Our Choice of the Franciscan model of healthcare.

Our choice of the Franciscan model of healthcare was inspired by leading medical institutions such as the Mayo Clinic. The Mayo Clinic has consistently maintained its position at or near the top in hospital rankings in the United States.

What is this Franciscan model that is often the subject of much awe and curiosity?

The Franciscan model we adopt at SD Care requires us to be perceptive to the real needs of people. We must be willing to confront the experience of suffering in those we serve. We must acknowledge that suffering is often not only physical but also psychological and existential, proceeding from a sense of loneliness, of loss of meaning and self-worth. This is especially evident in those with chronic illnesses, the elderly, and those approaching death.

We would point you to a beautiful article written by a medical doctor and Franciscan priest called “Awakened by Love: Saint Francis of Assisi as Model for the Church’s Mission to Health Care and Charitable Service.” It talks about the cathartic moment of St Francis’ conversion when he hugged and kissed a leper at a time when leprosy was regarded with fear.

Francis Mirandah, Founder & CEO

Abstract

Departing from the story of his encounter with the leper, Saint Francis of Assisi is offered as a paradigm of Christian health care and charitable service. In this grace-filled moment, Francis testifies that what had previously seemed bitter to him “was turned into sweetness of soul and body.” He was changed by the encounter and awakened to his capacity to love. Francis’s story witnesses to the divine initiative in calling us to charity, of recognizing the presence of Christ in those who suffer, and of acknowledging that our service of others is a privileged space in which the mystery of God becomes a reality. Weaved together with reflections from recent magisterial teachings, Francis’s experience teaches us that Christian charity can never be reduced to an ideology or the accomplishment of works but flows from a heart touched by God, converted to truth, and expanded by love.

Summary: In speaking to those involved in the charitable mission of the Church, Pope Benedict XVI once spoke of the need for a formation of the heart through an “encounter with God in Christ which awakens their love and opens their spirits to others.” In this reflection, I offer Saint Francis of Assisi as a model of such formation, inspired by the celebrated moment of his encounter with the leper on the road: an encounter which witnesses to the primacy of God’s initiative in enabling us to love with His own love and see His presence in those we serve.

Following the example of the Good Samaritan, the Lord has constantly raised up in his Church persons outstanding in Christian charity toward the sick and suffering: figures courageous in their defense of life and the dignity of human beings created to the divine image and likeness. From among this countless host of witnesses (see Heb 12:1), Saint Francis of Assisi, “small yet strong in the love of God” (^{Francis 2013}, no. 216), emerges as a paradigm of the Church’s untiring mission of care toward the poor and vulnerable. As a Franciscan myself, with interests in health care and ethics, I here offer our Seraphic Father as a model for mission in health and charitable service.

My point of departure is the story of a pivotal moment in the life of Francis in which he encounters a leper on the road and shows him mercy. I do not offer this story as a commentary on leprosy, which has faded from our contemporary consciousness as a disease of the past. Nor, in the name of relevance, do I consider the need to identify possible modern-day equivalents (HIV/AIDS sufferers, the drug addicted, cases of gender dysphoria, street workers, etc.). Rather, I offer this story in its timeless capacity to challenge and inspire our Christian ministry of service to all who are vulnerable: in witnessing to the primacy of the divine initiative as the wellspring of our service, in recognizing the presence of Christ in those who suffer, and in acknowledging that our service of others is a privileged space in which the mystery of God becomes a reality. In its pastoral application, I draw on the thought of recent popes: especially of our current Pope Francis who, in his sensitivity to the poor and vulnerable, has styled himself on the figure of the Poverello of Assisi; and of our emeritus Pope Benedict XVI who treats of the Church’s mission of charity in his encyclical Deus caritas est with a sensitivity that is in harmony with the witness of the saint.

