Catholic health care facilities need to be vigilant

By Carol Glatz

VATICAN CITY (CNS) – In their mission to serve all people, Catholic health care facilities also must be vigilant in maintaining their Christian identity and protecting the life and dignity of the human person, said the head of the Pontifical Council for Health Care Ministry.
“It’s fundamental that Catholic health centers maintain their proper identity without compromise, welcoming everyone without, however, ceding to harmful forms of secularization or relativism,” said Archbishop Zygmunt Zimowski, council president.
The archbishop opened the council’s Nov. 15-17 international conference, which focused on “The Hospital, Setting for Evangelization: a Human and Spiritual Mission.”
Adhering to the Gospel is “almost impossible to undertake and maintain faithfully” if people don’t see their work as “an authentic vocation” and if people’s lives are “devoid of faith in humanity and charity-love,” he told the nearly 600 participants from around the world.
While Catholic health workers are expected to be at the forefront in medical and scientific developments and therapies, they must also “humanize” such progress, protect patients from being turned into “mere objects,” and respect all human life from its conception to its natural end, he said.
Catholics who are inspired by their faith “have to be proponents and pioneers of an ethical formation that will accompany their professional studies,” said Msgr. Jean-Marie Mupendawatu, the council’s secretary.
Health care workers can’t ignore ethical problems they encounter on the job thinking such dilemmas are a concern only for ethicists and moral theologians, he told journalists Nov. 13.
Experts in ethics and morality aren’t making abstract pronouncements “from an ivory tower” nor are they regarding “the necessary and exciting progress of science and technology” with suspicion and distrust, he said.
Morality and medicine, ethics and science have to work together in partnership and translate into ethical and moral practice in the workplace, he said.
In a talk Nov. 15, South African Cardinal Wilfrid Napier of Durban told conference participants that “bishops need to speak up in support of health care workers” and to support them spiritually.
Catholic “workers are under tremendous pressure to conform to political whims” that go against church teaching and their facilities run the risk of forfeiting public funding when they refuse to cooperate with unethical policies, he said.
Bishops and the religious orders that run Catholic facilities need to be “the caregivers of the caregivers,” helping them face the risks and withstand the pressures by bolstering their faith, he said.
Offering people in the health field spiritual and pastoral support “dignifies their work, grounds their work in God and inspires workers to see their work as a service to Christ and to the least of his brothers and sisters,” Cardinal Napier said.
U.S. Father David G. Murray, who worked at the Pontifical Council for Health Care Ministry for 12 years, has begun a project with the Rome Diocese to help Catholics apply the Gospel in the field of health care.
The Christian Association for Health Care, which can be set up in any facility – public, private or Christian – by Catholics who work there, aims to gather Catholic employees and help ensure their identity shines through in action, he told Catholic News Service Nov. 10.
“There is a lack of communion among the different health professionals” in each facility, said Father Murray, who also works with the Idente Missionaries of Christ the Redeemer.
Professional barriers need to be broken down so Catholic administrators, doctors, nurses, assistants, volunteers, janitors, security and so on can unite to manifest the Gospel, he said.
“You can’t testify the Christian spirit unless there’s a genuine Christian spirit” manifest in the unity of people coming together as one family, he said.
By coming together, the Catholic staff can lobby administrators on policies and practices, which could include simple measures to protect patient dignity during an exam or even working for recognition of the right to conscientious objection for more grave matters, he said.
“We feel it’s useless to talk about the Christian spirit if you don’t fix something that’s wrong in the health system. People will never believe that you are actually doing the will of God if you don’t take care of these details” of concretely protecting and respecting human life and dignity, he said.
Association members also would come together for prayer and education aimed at developing “a deeper understanding of the human being” and its unity of body, mind and soul, he said. Such a strategy is even more necessary as dioceses or religious orders sell their facilities or turn control over to secular administrators, Father Murray said.
In these instances “we can concentrate on the spirit of the Catholics who are at the facilities,” he said, “empowering them spiritually, humanly and doctrinally so that they can be the church in the health field.”
Bishop Robert J. McManus of Worcester, who is a member of the U.S. bishops’ Committee on Doctrine and chairs its subcommittee on health care issues, attended the Vatican health care conference.
He said that in the United States, the Catholic identity of Catholic hospitals “is rooted in and overseen by” the bishops’ document, “Ethical and Religious Directives for Catholic Health Care Services.”
“That document really presents the Catholic framework and identity which should characterize the hospital that calls itself Catholic,” he told CNS Nov. 15.
As the number of religious men and women who worked at and ran Catholic facilities in the United States decreased, the need grew to articulate clearly the elements that constitute a Catholic insitution, he said.
“When the sisters and the brothers were there, the Catholic identity was very much enforced by their presence,” said Bishop McManus. As they began leaving, the bishops saw the need for guidelines to ensure “the identity would not wither away with the absence of the religious.”
The directives reaffirm ethical standards taught by the church and offer guidance on specific moral issues, especially concerning respect for life and human dignity, and ministering to people’s physical and spiritual needs.
Bishop McManus told The Catholic Free Press when he returned from the conference that he was assigned the topic: “The Catholic Hospital in the Changing World.”
He said he tried to present the challenge posed by the “technological imperative,” which says, “If we can do it technologically, we should do it.”
The bishop said he told listeners: “We live in an age of moral relativism.” Many people don’t believe in objective moral truth. Instead, consequentialism, utilitarianism and emotivism have filled the moral vacuum left by the rejection of natural moral law.
Bishop McManus, the only bishop from the United States speaking the second day, said he did not talk about Obamacare nationally or the defeat of the ballot question seeking to legalize physician-assisted suicide in Massachusetts.
But after his talk a representative from Vatican Television asked him for an interview, in which he was asked whether there is an effort in the United States to make Catholic hospitals places of evangelization, he said. He said he replied that that is being attempted – if Catholic hospitals are allowed to be run according to Catholic moral teaching.
He said he spoke of trying to convince the Obama administration that the Health and Human Services Department mandate compromises religious freedom, and that exceptions to it need to be broadened or it needs to be done away with.
He said the “Ethical and Religious Directives” help Catholic hospitals do things in morally justifiable ways, and that each bishop interprets them for his diocese. That way, Catholic hospitals can continue to be places of evangelization, because they are operated according to objective moral truth.
“My participation was very profitable,” Bishop McManus said, when asked what he is bringing back to the diocese from the conference. He said there was much good information that can help the bishops in the Commonwealth keep the focus on end-of-life issues in a way that reflects Catholic moral teaching. He said he and Cardinal Seán P. O’Malley, OFM, Cap., archbishop of Boston, said, after the ballot question was defeated, that its opponents cannot sit on their laurels, but must be attentive to giving people at the end of life the respect and assistance they need.
Good health is a benefit that needs to be defended and guaranteed for all people, not just for those who can afford it, Pope Benedict XVI told hundreds of health care workers.
The new evangelization is needed in the health field, especially during the current economic crisis “that is cutting resources for safeguarding health,” he said Nov. 17, addressing participants at theconference.
Hospitals and other facilities “must rethink their particular role in order to avoid having health become a simple ‘commodity,’ subordinate to the laws of the market, and, therefore, a good reserved to a few, rather than a universal good to be guaranteed and defended,” he said.

