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BY: TOBIAS WINRIGHT, MDiv, PhD

The introduction to Pope Francis' encyclical letter, Laudato Si', includes medical terminology when the pope refers to "the symptoms of sickness evident in the soil, in the water, in the air and in all forms of life."¹ In describing the environmentalcrisis in this way, the pontiff immediately interconnects health care and the environment, and given what he implores as our Christian and human moral responsibility towards one another and to the Earth, I believe that health care professionals, institutions and systems — Catholic or otherwise — not only should "do no harm," by stopping practices that negatively impact the environment (and people), but also pursue creative new ones that proactively benefit the planet and its people. In other words, health care should, as the motto on my patrol car said when I used to be a reserve police officer, "serve and protect" the health of humans and the Earth.

Throughout this incredibly important document, the Holy Father highlights interconnections such as the link between war and environmental destruction and the relationship between consumptive cutting of tropical forests, climate warming and the melting of the polar ice caps. He repeatedly uses words such as "connected," "linked" and "interwoven." As Daniel R. DiLeo at the Catholic Climate Covenant has noted, Pope Francis is like a physician when he "utilizes the best available science to assess the symptoms of ecological destruction, diagnoses the illnesses that produce these symptoms, and prescribes a cure to heal our current ecological disorders."²

Admittedly, the encyclical does not address health care as a primary issue, and only a handful of times does it directly mention health. For instance, in paragraph 20, pollution's production of "a broad spectrum of health hazards, especially for the poor," leads to "millions of premature deaths." Cities, "which have become unhealthy to live in," are particularly problematic "not only because of pollution caused by toxic emissions but also as a result of urban chaos, poor transportation, and visual pollution and noise," according to paragraph 44.

Beyond these general references to health, Pope Francis notes in paragraph 28 that fresh, drinkable water is "indispensable for human life" and, as he more directly observes, "for health care." In paragraph 21, he criticizes the hundreds of millions of tons of nonbiodegradable, radioactive and toxic waste generated annually from homes, businesses, industries and "from clinical … sources." Thus, while health and health care appear to be very important, according to this encyclical, some health care practices actually undermine or go against the health and well-being of people as well as the planet.

Cristina Richie, in a brief article about Laudato Si' and Catholic health care, reinforces these points when she touches on how hospitals and health care facilities have been "major contributors to carbon emissions due to electricity, air conditioning, and single-use instruments." Fortunately, a number of these entities, like Dignity Health in California, are beginning to explore ways to reduce emissions "in an effort to curb climate change."³ She also notes that Catholic Health Initiatives in Colorado is doing away with the use of plastic-bottled water since approximately only 20 percent are ever recycled.

Although health care is mentioned only a few times, the overarching theological and moral frame of the encyclical, I think, is congruent with and should integrate well with the principles, values and virtues of medicine, especially Catholic health care. Building on earlier references by Popes John Paul II and Benedict XVI to "human ecology," which refers to a right ordering of persons, and "natural ecology" or "environmental ecology," which refer to the right ordering of nonhuman creation, Pope Francis in paragraph 225 calls for an "integral ecology" that recovers "a serene harmony with creation"⁴ — that is, the pope is seeking to integrate human and natural ecology.

Catholic medical ethicists Fr. Kevin O'Rourke, OP, and Philip J. Boyle also use the word "integrated" in connection with health: "From a Christian perspective, then, health envisions optimal functioning of the human person to meet physiological, psychological, social, and spiritual needs in an integrated manner."⁵

A dualism between spirit and body or any other similar dualisms are counter to Catholic theology and health care ethics. After all, we are not separate from nature. We, too, are creatures of our Creator. And we are made of the molecules and atoms of our natural environment. Unfortunately, as Pope Francis observes in paragraph 2, "We have forgotten that we ourselves are dust of the Earth (cf. Gen 2:7), our very bodies are made up of her elements, we breathe her air and we receive life and refreshment from her waters."

In Pope Francis' phrase, "a serene harmony with creation," the word "harmony" brings to mind the Hebrew word shalom, which means a positive peace or harmony, not simply the absence of violence. In the creation accounts of Genesis, such harmony existed in human relationships with one another and with nonhuman creation. The prophets foretold of a day when such a harmony would be restored in the peaceable kingdom. As Isaiah envisioned it:

The wolf shall live with the lamb,

the leopard shall lie down with the kid,

the calf and the lion and the fatling

together, and a little child shall lead them.

