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BY: SR. MARY ANN DILLON, RSM, PhD

Sr. Dillon is dean of general education and assistant professor of philosophical and religious studies at Saint Francis College of Pennsylvania, and ethics consultant and chairperson of the Ethics Committee, Bon Secours Holy Family Regional Health System, Altoona, PA.

The Common Good Provides the Rationale For a Healthcare System for All

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Summary

In advocating for a reformed healthcare system, the Catholic healthcare community has claimed that responsibility for the common good is of the highest ethical importance. Yet to many the concept of the common good remains elusive.

As the common good evolved in Catholic social teaching, it grew to include its anthropological origins, the principle of subsidiarity, and the virtue of solidarity. Above all, it is characterized by justice and refers to a social order that reflects peace, unity, and harmony. As an organizing principle for civil governments, the common good calls on them to foster societies that provide spiritual, cultural, political, and economic conditions in which all persons can realize their human dignity.

By viewing healthcare and the right to security in case of sickness as among the particular goods that make up the societal common good, Catholic social teaching provides the rationale for a just healthcare system on a national level. In addition to advocating for a national healthcare system designed to serve the common good, Catholic healthcare entities must evaluate their own programs and services in light of the common good and examine proposed initiatives with other providers, especially for-profit organizations, in that context, as well.

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In advocating for a reformed healthcare system, the Catholic community, through the National Conference of Catholic Bishops, the Catholic Health Association, and numerous state and regional organizations, has claimed that responsibility for the common good is of the highest ethical importance.¹ Catholic systems, individual facilities, and their sponsoring groups assert that promotion of the common good is an essential criterion in determining the appropriateness of proposed mergers, acquisitions, and sales. Yet, when pressed, many admit that the notion of the common good is decidedly elusive.

To help bring this concept into sharper focus, this article presents the common good in the context of Catholic social thought. Viewed in this light, the concept can provide fresh energy and creativity to those charged with translating the mission of Catholic healthcare into action in continually changing environments.

The Common Good in Catholic Social Teaching
Fundamentally rooted in theological reflection on belief in the communal nature of the divine--the triune God--the common good captures for the Christian imagination the sense that relatedness is at the heart of all human reality. The biblical images of covenant, community, and reign of God further inform the common good as a theological symbol. Continual reflection on the experience of human history through the prism of these religious beliefs has given rise to a vision of the good life, with the common good as its center.

Evolution of a Religious Symbol According to Catholic social teaching, the human person is (1) transcendent--naturally oriented to God; (2) sacred--made in the image and likeness of God; and (3) integrally social--naturally inclined toward a life with others. As a religious symbol, the common good has appropriated these three anthropological assumptions and furthered their realization in specific historical situations, although the assumptions' meaning and relative importance have shifted over time. Over the centuries the concept of the common good has been altered and deepened by other factors, including radical changes in the world view of those who articulated its meaning and new insights regarding societal organization and the nature and complexity of human interaction.

The Catholic ethical tradition has consistently held that the furtherance of the common good in society is the first duty of the state and the particular, but not exclusive, responsibility of political leaders. Beginning with Pope Leo XIII, the common good has been recommended as the overarching norm for decisions about the state's proper intervention in economic matters.² Later the common good was applied to questions of state intervention in social and cultural matters as well.

With Pope Pius XI's introduction of the principle of subsidiarity, the common good became a goal shared by numerous groups and institutions within society, whose effective interaction the state orchestrates for the precise purpose of furthering the common good.³ The encyclicals of Pope John XXIII first presented the common good as a moral mandate that applies to the good of the whole world and extends to generations not yet born.⁴ Its realization depends on international cooperation, with particular responsibility falling to those who control most of the world's resources. Solidarity, a notion first linked to the common good in the writings of Pope Paul VI, calls individuals and nations to build a society and a world in which there is an equitable distribution of goods.⁵

Characterized by Justice In the Catholic social tradition, the common good is characterized above all by justice. Social justice requires that everyone contribute to the good of the whole; distributive justice requires that all benefit from the goods that will provide for their flourishing as human beings. Within the past 20 years the tradition has strongly accented the need for a more equitable distribution of goods to achieve justice.⁶

Throughout the Catholic tradition, the common good has referred to a societal order characterized by peace, unity, and harmony. Although the early tradition tied the achievement of the common good to hierarchical and monarchical models of government, the Church later acknowledged that, at least theoretically, many potential societal arrangements might incarnate the common good. Thus the common good came to be understood more as a dynamic organizing principle for civil governments, calling on them, together with other subsidiary organizations, to foster societies that provide spiritual, cultural, political, and economic conditions in which all persons are able to realize their human dignity.

