Chapter III of «A Prescription for Health Care Reform»
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“The Church’s social teaching proposes principles for reflection; it provides criteria for judgment; it gives guidelines for action.”
- Catechism of the Catholic Church, no. 2423
That the Church should have something valuable to contribute to public discussion of a social policy issue such as health care has been well established: "Experience has shown that good morality is also good economics and makes for a good society … these principles have much to contribute to prosperity and peace.” The Catholic social justice tradition yields considerable insight into contemporary challenges of business, society, and politics.
Pope Benedict XVI explains the relationship between Church teaching and the policy sphere:
The Church’s social teaching argues on the basis of reason and natural law, namely, on the basis of what is in accord with the nature of every human being. It recognizes that it is not the Church’s responsibility to make this teaching prevail in political life. Rather, the Church wishes to help form consciences in political life and to stimulate greater insight into the authentic requirements of justice…
As a political task, this cannot be the Church’s immediate responsibility. Yet, since it is also a most important human responsibility, the Church is duty-bound to offer, through the purification of reason and through ethical formation, her own specific contribution towards understanding the requirements of justice and achieving them politically. (Deus Caritas Est, no. 27)
Catholic social teaching (CST) insists that all human beings possess a right to life, and this right is the starting point of reflection about health care. For every Christian medical professional and health care provider, respect for the life of the patient is an inviolable principle. The weight of this obligation precludes any medical procedure that directly takes the life of a person, including abortion, euthanasia, and physician-assisted suicide. This and other principles from CST apply as well to infertility medical technology and research involving human embryos. The United States Conference of Catholic Bishops’ approach to health care follows from the fundamental principle of the dignity of human life. “Catholic health care ministry is rooted in a commitment to promote and defend human dignity,” they explain, “This is the foundation of its concern to respect the sacredness of every human life from the moment of conception until death. The first right of the human person, the right to life, entails a right to the means for the proper development of life, such as adequate health care.” Elsewhere, the bishops add, “This right flows from the sanctity of human life and the dignity that belongs to all human persons, who are made in the image of God.”
The Christian tradition displays a long history of not only reflection but also practical experience and commitment. From early in its history, the Church and especially its religious orders of consecrated men and women have been significant providers of health care. The Council of Carthage (436) urged bishops to offer hospice, which included care for the traveler and the sick. “This injunction echoed the words of Paul in First Timothy 3:2 that the bishop must be ‘temperate, self-controlled, decent, and hospitable.’” The bishops’ solicitude for the sick was supplemented by the charity of wealthy Christians who maintained houses for the ailing.
This Catholic commitment to health care has endured. Presently, one in six patients in the United States receives treatment in a Catholic acute-care facility each year. In 2005, more than 5.5 million patients were admitted to Catholic health care facilities, and in 2006 Catholic hospitals provided more than $5.7 billion in community health care services.
The motivation of Christian health care providers reflects the Church’s teaching on the subject. “Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance” (Catechism of the Catholic Church [hereafter, CCC], no. 2288). Health is a fundamental component of the common good, which we discuss in more detail below.
Flowing from Christ’s words and example, CST supplies four key concepts in the consideration of health care resource allocation. Foremost is the dignity of human person, from which follow inherent rights and responsibilities. Second, the concept of the common good must be taken into account. Third, solidarity and the preferential option for the poor and vulnerable apply. Finally, the principle of
subsidiarity must be considered.
Dignity of the Person
The Catholic Church’s teaching concerning health care is rooted, like the rest of its social teaching, in the principle of the dignity of the human person. Because every person is made in the image of God, he or she possesses inherent and inestimable value, and deserves to be treated accordingly by others. Furthermore, human beings are endowed with free will and are held responsible for their actions.
Our health is a gift that ought to be respected. “Your body, you know, is the temple of the Holy Spirit, who is in you since you received him from God” (1 Cor. 6:19). We can expect to be held accountable for choices we make, including those regarding our personal health. “Freedom makes man responsible for his acts to the extent that they are voluntary” (CCC, no. 1734). A Christian discussion of health care reform cannot neglect the role of personal responsibility when considering the prevalence of obesity, alcohol abuse, smoking, and lack of exercise: “For all the truth about us will be brought out in the law court of Christ, and each of us will get what he deserves for the things he did in the body, good or bad” (2 Cor. 5:10). Pope John Paul II emphasized the role of the individual:
Not only the world, however, but also man himself has been entrusted to his own care and responsibility. God left man “in the power of his own counsel” (Sir 15:14), that he might seek his Creator and freely attain perfection. Attaining such perfection means personally building up that perfection in himself. Indeed, just as man in exercising his dominion over the world shapes it in accordance with his own intelligence and will, so too in performing morally good acts, man strengthens, develops and consolidates within himself his likeness to God (Veritatis Splendor, no. 39).
