BY: FR. MICHAEL D. PLACE, STD
Fr. Place is president and chief executive officer, Catholic Health Association,
St. Louis.
This issue's column will be a series of reflections on some of the theological/ethical
issues that have been discussed in recent issues of Health Progress.
Principle of Cooperation
The November-December
2002 issue included several articles on the principle of cooperation. Discussion
of the principle contributes to the realization of one measure of success of
our current strategic plan: "Our voice has contributed proactively and positively
to church positions on one or more key ethical issues."
As we know, application of the principle has not always been easy. However,
we have learned much. We also have recognized the need to clarify our understanding
and to evaluate how we have applied it. The revisions, in 2001, of Part Six
of the Ethical and Religious Directives for Catholic Health Care Services
were part of that process.
Last February, the biannual workshop for bishops sponsored by the National
Catholic Bioethics Center (NCBC), Boston, provided the bishops an opportunity
to reflect on the principle and its application. I was invited to welcome the
bishops. My remarks follow:
It is an honor to extend to you tonight the greetings of the Catholic health
care ministry in the United States; a ministry that our Holy Father in Phoenix
in 1987 described as being "one of the most vital apostolates of the ecclesial
community and one of the most significant services the Catholic Church offers
society in the United States in the name of Jesus Christ."
Ours is a vibrant ministry that includes over 600 hospitals and over 1,300
continuum-of-care services, facilities, and programs in all 50 states and
the District of Columbia. There is at least one facility in 173 of 176 dioceses.
Ours is a time of great opportunity. Externally we are experiencing new
forms of collaboration under the New Covenant initiative. For example, last
August we jointly celebrated 275 years of Catholic social services and health
care in what today is the United States. Internally, we have new opportunities
to strengthen our identity as a ministry of the church and to ensure that
our commitments are reflected in all we do. Clearly we can be proud of our
incredible service to the poor and the vulnerable, in particular, women and
children. Supporting the prolife cause from conception to natural death is
an integral dimension of who we are.
But today also is a time of challenge. State reductions in Medicaid funding
are affecting Catholic health care and Catholic Charities. It is likely that
similar challenges will emerge from the new federal budget. There also have
been other changes and pressures that have made it difficult to operate in
isolation. Though the number of new joint ventures and collaborative arrangements
with other-than-Catholic partners has decreased, the need to explore such
possibilities remains a reality.
As we do so, however, the first priority must be remaining faithful to who
we are as disciples of the Lord Jesus and as a ministry of the church. We
are fortunate that our theological heritage has provided us with tools to
guide us, such as the principles of cooperation and double effect, as we labor
to craft morally correct "business" arrangements. We also have the guidance
offered by you, our bishops, through the Ethical and Religious Directives
for Catholic Health Care Services and your pastoral leadership within
your particular churches.
Despite these remarkable resources, the path is not always easy. Prudential
reasoning, though well intended, might err. It is imperative that we remain
open to new insights and to developing our skills of ethical discernment in
complex situations. Clearly, we learned a great deal as we responded to the
concerns of the Apostolic See that resulted in the most recent revisions of
the Ethical and Religious Directives. The health care ministry remains
indebted in a very special way to the thoughtful and patient leadership
of Archbishop Pilarczyk and Bishop Wuerl as those revisions were developed.
It is our hope that your participation in this time of study will allow us
to further that spirit of solidarity. We look forward to continued collaboration
with Dr. Haas and his colleagues. Know of my prayers for you and your ministry
in these complex times even as I ask for yours for the ministry of Catholic
health care.
Recently a letter about the utilization of the principle of cooperation was
sent to the bishops of the United States by Bishop Robert C. Morlino, Helena,
MT, in his capacity as chair of the United States Conference of Catholic Bishops
(USCCB) Ad Hoc Committee on Health Care Issues and the Church, and Bishop Donald
W. Trautman, Erie, PA, chair of the Committee on Doctrine. For Catholic health
care the letter is, in effect, another component in our ongoing learning about
how to apply the principle of cooperation. The letter points out that the Congregation
for the Doctrine of the Faith considers the revised arrangement of the relationship
between Seton Healthcare Network (part of Ascension Health, St. Louis) and Austin,
TX, with regard to that city's Brackenridge Hospital, to be "minimally acceptable."