The right to have access to common goods has always been an intrinsic aspect of the societal common good. When all members of a society are able to enjoy certain common goods, then the conditions that make up the aggregate, the common good, are manifest. Upon distribution, goods become private goods, but their very distribution ought to serve the common good, since they provide for the participation of persons in the greater good. As Catholic social teaching and the concept of the common good have evolved, healthcare and security in case of sickness have been explicitly cited as goods to which all have a right.⁷

Significant Shifts The most significant shifts in the meaning of the common good have occurred when emphasis has moved from one of its three anthropological foundations to another. St. Thomas Aquinas, and the papal literature based on his thought, emphasized the human person as inherently social, dependent on and perfected through life in community. The common good was primarily an ensemble of social virtues and values. Human rights and freedom needed safeguarding, but only to promote the good of the whole. For Aquinas:

The person who seeks the good of the many seeks in consequence his own good, for two reasons. First, because individual good is impossible without the common good of the family, state, or kingdom. . . . Secondly, because, since the person is part of the home and state, he must needs consider what is good for him by being prudent about the good of the many.⁸

Beginning with the writings of John XXIII, however, the common good has stressed the dignity of each human person, a quality that follows from the theological assumptions of the transcendent and sacred nature of the person. These writings describe the common good in terms of conditions that guarantee the achievement of human rights and the discharge of correlative duties. Thus the Second Vatican Council, echoing the words of John XXIII, stated, "Now, the common good embraces the sum of those conditions of social life by which individuals, families, and groups can achieve their own fulfillment in a relatively thorough and ready way."⁹

A Dynamic Force In their 1986 pastoral letter, Economic Justice for All, the U.S. bishops merged the themes of justice, human rights, and community under the rubric of the common good in a distinctively American fashion.¹⁰ "Social justice implies that persons have an obligation to be active and productive participants in the life of society and that society has a duty to enable them to participate in this way," the bishops wrote.¹¹ Further, human rights are basic demands of justice and "prerequisites for dignified life in community."¹² Thus, "the common good demands justice for all, the protection of the human rights of all."¹³ Only through access to the goods classified as human rights, including the right to healthcare, can individuals truly participate in and contribute to the good of their society.

The common good, a dynamic force fueled by justice, requires society to give special attention to the needs of its marginalized members. The nonparticipation of marginalized people erodes their human dignity; it also erodes the common good and ultimately redounds on the welfare of each member of society. Borrowing the language of the Latin American episcopate, the U.S. bishops concluded that the common good requires that individuals and the nation "make a fundamental option for the poor."¹⁴

An Interconnected Web As Catholic social theory evolved, the common good emerged as the center of an interconnected web, linked dynamically to other vital components, particularly a distinctive anthropology, a nuanced theory of justice, the principle of subsidiarity, and the virtue of solidarity. Sometimes the common good has been a material norm against which to weigh particular judgments. More frequently, however, it has been a formal maxim referring to a future yet to be realized, an ideal being discovered and pursued, or a horizon from which to view concrete choices. The latter conceptualization captures the fullest sense of the symbol.

The Common Good and the Practical Order
Healthcare and the right to security in case of sickness are among the particular goods that make up the common societal good described in Catholic social teaching. By identifying these specific goods as essential common goods and by classifying these goods as human rights, Catholic social teaching provides the rationale for the development of a just healthcare system.

A National System For those committed to promotion of the common good, advocacy of a national healthcare system that embodies such a commitment must be a priority. Such a system would have the characteristics listed in "National Healthcare System Based on the Common Good" at the end of this article.

