President Barack Obama is addressing the future of health care at the Catholic Health Association’s annual assembly today. The Affordable Care Act (ObamaCare) has had a tense relationship with the Catholic Church since its passing in 2009 and subsequent implementation. The controversy has centered especially on the provision of contraceptives in health-insurance plans and a lack of the “robust conscience” protections promised by the president prior to the law’s passing.
However, the expansion of the euphemistically dubbed “reproductive rights” is merely the fruit of a tree with much deeper roots.
Catholics know that, just like in any other area of human life, medical care must be informed by a consideration of the good to be pursued and the evil to be avoided — the so-called first principle of practical reasoning. Further, the bulk of the Church’s teaching on medical ethics is simply an analysis of what is knowable by reason alone. To this end, the distinctive beliefs that mark Catholic health care are meant not only for Catholics qua Catholic, but for every human person.
The “Catholic” approach, then, ought to be distinguished from competing visions of health care — even President Obama’s “naked” approach to health-care reform (to apply Father Richard John Neuhaus’ term for the secularization of public discourse) — by a firm commitment in principle and practice to the Church’s teaching. This is essential to the witness that Catholic health care provides.
Obama’s address provides an occasion to reflect on whether Catholic health care has divested itself (even if only partly) of its distinctive identity in an effort to fit in. While Catholic health care skinny-dips with its secular counterparts, the culture at large finds it more difficult to discriminate between them. Not to say they shouldn’t be in the same pool, but one should be able to tell clearly which is the Catholic party.
Within Catholic facilities there is an uneasy tension among staff and patients on matters of prescribing birth control and referring for sterilization, to give just two examples. Catholic health care’s discomfiture with its own distinctive beliefs has contributed to the homogenization between Catholic and non-Catholic institutions. Remember the whole bit about being “faithful in small things”? It cuts the other way too: Infidelity in little matters leads to infidelity in big ones.
Organizational peccadilloes make easy the path to institutional mortal sins. One day, the hospital administration turns a blind eye toward the doctor who regularly performs tubal ligations during cesarean sections. The next day they propose building a new hospital, which just happens to be in a nicer part of town away from the hospital’s indigent population, i.e., the kind of inconvenient, poorly compliant, health-illiterate type of people Jesus was always healing of their diseases and saving from their sins. If the teaching on permanent sterilization can be discounted, then why not even a less controversial one like the preferential option for the poor?
The Catholic hospital has in some ways been sterilized of its Christian ambiance. Receiving care at Good Samaritan ought to be different from being treated at the state university hospital. The difference should extend beyond the crucifixes that adorn the walls of the former. So far as possible, it should extend the healing ministry of Jesus. It should be Catholic, first and foremost.
What constitutes “health care” is subject to the political and legal climate and to prevailing social mores, as the controversies surrounding ObamaCare have shown. Right and wrong can become democratic determinations. Hence, when the majority approves of contraception, abortion or providing care only to the deserving — i.e., the ones who can pay or who are not deemed “burdensome” to society (e.g., patients with substance dependence or who have been pregnant “too many” times), then these become etched into the stone tablets that define standards of care.
Not so with Catholic teaching.
Catholicism adheres to an unchanging law that circumscribes — to paraphrase G.K. Chesterton, more like the boundaries of a playground than a prison — the scope of activity in all areas of life. It only makes sense to forge one’s moral principles on the iron of eternal law rather than the changing circumstances of social fancy.
The rub is figuring out what these principles entail in practice and then living up to what follows from them. Granted, consistency is one of the most difficult aspects of the moral life for both individuals and institutions, but its pursuit is not for that reason worth abandoning.
In this country, the U.S. Conference of Catholic Bishops’ document “Ethical and Religious Directives for Catholic Health Care Services” is the handbook of Catholic health care, which includes four of the 10 largest health-care systems in the United States, more than 500 hospitals and 700 skilled-care facilities. The handbook explains both the “whys” and the “why nots” of Catholic medical ethics and outlines both the “whats” and the “what nots” of medical practice which follow from them.
Prior to his election to the papacy, Cardinal Joseph Ratzinger preached, “Love without truth is blind, and truth without love is empty.” These are the twin peaks of any authentic Christian mission. In fact, fidelity to truth, to invoke the pope emeritus once more, prevents charity from degenerating into mere sentimentality, which is why the bishops’ handbook negatively proscribes and positively prescribes with equal force.
It addresses moral issues in compassionate but no-nonsense language. For instance:
“Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church’s teaching on responsible parenthood and methods of natural family planning” (52).
A Catholic institution’s identity is not comparable with nor can it be reduced to compliance with Church teaching on contraception. In the moral economy, certainly there are things of greater concern. Nevertheless, the teaching on contraception is a distinctively Catholic belief in this day and age. Fidelity to it ought to be innovative in the setting of Catholic health care and be comprised of something more robust than a footnote in the hospital’s bylaws. At the very least, a winsome effort at evangelization in this arena must begin with its unapologetic acceptance.
On the positive side, the U.S. bishops’ directives enjoin Catholic health care to:
“distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn; single parents; the elderly; those with incurable diseases and chemical dependencies; racial minorities; immigrants and refugees” (3).
On this point, Catholic health care has proven to be salt and light. Catholics lead the charge in alcohol and drug treatment, HIV/AIDS care and geriatrics. And Catholic health care must continue to do so by leading the charge in terms of an unceasing commitment to human dignity in plans for organizational expansion, billing practices and the culture of human dignity fostered within its walls. Obamacare has achieved the laudable goal of expanding health-care coverage and access to the poor. But the Catholic voice must challenge efforts at greater enfranchisement that would do so at the expense of human dignity and fidelity to the moral law — especially within Catholic institutions themselves.
Undeniably, we face an extraordinary crisis in health care. Economic challenges threaten the continued operation of numerous Catholic health systems and force tense mergers with institutions that often hold diametrically opposed convictions on the nature of the human person. Government pressure to conform to the culture threatens the integrity of Catholic hospitals and physicians to practice according to their values.
Health-care providers are increasingly disenchanted with a medical culture that subsumes all other considerations to profit and transmogrifies their role in healing to functionaries of a bottom line at worst or technicians at best. A pervasive spiritual apathy even has patients accepting their place in the “health-care market,” cut off from a holistic approach to their health and lives, and which reduces them to mere consumers.
The Catholic hospital should be the bulwark of truth and the oasis to which the disenchanted and disheartened fly.
The commodification of health care, which has brought secular and faith-based institutions into uneasy alliances as a means to survival, lay somewhere near the root of many of these difficulties. The fight-or-flight response is certainly a mitigating factor when it comes to culpability, but appeasement should not be the default position.
Catholic health care must never forget that martyrdom is always an option and should be willing to challenge the president’s position when it is at odds with Catholic teaching.
Fidelity to Christ must be the default position, even if it means losing one’s life. Better any day to be Ignatius of Antioch and be fed to the lions if the cost of survival is apostasy.
Patrick Beeman, M.D., is an obstetrician/gynecologist in St. Louis.
His writing has appeared in First Things, Our Sunday Visitor, Touchstone
and the National Catholic Bioethics Quarterly.