BY: FR. CHARLES E. BOUCHARD, OP, STD
In 2017, the British pharmaceutical company AbbVie and the London-based think tank 2020health published a study indicating that despite the abundance of medical knowledge available to patients in the United Kingdom, FOFO — that is, "fear of finding out" — was one of "the main barriers to healthier life style choices."
This fear, the study reported, accounts for nearly a third of all conscious reasons why individuals may be delaying or avoiding visiting their doctor or seeking medical advice.1 Indeed, all of us probably have put off a doctor's appointment, hoping that whatever symptoms we have will go away on their own.
Jonathan Goodman, a columnist for the London daily newspaper The Guardian, identifies another kind of fear when he describes "job lock" — the tendency of many Americans to stay in jobs they really don't like or that don't match their talents because they are afraid of losing their health insurance.
A high job-lock rate "is linked to fewer small businesses, despite the seemingly universal agreement that small business is the 'backbone' of the American economy," Goodman says. Will fear of losing insurance lead to a less creative country? Will we trap "the next William James, Herman Melville or Bob Dylan" in a "prison installed by unchecked insurance companies" and exorbitantly priced drugs?2
Fear of deportation is another troubling aspect of the American health care context. We long have known that undocumented immigrants avoid health care providers because they fear deportation if they draw attention to themselves, but now, says writer Jesse Hicks, even legal immigrants are reluctant to sign up for subsidized insurance coverage provided by the Affordable Care Act and Medicaid or to see a health care provider for fear that their personal information will be used against undocumented relatives to locate undocumented family members.3
Hicks quoted an Associated Press interview in which a woman from Mexico, who is a legal U.S. resident, said, "We're afraid of maybe getting sick or getting into an accident, but the fear of my [undocumented] husband being deported is bigger." The woman decided to go without insurance and is considering not re-enrolling her two children in the state's Children's Health Insurance Program.
For Americans, everything changed on September 11, 2001. The fall of the World Trade Center's twin towers shifted our normally optimistic, can-do culture into a fear mode. Since then, fear of foreigners, fear of dependence, fear of economic insecurity and fear for our own safety and that of our children, all have grown. This has spilled over in specific ways that impact provision and access to health care, but it is a larger cultural and spiritual problem as well.
"Fear has transformed safety into one of the main virtues of society," says Frank Furedi, author of a book on fear.
"This worship of safety," Furedi says, "has fostered an inclination to continually exaggerate the problems facing society, which in turn has encouraged a cautious and anxious outlook. The disposition to perceive one's existence as being at risk has a discernable effect on the conduct of life … the disposition to panic, the remarkable dread of strangers and feebleness of trust … leads to a world view which equates the good life with self-limitation and risk aversion."4
Since 9/11, there has been a great deal of discussion of how we live with fear, especially fear of terrorism. There are many other kinds of fear that we live with, from ordinary fears we experience every day to spiritual and cosmic fear. Fear has its place in the moral life, but too much fear is incompatible with the Catholic world view, which sees the world as a graced and hopeful place. Living a life of fear is a hazard to virtue, an impediment to health care and a betrayal of our vocations to service.
Furedi's concerns are echoed by Scott Bader-Saye, professor of Christian ethics and moral theology at the Seminary of the Southwest in Austin, Texas. He says, "fear becomes the story we share in the absence of any shared account of goods and goals."5 The only thing we have in common is what we want to avoid. Nothing draws us into the future, and there is little room for a positive movement toward building the common good.
However, the Catholic view of the world is rooted in the common good — a set of social and economic circumstances that enable all of us to flourish. The common good requires sacrifice from individual citizens and continual recalibration of rights and responsibilities to assure relative justice for everyone. This hopeful striving for a good society — which mirrors the Reign of God — requires active engagement with others, even when that poses some risk.
