This article appears in the November 2005 edition of the Catholic Medical Quarterly
Do We Need a Catholic Hospital?
The Catholic Church is still proudly the oldest and largest provider of health care in the world. But, in what is euphemistically termed the developed world, there is an increasing complexity of health care, which requires many forms of co-operation to meet the needs of the people who are served; the need to eliminate duplication in order to limit escalating costs; the demands of governments and insurance companies as to their conditions with respect to benefits and their arrangements to finance them; and the resistance of non-Catholics (and also of Catholics who do not agree with some of the Church's teachings). It means either that our hospitals will have so to participate in various sorts of co-operative relationships or they will become increasingly marginalised and ultimately financially non viable.
No general hospital today is able to provide a complete service for every medical condition. Does this mean that the Catholic hospital is doomed in the developed world?
In addition, the lack of available Catholic consultants able to staff fully the various medical divisions, and the decline of the religious orders, which provided such a contribution in the past, has resulted in the appointment of non-Catholic medical personnel. Management has been handed over to lay trustees, administrators and clinical staff who, believers or not, represent a wide range of value perspectives. So we now find that Catholic hospitals rely less and less on the institutional Church and private donors for finance and more and more upon governments and private insurers, losing in this process considerable financial and administrative autonomy: `healthcare providers', ministering to ‘health care consumers’ under what are officiously termed `healthcare managers', has become the vogue rather than a form of compassionate service between professional and patient.
Faced with what seems to be an insurmountable problem, there is a trend, particularly in America, for the health care providers to redevelop horizontally. Catholic and secular providers are co-sponsoring joint delivery networks or health maintenance organisations which can better provide the full spectrum of services and compete for a fuller share of the market. As healthcare is now regarded as a market, in which the private sector is being encouraged to participate along with social services, this seems an eminently sensible solution. But it is not without its own difficulties. Benedict Ashley and Germain Grisez have recently argued that such arrangements often involve wrongful co-operation with evil, whether formal (1) or material (2). Ashley suggests that it radically erodes their Catholic identity while doing no service to the poor, the sick and the dying.
Those responsible for Catholic hospitals must not subordinate their mission to their (otherwise quite necessary) concern for economic stability, professional reputation and cultural acceptability. Grisez argues that the material co-operation of Catholic hospitals with others, in their immoral activities, is usually morally unacceptable, because it is an occasion of formal co-operation or other corruption; it causes scandal (in the theological sense), impairs the hospital, and its members' and the Church's capacity to give credible witness against evil.
Clearly, very careful thought must be given to any such arrangements in advance, various procedural safeguards put in place, and eternal vigilance exercised by all concerned with respect to the maintenance of a specifically Christian and Catholic character.
The Catholic hospital in a plural society would aim to be the humanly best hospital, demonstrating the greatest respect for human dignity and rights such as life and health, human norms and virtues; and technically the best hospital in the areas in which it is most proficient. It would represent the highest standards of healing and care. It would stand out as a high quality alternative to the run of the mill as a hospital best able to justify the continued tolerance and support of funders and regulators. With unashamedly Catholic codes of ethics and practice, ethics committees, and staff education programmes, it will occupy a `market niche' as a refuge for those still committed to a genuinely Hippocratic medicine.
The Catholic hospital will not allow the scope of its moral concerns to be narrowed to the stereotyped ‘Catholic club rules’ against contraception, abortion and euthanasia - important as those are in themselves - as litmus tests of professionalism and of the Catholicity of the institution. Rather it would see as one of its fundamental purposes the propagation of the ethos among patients, health professionals and the community of spiritual heart transplant to match the physical health of the body.
In that perspective the Catholic hospital becomes a challenge and an inspiration: that good obstetrics does not require the mutilation of the embryo or fetus, that medical practice does not necessitate the withdrawal of healing and life support when it is deemed not to be in the best interests of the sufferer; or, that life itself should be terminated as a consequence of a false conception of compassion. Looked at in this way, what we are prescribing is a system of medicine based on natural law. Christianity does not hold the copyright; it has support from large numbers of practitioners in the other main faiths. Observe the numbers of patients from other faiths who feel safe in the care of natural law practitioners.
As has been emphasised, no general hospital can nowadays provide a complete range of technical medical care. The Catholic hospital, by promoting its most efficient departments, will inevitably find itself in a ‘market niche’ with funding overtaking its financial liabilities.
Benedict Ashley OP., ‘The documents of Catholic Identity’ in Russell E. Smith (ed), The Gospel of Life and the vision of HealthCare: Proceedings of the 15th Workshop for Bishops, Braintree, Massachusetts: Pope John Paul Center
Germain Grisez, `Difficult Moral Questions' Quincy. Illinois: Franciscan Press 1997 q 87