Daniel R. DiLeo, M.T.S.
Flatley Fellow and Ph.D. Student in Theological Ethics
Boston College
[email protected]

Since the publication of Laudato Si' (LS'), Pope Francis has been called many names: prophet, Marxist, eco-pope, radical, rock-star and Christian.¹ One name that does not seem to have been used, however, is physician. Perhaps it is because I write for health care professionals, but it seems to me that — save for Christian and prophet — physician is a term that describes the author of LS' better than most others. This is due to the fact that in LS', Francis utilizes the best available science to assess the symptoms of ecological degradation, diagnoses the illnesses that produce these symptoms, and prescribes a cure to heal our current ecological disorders. Understood as such, the Catholic health care ministry has a unique vocation to serve as ecological nurse, partnering with the physician to help the world implement the doctor's orders prescribed in LS'.

ASSESSING THE SYMPTOMS
Francis the physician begins his ecological exam in LS' by utilizing cutting-edge science to evaluate the physiological symptoms of illness that non-human creation is presenting. In particular, he notes that "a very solid scientific consensus indicates that we are presently witnessing a disturbing warming of the climatic system" (23). Additionally, the pope also observes the physical realities of increasing water scarcity and the widespread "loss of biodiversity" (38).

While Francis thus assesses the biological symptoms that creation is experiencing, he also evaluates the symptoms of illness that humanity is concurrently suffering. These include climate change-induced loss of resources and population displacement among the poor, "social exclusion, an inequitable distribution and consumption of energy and other services, social breakdown, increased violence and a rise in new forms of social aggression, drug trafficking, growing drug use by young people, and the loss of identity" (24, 46).

At first glance, it may seem odd for the pope to attend to social ills in an ecological examination. Here, however, Francis pioneers the term "integral ecology" to name the precedent of Catholic awareness that human flourishing is inexorably connected to the rest of creation.² He insists that "it cannot be emphasized enough how everything is interconnected" in the world, and says this is especially true of human and non-human creation (138). As such, Francis says, "we are faced not with two separate crises, one environmental and the other social, but rather with one complex crisis which is both social and environmental" (Ibid.). As one example, Francis highlights how the physiological consequences of anthropogenic climate change are already forcing the migration of poor persons who are unjustly least responsible for historical greenhouse gas emissions (25) — a particular reality which highlights the general fact that the poor are often disproportionately harmed by ecological degradation.

DIAGNOSING THE ILLNESS(ES)
Following his assessment of the symptoms presented by human and non-human creation, Francis, the ecological physician, diagnoses the underlying illness that is their cause. Guided by the concept of integral ecology, Francis recognizes that the combination of cataloged biological and humanitarian symptoms is due to comorbid illnesses in the body of society. As he says, awareness of widespread ecological degradation means that "it is no longer possible to find a specific, discrete answer for each part of the problem" (139). In particular, Francis diagnoses several structural, anthropological and theological illnesses in which contemporary ecological harm is rooted.

Structural Diagnoses: Technocracy, Economics and Politics
Francis' most over-arching structural diagnosis is that humanity suffers from the illness of what he calls a "technocratic paradigm." By this, he means:

An undifferentiated and one-dimensional paradigm ... [which] exalts the concept of a subject who, using logical and rational procedures, progressively approaches and gains control over an external object. This subject makes every effort to establish the scientific and experimental method, which in itself is already a technique of possession, mastery and transformation. It is as if the subject were to find itself in the presence of something formless, completely open to manipulation (106, emphasis in original).

Plagued by this technocratic paradigm, Francis observes how humans have moved from a symbiotic relationship with creation — including with other persons — to one of domination and exploitation. In particular, Francis observes that "the technocratic paradigm ... tends to dominate economic and political life" (109). With respect to economics, Francis critiques neoliberal capitalism in particular for its "accept[ance of] every advance in technology with a view to profit, without concern for its potentially negative impact on human beings (Ibid.). Relatedly, and with special focus on human-forced climate change, Francis highlights the failure of civil society to enact policies that mitigate ecological harm:

It is remarkable how weak international political responses have been ... There are too many special interests, and economic interests easily end up trumping the common good and manipulating information so that their own plans will not be affected (54).

