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BY: FR. THOMAS NAIRN, OFM, Ph.D.

Integrity is Key

The question has several variations: "What's unique about Catholic health care?" "How do we stand apart as Catholic?" "What about Catholic health care ethics is distinctively Catholic?" These sorts of questions came back to me as I read a recent book by Oxford University Professor of Moral and Pastoral Theology, Nigel Biggar, and it reminded me of the sorts of debates I had in graduate school.¹

Often these debates were simply arguments for the sake of argument, but at stake also were issues more important than we might have realized at the time, including possibly the most important question, "Does the fact of our being Catholic matter morally?" Christian ethicists have tended to describe what they do in terms of "unique" or "distinctive." These terms are inappropriate, Biggar's book suggests, and the proper term to describe Christian ethics should be integrity.

UNIQUE — NO
The dictionary defines "unique" as "being the only one of its kind" or "without an equal or equivalent, unparalleled." This often does seem to be what people are searching for when they discuss Catholic health care and Catholic health care ethics: They want to know what sets us apart from the rest — all other health care systems and all other forms of ethics.

There are at least two difficulties with attempting to formulate the issue in this way, one factual and the other theological. The factual difficulty is relatively straightforward: Strictly speaking, there is probably no single position Catholic health care ethics has taken that is unique to Catholicism. Even ethical positions most often labeled as Catholic, such as those proscribing contraception or direct sterilization, are shared by other individuals and groups.

However, there is a more important reason to question the appropriateness of calling Catholic health care ethics unique. The basis of Catholic ethics has been an understanding of natural law, which in principle is available to all persons of good will. The Second Vatican Council, for example, spoke about the necessary dialogue with others of good will, "in whose hearts grace works in an unseen way."² Similarly, the Ethical and Religious Directives for Catholic Health Care Services speak of the importance for Catholics to engage in dialogue with others.³ A truly unique Catholic morality would suggest that Catholics share nothing in common with other people of good will. Catholic ethics would become a sectarian ethic, unavailable to anyone outside the Catholic community and unable to be communicated to them by Catholics.

DISTINCT — NO
In discussions regarding the foundations of Catholic morality, the usual alternative to "unique" has been "distinctive," as shown in the title of the second volume of the series, Readings in Moral Theology.⁴ If we were to look again in the dictionary we would see this term defined as "serving to identify or distinguish" or "a distinguishing factor, attribute, or characteristic." An essay by James Walter within the above-mentioned volume says "the term 'distinctive' only connotes a characteristic quality or set of relations which are typically associated with any given reality,"⁵ rather than a quality that is unique to that reality.

Those who speak of Christian ethics as distinctive usually mean they bring a particular set of presuppositions based on Scripture and their moral tradition to their analysis of ethical questions and issues. For them, Christian morality is not unique so as to make it inaccessible to others who are searching for meaning in their lives, but it is distinctive insofar as it calls the hearer to a distinctive way of life, that witnessed by the Gospel.

Although Biggar has no difficulty with this understanding of the foundation of Christian ethics, he does have a problem with the term "distinctive." He says: "Whether or not what the Christian ethicist has to say is distinctive depends on the happenstance of whom he is taking with and what he is talking about; it is a matter of historical accident."⁶ He concludes that distinctiveness "is strictly beside the point."⁷ Furthermore, the language of distinctiveness has been misused to idealize the church and Christian ethics so much that it tends to denigrate other ethical positions. Biggar quotes John Milbank ("Christian morality is a thing so strange that it must be declared immoral or amoral according to all other norms and codes of morality") and concludes that "the more distinctly the Christian option is made to shine, the more the alternatives are cast into darkness."⁸

