I recommended Dr. Leonard Nelson's new book, Diagnosis Critical as a start. It's a very clear intro to the subject - the historical, ethical, canonical and legal context of the provision of
health care by the Catholic Church in the United States. For deeper background, he has some helpful introductory chapters on the shifting grounds of Catholic moral theology over the past few decades.He looks at the development of ethical guidelines over the past century, and the origins of Catholic health care institutions which, it's important to know, in the case of hospitals at least, have never been totally disengaged from government, even before Medicaid and Medicare. Many Catholic hospitals were actually built by local communities, with the physical plant paid for by local governments, with Catholic religious orders invited to staff and run them. This arrangement developed a federal element with the Hill-Burton act in 1946.
The issue of the provision of procedures contrary to Catholic moral teaching broke open in the mid-60's with Humane Vitae and the resistance to it by large numbers of ethicists. This internal resistance, combined with the external economic and government pressures have resulted in the current situation that some Catholic health systems find themself in.
I want to isolate two points from the book.
First, this: One of the arguments you hear - I've read it in relationship to the Caritas situation - quite often is that these arrangements in which Catholic institutions are in some way connected to the provision of morally objectionable procedures is justified by the larger social justice concern of providing health care for communities, especially health care for the poor. Basically: we have to do this to survive economically, and if we don't, what we provide will be lost.
This isn't a new argument. It was advanced forty years ago by ethicist Richard McCormick. Nelson quotes him as he criticized the bishops' 1971 Ethical and Religion Directives (ERDs) for Catholic health care institutions. McCormick's first argument was that many "Catholic hospitals" are no longer that anyway:
Nelson continues to summarize:Increasingly they have become community hospitals, often with heavy non-Catholic staff and clienteles. They were frequently financed through public funds or by appeal to the whole community, and still often enough the only health facility reasonably available to a community. In this climate the concept of a 'Catholic hospital' becomes problematic. (that's McCormick, cited in Nelson)
This should sound familiar. We're hearing a lot of it these days - and the argument plays on the other side as well, as, for example, abortion and contraceptive advocacy groups have fought against Catholic health care institutions buying up other systems, moves that would result in the end of sterilization and/or abortion services in a certain area.McCormick argued it was morally permissable for a hospital to permit immoral procedures when it served 'the total good of its patients.' By way of example he suggested that a prohibition on postpartum sterilization would be unjustified if it would result in the closing of an obstetrics-gynecology department. He thus concluded that 'the revised code does not adequately deal with the phenomenon of cooperation.'
So there's the bottom line: Catholic health care institutions have to survive, and in the present climate, the only way they can is to partner with other entitities, no matter what these other entitites provide or finance. Don't worry, it's said, these bad things will happen in different rooms, on different floors and we won't see the money.
Catholic hospitals must survive.
But...do they?
That's the question with which Nelson ends his book.
The bottom line is that in this crisis, we're talking about financial and government pressures forcing compromise for large healthcare systems that include acute care hospitals.
Is it time for the Church to look at getting out of the acute care hospital business?
Nelson writes:
Is it time for the Church to look at getting out of the acute care hospital business?
Nelson writes:
"The primary role of Catholic health care should be to provide support for the culture of life and to evangelize the secular culture....It is increasngly difficult to perform those roles in the acute care hospital setting. In order to survive financially, Catholic hospitals are entering into complex and nuanced arrangemenst with non-Catholic providers who are involved in providing reproductive services that are incompatible with Catholic teaching. the cumulative effect of all this activity tis to undermine Catholic teaching on abortion, contraception and sterilization. In addition, health care is becoming less personal and more reliant on technology. Perhaps it would be better to divert the resources of Catholic healthcare to alternative minsitries. This could be a series of hospices to support the dying or those in a persistent vegatitve state. It could include a system of family health centers that would provide Natural Family Planning instrucitona and birthing facilities, as well as general heatlh care fo families, clinics in underserved areas that could focus on preventive care, rehabilitation facilites and centers for tcare of the mentally illand handicapped. And all of these efforts should be permeated with spiritual support for both patients and providers.....So there are a couple of points to chew on: First, the argument that social justice demands that Catholic health care continue to exist in its present form, even if such existence requires provision of immoral procedures. Secondly, that the massive-business model centered around the acute care hospital may have to be abandoned by Catholic institutions, and this is not necessarily a bad thing.