Man does not seek perfection in isolation. Because persons by their nature form communities, it is not possible to understand the individual pursuit of the good apart from the good of the community more broadly speaking—that is, the common good. Taking its cue from the Second Vatican Council, the Catechism defines common good as “the sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily” (CCC, no. 1906). As this definition makes clear, the common good should not be seen as an abstract goal that might somehow be set in opposition to the good of individual persons. Instead, the common good consists precisely in the creation of those institutions, circumstances, and conditions that facilitate the pursuit of good on the part of families and individuals. It follows that each individual has a responsibility to promote such conditions, enabling the flourishing of both himself and his neighbor.
The principle of solidarity is simply a particular application of Christ’s command to “love your neighbor as yourself.” Solidarity is love in its social dimension: the obligation to seek the good of others. We ought to love our neighbor, feed the poor, clothe the naked, and care for the sick (Matt. 25:40). Solidarity binds Christians not only to those closest to us whom we are inclined to love (friends and family) but also with the Church as a whole and, indeed, with all humanity. “Solidarity, which springs from human and Christian brotherhood, is manifested in the first place by the just distribution of goods, by a fair remuneration for work and by zeal for a more just social order. The virtue of solidarity also practices the sharing of the spiritual goods of faith which is even more important than sharing material goods” (CCC, no. 1948).
Christians and all people of good will are expected to serve others with a preferential consideration for the poor and underserved. The proverb, “A nation’s greatness is measured by how it treats its weakest members,” is attributed to Mahatma Gandhi. Because those with few resources are least able to defend their own interests, it is incumbent upon the Christian to have special regard for the impact of policy decisions on the poor and vulnerable. With respect to health care, it is the poor and unemployed who are least likely to afford private insurance plans and who are thus dependent on government-sponsored services or on emergency rooms to provide care.
It is important to inquire, then, as to whether the existing situation of government or employer dependence is one that serves the poor well. Do the poor have access to levels of health care quality similar to those enjoyed by those better off? Is there a way by which the poor, too, can assume more responsibility for their health care decisions, a way that is more reflective of their dignity as persons?
Are employees rendered vulnerable to injustice by virtue of benefits coercing them to remain with a particular employer? Does the tax-favored status of employer-based health care discriminate against other tax payers not receiving the same benefit? Any proposed reform to our health care crisis that aspires to be compatible with CST must take into account the consequences those solutions would have on the poor and vulnerable.
Solicitude for the needy must be exercised in a way that preserves the individual’s dignity. The Church guides us toward this difficult goal by offering the principle of subsidiarity: “a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to coordinate its activity with the activities of the rest of society, always with a view to the common good” (Centesimus Annus, no. 48). Subsidiarity places a duty on those closest to a need to provide care (CCC, nos. 1803, 1894, 2209). For example, families should raise children, counties ought to maintain roads, and the federal government appropriately provides national defense.
Nor should business bear responsibility for needs better fulfilled by those closer to those in need. Theologian Michael Novak, describing the responsibilities of businesses, observes that the corporation is a social institution independent of the state and not “a welfare agency.” With respect to health care, an application of subsidiarity suggests that more responsibility—and therefore, control—be lodged in individuals and families. Local organizations and religious groups will have a vital role to play in the delivery of health care. If these functions are usurped by government or corporate bureaucracies at a distance from the provision of care, then serious inefficiencies and injustices are likely, as we have already discussed. In fact, it would appear that needs are best understood and satisfied by people who are closest to them and who act as neighbors to those in need.
When considering how best to implement the principles of solidarity and preference for the poor —when exploring how most effectively to fulfill our obligation to love all people, with special solicitude for the marginalized— subsidiarity guides our choices about potential solutions to the health care crisis. At the service of solidarity, subsidiarity helps to ensure that love does not remain a vague gesture of goodwill toward all coupled with a failure to practice charity toward actual persons with whom we come in contact. Subsidiarity reminds us that human dignity is more likely to be preserved when personal relationships rather than bureaucratic or professional commitments form the basis for action.
While our domestic medical scheme is at a crossroads of increasing demand, unsustainable expense escalation, and social injustice compromising the common good, CST provides a compelling approach based on respect for human dignity and truth. These four social justice principles provide a foundation for a virtuous and economically sound improvement in medical resource allocation.
To apply that approach effectively, we must understand the practical realities of contemporary health care. To do so requires a brief look at its evolution. How have we come to the place at which we now find ourselves?