Leprosy in the Middle Ages

While leprosy is not in itself integral to this discussion, a consideration of its social effects, especially in the medieval world, helps to contextualize the nature of Saint Francis’s response. Leprosy (Hansen’s disease, named after Gerhard Henrik Armauer Hansen, a Norwegian physician, who in 1873 identified the disease-causing bacillus, Mycobacterium leprae) is a chronic, granulomatous infection that particularly affects the skin and peripheral nerves, causing the characteristic rashes and bumps, neuropathy, muscle weakness, and awful deformities typical of florid cases. Transmitted via droplets from nose and mouth, the responsible bacilli are not highly contagious; and leprosy is rarely fatal in itself. However, throughout history the mere hint of contagion has sent a wave of fear through people and societies. And while effective treatment has helped temper this fear in the contemporary context, it was a frightening reality in the medieval world of Saint Francis.

More than a disease, leprosy was a life sentence to exclusion from society and banishment beyond the city walls. In medieval Europe, harsh rules governed the movement of lepers. They were forbidden to enter the city. All public places, such as churches, markets, taverns, and mills, were off limits. They could not drink from or bathe in public springs. They were forbidden to touch anything that was not their own without gloves nor to go about barefoot. If venturing beyond the confines of their colonies, lepers were to identify themselves by their unique dress, by sounding a bell or clapper, or by some such sign. They were to avoid coming into close proximity to others, forbidden from walking along narrow paths, or to answer those who addressed them except in whispers, such that others “be not annoyed by his pestilent breath” (^{Weymouth 1938}, 90).

Lepers were the “walking dead” of their time. Their removal from society was associated with a funeral rite that rendered them dead to society. In a fourteenth-century Sarum Manual, it was stipulated that before being caste out from the city, the priest should come to the leper’s home and encourage him to accept his cross and hope for salvation. Then, he would bless him with holy water and lead him in procession to the church: “the cross in front, the priest following, and the sick man last of all” (^{Weymouth 1938}, 15). Once within the church, the leprous man, “as one already dead,” would be placed kneeling under a black cloth stretched between two trestles, like a catafalque over a coffin (^{Weymouth 1938}, 15). Mass followed, at the end of which he was again sprinkled with holy water and led by the cross to his new dwelling. At this point, the coped priest would throw earth on the feet of the leper, saying: “Be dead to the world and again living to God” (^{Weymouth 1938}, 15).

Francis’s Conversion

As a young man, Francis naturally accepted this separation. He avoided lepers and feared and abhorred them. In his Testament Francis attests: “when I was in sin, it seemed too bitter for me to see lepers” (^{Francis of Assisi 1999b}, no. 1, 124). Even at the sight of their dwellings some miles off “he would cover his nose with his hands” (^{Thomas of Celano 1999b}, no. 17, 195). However, in one of the decisive moments in his life all this radically changed. His biographers tell of an episode, before Francis had “left the world” or attracted followers, in which he was confronted by a leper on the road. Instead of turning away in fright, as was his custom, Francis was moved, interiorly impelled, to engage him. And not merely to acknowledge him but to embrace him and kiss him. “And suddenly, as he kissed the lacerated flesh of the creature who was the most abject, the most hated, the most scorned, of all human beings, he was flooded with a wave of emotion, one that shut out everything around him, one that he would remember even on his death bed” (^{Fortini 1980}, 211). From that moment, the direction of Francis’s life changed. Instead of avoiding lepers, he actively sought them out. Several days after his encounter with the leper on the road, his biographers tell us that he visited the leper hospital of San Lazaro, which had previously filled him with disgust. To each of the lepers, he gave alms and kissed them on the hand (see ^{“The Legend of the Three Companions” 2000}, no. 11, 74). He began to stay with the lepers in their colonies and take care of them. “He washed their feet, bandaged sores, drew pus from wounds, and wiped away filth” (^{Bonaventure 2000}, no. II.6, 539). He joined them in their isolation, willingly embraced their rejection, and did not care that others despised him because of it (see ^{Julian of Speyer 1999}, no. 12, 376–77).