It is my hope that the Catholic health care ministry will continue to adhere to the ERDs and promote a culture of life even in the face of challenges from a post-Christian society that embraces a culture of death. It is also my hope that Catholic hospitals will remain free to develop their own value-based moodel of health care free form state and federal legislative mandates that will require them to violate the ERDs But if this is not the case, then the path of resistance to such mandates may become necessary. As the late Robert Cover noted, sometimes resistance to the state provides the deifining moment for a religion. It may be that Catholci health care in the United States will be called up on te reist the culture of death in the face of state attempts to force Catholic institutions to provide immoral procedures. In his last novel, The Thanatos Syndrome, Walker Percy articulates an alternative vision for a marginalized Catholic health care ministry through the fictional character of Fr. Rinaldo, an alcoholic priest who some regard as insane. Fr. Smith's hospice was closed down for a time by medical authorities, but at its reopening, he pleads:
"Listen to me, dear physicians, dear brothers, dear Qualitarians, abortionists, euthanasists! Do you know why you are going to listen to me? Because every last one of you is a better man than me and you know it! And yet you like me. Every last one of you knows me and what I am, a failed priest, an old drunk, who is only fit to do one thing and to tell you one thing. You are good, kind, hardworking doctors, but you like me nevertheless and I know that you will allow me to tell you one thing -- no, ask one thing -- no, beg one thing of you. Please do this one favor for me, dear doctors. If you have a patient, young or old, suffering, dying, afflicted, useless, born or unborn, whom you for the best of reasons wish to put out of his misery -- I beg only one thing of you, dear doctors! Please send him to us. Don't kill them! We'll take them -- all of them! Please send them to us! I swear to you you won't be sorry. We will all be happy about it! I promise you, and I know that you believe me, that we will take care of him, her -- We will even call on you to help us take care of them! -- and you will not have to make such a decision. God will bless you for it and you for it and you will offend no one except the Great Prince Satan, who rules the world. That is all."
A third point, though, and one that Nelso deals with, but delicately: greed, and an enthusiastic, as opposed to reluctant, abandonment of Catholic principles on life.
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Jim,
Catholic hosptials have been receiving government funding for decades including Medicare and Medicaid payments for services provided to the elderly, disabled, and poor. And yes, there are stipulations for receipt of those funds including accreditation of the facility.
It would be impossible to expect Catholics in the pews to finance the care provided in Catholic hospitals without any government third party payments.
Given other opportunities, few women want a life of poverty and servitude. The system that grew up in the nineteenth and and twentieth century depended on the labor of women who were paid little more than room and board for a lifetime of service. Furthermore, that system worked when most hospital care involved little more than meals and nursing care. Today's hospitals require millions of dollars of equipment and supplies to provide the standard of care we've come to expect from modern medicine. No patient with chest pain would tolerate being put in bed for two weeks, provided with nitroglycerine, bed baths, a light diet and the prayers of their dedicated nurses.
Karen said: "I'm not and have never been Catholic. I disagree with every single assertion in Humana Vitae and think that it's the worst possible policy."
Karen, I am curious as to what drew you "Amy Welborn's Catholic journey through life's mysteries"?
"Your Name" wrote:
"Given other opportunities, few women want a life of poverty and servitude."
Such a dismissive description of the women and men in religious life who built our Catholic schools and Catholic hospitals! It's truly disgusting!
As I said earlier in this thread, Catholics have just swallowed American materialism hook, line and sinker. Even the most conservative American Catholics somehow seemed just as addicted as anyone else to feeding on the American governmental teat.
Once we defined the fields of private, faith-based schools and hospitals..........now we just want more governmental dollars pumped into our systems for the rich elites.
So, if someone else will contract with the government to do certain jobs, why should a Catholic group take that on unless we do something that won't otherwise get done? Like teaching young people the Catholic faith every day they're in school?
In medicine, the gaps increasingly, are providing care as if each patient is a child of God, not a diagnosis code.
For women, providing NFP and prenatal care without the pressure for screening and abortion if there's a "problem."
For the disabled, especially if the problem is neurological, we might be the only ones left who want to care for them. And the government might not be willing to pay us for it.
People will get cardiac stents and ACL repairs for their knees if Catholic healthcare vanishes.
Maybe we need to focus on the other concerns I listed. I'm really not sure someone else will pick those up.
The biggest problem I have is with Boston's claim that if they don't do this with government money, then they won't be fulfilling their duty to the poor. Sorry, but that's not the way it works. Being a funnel for government money doesn't fulfill the mandate, "I was sick and you cared for me." Notice that statement -- "YOU cared for me." Not "you got taxpayer dollars to hire nurses and doctors to tend my wounds." The Good Samaritan cared for the injured man with his own time, beast and money. Catholic health care is Catholic when it uses Catholic money to do its job.
This is like Catholic Charities being a funnel for government money. All it does is put you in bed with the government, hence the problems which Caritas Christi is facing today. One cannot expect to ally oneself with the government -- even in the cause of doing good -- and not expect Caesar to make demands.
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