Our religious duties towards the sick

by Doctor Pierre Barbet

Doctor Pierre Barbet, a surgeon at Saint-Joseph Hospital in Paris, is known for the studies he conducted on the Shroud of Turin in the 1930s. He examined the anatomy of the man who was laid in the Shroud, based on the traces of the body and blood visible upon it. He did so with all his skill as a surgeon and at the same time with great emotion, understanding the excruciating sufferings that Our Lord had endured during His Passion. We knew a priest who had attended the lecture he gave at the seminary in Issy-les-Moulineaux in 1938 on the physical Passion of Our Lord. Pierre Barbet was so moved that he wept; it was the first and last lecture that he delivered on that subject! He never dared to give another.

His booklet Our Religious Duties Towards the Sick was published in 1936 by the Archconfraternity of Our Lady of the Sacred Heart.

“CAN we ever condemn strongly enough the notion occasioned by both a false sense of professional duty among Christian doctors and a false sense of filial duty among the faithful making them lamentably fear that (by speaking to the sick of their religious duties) they are going to shorten the number of days, the number of minutes that the poor body will go on gasping for breath?”

I am entirely in agreement with Father Doncœur. Our death and that of our loved ones must not be an accident; the death of a Christian cannot be improvised. We must know in advance what we have to do in these grave hours, and we will only totally fulfil our duty if we are prepared for it. Yet, it must be said that, even in the most religious circles, death is all too often an improvisation, a catastrophe that one refuses to acknowledge until the final gasps of agony. The family and the doctor have but one thought, even when hope seems lost: to direct all their efforts, all their thoughts and those of the patient towards a single goal: recovery. It is still “too early” to call for the priest; any “emotion” could be dangerous; the “doctor has expressly advised” that the patient be left to rest (or, at the very least, that is what he is made to say!) And so it is that the poor priest, who asks for nothing more than to do his duty, provided he is given permission, arrives to administer Extreme Unction – that “Sacrament of the Sick” – to a dying person, or to administer absolution without confession to someone in a coma.

It is therefore we, the laity, who do not always and completely fulfil our duty, and it is to us, the laity, that I propose this collective examination of conscience. Moreover, it seems to me appropriate that it should be a lay person, not a priest, who writes this; the lay person, including us, doctors, must beat his breast for not always having done all he ought to have. That fact that it should be a doctor who is writing can only be an advantage: it is he, more than anyone else, who has seen his brothers die. Who better than a Christian doctor can fully understand what death is? Does he not, after all, have special duties towards the sick, since his ministry makes him in some way responsible, not only for their bodies, but also for their souls? This is a truth that a Catholic doctor must not doubt, and we will deal with this further below.

The idea of responsibility lies at the heart of this entire meditation: we are responsible for our own eternal salvation, but we are also, collectively and personally, responsible for that of all our brothers to the best of our ability. This is, moreover, merely a particular form of charity; and, if “well-ordered Charity begins with oneself”, it must extend widely to all people, being all the more active and effective the closer those people are to us. Hence it follows that, in the face of death, we have responsibility for souls: first for our own, then for that of our loved ones, and finally, for us as doctors, for that of our patients.

Now, what is death? Science replies: the cessation of life; and I am not exaggerating! As for life, for an organism, it would be the act of multiplying its cells and transforming ingested food into their specific substance: multiplication and assimilation. This proves that science wishes to know, and can know, only material facts. For us Christians, in whom Revelation has shed some light on divine Knowledge, the death of a human being is caused – regardless of the physiological phenomena that accompany it, as in animals – by the separation of the immortal soul from the perishable body. A separation that is, moreover, temporary, since our bodies will be resurrected on the Last Day, freed from all their earthly bonds, to be reunited with their souls and to enjoy or suffer eternally for what, with or in spite of God’s grace, they have deserved during this brief earthly life. This is our admirable dogma of the resurrection of the body, one of the most human and at the same time most divine dogmas: et exspecto resurrectionem mortuorum.

Death is therefore, for us, merely a passage from this temporary life to eternal and definitive life, to true life. It is the ‘transito’ of Saint Francis of Assisi, the passing away; do we not say of a dying person that he is about to pass on? It is the return to the Father’s House, the entry into the normal state, the long-desired union, and for ever, with God and those who have gone before us with the sign of faith. If it is painful, as on a great journey, to leave behind on the quay those who are not setting out, at least we know that they will soon join us. If the flesh rebels – and this is the consequence of original sin – the soul, at any rate, must rejoice at the approach of great happiness. How I understand that Christian, my friend Dr Jean Camus, who, on his deathbed, asked his wife and his twelve children to recite the Magnificat immediately upon his passing!