In time he would demand the same of his followers, exhorting them to be joyful in living “among people considered of little value and looked down upon, among the poor and the powerless, the sick and the lepers, and the beggars by the wayside” (^{Francis of Assisi 1999a}, no. IX.2, 70). Whether nobles or commoners, all were expected “to serve the lepers and stay in their houses” (^{“The Assisi Compilation” 2000}, no. 9, 123). The leprosarium became a type of novitiate for the first friars; “the indispensable condition for being accepted into the Fraternity” (^{Canonici 1995}, 252). While, with the dramatic expansion of the Order, this intimate association with lepers would fade over time, a sensitivity to the vulnerable and marginalized within society would remain as one of the “charisms” of the Franciscan movement. Francis himself would often remind the friars of this humble beginning and express his desire to return to it at the end of his days (see Thomas of Celano, “The Life of Saint Francis,” ^1999b, no. 103, 273; Bonaventure, “The Major Legend of Saint Francis,” no. XIV.1, 640).

The Divine Initiative

What could explain the dramatic nature of Francis’s change of heart toward lepers? Why should that which had previously been bitter to him be turned into sweetness? (see Francis of Assisi, “The Testament,” ^1999b, no. 3, 124). In his Testament, written at the end of his earthly life, Francis reflects on this pivotal moment of encounter with the leper, recalling what ^{Bodo (1988}, 12) rather poetically calls “the first victory of his new heart.” In this decisive moment, Francis recognized the Lord’s initiative in calling and leading him: “for when I was in sin, it seemed too bitter for me to see lepers. And the Lord Himself led me among them and I showed mercy to them” (Francis of Assisi, “The Testament,” ^1999b, nos. 1–2, 124). According to Francis’s own sentiments, the meeting of the leper on the road was no chance encounter. God willed it as a means of drawing close to him and speaking to his heart. The initiative was God’s. Francis was being awakened to a new reality: a new understanding of himself and his neighbor.

Furthermore, Francis acknowledges that his response to the leper—not to run away, as was his usual reaction, but to embrace him—was likewise empowered by God. The Lord was nudging him toward the leper, opening his eyes to see him as God sees him, and enflaming his heart with a love that overflowed in his impulsive embrace. Accordingly, ^{Benedict XVI (2007)} referred to this moment in the life of Francis as a truly religious experience, “commanded by the initiative of God’s grace and love.” It was not merely a “philanthropic gesture” or “social conversion.” It was a moment of true religious conversion in which God was both reaching out to Francis and enabling him to respond through the gift of his grace.

Francis himself does not give us much insight into the dynamics of this conversion. He merely attests that, with the Lord leading him among lepers, what had previously seemed bitter “was turned into sweetness of soul and body” (Francis of Assisi, “The Testament,” ^1999b, no. 3, 124). His biographers, however, attempt to fill in some of the gaps. What becomes clear is that this graced moment of conversion had a prehistory. It was prepared for by Francis’s naturally generous and impulsive character. He had already begun his inward journey toward God in moments of solitude and prayer. His disillusionment with the world of power and wealth created an opening for the word of the Gospel, to be drawn by the poor Christ to embrace his poverty and weakness as the way to transformation (see ^{Nothwehr 2005}, 11). The flame of charity had already been ignited within his heart. Although the sight of lepers would fill him with disgust, his pity toward them moved him to give alms through an intermediary (see ^{“The Legend of the Three Companions” 2000}, no. 11, 74).

But in the imperfection of his humanity, there were also those obstacles that needed to be overcome and “ground down” by grace. ^{Canonici (1995}, 251) portrays Francis as one who “aggressively combatted himself in a continuous, graced effort that sustained him against the weakness in his nature, against a small-spiritedness.” Such was Francis’s struggle with his gut reaction toward lepers: an instinct, which in the words of ^{Robson (1997}, 19), was “capable of distorting the Gospel” and threatened his newly discovered faith; a sin that “prevented him from overcoming his physical repugnance to recognize them as so many brothers to love” (^{Benedict XVI 2007}). Thus, in that key moment before the leper on the road, Francis is portrayed as “doing violence to himself” (^{Julian of Speyer, “The Life of Saint Francis,” 1999}, no. 12, 377), resisting the instinct to flee from the leper and moving toward him instead. It demanded courage. It challenged his will. It called for humility, “to consider himself less and less, until by the mercy of the Redeemer, he came to complete victory over himself” (^{Thomas of Celano, “The Life of Saint Francis,” 1999b}, no. 17, 195).

