. Teresa Collett Professor, School of Law University of St Thomas, St Paul, MN

Human Dignity, Human Rights and the End of Life: The North Wind Blowing from Canada Recently U.S. courts have been drawing on Canadian constitutional rights jurisprudence, notably on the issue of same-sex marriage. This paper will examine another development in Canadian constitutional law the reliance on a conception of human dignity to anchor the interpretation of constitutional rights. Human dignity, in the Canadian constitutional context, places a heavy premium on the primacy of individual autonomy and tends to regard pain and suffering as an affront to dignity. The paper will assess the implications of such a conceptualization of human dignity for the judicial determination of end of life issues. Dr. D. M. Brown Stikeman Elliot LLP, Toronto, Canada

Does Suffering Have an Ethical Value? This paper presents a philosophical argument for the position that suffering can have an ethical value relevant to medical specialization of palliative care. It considers the end of palliative care as proposed in the W.H.O. definition, to improve the quality of life of patients and their families, and the methodology stated in that definition, to prevent or relieve suffering. This paper argues that the stated methodology must admit of certain exceptions, on the grounds that to improve the patients quality of life may necessitate the omission of the prevention or relief of some suffering on the part of the palliative caregiver. An example would be for a patients physician to omit to administer the most effective pain medications in the patients last hours so that he or she could bid goodbye to his or her family, and make his or her final act of contrition (which acts require lucidity). The full version of the paper considers some common objections which are omitted in the version for oral presentation. Mr. A. Somerville University of St Thomas, Houston

Pain Relief and Neo-Scholastic Medical Ethics The rise of modern Western medicine in the 20th century gave doctors and patients the ability to alleviate pain with some regularity/reliability. This development occurred in a significant way in Catholic hospitals, which led to reflection on medicine and its practice by Catholic moralists. While this literature has been all

but forgotten (or perhaps ignored) by contemporary medical ethicists, it provides interesting historical and philosophical arguments about the ethics of early medicine. One of these medical developments was pain medication. Authors S. A. LaRochelle and C. T. Fink (who published their Handbook of Medical Ethics in English in 1942) asked under what circumstance it was licit or illicit to provide pain relief in itself, especially if the effects of such medication would impair the senses and the mind and perhaps even hasten death. Their primary concern with the use of any pain medication was the effect it would have on the rational and spiritual life of the patient, especially in his final moments of life. Their answers employed primarily the principles of proportionality and double effect, although they always explicitly allowed prudence and the doctors or nurses own informed conscience to make the final determination. This latter element is often ignored in the caricatures presented about these neo-scholastics and manualists, but it is essential for an accurate description of their ethics for two reasons. First, the constant innovation of the medical field, its knowledge of the human body, and new medications makes any judgment about specific techniques and drugs liable to obsolescence. Second, the individual nature of the moral life itself cannot be reduced to principles alone to determine good moral acts but must always be judged prudently according to the particular circumstances of each individual case. Both of these elements require that doctors and nurses be able to judge how to use new treatments without the guidance of moralists; in other words, these manualists are not simply dogmatic in their works but clearly recognize the need for virtue, especially in the medical profession. While much of their discussions concerning specific drugs and treatments are no longer relevant to contemporary practices, the arguments and principles they used can still be helpful to our discussions. Examining these early moralists of medicine may prove to be beneficial for a number of reasons. First, it will enable us to understand an important and often ignored period of scholarship in medical ethics. Second, this examination may show us how best to proceed in our own inquiries regarding these critical questions of palliative care.

Mr. M. Lomanno University of St Thomas, Houston

Recognizing the Value of Suffering in Caring for Terminally Ill Patients In this paper, I present reasons why a terminally ill patient, enduring extreme levels of pain and suffering, can nevertheless find an instrumental value to their suffering for both religious and non-religious goals. I proceed by first delineating the concepts of pain and suffering and then demonstrating that pain and suffering at any level may have an instrumental value. Religious goals include the development of personal integrity, as in the Japanese samurai concept of bushido, and redemption, as in the Christian concept of uniting oneself with the redemptive suffering and death of Christ. Pain and suffering are, in various religious contexts, conceived of as a form of punishment or atonement for sin, as a source of healing, or as a trial leading one to virtue. Non-religious goals of suffering include a patients self-fulfillment, their experience of respect and love in solidarity with their caregivers and the rest of humanity, and the exercise of autonomous self-determination in responding to their experience of pain, suffering, and impending death. I conclude with guidelines for how patients, their family and friends, and health care workers should respond to the experience of extreme pain and suffering in order to create intimate interpersonal bonds between a patient and their caregivers, which in turn can lead to the realization of self-fulfillment for all involved. Dr. J. Eberl Indiana University

The Dynamics of Not Knowing and Knowing: A Psychosocial Perspective of Suffering and Hope

Dr. M. Lockey University of Texas MD Anderson Cancer Center Approaching the Threshold: Relational Spirituality in End-of-Life Care This paper focuses on the centrality of the relationship between the caregiver and dying patient within a Hospice situation. This relationship bears the potential of what I call relational spirituality. I understand spirituality as involving the experience of transcendence the moving beyond ones self both horizontally to positively engage other people, and vertically to humbly encounter ones Higher Power, God. This transcendence is achieved relationally i.e., through the very attitudes, words and actions of the patient and caregiver in their daily communications with each other. I use insights from several existentialist philosophers to develop this notion within the Hospice context. Tillichs notion of the courage to be provides the umbrella for my reflections. Merleau-Pontys understanding of ones body as ones point of view on the world serves as the foundation. I also employ Jaspers concept of communication as a loving struggle, Marcels notions of availability and engagement, Heideggers view of oneself as ones history, Sartres notion of freedom, and Husserls distinctions regarding time. My goal is to offer applications of these philosophical concepts to the real-life situation of caregivers and their dying patients. I am convinced that as the caregiver (and patient) gain more knowledge, awareness, and insight into the dynamics of their relationship, the partnership will be nurtured. As their partnership is nurtured, their relational spirituality will blossom.