It cannot occur if our primary concern is personal safety and constriction of our hopes and desires. In our view, grace draws us upward and outward, not into a safe cocoon. This is not to say that fear is useless. As an emotion, it can serve as an ethical early warning system when it senses danger or moral hazard, even before we are able to process it rationally. Fear also tells us what we love, says St. Thomas Aquinas: "Fear is born of love, since we fear the loss of what we love,"6 so it can "alert us to our loves in a powerful way," as Bader-Saye put it.7
"Moderate fear conduces to working well, in so far as it causes a certain solicitude and makes us take counsel and work with seriousness and greater attention," Aquinas says.8
But fearing the wrong things, or fearing real things too much, can lead us astray. Courage is the antidote for fear, enabling us to pursue the good despite adversity. Courage isn't only the virtue of heroes. It also is an everyday virtue, one that enables us to get up in the morning, develop spiritual purpose and vocation and stick to them. Whether our commitments are to justice, quality patient care, equitable health care financing or those we love, overcoming fear to maintain those commitments is a primary human virtue. Few things worth pursuing can be achieved without some measure of courage.
I hate to add one more thing to the list of concerns that health care providers have. We have had to embrace justice and equity, diversity, disparity and population health, and now we're supposed to be cheerleaders for courage? Well, yes.
This is true at a micro level when we are trying to sign up fearful immigrants for care, because we believe in human dignity and the common good. It is true at a personal level when we help patients face their own fears so they can make solid health care choices. And it is also true at a political level when we lobby for more equitable access to health care so that people are free — and healthy enough — to follow their deepest hopes and dreams without worry over getting sick.
Health care providers encounter fear more than most of us. They see it in the eyes of patients and their families when they face bad news or tragedy. They experience it personally when they make treatment decisions with less information than they would like to have, or when they are confronted by a medical error that has legal or professional consequences.
Yet we can't let fear get the best of us. We have to be honest about real dangers, but we also have to temper the prejudice, xenophobia, doubt, lack of faith and individualism that lead to excessive fear. In the Gospels, Jesus frequently tells his disciples not to be afraid.9 In one case, he tells them to "put [their boat] out into deep water..."10
We're in pretty deep already, but, like the disciples, we need to trust in the Lord and pursue the noble work we have been called to. This is going to put us at some risk, but for the sake of the common good and the Reign of God, that is part of our vocation.
FR. CHARLES E. BOUCHARD, OP, STD, is senior director, theology and ethics, the Catholic Health Association, St. Louis.
NOTES
- Jon Paxman, Julia Manning and Matt James, The Fear of Finding Out: Identifying Psychological Barriers to Diagnosis in the UK (London: 2020health, 2017). 2020health is an independent think tank whose mission is to "make health personal." This article is available for download at www.2020health.org/2020health/Publications.html.
- Jonathan R. Goodman, "Fear Over Healthcare Locks Americans in Jobs — and Throttles Creativity," The Guardian, Nov. 13, 2017. www.theguardian.com/commentisfree/2017/nov/13/fear-over-healthcare-locks-americans-jobs-throttles-creativity.
- Jesse Hicks, "Fear of Deportation Is Scaring Legal Immigrants Out of Getting Health Care," Tonic, a Vice Media website, Jan. 22, 2018. https://tonic.vice.com/en_us/article/a3n995/legal-immigrants-healthcare-deportation-fears.
- Frank Furedi, Culture of Fear: Risk Taking and the Morality of Low Expectation (London and New York: Cassell, 1997), 147. See also Furedi's essay "The Politics of Fear" at http://www.frankfuredi.com/articles/politicsFear-20041028.shtml.
- Scott Bader-Saye, "Thomas Aquinas and the Culture of Fear," Journal of the Society of Christian Ethics 25, no. 2 (Fall/Winter 2005): 95-108, at 99. See also Scott Bader-Saye, Following Jesus in a Culture of Fear (Grand Rapids: Brazos Press, 2007), 41.
- Thomas Aquinas, Summa Theologica, Second Part of the Second Part, question 19, answer 3.
- Scott Bader-Saye, Following Jesus in a Culture of Fear, 41.
- Summa Theologica, First Part of the Second Part, question 44, answer 4.
- Both the Hebrew and Christian Scriptures are filled with admonitions against fear. See Isaiah 35:4 and 43:1, Matthew 10:28 and 14:27 and John 14:27, for just a few examples.
- Luke 5:4, New American Bible.