Catholic moral tradition provides important perspectives as Catholic healthcare organizations strive to reach their goals in caring for individuals, asserted Rev. Thomas F. Schindler, PhD, at the Catholic Health Association's System Leadership Development Forum in November. Fr. Schindler is director of ethics, Mercy Health Services, Farmington Hills, MI.
Participants wrestled with defining the elements of Catholic identity and their relevance in a reformed healthcare system. Catholic values help people think through ethical dilemmas, Schindler noted. "It is impossible to make decisions and policies without values. Being value driven is part of life," he said. The questions for Catholics, he continued, are, "Can we make explicit the values driving us in any given situation? Are the values we're using all the values we need to consider? Are these the most appropriate values?"
Schindler noted that in Roman Catholic ethics, when something is judged to be wrong, the official teaching tries to demonstrate how the inappropriate act offends human dignity or breaks relations with God, others, and the world. The Roman Catholic community is involved in a constant dynamic to understand what truth is. "It is the responsibility of everyone. Nobody can bow out; everybody is part of this process."
As the Catholic Church enters into the mainstream of society, Schindler asserted, the price of being able to influence society sometimes means some compromising in order to have a voice. "As we try to concretize the elements of Catholic identity, to spell them out specifically in operational terms and then begin to try to work with them in concrete situations, . . . what we're constantly trying to deal with is, How do we maintain influence and how do we maintain our identity" as part of the Catholic healing tradition?
The Catholic moral tradition provides three principles that can guide healthcare organizations in situations of values conflict, Schindler said:
- Toleration of evil
- Material cooperation
- Prudential judgment
Toleration of Evil
The principle of toleration speaks of detachment, of permitting something evil to happen, if not actively opposing it. Augustine tolerated prostitution in the city of Hippo even though he had the power to stop it, Schindler noted, because stopping it would have prevented him from accomplishing other things. Augustine's decision shows that "when you have goods and bads tied together, you have no nice, easy, pure way out," Schindler said. In some situations, it is possible to tolerate evil because in stopping it, other greater goods would be lost.
Material Cooperation
The principle of material cooperation goes one step beyond toleration of evil and deals with situations in which one is somehow involved in the evil. Schindler explained that, according to the principle of material cooperation, just the fact that one is actually involved in an evil activity does not in and of itself rule the activity out as a possibility. The activity is judged according to the degree of evil and the actor's proximity to the act. The greater the evil, the greater the distance one must have. Within the Catholic tradition, acts like abortion and direct sterilization are not judged to be on the same level, he said. Abortion is understood to be a greater evil.
Another important aspect of the principle is weighing the good to be achieved and the evils that will likewise come about. Schindler explained that "the lesser the evil and the more the good to be achieved, the closer we can be to it [the act]. Conversely, the greater the evil and the less the good to be achieved by it, the greater the distance has to be." The principle recognizes that in the face of evil we do not automatically walk away. The principle allows us to work through whether we can cooperate in some way as long as we maintain some distance, Schindler said.
Prudential Judgment
A third methodology of looking at situations was enunciated by the U.S. bishops in their 1986 pastoral letter on the economy, in which they stated, "We are aware that the movement from principle to policy is complex and difficult and that although moral values are essential in determining public policies, they do not dictate specific solutions. They must interact with empirical data, with historical, social, and political realities, and with competing demands on limited resources." The pastoral shows that once a value has been established, the policy which upholds that value must take into account the entire concrete situation, Schindler explained. "It is in the social justice realm [see "How Can Catholic Identity Be Relevant Today?" at the end of this article] that the complexities of situations we're dealing with become apparent," Schindler said.
He said the Church has a history of "openness to human reason," and the Catholic tradition does not suggest that a specific answer is absolutely apparent and rule out any further consideration. Catholic healthcare organizations should be in dialogue with the bishops as they deal with complex situations, Schindler advised.
— Judy Cassidy
HOW CAN CATHOLIC IDENTITY BE RELEVANT TODAY?
Does Catholic tradition provide a substantive way to respond to the major issues facing Catholic healthcare organizations today — (1) the development of managed care and integrated delivery networks, (2) persons other than members of the religious congregation in management and governance, and (3) growing concern about the social implications of healthcare?
Yes, according to Rev. Thomas F. Schindler, in a society where other organizations hold many of the same values as Catholic organizations. The tradition's power lies not in unique elements that are not found in other non-Catholic organizations, he noted. Catholic identity provides the basis for influencing and collaborating with those who can connect with its values.
The Catholic healing ministry can distinguish itself by being exemplary in carrying out those values, Schindler said. Especially relevant today is the Catholic tradition's value of social justice.
The Catholic tradition, Schindler noted, goes beyond requiring the civil rights of freedom of speech, religion, and assembly. It calls as well for the rights that make it possible for people to participate in and contribute to society: rights to food, shelter, medical care, basic education.
Catholic healthcare "can speak to society in a powerful way," he said, by leading in raising the health status of the communities it serves, emphasizing care of the whole person, creating just work environments, and being open to limiting treatment when appropriate. Through these traditional elements of Catholic identity, Catholic healthcare organizations can "recreate the world in justice" and make a substantial contribution to society, he insisted.