Anthropological and Theological Diagnoses: Anthropocentricism, Selfishness and Sin
Although Francis offers perceptive diagnoses of the structural ills that plague the physical, material and enlivened inhabitants of our common home, the pope also identifies deeper anthropological and theological maladies that gave rise to and perpetuate ecologically deleterious systems. First, Francis identifies "modern anthropocentricism" which overemphasizes humanity's distinct place in creation and is partly rooted in skewed Christian theology which overstates humanity's autonomy in creation (116). Interestingly, this insight tacitly embodies the robust controversy around Lynn White, Jr.'s classic essay, "The Historical Roots of our Ecological Crisis."³

In 1967, White alleged that contemporary ecological degradation is largely due to resource exploitation justified by Christians' appeal to Genesis 1:28, wherein God says to humanity, "Be fertile and multiply; fill the earth and subdue it. Have dominion over the fish of the sea, the birds of the air, and all the living things that crawl on the earth." In response, commentators point out that the Hebrew words for "dominion" and "subdue" —  rādâ and kābaš, respectively — do not call for heedless exploitation.⁴ The former is a term that signifies the governance of a benevolent ruler whose surrogates are called to exercise the same caring supervision over that which has been entrusted to them. Within the context of ecology, its use in Genesis 1:28 indicates that humans are called to steward creation with the ethic of our loving Creator. Additionally, the Hebrew term for "subdue," kābaš, is used in reference to an adversary and is thus employed in Genesis 1:28 to convey the difficulty of domesticating creation — not as exploitative license. As such, Francis' comments provide the latest rebuttal to White's controversial thesis in particular and to the larger problem of anthropocentricism in general.

In addition to anthropocentricism, Francis also diagnoses human selfishness — both individual and collective — as one of the ills in which contemporary ecological degradation is rooted. For example, he observes that "the cost of the damage caused by such selfish lack of concern [for creation] is much greater than the economic benefits to be obtained" (36). Moreover, he describes how "international [climate change treaty] negotiations cannot make significant progress due to positions taken by countries which place their national interests above the global common good" (169). Finally, the pope notes that "the current global situation engenders a feeling of instability and uncertainty, which in turn becomes 'a seedbed for collective selfishness'" antithetical to integral ecology (204). This is especially so due to the fact that "when people become self-centered and self-enclosed, their greed increases" and they consume resources at an insatiable rate (Ibid.).

Ultimately, Pope Francis points out that the human illness at the core of ecological harm is sin. He describes sin as the "rupture" of the "three fundamental and closely intertwined relationships" that constitute the human condition: "with God, with our neighbour and with the earth itself" (66). Animated by this understanding, Francis quotes Patriarch Bartholomew who says that "'a crime against the natural world is a sin against ourselves and a sin against God'" (8). Additionally, the pope laments "our situation today, where sin is manifest in ... attacks on nature" (66) and "indifference" to the suffering of other creatures, both human and non (25, 52, 93, 115, 232, 246).

PRESCRIBING A CURE
Given his diagnosis of the human illnesses in which the symptoms of ecological degradation are rooted, Francis the physician prescribes theological, anthropological and systemic remedies by which humanity can heal the ecological wounds of creation. He recognizes that the scope of the contemporary ecological crisis means that "no branch of the sciences and no form of wisdom can be left out" of conversations about solutions (63). In particular, Francis asserts that its "syntheses between faith and reason" enables the Catholic Church to make several distinct contributions to conversations about solutions to ecological harm (63). As such, he prescribes to humanity "the Gospel of Creation" (62), an embrace of "integral human ecology" with special attention to particular tenants of Catholic social thought (137), political and economic policy interventions, and "ecological education" (202).

"The Gospel of Creation"
Pope Francis' regimen for ecological healing begins with consideration of "the Gospel of Creation" understood as the church's creation theology constituted by two key parts: "the wisdom of the Biblical accounts" (66-68) and "the mystery of the universe" articulated in non-biblical sources (76-83). The former, he says, can help humanity recognize the sinful roots of ecological harm and the need for reconciled relationships, and to recover an appreciation for the intrinsic goodness and dignity of all creation (66, 68). The latter, Francis insists, can destabilize anthropocentricism and foster a deeper "universal communion" between persons and with all other creatures characterized by "the common destination of goods," a preferential option for the poor and vulnerable, and "the subordination of private property" to the universal destination of goods (89-95).

