Yesterday, I attended an ethics talk on the potential issues of merging Secular and Religious healthcare organizations. It was an extremely interesting discussion and one that’s far too complex to try and detail here1.
For anyone who’s been living under a rock for the past few years, the US healthcare system is undergoing a tremendous amount of change and reorganization. Changes in treatment reimbursement and shifting regulations regarding electronic health records and such have seen many smaller hospitals consolidating into larger Accountable Care Organizations (ACO). This has inevitably resulted in religiously affiliated hospitals (primarily Catholic ones) merging with or associating with secular institutions. With these new agreements come another set of governing documents known as the Ethical and Religious Directives (ERD) which are handed down by the U.S. Conference of Catholic Bishops. These directives are an attempt to elucidate Catholic Social Teaching within the context of medicine and healthcare and provide a framework for not only reasoning about critical decisions, but also for defending existing doctrine. Of course, these documents don’t stand on their own, they are products of a current political and cultural climate and thus deal with extremely delicate topics centered around both the beginning and end of life. And it’s these stances that are proving to be problematic.
As the session opened the panelists each gave their perspective on the topic and attempted to explain the issues at stake. This is where things began to get interesting. Like any old fool, I’d originally assumed that in a discussion of both Catholic teaching and Catholic hospitals, there would be representatives from some of the respective organizations. Silly me, in fact, not only were they not in attendance, they were purposefully not invited, in order to keep the discussion focused on ‘the ethics’2.
The problem with this approach, is that catholic3 teaching is focused within a larger religious framework that makes it impossible to split off and analyze as a piece of secular health policy. Consider this section from the ERD Introduction:
The mystery of Christ casts light on every facet of Catholic health care: to see Christian love as the animating principle of health care; to see healing and compassion as a continuation of Christ’s mission; to see suffering as a participation in the redemptive power of Christ’s passion, death, and resurrection; and to see death, transformed by the resurrection, as an opportunity for a final act of communion with Christ.4.
As a religious person, I find this statement to be incredibly powerful, beautiful in its hopefulness for a world renewed, and invigorating in its extortion to us as agents of healing and change. To a non-religious individual, this statement is at best completely inaccessible, and at worst extremely offensive.
Consider Directive #61, which ends with:
… Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.
When trying to evaluate this as a piece of health policy it largely reads ‘let them suffer until the bitter end, and maybe preach at them until they pass out’. Which brings us to the crux of the forum, the prevailing opinion is that the merging of secular and religious hospitals is unethical because Catholic teaching is inconsistent with moral care of both the dying and the soon to be born, or accurately scheduling those soon to be born.
A religious person would bristle at this statement, and rightly so, but that fact remains, this is the perception of a huge swath of the American populace.
But why is this the case?
While there are most likely a myriad of reasons, the one that stuck out to me was the fact that religious views on health and ethics are inextricably rooted in a larger religious system. The reason Catholics oppose abortion, is not some form of uterine control, but a deep understanding on the meaning and value of life. Likewise, this concern is extended to include those whose time on earth is drawing to a swift, though painful, close. Thus, when you simply strip all that away, you’re left with a series of cryptic one-liners which seem to simply regurgitate the last remnants of some medieval council.
But this misunderstanding goes even further. Consider the recent supreme court case Sibelius v. Hobby Lobby, here the court wants to know why the actions and choices of an individual must be made subject to religious doctrine. A fair question, but one that’s inherently misguided. To a religious person, the question is not about why actions may be held to account for religious teachings, but if these specific actions can be held to such a standard. Religious people understand the concept of self-surrender, whereby our wants and desires are made subject to the perfect will of God. So, while you may argue over specific cases, it makes logical sense that there would be situations in which our own wants and desires would have to be surrendered for some larger purpose5. Of course, without a theological framework to lean on, this explanation holds little to no weight.
At this point, there are probably quite a few people who would take issue with my characterization of religious doctrine, in that God’s truth extends beyond simple metaphor or liturgical ritual, it indeed resounds in the night and shines in the light of day6. This is absolutely true, and one need only take a cursory scan of places like The Public Discourse, or First Things in order to find logical, well reasoned discussions of Christian ethics and thought within the public realm; however, these discussions seem to be relegated to the back-burner of public society and have ceased to light the way forward.
But again, why is this the case?
I would hold that the fault lies not with the secular world, but with those of us who profess to hold such believes. We have failed. We have failed to translate the spiritual to the physical, not only in our explanations of truth, but in the way we model and reveal the glory of God in this world. We have become a Church defined by what we’re against, not what we’re for. A Church in which ‘not as you are’, has replaced ‘what you will become’. Is it any wonder people are pushing back against us? If the Church was really what they perceived it to be, would you want to be a part of it?
This is what I hear people rebelling against. Not our forms of worship, or our personal moral codes, but our perceived abandonment of mercy and compassion. The Church is seen not as a field hospital for those cast about by the waves of post-modernity, but as a wall with which to break upon. In discussions such as these, I hear less the mocking laugh of atheism, then the heartbroken pleas of those left behind. And while the Church’s truth on death and dying may hold together from a logical perspective, it seems a cold comfort to those on death’s door, without any hope of what lies beyond.
In the end, this is not a doctrinal issue, it’s a language issue, it’s a relational issue. Perhaps it’s an issue that will never be solved, perhaps the chasm is just too great, but if the Church ever hopes to regain its place in the public sphere, it needs to shift is language7, it needs declare its support for those in life’s most vulnerable states. It needs to show (through words and actions) how it values all people and that the truths it extols are, in fact, those most consistent with human flourishing. Only then, will people begin to understand the crux of the religious arguments, which are built upon the idea of a loving savior, and a world broken but longing to be renewed. Until then, we’ll all just be talking past each other and we’ll keep running down this same road, and I find it highly unlikely that things will simply work themselves out over time.
Today, I don’t really have any good answers, like everyone else, I’m still trying to figure out what it means to be a Christian in 2014, living in the community I’ve found myself in. I’m trying to figure out how my faith and beliefs work themselves out in the public life I live. And, like everyone else in that room yesterday, I’m trying to work towards alleviating the pain and suffering from those in this world who seem to have too much of both. But while I don’t have any direct answers, I do know one thing for sure. The way things are right now, does not bode well for the future of religion and American Christianity. Living in Seattle we find ourselves not in a post-Christian world but a post-post-Christian one, one in which the the forms and frameworks of religion have faded quietly into the past. Unless we change the way we communicate hope and truth people won’t understand. And unless we change the way we live out that truth in the world, they won’t listen.
The tax issues alone require at least a month to go through, but that’s probably because everyone would be falling asleep with regularity. ↩
In case you’re worried that this would cause a slant in the dialogue, fear not, the ACLU provided all the necessary expertise. ↩
Notice the small C spelling, from here on out I’m going to use Catholic doctrine as a model, but I think the issues are largely transferable between faiths and denominations. ↩
Ethical and Religious Directives for Catholic Health Care Services, 5th Edition (2009). ↩
Some questions will, naturally, be raised as to what type of freedom we’re promoting, but I would dodge that whole debate by simply stating ‘positive freedom’. Yes it’s a simplistic response, but it leaves a little something for next time. ↩
I love that UW’s motto is Lux sit ‘Let there be light’ ↩
notice I said language, not doctrine. ↩