Awakened by Love

However, this victory was not merely a renunciation of self-interest, a conversion away from sin. It was at the same time an awakening within Francis to his vocation to love. And in this too the initiative was God’s, in the realization that love given is conditioned by the primacy of love experienced and received. In this one might consider the thought of the great Swiss theologian Hans Urs von Balthasar in his illustration of the awakening of the human subject to love through the analogy of a mother’s smile directed toward her child. von Balthasar ( ^{Balthasar (2004, 76)} ) writes:

After a mother has smiled at her child for many days and weeks, she finally receives her child’s smile in response. She has awakened love in the heart of her child, and as the child awakens to love, it also awakens to knowledge: the initially empty-sense impressions gather meaningfully around the core of the Thou.

von Balthasar suggests that through his gaze upon humanity, which is itself love, God awakens love in the human heart through a similar process. God “radiates love.” His love awakens the human person to his vocation to love. “Insofar as we are his creatures, the seed of love lies dormant within us as the image of God (imago). But just as no child can be awakened to love without being loved, so too no human heart can come to an understanding of God without the free gift of his grace—in the image of his Son” (von ^{Balthasar 2004}, 76). This is also the basic tenet of Benedict XVI’s (2005) encyclical Deus caritas est. God is love. “He loves us, he makes us see and experience his love, and since he has “loved us first,” love can also blossom as a response within us” (no. 17; see 1 Jn 4:19).

Thus provoked by love, Saint Francis was imbued with a new sensitivity. Through his encounter with Christ, whom von Balthasar( ^{Balthasar (2004}, 56) describes as “the self-interpreting revelation-form of love itself,” Francis could perceive the truth of the human person as loved by God. He was graced with new sight, with what ^{Benedict (2005)} refers to as “a heart which sees,” that perceives “where love is needed and acts accordingly” (no. 31). Francis was able to recognize the other as his neighbour and to perceive his need for a sign, for an expression, of love. He was thus “willing and able to physically touch and embrace the untouchables of his day, because he believed that all humans deserve reverence” (^{Nothwehr 2005}, 12); to embrace “in them whatever others loathed” (^{Thomas of Celano 1999a}, no. 3, 320). He was awakened to new possibilities, new dimensions of his own humanity. He was empowered to do surprising and extraordinary things, “that only the power of Jesus’ Spirit could explain” (^{Bodo 1988}, 12), and giving testimony once again to the truth that what seems impossible to our frail and broken humanity is not impossible to God (see Mk 10:27; Mt 19:26; Lk 18:27).

Precisely those aspects about lepers which had previously filled him with disgust—their deformity, their smell, their disease, and their neediness—were transformed into signs of something precious and sweet. But, as Pope Benedict (^{Benedict (2005}, no. 18) writes:

This can only take place on the basis of an intimate encounter with God, an encounter which has become a communion of will, even affecting my feelings. Then I learn to look on this other person not simply with my eyes and my feelings, but from the perspective of Jesus Christ. His friend is my friend. Going beyond exterior appearances, I perceive in others an interior desire for a sign of love, of concern.

Thus, with new eyes for the world, Francis was able to see in lepers an object of divine love: beings created in his image. More specifically, he recognized in them an image of the suffering Christ who identifies himself with the poor, the hungry, the sick, the lonely, and rejected (see Mt 25:35–36). For him, God’s image in man was not something purely spiritual or ephemeral but is also recognized in the weakness and fragility of the human form. In the fragile flesh of a broken man, in the suffering face of a leper, Francis perceived the awful reality of the Incarnation: of God’s kenotic self-emptying in the flesh of the Son of Man. Taking upon himself this humility of Christ, Francis learned to identify with those whom he served. He did not stand over them in his ministry but saw in the sick and the abandoned an image of Christ to whom he desired to be configured more and more.