A Commitment to the Common Good In addition to advocating for a national healthcare system designed to serve the common societal good, Catholic healthcare entities must evaluate their own strategic plans and ongoing services in light of their impact on the common good of their communities and regions. In this era of networking and restructuring, it is especially important to evaluate proposed initiatives with other providers in light of their effect on the common good. For example, Catholic providers might assess whether a potential partner:

• Has established its current programs and services with an eye to promoting the common good of the communities they serve
• Is willing to participate in, and commit resources to, advocacy efforts for a redesigned national healthcare system that serves the common good
• Is willing to dedicate resources from the proposed joint venture to create programs to promote the common good of the community

In the course of establishing new alliances, Catholic healthcare entities should insist that the service of the common good be at least as high a priority as the goals aimed at securing economic advantages, such as increased market share. It is particularly important for those who are committed to the Catholic social ethic to carefully scrutinize proposed partnerships with for-profit organizations.

Commitment to the common good is an essential part of the mission of Catholic institutions. An appreciation of the theological and ethical context of the notion of the common good must combine with stamina and creativity to promote programs and secure partnerships that will convert the theory into practice.

NOTES

1. Catholic Health Association, Setting Relationships Right: A Proposal for Systematic Healthcare Reform, St. Louis, 1993, p. 3; Catholic Health Association, With Justice for All? The Ethics of Healthcare Rationing, St. Louis, 1991, p. 15; National Conference of Catholic Bishops, "Resolution on Health Care Reform," Origins, vol. 23, no. 7, 1993, p. 97.
2. Leo XIII, Rerum Novarum, 1891, paras. 26-28.
3. Pius XI, Quadragesimo Anno, 1931, para. 87.
4. John XXIII, Mater et Magistra, 1961, paras. 80, 155, 157; Pacem in Terris, 1963, paras. 99, 138.
5. Paul VI, Populorum Progressio, 1967, paras. 43, 44, 47, 76.
6. See Drew Christiansen, "On Relative Equality: Catholic Egalitarianism after Vatican II," Theological Studies, vol. 45, 1984, pp. 651-675.
7. Pacem in Terris, 1963, para. 11.
8. Thomas Aquinas, Summa Theologiae, II-II, quest. 47, sect. 10.
9. Gaudium et Spes, para. 74, in Walter Abbott, ed., The Documents of Vatican II, Guild Press, New York City, 1966.
10. National Conference of Catholic Bishops, Economic Justice for All: Pastoral Letter on Catholic Social Teaching and the U.S. Economy, U.S. Catholic Conference, Washington, DC, 1986.
11. Economic Justice for All, para. 71.
12. Economic Justice for All, para. 79.
13. Economic Justice for All, para. 85.
14. Economic Justice for All, para. 87 (Third General Conference of the Latin American Episcopate, Evangelization in Latin America's Present and Future, part VI, chapter 1, Puebla, Mexico, 1979).

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NATIONAL HEALTHCARE SYSTEM BASED ON THE COMMON GOOD

• Every citizen has access to a basic level of healthcare as a social good, regardless of his or her ability to pay or other extenuating circumstances.
• Every citizen bears a fair share of responsibility for healthcare as a portion of his or her commitment to the common good. Each is responsible for a healthy personal lifestyle and also is obligated to contribute resources to fund common services.
• A national allocation program distributes a percentage of the national budget to healthcare and other social goods, proportionate to their relative importance to the full common good. Each of the funded priorities has preestablished limits.
• The government taxes the citizenry to fund the services required to sustain the common good.
• The government oversees the provision of healthcare to ensure that all citizens have equal access to services to which they are entitled, according to a predefined list of basic services. (This does not imply that the federal government administers a national healthcare system.)
• A list of basic services would be determined through a broad-based consensual process, using criteria that consider the general health of the society and the particular needs of individual citizens. At the least, basic services for all citizens would include primary and emergency care and palliative, as distinct from curative, services. Regular revision of the list would take into account national experience, shifting social priorities, and available funding.
• There are explicit guidelines for rationing healthcare services nationally, driven by the common good. Application of the guidelines is equitable, as preestablished limits to healthcare expenditures require.