All this is nothing but elementary truth for us Catholics, and I apologise for having to state it. But, whilst we know it, it does not seem that we know how to live it, and, once again, improvisation is of no value. Our whole earthly life ought, in truth, to be a long preparation for death, which would thereby lose its air of disaster: “Blessed,” says The Imitation, “is he who always keeps the hour of his death before his eyes and who, every day, prepares himself to die,” for, as Jesus said: “The Son of Man will come at an hour when He is not expected.” It is this whole admirable Chapter XXIII of the first Book of The Imitation that we ought often to meditate upon. Then, yes, we would manage without too much difficulty to die willingly, to die wholly, as Jacques Rivière writes, to give, following Christ’s example, our soul, which no one was to snatch from Him; not to endure death, but to consent to it, to live our death; to make, as we simply say, the sacrifice of our life; to die, at last, joyfully, that is to say, to be born, truly and consciously, into the arms of the Lord.

Alas! These dispositions are all too rarely realised. But there are, in illness and in its sufferings, particular graces whose effects we, as doctors, observe: through divine goodness, they place our seriously ill and dying patients in a spiritual state that is generally far better than one might suppose and than their families usually expect.

This is a fact on which I must insist, because it is little known and because ignorance of it leads at every moment to appalling misunderstandings, whereas it so greatly facilitates all the efforts of those around them: the seriously ill and the dying almost always harbour a secret desire for a priest and for the comfort of religion.

Never, during the war, in my ambulances, where the chaplain had free access, did I see a wounded person refuse to hear him. The same might be true in civilian practice. Let us first set aside a certain number of cases of invincible obstinacy; these are not due to ignorance, for those who are ignorant of religion, in our France which has, alas, once again become a mission country, are quite happy to have it revealed to them at this supreme moment, provided they have sensed a little kindness in those who offer it. No, these forms of resistance stem from a long-held attitude of pride, from a sin against the Spirit that blocks the path to grace; or else it is a matter of prior commitments, such as membership of Freemasonry, for example, and you can be sure then to see a circle of people, often outside the family, ensuring that the unfortunate soul does not ‘waver’ at the last moment; a work of demons who may well receive their reward at the hour of death.

In the vast majority of cases, the sick person, even when he has long since ceased to practise, reflects on the end of his life and, quite naturally, the illusions of life that obsess the minds of the healthy dissipate like a cloud before his eyes. Little by little, the light dawns; the fire of faith, which smouldered beneath the ashes, flares up into sparks; the desire for reconciliation takes shape and grows, like a thirst for peace, a pledge of eternal certainty. As all this generally takes place in the secrecy of the conscience (I speak of this based on confidences), the result is that the sick person is very often, on the path to salvation, further along than those around him.

Yet he dares not speak of it. He sees his family’s grief – a grief poorly concealed from him – and he fears adding to that pain or despair. Often, he realises the extent of his state, but, unconsciously, he clings to the lies he is fed; he senses so clearly that, if he speaks of his death, he will be told he is not there yet. So he lies too; he lies through reticence, he lies by omission; he pretends to believe in the vain encouragements, in the fallacious promises of recovery. A tacit understanding develops between the dying person and his loved ones, as if not speaking of death could delay it, and this tragic agreement in falsehood will continue and become entrenched; for it is always harder to speak as the outcome seems less uncertain; death is all the more frightening the closer one feels it is. The right moment has passed, when one could still, more or less sincerely, present it as an authentic reality; on both sides, people are becoming increasingly reluctant to speak of it.

But in the meantime, anxiety grows ever more in the patient’s conscience; sometimes, I have seen him, to the point of tearing away the veil of falsehood and bursting into a pitiful cry for help: “Are they going to let me die without the sacraments?” All too often, however, this cry is timid, shameful, quickly stifled by affectionate assurances and so-called certainties of improvement. The sinister hypocrisy continues from then on until the agony gradually dissolves the last vestiges of mental faculties, without alleviating the anguish. At the very last moment, when they believe they can safely remove the mask of falsehood without endangering the human wreck gasping in bed, they will quickly send for the priest, quickly, quickly (How is it that he is not here yet!). The unfortunate curate will do his best, standing by this half-corpse incapable of communicating with him, giving a conditional absolution; then leaving, heartbroken, commending him to divine mercy.