The cow and the bear shall graze,

their young shall lie down together;

and the lion shall eat straw like the ox.

The nursing child shall play over the hole

of the asp, and the weaned child shall put

its hand on the adder's den.

They will not hurt or destroy

on all my holy mountain;

for the Earth will be full of the knowledge

of the LORD as the waters cover the sea.⁶

In the opening paragraphs of the encyclical, Pope Francis highlights Pope John XXIII's Pacem in Terris (Peace on Earth), which he notes "not only rejected war but offered a proposal for peace." Perhaps an alternative title for Laudato Si' could have been Pacem cum Terra (Peace with the Earth). Or, a slight modification of the traditional "Gloria" in the Catholic Mass, from "Glory to God in the highest, and peace to God's people on Earth" to "Glory to God in the highest, and peace to God's people and Earth."

Pope Francis emphasizes that how we treat the planet often is how we also treat the poor: Both are reduced to be objects to be exploited, plundered, manipulated, controlled, disposed of and thrown away. A number of times the target of his criticism is "a throwaway culture."⁷ Catholic health care, which has been a genuine witness of our call to care for the poor, should also lead the way in caring for the planet as it continues to serve the poor, the sick, the suffering and the dying.

In his article on the encyclical, DiLeo rightly notes that the words "dominion" and "subdue" (ra¯dâ and ka¯baš, respectively) from Genesis 1:28 have been misunderstood as calling for exploitation of the rest of creation. Although DiLeo does not refer to it, another very good way to translate the Hebrew words in Genesis 2:15 — "to till and keep it" — is "to serve and protect it."

Indeed, Pope Francis writes in paragraph 217, "Living our vocation to be protectors of God's handiwork is essential to a life of virtue; it is not an optional or secondary aspect of our Christian existence." Discipleship ought to be green. So too, Catholic health care should entail verdant virtues, values, principles and practices.

Growing up on a small farm, I loved spending time outside and, in particular, exploring the woods and the creeks. While attending St. Joseph's Catholic School in Blakeslee, Ohio, as a young boy, I learned about St. Francis of Assisi, and I would attempt (in vain) to communicate, like the stories claimed he did, with the birds and squirrels I encountered. During those years (the 1970s), my teachers — sisters and laity — not only tried to teach us to be pro-life in connection with the issue of abortion, but they also introduced us to the "Save the Whales" campaign underway at the time. Catholic teaching in each of these areas — health care ethics and environmental ethics — has come a long way in a short time. And women religious have paved the way in both areas as well as in their integration.

My own teaching and writing on the latter began in 2004 when I was teaching at Walsh University, which was founded by the Brothers of Christian Instruction in North Canton, Ohio. The Sisters of the Humility of Mary, who operate Villa Maria, a retreat and educational center just across the border in western Pennsylvania, generously gave me a grant to read up on the subject and to construct a new course on theology and the environment to teach at Walsh. I continue to offer the course regularly at Saint Louis University, as well as others, including Catholic health care ethics. In my view, Laudato Si' offers helpful theological and moral insights for interrelating and integrating the two.

TOBIAS WINRIGHT holds the Mäder Chair of Health Care Ethics in the Albert Gnaegi Center for Health Care Ethics and is associate professor of theological ethics in the Department of Theological Studies at Saint Louis University. He edited Green Discipleship: Catholic Theological Ethics and the Environment (Anselm Academic, 2011) and most recently edited and contributed to Can War Be Just in the 21st Century? Ethicists Engage the Tradition (Orbis Books, 2015).

1. Francis, Laudato Si', paragraph 2. http://w2.vatican.va/content/francesco/en/encyclicals/documents/papa-francesco_20150524_enciclica-
   laudato-si.html.
2. Daniel R. DiLeo, "Francis the Ecological Physician: Assessing the Symptoms, Diagnosing the Illness and Prescribing a Cure," Health Care Ethics USA 23, no. 3 (Summer 2015): 1.
3. Cristina Richie, "Laudato Si', Catholic Health Care, and Climate Change," Health Care Ethics USA 23, no. 3
   (Summer 2015): 30.
4. I am grateful to Dan DiLeo for explicating these terms in this way via personal correspondence on Facebook.
5. Kevin D. O'Rourke and Philip J. Boyle, Medical Ethics: Sources of Catholic Teachings, 4th ed. (Washington, D.C.: Georgetown University Press, 2011), 7.
6. Isaiah 11:6-9, (New Revised Standard Version).
7. Francis, Laudato Si', paragraph 22.