In other words, it should not be considered an acceptable model or template
for other applications of the principle of cooperation. When this letter is
read in light of other Vatican interventions, it would seem that the "condominium"
approach, involving the isolation of prohibited services in a separate entity
within a Catholic institution, is problematic. Clearly, this communication
invites further theological reflections.
* Archbishop Daniel E. Pilarczyk, is archbishop of Cincinnati; Bishop Donald
W. Wuerl is bishop of Pittsburgh; John M. Haas, PhD, STL, is president of
the NCBC.
It should be noted, however, that it was possible for the local Catholic provider
to revise an existing arrangement in a manner that addressed the practicalities
of the local situation so that it would be ethically acceptable to the Holy
See, albeit minimally so. For the ministry, this means that a process of careful
ethical analysis involving the diocesan bishop and ministry leaders can have
a successful outcome even in quite challenging situations.
All of the above points out the continuing importance of the dialogue on the
principle of cooperation that is being sponsored by CHA. It is critically important
that we truly become a "learning community" concerning how we can act with integrity
in complex and challenging markets. Health Progress will continue to
serve the ministry in that process.
Rape Treatment
In the September-October
2002 issue of Health Progress, we had articles on the ethical issues
associated with providing compassionate and appropriate service to women who
have been victims of sexual assault. Within the ministry, several understandings
have emerged as to how to interpret and apply Directive 36, which reads:
Compassionate and understanding care should be given to a person who is
the victim of sexual assault. Health care providers should cooperate with
law enforcement officials and offer the person psychological and spiritual
support as well as accurate medical information. A female who has been raped
should be able to defend herself against a potential conception from the sexual
assault. If, after appropriate testing, there is no evidence that conception
has occurred already, she may be treated with medications that would prevent
ovulation, sperm capacitation, or fertilization. It is not permissible, however,
to initiate or to recommend treatments that have as their purpose or direct
effect the removal, destruction, or interference with the implantation of
a fertilized ovum.
Recently, the USCCB Committee on Doctrine sponsored a study day on the many
aspects of this issue: the nature of the reproductive process, how various available
pharmacological agents work, the experience of emergency room clinicians, and
the theological principles. After reflecting on the results of the dialogue,
the Committee on Doctrine concluded that testing only for a pregnancy unrelated
to the sexual assault is not inconsistent with Directive 36.
Let me offer several observations on this carefully worded statement. First,
it is based on "the present state of scientific and medical research." In other
words, additional evidence could change the understanding of what constitutes
appropriate testing. Second, the committee's decision does not indicate a preference
for any particular approach. Rather, its members have said that protocols that
do not include testing for ovulation are not in violation of Directive 36. Finally,
diocesan bishops are left free, if they choose to offer pastoral guidance, to
determine the approach they deem to be in accord with the directive.
From the perspective of the ministry, the process that led to this determination
was a good one. Health Progress played a critical role in outlining the
various approaches. The ministry also was involved in the study day. There is,
however, more to be done. Continued research and scholarly discussions on the
part of moral theologians and medical researchers are critically important.
As a ministry gathered and engaged, we will be involved in both. Hopefully,
Health Progress will be a forum for sharing the results of that research
and thus contribute to resolving some of the remaining ambiguity.
Sponsorship
The July-August
2001 and January-February
2002 issues of Health Progress highlighted the critically important
issue of sponsorship. One of our measures of success relates to sponsorship.
It reads: "Ministry-wide understanding of sponsorship has deepened, and alternative
models of sponsorship—in addition to the 'Public Juridic Person' model—have
been articulated."
As part of our efforts to meet this measure of success, a group of theologians
has been working over the course of the last year to develop a draft of a theology
of sponsorship. This document has as its foundation the earlier CHA work that
had developed an initial definition of sponsorship and its theological components.
When the internal dialogue about the text is completed, it will be shared with
the ministry as a study document that will serve as a basis for reflection and
dialogue within the ministry. Health Progress will be one of many venues
in which that dialogue takes place.