– Tanya Connor contributed to this report. Bishop McManus’
talk can be found at www.catholicfreepress.org

PHOTO:Bishop Robert J. McManus of Worcester, Mass., attends the International Conference of the Pontifical Council for Health Care Ministry at the Vatican Nov. 15. (CNS photo/Paul Haring)

The Catholic Hospital in a Changing World/ Bishop McManus

I.    Introduction
I.1    The topic of our discussion is “The Catholic Hospital in a Changing World.”  It is an indisputable fact that rapid and often dramatic change is characteristic of our contemporary society and culture.  One of the driving forces behind such change in the world is the advent of modern technology, particularly the technology of modern communication.  One far-reaching result of this explosion of highly innovative and sophisticated communications media is the phenomenon of globalization.
I.2    The arrival of modern technology has also had a dramatic effect on Catholic hospitals.  In the last century, there has been a radical transformation in how Catholic hospitals operate and organize themselves, in large measure because of significant advances in medical technology.  But what has not changed in the culture and daily operations of Catholic hospitals and what is responsible for the continuity of health care in these Catholic medical institutions is their distinctively Catholic mission.  This mission finds its foundation in the healing ministry of Jesus which he exercised during his public ministry two thousand years ago.
II.    The Mission of Jesus and the Mission of the Catholic Hospital
II.1    All four canonical Gospels attest to the fact that healing the sick was an integral and awe-inspiring part of the public ministry of Jesus of Nazareth.  He cleansed the ten lepers (Lk. 17: 11-19); he restored sight to the blind (Mt. 20: 29-34; Md. 10: 46-52); he made the lame walk (Mt. 15: 29-31) and he even raised the son of the widow of Naim from the dead (Lk. 7: 11-17).  Indeed, the words of the prophet Isaiah “Yet it was our pain that he bore, our sufferings he endured … by his wounds we were healed” (Is. 53: 4-5) were fulfilled in the healing ministry of Christ.
II.2    The healing ministry of Jesus was also confided to the Twelve: “He summoned the Twelve and gave them power and authority and to cure diseases and he sent them to proclaim the Kingdom of God and heal the sick.” (Lk. 9: 1-2).  The Acts of the Apostles which narrates the life of the early Christian community speaks of the healing ministry of the apostles.  St. Luke even notes that people would place the sick in the streets on their mats so that “when Peter came by, at least his shadow might fall on them” (Acts. 5: 15) and they might be healed.
II.3    Over the centuries the charismatic healing performed by individual Christians was formally institutionalized in Catholic hospitals, often sponsored by religious communities, that understood themselves as perpetuating the healing mission of the Lord Jesus.  Since the Church is the body of Christ in the world, to which Christ’s saving mission has been confided, it was only appropriate that such a central activity in Jesus’s proclamation of the dawning Kingdom of God should remain throughout history in the life of the Church’s pastoral ministry.

