REVIEWED BY SR. PATRICIA SMITH, RSM, PhD
Helping and Healing: Religious Commitment in Health Care
Edmund D. Pellegrino and David C. Thomasma
Georgetown University Press, Washington, DC, 1997, 176 pp., $15.95 (paperback)
Written from a philosophical perspective, this book seeks to complement the authors' previous efforts to establish a "moral philosophy for medicine" with religious and theological sources that explore the nature of healthcare and the healthcare professional. Although focusing on bioethics, they interweave a pervasive critique of today's healthcare system, which is based on commercialistic, competitive, entrepreneurial medicine. Their intent is ultimately practical: "What influence does . . . religion have on the kind of person the health professional should be, and on what constitutes healing in the fullest sense of the term?"
Transitions from chapter to chapter are not always clear, but two chapters are especially interesting. "The Principle of Vulnerability" explores professionals' obligation to protect and never exploit their patients. The current environment of "social parsimony," where respect and resources for society's most vulnerable persons are restricted, makes fulfilling this obligation increasingly difficult. The conflict between individual rights and the common good is the ethical challenge of our time.
"Medicine as a Calling" presents the differences among an occupation, a profession, and a vocation. An occupation is only a job. A profession entails participating with others dedicated primarily to the service of others. Vocation is God's call to transform one's occupation and profession into serving God by serving others.
The audience is healthcare professionals, although most references are to physicians. Most of my collegues would find this work overly abstract. The authors presuppose familiarity with various philosophical systems — ancient, medieval and modern. They proceed more from a deductive than an inductive method, whereas healthcare professionals often become engaged and move toward general principles through particular cases.
The authors present a challenging critique of numerous dangers, most notably commodification of healthcare and market-defined healthcare. In an "alienating environment," they see religiously identified organizations tempted to sell out their mission.
The book purports to focus on religious commitment, but it seems based more on philosophy than theology. Although the authors refer to Scripture and the Catholic tradition, such themes as the image-of-God theology (Genesis) and Jesus' healing ministry (Gospel stories) receive much less attention than principle-based argument. The authors also presuppose an earlier homogeneity of philosophical and theological values, which I question.
Overall, I am more sanguine about the future of Catholic healthcare than are the authors. Whether or not my colleagues are explicitly religious, most are committed to our mission, as rooted in God's healing love for all people. They are leaders in making that mission real in concrete, behavioral ways. We do have difficult choices to make today. But, at least to this point, we seem able to make them with moral integrity. My theological vision stems from Karl Rahner's insight that God's grace is indeed present and discovered "in the midst of the mess" of our daily lives. That often sustains my hope.
The sources that the authors use to develop and support their case include few women and even fewer professional philosophers or theologians. Both Lisa Sowle Cahill and Margaret Farley, RSM, have made significant contributions to healthcare ethics. I expect to find them in any serious work addressing healthcare in the Catholic tradition today.
Reviewed by Sr. Patricia Smith, RSM, Assistant to the President for Theology, Mission and Ethics, Mercy Medical Center, Baltimore