And the family, grim and foolish, will moan piously, between two wipes of a handkerchief: “He had a very good death; he did not suffer; he did not see himself dying at all.” – How dreadful! – And the obituary will state: “Fortified with all the sacraments of the Church. Pray for him!” – Oh yes, pray for him! And pray for his family, who have gravely failed in their duty! “Do not rely on your friends and relatives,” says The Imitation.

We have seen what happens all too often; let us say what the sick person and those around him must do. Let us first note that these duties of charity, which are binding on every Christian, will be all the easier to fulfil the sooner one begins to deal with them. It will be easier because humanly speaking, this charity will have created a habit, a state of mind; and divinely speaking, every effort is met with an increase in grace. Once again, this condemns improvisation: “Consider yourself on earth as a pilgrim and a guest,” says The Imitation, and again: “You can do many good works whilst you are in good health; but when you are ill, I do not know what you will be capable of.”

For the Catholic who has obeyed these precepts, the question hardly arises, or rather, he will resolve it spontaneously, making things right with God at the slightest warning sign. Yet we still have a duty to warn him, if he does not realise the danger: we are not masters of his conscience, and even the most edifying Christians may have their stain of sins from which they ought to cleanse themselves, even if they are venial: Purgatory is not so pleasant that we should not strive to shorten the ordeal.

For everyone, when is the right time to intervene? I say it plainly: before the certainty or imminence of an approaching end.

If one then advises the sick person to draw closer to God by receiving his priest, it is much easier, to affirm – with a conviction all the greater for being perfectly sincere – the possibility of all hopes of recovery; and these are nuances that patients, who are otherwise so easily deceived, grasp very well. One can reinforce this persuasion by adding that one would do the same in such a case, without waiting for the danger of death to arise. Moreover, even if the patient has not agreed to this first invitation, it will be much easier, later on, when the danger has worsened, to return to the same advice, keeping it in a similar form, or making it slightly more urgent, without this appearing to be a grim announcement of imminent death.

It is an excellent technique; take it from a practitioner. I am so convinced of this that I feel it necessary to encourage those who are about to undergo surgery to follow the same approach (I am speaking, for the moment, only of confession and communion). The risk involved – and this is a surgeon speaking – although often minimal, is nevertheless always real. All the more so if it is a serious operation. This has become so ingrained in our customs, for us Catholic surgeons, that there is a colloquial expression in our French hospital jargon which, though vulgar, is perfectly apt for the great journey. If we ask a nun: “Has such a patient waxed his boots?” To answer affirmatively, she replies that the chaplain has seen to it.

Therefore, it is the duty of those around the patient to act as soon as possible. But if, due to circumstances, we reach the critical stage without having done anything, Oh! then, I beg you, you who are at the bedside of a dear relative, do not wait any longer to alert him! I know this requires courage, if you yourselves are not deeply imbued with the Christian truths we have just examined, or rather if, whilst believing in them, you have not made a habit of living them out. But this courage will soon be rewarded. It also requires great gentleness and charity. But is not the greatest charity to love, above all, the soul of one’s brother? True love disregards one’s own suffering. In measured, tender yet firm terms, tell him that there is danger for him, for his eternal rest, that he must make his arrangements, that he will be more at peace once his spiritual affairs are settled. You do not know how right you are!

You will be amazed at the joy you bring to this poor sick person, who is still in full possession of his intellectual and emotional faculties: “But I wouldn’t have it any other way.” – “Why didn’t someone tell me about this sooner?” – “I was waiting for someone to suggest it to me.” Do not forget that the sick person, even if he is in full possession of his faculties, is very often like a big child, whose will is somewhat diminished (as evidenced by his whims), and needs to be guided.

Once this is done, the priest will come. He will grant absolution after a lucid confession, and bring him the Body of Jesus Christ. Quite naturally, the sick person will accept, and sometimes even ask for Extreme Unction; especially if one knows how to explain to him – and many are unaware of this – that it is the sacrament for the sick, and not for the dying. How often have we seen a physical improvement follow this administration, which is not only beneficial to the soul! It is a matter of common experience.

Once you have fulfilled one of the most sacred duties – without which all declarations of love are nothing but lies and palinodes – you will be amazed and delighted by the good you have done, perhaps without even realising it. I have described to you this secret anguish, which we so often sense, of the unconfessed sick person. Once the patient is in right with God, you will no longer recognise him. It is the relief of someone who sees the light again upon leaving a prison; it is peace, great peace, a foretaste of eternal Peace; the feeling of security, of total and trusting surrender into the Lord’s hands, come what may: “How happy I am! How grateful I am to you for having brought me such joy! Now I am at peace; now I can die!” How often have we heard these poor words, so divinely significant!