III.    Modern and Past-Modern Anthropologies
III.1    The psalmist writes: “What is man that you are mindful of him, and a son of man that you care for him?  Yet you have made him little less than a god, crowned him with glory and honor” (Ps. 8: 5-6).  Biblical revelation teaches that God is the creator of all that is, and that the pinnacle of his creative activity is the human person.  While the human person is made in the image and likeness of God, he or she still remains a creature.  The human faculties of intellect and free will do indeed make the human person “God-like,” but they do not make the human person divine.  The human person’s share in divinity is a result of grace.
III.2    In anthropological terminology, the creaturely status of the human person may be described as a person’s enjoying a “theonomous autonomy”. To be who he or she is called to be, to achieve that fullness of humanity that is God’s will for all his human creatures is to live one’s life in relation to the God who is the Author of all life itself.  This dependent, metaphysical relationship between Creator and creature does not detract from the fundamental dignity of the human person but is in fact the very condition of possibility for the existence of such a lofty human dignity.
III.3    The recognition of the Creator/creature relationship was an integral part of the theological and philosophical patrimony of Western culture until the modern period when there appeared the philosophy of Immanuel Kant that introduced the notion of “the turn to the subject”.  In some ways, the Kantian turn to the subject precipitated an anthropological shift in the understanding of the human person.  The dependent relationship between God and the human person was no longer viewed as a reason for the dignity of the human person but rather as establishing a type of rivalry between the divine and human.  If the human person were dependent on God, that is, if the human person were not autonomous, then men and women could not be truly free and fully human.
III.4    The anthropological shift from theonomous autonomy to the absolute autonomy of the human person became a unquestioned presupposition in the philosophy and politics of the Age of Enlightenment.  Reason, unencumbered by the shackles of an outdated faith, would be free to create a world where men and women were capable of constituting themselves.  In the post-modern period with the rise of such philosophies as deconstructionalism, the very ability of human reason to construct a society where the human person could flourish was soon called into question.  Moreover, with the demise of a traditional metaphysics, the notions of a common human nature and of the natural moral law that is derived from the fundamental inclinations of such a nature were called into question.  The very meaning of human existence was subject to various speculations, and the ability to know objective truth and morality was widely doubted or even rejected.
A disturbing example of the rejection of the objective meaning of human existence that derives from both faith and reason can be found in a decision of the United States Supreme Court of 1992.  In that decision, a Supreme Court justice wrote, “At the heart of liberty is the right to define one’s own concept of existence, of meaning, of the universe and of the mystery of human life…”
IV.    The Dictatorship of Relativism
IV.1    The anthropological shift that happened during the Enlightenment and post-Enlightenment periods laid the philosophical basis for what Pope Benedict XVI has repeatedly referred to during his pontificate as “the dictatorship of relativism.” This intellectual and moral phenomenon has influenced every dimension of life in our contemporary Western culture, including the field of medicine and in particular, the doctor-patient relationship.  Within the last forty years, the principle of patient autonomy in the moral decision-making process concerning the use or non-use of medical technology has become predominant.  In a perhaps overly simplified way of speaking, the presumption that “the doctor knows best” has given way to the presumption that “the patient knows best”.
IV.2    The principle of patient autonomy is intellectually and morally defensible if its exercise involves a well-formed conscience in making decisions relative to one’s health care. In a culture and society influenced deeply by moral relativism where there are no moral absolutes because, in great measure, there is no commonly accepted understanding of the nature of the human person, or an acceptance of the natural moral law, the presumption that patients have well-formed consciences can readily be called into question.  In secular hospitals, it can be reasonably argued that the physicians in such hospitals share the prevailing cultural bias in favor of moral relativism.  Moreover, even if such secular hospitals have in place ethic committees that can be appealed to in helping to resolve morally contentious medical decisions, it might certainly be the case that at least a majority of the members of a hospital’s ethics committee work out of an framework of moral decision-making that is relativistic.  This is not the case with a Catholic hospital that is true to its mission to provide compassionate care that respects and promotes the inviolable dignity of the human person.
V.    The Catholic Hospital in the United States of America