For Francis, therefore, lepers became a type of sacrament—what Canonici ( ^{Canonici (1995}, 254) again calls an “eloquent image and sign of Christ: Christ who suffers; who took on the sins of the world; Christ who atoned with his own suffering; Christ marginalized by society; Christ who needed love.” Thus, in that moment of awakening, of conversion, Francis perceived that it was Christ before him in the form of the leper. Some of his biographers make this explicit, noting that after Francis had embraced the leper, and continued on his way, on turning back he saw no one on the road: “and although the field was wide open, without any obstructions, when he looked around he could not see the leper anywhere” (^{Thomas of Celano 2000}, no. 9, 249). The leper had disappeared, drawing the reader to presume that it really was Christ himself in a leper’s disguise. And while this interpretation takes us beyond the historical event, it nonetheless acknowledges the truth of Christ’s words in the Gospel, that “as you did it to one of the least of these my brethren, you did it to me” (Mt 25:40). Gifted with a heart that sees, Francis was able to recognize Christ within those whom he served and to reverence them with a divine awe and respect. He thus called lepers by a new name: “Christian brothers” (^{“The Assisi Compilation” 2000}, no. 64, 166), recognizing (in the words of the Council) that through his Incarnation, Christ “has united Himself in some fashion with every man” (^{Vatican Council II 1965}, no. 22).

Practical Application

This accent on the incarnational gives pastoral direction to those involved in health care and charitable services. In Evangelii gaudium, Pope Francis speaks of the pastoral need to be renewed in our sense of the novel dynamic that Christ brings to our relationships with others. Echoing the experience of Saint Francis and the leper, he speaks of the Gospel imperative “to run the risk of a face-to-face encounter with others, with their physical presence which challenges us, with their pain and their pleas, with their joy which infects us in our close and continuous interaction” (^{Francis 2013}, no. 88). He speaks of the need to overcome all suspicion, mistrust, and fear that prevents us from embracing the other. He also warns against the temptation toward a privatized faith in “a purely spiritual Christ, without flesh and without the cross” (^{Francis 2013}, no. 88). The pope’s point is that the Christian faith is a faith of encounter. The logic of the Incarnation is the logic of presence: of gift and service and reconciliation. Following this logic, Christian charity moves forward to those who suffer, boldly takes the initiative, and goes out to others. It is willing to get involved in people’s lives; “it bridges distances, it is willing to abase itself if necessary, and it embraces human life, touching the suffering flesh of Christ in others” (^{Francis 2013}, no. 24).

At the same time, the primacy of the divine initiative, as also witnessed in the life of Saint Francis, points to the source of our charity. One cannot always give love. One must also receive. As Benedict XVI (2005, no. 7) writes:

Anyone who wishes to give love must also receive love as a gift. Certainly, as the Lord tells us, one can become a source from which rivers of living water flow (cf. Jn 7:37-38). Yet to become such a source, one must constantly drink anew from the original source, which is Jesus Christ, from whose pierced heart flows the love of God (cf. Jn 19:34).

Anyone who attempts to render charitable service to others without themselves experiencing the charity of God risks seeing their service as mere activity: a task to be fulfilled, a work to be accomplished—what Pope Francis (^{Francis (2013)} ) characterizes as a failure to integrate the mission of Christ with their work; of seeing it “as a mere appendage to their life, as if it were not part of their very identity” (no. 78). This failure of integration risks rendering our service ineffective. In the first place, it calls into question the merit of our good works. Christian service is not distinguished by activity but by its source in divine charity. Merit is not estimated by the work itself but in its capacity to be directed toward God as an act of love. Furthermore, when viewed as mere practical activity, works of service fail to gauge the needs of those we serve. As Pope Benedict (^{Benedict (2005)}) reflects, “human beings always need something more than technically proper care. They need humanity. They need heartfelt concern” (no. 31). They need affirmation and comfort. They need love. Thus, in addition to the professional competence that is essential to any service, Benedict speaks of the need for a “formation of the heart” through an “encounter with God in Christ which awakens their love and opens their spirits to others” (no. 31).

