Converging Roads: Bioethics, Health Care, and Catholic Teaching
Part I. A Catholic Vision of Health Care
by Eric Brown & DarwinCatholic
The rich body of Catholic social teaching provides the faithful with moral principles to guide their thoughts and actions in political life. All too often, however, discussion of the Church’s social teaching is hijacked by a partisan political agenda — with the elements that seem to agree with one’s own party emphasized and all else ignored in order to give the stamp of Church approval to one’s party of choice. This deprives American Catholics of a meaningful analysis and reflection over the wisdom of the Church. This could not be more true on any subject than on health care.
The American bishops in Faithful Citizenship remind Catholics that “affordable and accessible health care is an essential safeguard of human life and a fundamental human right. With an estimated 47 million Americans lacking health care coverage, it is also an urgent national priority. Reform of the nation’s health care system needs to be rooted in values that respect human dignity, protect human life, and meet the needs of the poor and uninsured, especially born and unborn children, pregnant women, immigrants, and other vulnerable populations.” The Bishops also state that “religious groups should be able to provide health care without compromising their religious convictions.”
This is an often heated, passionate debate. It remains clear, however, from the American Catholic bishops that, “…although choices about how best to respond to these and other compelling threats to human life and dignity are matters for principled debate and decision, this does not make them optional concerns or permit Catholics to dismiss or ignore Church teaching on these important issues.” In other words, there is a clear and identifiable problem before us, which mandates a public dialogue and a just solution.
Yet, the very phrase “just solution” is loaded and not self-explanatory. In the American situation, there is scarcely an industry or person left without something at stake in the shaping of the health care system — whether it is hospitals and providers, insurance companies, drug companies, businesses and employers co-paying for their employees, religious and private institutions, non-profit organizations, or most importantly, American families. So what exactly does a “just solution” entail?
The Catechism of the Catholic Church list health care among the basic human needs which a society should help its members attain:
“Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good. Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance (2288).
Catholic social teaching is still comparatively in its infancy, finding its first clear expression under Pope Leo XIII in the 1890s, as the papacy (so recently divested of its temporal rule over the papal state and accepting its place as a strictly spiritual and moral authority) struggled to provide a clear application of Catholic moral and social teaching to the unprecedented turmoil society was undergoing as a result of the latter stages of the industrial revolution and the beginnings of a true mass society.
In respectful disagreement with the U.S. Catholic bishops, it is difficult to argue that health care is a “fundamental right” either theologically or philosophically — at least in the sense which the phrase has traditionally been used. Health care is not per se natural, therefore, not a natural inalienable right. Health care is no more a “right” than education is a “right”, in the sense that it is not something which one naturally possesses and only lacks to the extent someone takes it away. However, given its availability in the modern world, heath care is certain a basic human need and a prerequisite for a flourishing society — it is not a mere product or commodity — and therefore it is a national interest and a vital area of public policy. Further, one might argue that health care is a “civil right” in an affluent society, in that there is no reason as to why anyone should be unjustly denied basic health care.
The Compendium of Catholic Social Doctrine often talks about health care in terms of two vital principles: (1) preferential option for the poor and (2) solidarity. The means to achieve this goal is at the forefront of the debate. How much of a role, if any, should the government have in this regard? The Catechism seems to suggest that the government does have a role in societal affairs, though not without limits. The principal task of the state is to “guarantee…security” so that the people can work efficiently and honestly and enjoy the fruits of their labor.
Another task of the state is that of overseeing and directing the exercise of human rights in the economic sector. However, primary responsibility in this area belongs not to the state but to individuals and to the various groups and associations which make up society” (2431)
This latter point re-emphasizes the primacy of the principle of subsidiarity. Yet, for the sake of justice, “political authority has the right and duty to regulate the legitimate exercise of the right to ownership for the sake of the common good” (2406). The State can intervene to ensure respect for the universal destination of goods, particularly to those lacking. However, again, taking principles set forth at their word, this activity by the State cannot be arbitrary or in direct violation of the principle of subsidiarity.
In light of these principles, The Catholic Health Association of the United States broadly outlines a conceivable “health care system” that is in conformity with Catholic social teaching. First and foremost, any health care system must be one that “truly promotes the nation’s well-being and respects the dignity of every person.”
Because each person is created in the image of God, each life is sacred and possesses inalienable worth. Health care is essential to promoting and protecting the inherent dignity of every individual from conception to natural death.
Concern for the poor & vulnerable
The moral measure of society is how it treats the poor and vulnerable, who are particularly marginalized by a lack of access to health care.
Health care is a basic human right alongside food and shelter, all of which are necessary for individuals to participate fully in society.
The health and well-being of each person is intertwined with the health and well-being of the broader community. Access to health care is an essential element contributing to the common good alongside others such as education, employment and a safe environment.
Our societal resources are finite, and we must make wise choices for how they are allocated. Health care resources should focus on the well-being of the community and be structured to deliver the care that is most medically beneficial and promotes public health.
The health care system should allow and encourage involvement of the public and private sectors including voluntary, religious and not-for-profit organizations, and it should respect the religious and ethical values of patients and health care providers alike.
Available and accessible to everyone, paying special attention to the poor and vulnerable
- Ensure that each person has a core health benefit package covering services across the life span of care.
- Deliver the same level and quality of care to everyone without limits or variations based on age; race; ethnicity; financial means; or health, immigration or employment status.
Health & prevention oriented, with the goal of enhancing the health status of communities
- Make preventive care a core part of health benefits in every community and develop provider and patient incentives that reward prevention.
- Improve health literacy and education to help patients play a greater role in maintaining their own health and wellness.
Sufficiently and fairly financed
- Share the responsibility of financing among all stakeholders.
- Care for those who cannot help themselves by having all stakeholders, including government, employers, individuals, charitable organizations and health care providers, collectively assume responsibility.
Transparent and consensus-driven in allocation of resources, and organized for cost-effective care and administration
- Manage cost growth to promote affordability and sustainability; efficiently use facilities, equipment and services; minimize administrative expenses.
- Spend resources on care that is most medically beneficial.
Patient centered and designed to address health needs at all stages of life, from conception to natural death
- Ensure that services are coordinated and integrated all along the continuum of care — the system should be truly accountable for health outcomes.
- Design palliative and end-of-life care to ensure the best and most compassionate treatment for persons with serious, complex diseases and those in the final stages of life.
Safe, effective and designed to deliver the greatest possible quality
- Standardize and expand the use of information technology to improve clinical coordination, reduce medical errors and improve the patient experience.
- Use evidence-based medicine to optimize outcomes and quality; prioritize patient safety by minimizing the systemic causes of errors.
Without question, this is not the Catholic vision of health care, but it is at least a Catholic vision for possible reform. As Catholics and American citizens, we would do well to think a good deal over the next few months about what sort of health care reform would be beneficial (or at least acceptable) from a Catholic point of view, because it seems increasingly clear that the Obama Administration and the Democratic-majority Congress will be moving to draft a significant health care reform package this year. If we find ourselves with nothing more constructive to say than “yes” or “no” we are likely to find ourselves used or ignored by those who are clear on what their goals for American health care are.
From a Catholic point of view it would seem that any new system must be built on an ethical foundation; be respectful of both subsidiary institutions and solidarity with those most in need; and include a proper understanding of life, death, human sexuality, and bioethics. In the following posts in this series, we will seek to provide a diversity of Catholic views on addressing the health care issue, both in general terms and as regards the initiatives currently making their way forward in Congress.