Integral Ecology
In addition to the "Gospel of Creation," Francis prescribes that humanity embrace the aforementioned notion of integral ecology in order to recover from the illnesses that cause ecological harm. In the words of Pope John Paul II, this will entail awareness of and response to the fact that "we cannot interfere in one area of the ecosystem without paying due attention both to the consequences of such interference in other areas and to the well-being of future generations" (emphasis in original).⁵ This, Francis, says, requires candid "reflection and debate about the conditions required for the life and survival of society, and the honesty needed to question certain models of development, production and consumption" (138). It also calls for particular commitment to three other pillars of Catholic social thought: the common good which requires peace and is understood as "'the sum of those conditions of social life which allow social groups and their individual members relatively thorough and ready access to their own fulfilment'" (156-158)⁶; the preferential option for the poor and vulnerable (158); and "intergenerational solidarity," i.e., commitment to the common good of future generations (159-162).⁷

Political and Economic Policy Interventions
Given the scale of ecological degradation — especially human-forced climate change — and historical lack of solutions, Pope Francis goes on to prescribe political and economic policy interventions essential to ecological healing. First, he insists that "technology based on the use of highly polluting fossil fuels — especially coal, but also oil and, to a lesser degree, gas — needs to be progressively replaced without delay" (165). Towards this end, he asserts that "enforceable international agreements are urgently needed" and must be guided by "common and differentiated responsibilities" which account for the "ecological debt" owed by the historically fossil fuel-intensive Global North to the exploited Global South (51-52, 170, 173). Additionally, Francis emphasizes the need for just local and national environmental policies (176-181). In all cases, the pope insists that "politics and economics [must] enter into a frank dialogue in the service of life, especially human life" (Ibid.). Furthermore, he also holds that such interventions should always be guided by the principle of subsidiarity which addresses problems at the lowest possible but highest necessary level of society (157, 196).⁸

Ecological Education
A final prescription that Francis offers in response to the ecological illnesses of creation is ecological education (209-215). In particular, the pope teaches that successful ecological education can highlight:

the gravity of today's cultural and ecological crisis ... critique of the 'myths' of a modernity grounded in a utilitarian mindset (individualism, unlimited progress, competition, consumerism, the unregulated market) ... restore the various levels of ecological equilibrium, establishing harmony within ourselves, with others, with nature and other living creatures, and with God ... facilitate making the leap towards the transcendent which gives ecological ethics its deepest meaning [and] instill good habits (209-211).

Such education, he says, "can take place in a variety of settings: at school, in families, in the media, in catechesis and elsewhere," and requires "educators capable of developing an ethics of ecology, and helping people, through effective pedagogy, to grow in solidarity, responsibility and compassionate care" (210, 213).

CATHOLIC HEALTH CARE AS ECOLOGICAL NURSE
Given the assessments, diagnoses and prescriptions of Pope Francis the ecological physician, the Catholic health care ministry is now called to respond as an ecological nurse that helps persons and society implement and follow the script of LS'. This distinct vocation is rooted in the ministry's Catholic mission, experience of how ecological degradation harms human health (20, 21, 28, 44) and capacity to effect change through operations and advocacy. As such, there are several things that Catholic health care can do.

First, the Catholic health care ministry can implement Francis' prescription of "the Gospel of Creation" by creating and sharing resources that help persons reflect on Catholic teaching about creation. For example, systems can follow the advice of the Catholic Health Association (CHA) to utilize encyclical prayer cards in meetings or shared spaces.⁹ Additionally, hospitals might display pictures that combine images of creation and ecological Scripture passages in hallways and patient rooms.

Next, the ministry could embrace integral human ecology by recognizing ecological harm as a cost to be considered in economic calculations. For example, a system could utilize renewable energy that is more expensive in the short term based on the understanding that climate change compromises the life, health and dignity of the world's poorest and most vulnerable persons. Moreover, a hospital could decide to pay a premium for more ecologically responsible health care products, office supplies and cafeteria foodstuff.

Third, Catholic health care might implement Francis' prescription of political and economic policy interventions by advocating for domestic and international climate change policies. In the U.S., it is especially important that the ministry urge Congress to support the CHA-backed national carbon pollution standard (Clean Power Plan) and contribute to the United Nations' Green Climate Fund for adaptation.¹⁰ This is due to the fact that both are considered critical to the adoption of an international climate change agreement.¹¹

Finally, the ministry could employ the pope's prescription of ecological education by pushing for greater attention to integral ecology in all types of health care education. This would include, for example, working to further incorporate integral ecology into medical school curricula, undergraduate and graduate programs in bioethics and health care ethics, and continuing education programs for all health care professionals.