V.1    Catholic hospitals in the United States of America are governed by a document that the United States Conference of Catholic Bishops (USCCB) has crafted and that is now in its fifth edition.  This document is entitled:  Ethical and Religious Directives for Catholic Health Care Services (ERD).  It has been adopted as particular law in many of the archdioceses and dioceses in the United States and reflects a body of moral principles that has developed throughout the centuries.  In the Preamble of the ERD’s, the purpose of these directives is articulated as follows: “The purpose of the Ethical and Religious Directives is two-fold: first, to reaffirm the ethical standards of behavior in health care that flow from the Church’s teaching about the dignity of the human person; second, to provide authoritative guidance on certain moral issues that face Catholic health care today.”
V.2    The ERD’s touch upon a number of current realities that are integral to the mission of an authentically Catholic hospital: 1) the social responsibility of Catholic health care services; 2) the pastoral and spiritual dimensions of Catholic health care; 3) the doctor-patient relationship; 4) medical-ethical issues concerning the beginning and end of life and 5) Catholic hospital partnering or merging with secular medical facilities.
V.3    The moral principles that are presented in the ERD’s as part of the patrimony of the centuries-old Catholic moral tradition seek to provide an objective moral framework within which health care providers and patients can make moral judgments and decisions.  The document states, “The moral teachings that are presented here (the ERD’s) flow principally from the natural law, understood in the light of the revelation Christ has entrusted to his Church.  From this source the Church has derived its understanding of the nature of the human person, of human acts, and of the goals that shape human activity.”
V.4    The ERD’s are an invaluable instrument in assuring that the moral decisions concerning the practice of medicine in a Catholic hospital are not subject to a calculus of decision-making that is morally relativistic.  This moral assurance is not readily available in secular hospitals in the United States of America in our rapidly changing world.
VI.    The Role of the Diocesan Bishop in a U.S. Catholic Hospital
VI.1    A final point that is pertinent to our discussion of “The Catholic Hospital in a Changing World” is the role of the local diocesan bishop in safeguarding the Catholic identity and mission of a Catholic hospital under his jurisdiction.  The pastoral responsibilities of a diocesan bishop flow from the episcopal “triplex munus” of teaching, governing and sanctifying.  The ERD’s concisely express how these episcopal responsibilities are exercised in relation to a Catholic hospital in his local Church: “The diocesan bishop exercises responsibilities that are rooted in his office as pastor, teacher and priest.  As the center of unity in the diocese …, the diocesan bishop fosters the mission of Catholic health care in a way that promotes collaboration among health care providers, medical professionals, theologians and other specialists.  As pastor, the diocesan bishop … encourages the faithful to greater responsibility in the healing mission of the Church.  As teacher, the diocesan bishop ensures the moral and religious identity of the health care ministry … As priest, the diocesan bishop oversees the sacramental care of the sick …”
VI.2    The role of the diocesan bishop is not to be the Chief Executive Officer (CEO) of a Catholic hospital.  His responsibility is to assure that the Catholic hospital is authentically Catholic in all dimensions of its operation by adhering to the fundamental and objective moral principles of the Catholic moral tradition.  The diocesan bishop in a very practical manner exercises his teaching and governing roles in relation to Catholic hospitals within his local church by being the authoritative and ultimate interpreter of the Ethical and Moral Directives and their proper implementation in his diocese.
VI.3    A related matter to the exercise of the diocesan bishop’s teaching and governing roles is the matter of Catholic hospitals’ merging and affiliating with secular hospitals.  These mergers and affiliations can present serious challenges to the preservation of the Catholic hospital’s identity and medical service.  Yet such challenges do not automatically preclude on moral grounds the possibility of these types of mergers and affiliations.  The ERD’s offer several directives pertinent to assuring that proposed mergers and affiliations of Catholic and secular hospitals are done in a morally justifiable manner.  Directive 67 states, “Decisions that may lead to serious consequences for the identity or reputation of Catholic health care services, or entail the high risk of scandal, should be made in consultation with the diocesan bishop …”
VII.    Conclusion
VII.1    In 2003, Blessed John Paul II wrote in his message on the occasion of the World Day of the Sick in Washington, D.C., “Catholic hospitals should be centers of life and hope which promote ~ together with chaplaincies ~ ethic committees, training programs for lay health care workers, personal and compassionate care of the sick, attention to the needs of their families and a particular sensitivity to the poor and marginalized.”   A Catholic hospital that strives to promote the mission articulated by the late and beloved Blessed John Paul II is desperately needed in a changing world that is becoming increasingly secular and indifferent to the Gospel of Life.
VII.2
Most Reverend Robert J. McManus, D.D., S.T.D.
Bishop of Worcester
Chairman
Subcommittee on Health Care