INTEGRITY: THE FINAL OPTION
If "uniqueness" says too much and "distinctiveness" is beside the point, are we left with any other option? What I found enticing about Biggar's book was his suggestion that the appropriate term should be integrity. He explains, "What the integrity of Christian ethics requires is careful reflection, running all the way up and down the chain of moral reasoning between the theologically sublime and the casuistically meticulous, on whether the ethical concepts used are sufficiently shaped at all the appropriate points by relevant moments in the whole theological narrative. In a nutshell ... what we need is not distinctiveness but discrimination."⁹

The language of integrity does not compare or contrast Catholic ethics with that of another tradition. Rather it simply asks whether we are what we claim to be and whether what we do follows from this. It is open to the fact that often what Catholic ethics calls us to do is quite similar if not identical to that of other ethical traditions. Thus, it seems that the language of integrity allows on the one hand for a certain humility rather than the oversimplification to which talk of uniqueness or even distinctiveness can lead. In many circumstances, ethical deliberations of Catholic ethicists will not be very different from those of other faith traditions or even of secular ethicists.

On the other hand, it also allows us to appreciate the ethical sensitivity and genuine ethical character of other traditions. As Biggar affirms, "Theological narrative integrity itself should lead the Christian church to expect to find common ground with others. The Christian ethicist has good theological reasons to expect that unbelievers will not feel the need to deny everything that he affirms."¹⁰ Quoting Karl Barth, he suggests "the Christian should be open to hearing God's Word from the lips of the apparently indifferent and godless, for … it may be that the Lord has bidden those outside the Church to say something important to the Church."¹¹

Moving from the language of uniqueness or distinctiveness to integrity allows us to engage the complexity of our own theological and ethical tradition and the complexity of our surrounding culture. Secular American culture is not a monolithic "culture of death." Nor is Catholic theology, ethics or culture itself monolithic. Theologian Vincent Miller speaks about Catholicism in terms of breadth, of communion of difference and of depth.¹² He maintains that "we must now intentionally work to hear the truth in the other side and to preserve it as part of the fullness of the [Catholic theological] tradition."¹³

Similarly, Biggar speaks of his experience of having his expectations about the other surprised and of having to "crawl out" of the stereotypes that others have of him and his theological position.¹⁴ Integrity, it would seem, challenges all to listen more closely to the other and also to ensure that what we do truly issues from who we are. It challenges all to affirm what we have in common and to challenge one another so that our actions do not belie our identity.

If in the past several decades we have tried to express what we are doing in Catholic morality by using terms such as uniqueness or distinctiveness, terms that connote difference, it seems that now the real challenge is to demonstrate how what we do is aligned to who we say we are. And if this is our ethical task, it would seem that integrity most aptly describes this task. Words do matter.

FR. THOMAS NAIRN, OFM, Ph.D., is senior director of ethics, Catholic Health Association, St. Louis.

1. Nigel Biggar, Behaving in Public: How to Do Christian Ethics (Grand Rapids, Mich.: William B. Eerdmans Publishing Company, 2011).
2. The Second Vatican Council, Gaudium et Spes, par. 22.
3. United States Conference of Catholic Bishops, "General Introduction," Ethical and Religious Directives for Catholic Health Care Services, Fifth Edition (Washington DC: USCCB, 2009) .
4. Charles E. Curran and Richard A. McCormick, eds., Readings in Moral Theology No. 2: The Distinctiveness of Christian Ethics (New York: Paulist Press, 1980).
5. James J. Walter, "Christian Ethics: Distinctive and Specific" in Curran and McCormick, Readings in Moral Theology No. 2, 101.
6. Biggar, 8.
7. Biggar, 25.
8. Biggar, 98. Biggar is quoting from John Milbank, The World Made Strange: Theology, Language, Culture (Oxford: Blackwell, 1997), 219.
9. Biggar, 23.
10. Biggar, 26.
11. Biggar, 87. He is quoting from Karl Barth, Against the Stream (London, SCM Press, 1954), 228-229.
12. See Vincent J. Miller, "Where Is the Church? Globalization and Catholicity," Theological Studies 69, 2 (June 2008): 424-431.
13. Miller, 426.
14. Biggar, 89.