As a practical example of being perceptive to the real needs of people, healthcare workers must be willing to confront the experience of suffering in those whom they serve. They must acknowledge that suffering is often not only physical but also psychological and existential, proceeding from a sense of loneliness, of loss of meaning and self-worth. This is especially evident in those with chronic illnesses, the elderly, and those approaching death. While euthanasia is often presented as the humane response to suffering at the end of life, Pope John Paul II (^{Pope John Paul II (1995}, no. 66) reminded us that it is a sham and “disturbing ‘perversion’ of mercy.” It fails to perceive that the tortured request to help end one’s life flows from a soul adrift in an ocean of meaninglessness; that it is essentially “a plea for help to keep on hoping when all human hopes fail” (^{John Paul II 1995}, no. 67); that it is a plea for companionship, for closeness, for compassion which, as ( ^{John Paul II (1995)} ) explains, “leads to sharing another’s pain” and not to “kill the person whose suffering we cannot bear” (no. 66).

Christian love has something distinctive to offer in this regard. Our concrete acts of care and love, going beyond mere technical skill, have the power to give comfort and awaken hope. Compassion awakens hope, for hope is essentially the conviction that the love experienced in this life will not end: “the certainty that I shall receive that great love that is indestructible and that I am already loved with this love here and now” (^{Ratzinger 1991}, 70). Our love, limited and fumbling as our attempts might be, points to a surer and enduring love. These small signs of hope lead one into an experience of the great and definitive hope, which is the security of God’s love. In our service, we must be witnesses to this love. Just as Francis drew the leper into the web of divine mercy, so our care should aim at leading others into an experience of God’s love. Accordingly, our service is not just diakonia or martyria but an act of leitourgia in which health care embodies and proclaims the presence of God in our midst (see ^{Fisher 2012}, 296).

Of particular import is the proclamation of God in the midst of suffering. To many, suffering constitutes the absence of God. And in truth, when grounded in contingence, fragility, and incompleteness, there seems to be no room for suffering in God. But when looked at from the perspective of love—from von Balthasar’s ( ^{Balthasar’s (1994)} ) idea of a self-emptying kenosis within God, in which the Father “strips himself, without remainder, of his Godhead and hands it over to the Son” (p. 323), and in which the Son pours out his life in obedience unto the cross (see Phil 2:7)—suffering finds its logic within God himself. Thus, the Christian conviction is that suffering reveals something of the nature of God. It invites one to share intimately in the divine life. Through his Passion, Christ reveals that suffering is not the absence of love but the place of its revelation. Thus, when seen through this lens, human suffering is not defined merely in negative terms but is appreciated as an invitation “to release love, in order to give birth to works of love towards neighbour, in order to transform the whole of human civilization into a civilization of love” (^{John Paul II 1984}, no. 30). And for those who engage in ministry to the sick, it means that before the suffering of others, we enter into the privileged space in which the mystery of God becomes a reality.

Conclusion

Notwithstanding the substantial historical and cultural differences that separate us from the world of Saint Francis, I contend that his response to the lepers of his day offers us a way to engage those who are vulnerable in contemporary society. It is not a matter of identifying the “lepers” of our time nor of imitating Francis in his precise actions. Rather, it is a matter of seeing what he saw, inspired by the humility and love of Christ. I have identified two essential points on which Saint Francis, in his ministry of charity, retains particular significance: (1) in bearing witness to the primacy of divine initiative and, (2) in the Christocentric nature of his ministry, recognizing service to the poor as a privileged place of communion with the kenotic Christ, and thus allowing himself to be conformed to Christ’s humility in being a brother to all. In this, Saint Francis offers hope for an authentic Christian ministry of service, that, awakened by divine love, recognizes the depths of human need, and knows how to respond to it.

Biographical Note

Paschal M. Corby, OFM Conv. MBBS (Hons, Monash University, Melbourne), BTheol (Hons, Catholic Theological College, Melbourne), STL (Lateran, Rome), STD (Lateran, Rome), is a priest of the Order of Friars Minor Conventual in Australia. With a background in medicine, and recently completed doctorate from the Pontifical John Paul II Institute in Rome, he currently teaches bioethics at the institute’s Melbourne campus.

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