Henceforth the barrier is broken, the one that kept a distance between the family and the beloved patient, a distance that was filled with mutual pretence, so painful for everyone. That desperate, strained effort – painful as a cramp – towards a life we know full well cannot last, is now over. There will still be pain (is there anything else of value on earth?), but a pain that is soothed, divinely reasonable, in communion with the pain of Jesus, co-redemptive of that of the Divine Crucified One. We shall be able to speak of death, because we have at last understood what it really is; we knew it, but we lived as though we did not. Instead of the fall into the black hole of the unknown, instead of the heart-rending and definitive separation, the future will open up with bright prospects of eternal happiness and reunion in Paradise. The farewell, though still a hard trial, yet full of merit, will, in absolute submission to Providence, no longer be that lamentable farewell created by our practical paganism, but the sublime adieu that soothed the agony of our forefathers.

And if the body’s resources, sometimes unknown to itself, aided by God’s grace, do not bring about convalescence and healing, it will be a gentle journey towards death, a gentle death, even in suffering, a death accepted in full knowledge. I would almost call it a desired death, so much can union with the divine will elevate our will above its meagre human possibilities; a death, at last, lived in perfect union of heart and love, not only with God, but with those dearest to us whom we are about to leave for such a short time.

Compare and tell me if this is not better than agony in falsehood, than the bestial struggle of the animal clinging to life: if this death is not akin to that of Christ, if it is not the only one truly worthy of a Christian. And this, relatives who cry out in your grief and protest your love, this depends entirely on you!

I would have finished this examination of conscience were it not for the fact that I must still briefly examine our own, that of doctors. I say briefly, because it is, in truth, only a special case: its importance stems from its relative frequency.

Our colleagues are rather divided on the existence of their spiritual duties in the face of illness and death. Some take practically no interest in them and do not even raise the issue. Others consider the issue and resolve it in the negative: they take the principle that we are here to care for the body; that the family and the priest should look after the soul; the latter is not within their remit. I know doctors, even among good Catholics, who, out of excessive reserve or discretion, would feel they were overstepping their remit if they ventured into this area!

However, it should be noted that, quite apart from any direct and spontaneous intervention on the patient, the question already arises in a way that makes it necessary to resolve it: the family, willing to do its duty, asks the doctor whether it is time to call the priest. Now, the doctor often has a policy of concealing the truth from his patient until the very end, of lying to him about the gravity of his state, on the pretext that he needs to preserve as much of his strength as possible. It will therefore be very difficult for him to abandon this rule; he will tend to delay the priest’s intervention until the very last moment; he may even use his influence to alarm the relatives about the dangers of such ceremonies, which he portrays as harbingers of death, and exaggerate the need to spare the poor patient any emotional distress. I have encountered far too many of these villains!

What is more, when the family knows the truth and is aware of its responsibilities, it ignores these empty threats and, with heavy hearts, tries to warn the patient. But as his doctor has fully reassured him, the patient may reply that he is not actually that ill yet. Fortunately, his trust in his loved ones, his own hidden desire, may prevail; but he is already somewhat in a state of confusion. And if he continues to rely on the words of his quack doctor, must we tell him that he has lied?

For he has lied and, moreover, he has made a grave mistake. “And even if these great efforts of prayer and trust,” writes Father Doncœur, “were to cause him to die, like Saint Benedict, inter verba orationis,● would we retain an image less precious of our loved ones than that of this endless humiliation?” Yet that is not even the issue: as I have already said above, and I solemnly affirm this in my soul and in my conscience as a doctor, I have never seen or heard of a worsening of the illness following a visit from the priest and the administration of the sacraments. I do not say ‘The Last Sacraments’, for one never knows whether they will be the last. How many times, on the contrary, have I observed an alleviation of moral and physical anguish, which can only be beneficial to the body’s resistance? Let us put an end to this stupid prejudice once and for all!

It is therefore becoming increasingly clear that, whether he likes it or not, the doctor bears responsibility. I must say that there are many, particularly among non-believers – and I am pleased to point this out – who, respecting the feelings of their patients, would have scruples about letting them die without having done what is necessary according to their beliefs. I have known some who, whilst admiring our faith without sharing it, would press the family, sometimes on the pretext of worldly affairs to be settled. There are good people everywhere.