Dr. G. Matejka Ursuline College, OH

Session VI. Suffering and Hope: the Testimony of History, Literature and Religious Experience Wrastle ageyn heuvynesses: Treating Mental Illness in the Middle Ages In approximately the year 1419, Thomas Hoccleve, poet and civil servant, wrote in his poem, Complaint, that five years earlier he suffered a mental breakdown, his wylde infirmitee, in which the substance of my memorie wente to pleye as for a certain space. God, however, made it to retourne into the place whens it cam, his wit was hoom come ageyn. Hoccleve makes use of specific vocabulary, which describes his experience as a journey from illness to health, from madness to sanity. How did medieval patients negotiate this journey? What strategies were available to enable mentally disturbed individuals to alleviate their suffering and return to their former selves? Allen Thiher, in Revels in Madness, suggests that the mad live their madness in conformity with the explanatory model that [their] era offers. The medieval era offered many treatment possibilities to the medieval patient, treatments that were in accord with medieval theories of mental illness. These included a variety of approaches: the physical/medical: restraints, fasting, flogging, medicine, diet, exercise; the religious/spiritual: prayer, penance, pilgrimage, meditation, exorcism; the intellectual: music; philosophy; rational discourse; and the social: work, friendship, conversation, creativity. This paper will explore how one medieval patient, Thomas Hoccleve, constructed a regimen of appropriate treatments that provided the model for his definition of a successful journey back to sanity and a future of hope, free from illness. The paper will further explore the binary oppositions implicit in Hoccleves response to his illness, illuminating the difference between illness and health in terms of a series of contrasts -- private/public; paranoia/trust; exclusion/inclusion; isolation/friendship; sloth/work; anonymity/identity; reticence/self-expression; and secrecy/revelation which were both drawn from and available to the greater community.

Dr. J. Gordon-Kelter University of St Thomas, Houston Magnanimous Virtue the Fruit of Redemptive Suffering Within our society, suffering is exploited within the entertainment media as violence. It is seen within daily life as that which is to be avoided at all costs, even in some cases, suicide. We will consider the positive fruit of suffering, that is, virtue, as seen in the life and writings of John Chrysostom and the late Pope John Paul II. Sr. Madeleine Grace CVI University of St Thomas, Houston

Affliction is a Treasure: Suffering and Hope in Donnes Devotions upon Emergent Occasions In the winter of 1623, John Donne Dean of St. Pauls Cathedral, the best metaphysical writer of the Renaissance, and the greatest love poet in the English language lay dying, probably of typhus. Although he eventually recovered, Donnes affliction produced one of the most penetrating and beautiful explorations of suffering ever undertaken, his Devotions upon Emergent Occasions. This presentation addresses several essential questions regarding the Christian understanding of suffering, as embodied in Donnes seminal exploration. First, what is at stake in our capacity to suffer? From Donnes point of view, what would a life devoid of vulnerability look like? To what degree do our contemporary biomedical attitudes toward suffering and its relief reflect the desire for such a life? If we take Donne at his word, how might we amend these aspirations in light of his perspective? Second, how can suffering enhance wisdom, our understanding of what it means to be human? What aspects of the human condition does suffering illuminate? What must we do to learn and grow from suffering? Finally, how can we foster such insight among patients and health professionals? How might we change our educational and institutional practices to foster the understanding and hope to which Donne thought suffering can give rise? Underlying each of these inquiries is one of the deepest and most timeless of human questions. In view of the great toll suffering exacts on human life, how could someone so gifted and wise as John Donne regard it as a treasure? Dr. R. B. Gunderman, Mr. B.P Brown Indiana University

The Development and Nature of the Ordinary/Extraordinary Means Distinction in the Catholic Tradition Ethical questions surrounding end of life issues are concerns that those most of us living in the 21st century and beyond will have to face. The bioethical challenge is how to uphold dignity of human life standards in the face of an improving technology capable of conserving life much longer than in years prior. This advance forces us to make fundamental moral distinctions about how aggressive we are to be in prolonging life. One Catholic bioethical principle is that a person is not morally obligated to use extraordinary means to conserve their life. But what does this mean and how does it differ from ordinary means? This essay

will cover the origin, development and contemporary magisterial understanding of this ordinary/extraordinary means distinction, and then briefly address the question of applying it in the case of artificial food and hydration. Mr. S. Sullivan University of St Thomas, Houston

FOR MORE INFORMATION ON THIS CONFERENCE CONTACT: Christopher Martin Center for Thomistic Studies University of St Thomas 3800 Montrose Boulevard Houston, Texas, 77006 U.S.A. or by e-mail to martincf@stthom.edu