CONCLUSION
At the end of LS', Francis the ecological physician finishes his work with "a Christian prayer in union with creation" (246). There, he offers a poetic synthesis of his script and provides a starting point from which the Catholic health care ministry might partner with the pope to nurse creation back to health following the publication of LS'. He writes:

Father, we praise you with all your creatures.
They came forth from your all-powerful hand;
they are yours, filled with your presence and your tender love.
Praise be to you!

Son of God, Jesus,
through you all things were made.
You were formed in the womb of Mary our Mother,
you became part of this earth,
and you gazed upon this world with human eyes.
Today you are alive in every creature
in your risen glory.
Praise be to you!

Holy Spirit, by your light
you guide this world towards the Father's love
and accompany creation as it groans in travail.
You also dwell in our hearts
and you inspire us to do what is good.
Praise be to you!

Triune Lord, wondrous community of infinite love,
teach us to contemplate you
in the beauty of the universe,
for all things speak of you.
Awaken our praise and thankfulness
for every being that you have made.
Give us the grace to feel profoundly joined
to everything that is.

God of love, show us our place in this world
as channels of your love
for all the creatures of this earth,
for not one of them is forgotten in your sight.
Enlighten those who possess power and money
that they may avoid the sin of indifference, that they may love the common good, advance the weak, and care for this world in which we live.
The poor and the earth are crying out.
O Lord, seize us with your power and light,
help us to protect all life, to prepare for a better future, for the coming of your Kingdom of justice, peace, love and beauty.

Praise be to you!
Amen.

1. Pope Francis, Laudato Si' (Vatican: Libreria Editrice Vaticana, 2015).
2. For an extended analysis of this term, see: http://teilharddechardin.org/mm_uploads/TP_Spring_Summer_2015.pdf
3. Lynn White, "The Historical Roots of our Ecological Crisis," Science 155, no. 3767 (1967), 1203.
4. Terence E. Fretheim, "The Book of Genesis," in The New Interpreter's Bible: Volume I- General Articles on the Bible, General Articles on the Old Testament, the Book of Genesis, the Book of Exodus, the Book of Leviticus, ed. Leander E. Keck et al., Vol. I (Nashville, TN: Abingdon Press, 1994), 346.; Richard J. Clifford, "The Bible and the Environment," in Preserving the Creation: Environmental Theology and Ethics, ed. Kevin W. Irwin and Edmund D. Pellegrino (Washington, D.C.: Georgetown University Press, 1994), 5.; R. Laird Harris, Gleason L. Archer Jr., and Bruce K. Waltke, eds., Theological Wordbook of the Old Testament (Chicago: Moody Publishers, 2003), 430.
5. Pope John Paul II, 1990 World Day of Peace Message: Peace with God the Creator, Peace with all Creation (Vatican: Libreria Editrice Vaticana, 1989), no. 6.
6. Cf. Second Vatican Council, "Gaudium Et Spes," in Vatican Council II: The Basic Sixteen Documents, ed. Austin Flannery, trans. Austin Flannery (Northport, New York: Costello Publishing Company, 2007), no. 26.
7. Pope John Paul II, Sollicitudo Rei Socialis (Vatican: Libreria Editrice Vaticana, 1987), no. 38. Cf. Pope Benedict XVI, 2010 World Day of Peace Message: If You Want to Cultivate Peace, Protect Creation (Vatican City: Libreria Editrice Vaticana, 2010), no. 8.
8. Pontifical Council for Justice and Peace, Compendium of the Social Doctrine of the Church (Washington, DC: USCCB Publishing, 2004), nos. 185-186.
9. Catholic Health Association of the United States, "Environment Encyclical," Catholic Health Association of the United States, https://www.chausa.org/environment/environment-encyclical (accessed July 20, 2015).
10. Sr. Carol Keehan, "CHA Supports New Efforts to Curb CO2 Emissions," Catholic Health Association of the United States, http://www.chausa.org/about/cha-supports-new-efforts-to-curb-co2-emissions (accessed December 17, 2014).
11. Mike Boots, "Action at Home, Leadership Abroad: Our Path to Climate Progress," White House Council on Environmental Quality, https://www.whitehouse.gov/blog/2014/12/12/action-home-leadership-abroad-our-path-climate-progress (accessed July 20, 2015).

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