In such circumstances, with an intelligent and Christian family, the doctor’s role is relatively straightforward. But if the family, steeped in all-too-common prejudices, shirks its duty or formally rejects it, what should be the doctor’s attitude – and I mean the Catholic doctor’s? It may be that the parents are cowardly and that they themselves delegate the doctor to inform the patient. This is rather rare; for this to happen, the doctor must have clearly expressed his opinion on the need to involve the priest. We all agree that we must inform the family. I also believe that no Catholic doctor would refuse the task of informing the patient, if the relatives entrust it to him.

However, for the doctor to be able to help the patient, he must not have been lying to him systematically since the onset of the illness. Admittedly, we must, in our dealings with him, appear optimistic, “cheer him up”, and this is part of the treatment. But we have to know how to measure out the truth to him – it is a matter of tact –, whilst giving him hope of recovery. This is, moreover, wiser than lying to him shamelessly, at the risk of losing his trust. We can thus be of real help in the event of danger. But how much more prudent and easier it is, if possible, to act sooner, whilst all hopes are still genuinely permitted. We can then present this making things right with God as a remedy intended to give him the necessary peace of mind. And we shall indeed see his resilience improve thereafter.

But what if the relatives, whilst retaining responsibility for themselves, wish to delay the priest’s intervention until the final decline, until the coma? There are still, in the presence of the sick person, a holy complicity with God. It is not for good reason that hospitaller nuns devote their entire lives to physical care. It is, of course, already a great deal for their spiritual growth to perform works of corporal mercy and to regard their patients as members of Christ: “I was sick and you visited Me.” But they are also concerned for the souls of their patients. And if one might be surprised to find them not only in hospitals among the poor, but even in nursing homes among the rich, it is because, there too, eternal lives are at stake, and their devotion is rewarded by the salvation of poor souls. It is therefore generally easy for the doctor to act through the nun or the Catholic nurse; and God knows how many conversions we see them bring about!

That we must work through the family and make use of the discreet zeal of our helpers is beyond dispute, but, in my view, this is not enough and we are not fulfilling our full duty if we do not go further. Pilate washed his hands!

We must – and I emphasise this all the more strongly as this view does not enjoy unanimous support, even within Catholic circles – we must, and it is a sacred duty, act discreetly towards our patients. This is to help the well-disposed but timid family, to guide and persuade those with foolish prejudices, and to stand up to and force the hand of hostile or malicious relatives. I am well aware that I shall be called a sectarian, but I have always regarded public opinion as an excellent armchair, in which one sits very comfortably.

For, to put the matter on a divine plane, setting aside all worldly chatter, it is none of the hostile family’s business; it is not they who are ill. It concerns only the patient; it is he who is going to die, to be judged by God; and, for Heaven’s sake, he is old enough to make his own decision, provided he is made to face up to his responsibilities. That is the whole question: the rest is mere verbiage and lies. If the family takes offence, so much the worse for them! Why did they choose a Catholic doctor, and why did Clémenceau have himself treated by nuns? Let them accept us as we are, without trying to split us in two: we are not Catholics who practise medicine, nor doctors who practise a religion; we are Catholic doctors, everywhere and always. If the patient refuses, then we bow to his will, because it is solely his affair, alas! his sole affair; all we can do is pray for him; our responsibility is discharged.

For, and I return to my starting point, we have a responsibility – I affirm it – a duty of charity towards our patients; and every duty entails rights. We are responsible not only for their bodies, but also for their souls, to the best of our ability. And that is why we must not wait until the last moment to win over that soul, which is, in a way, the ward of our own. If we truly live out our Catholicism, our patients know full well whom they are turning to, and we can do good with little effort. A word spoken in passing, a hint, a frank and simple attitude, a way of speaking quite naturally about what we do for ourselves, places us in their minds on a very clear footing, without ostentation, without provocation, for what we are, with the quiet pride of a faith that one cannot help but envy. Frankness pleases everyone, even those who lack it.

If there are narrow-minded, sectarian souls – yes, those to whom this attitude displeases – goodness gracious, let them find another doctor! But no, they know full well that, if we Catholics often possess a few small virtues, a little conscience, a little affection for our patients, it is our faith that is the source of it. So let them allow us, as well as our dear nuns, to seek – and this for their own good – our greatest reward beyond this world!

Doctor Pierre Barbet.