Essentials for Leading Mission in Catholic Health Care The Social Responsibility of Catholic Health Services The Ethical and Religious Directives for Catholic Health Care Services (Parts I and VI) FR. CHARLES BOUCHARD, OP, S.T.D. Senior Director, Theology and Ethics Catholic Health Association Catholic Social Tradition Theology, teaching and practice that have developed over centuries 1
Three Realms of Ethics From Jack Glaser, Ph.D. Social Ethics: Contribution to a Good Society The social question became pressing after the Industrial Revolution in the 1890s. 2
Mother Jones and Pope Leo XIII Mary Harris Mother Jones (1837 1930) The most dangerous woman in America Pope Leo XIII (1810 1903) The Catholic Social Tradition Catholic Social Practice 3
Catholic Social Thought The work of theologians, philosophers, economists, political scientists, management theorists, educators, and others Ongoing discussion and debate Catholic, ecumenical, interfaith: Heschel, Rauschenbusch Presumes no conflict between science and faith Catholic Social Teaching Formal Church Teaching Encyclicals Pastoral letters Vatican Council documents Rooted in Scripture and natural law (discovery of God s plan through reflection on human experience) 4
Catholic Social Practice Actions of Catholic individuals and organizations ministering throughout the world Heritage of Catholic health care systems, which embody or incarnate these values Catholic Social Practice Biblical Foundations: Hebrew Scriptures Rooted in notions of justice and concern for the poor in the Hebrew Scriptures Based on covenant with the God who saves Justice, justice shall you pursue, that you may thrive and enter the land the LORD has given you. (Dt 16:20) 5
Biblical Foundations: Christian Scriptures Jesus: Fulfillment of prophets God s own presence in the flesh. Jesus touched people at the deepest level of their existence.physical, mental and spiritual healing Concern for the poor, oppressed and disadvantaged His ministry was historical and eschatological What are the Ethical and Religious Directives? 6
What Are the Directives? A limited attempt to answer two questions: Who are we? Who should we be? (Identity) What should we do in light of this? (Integrity) And to provide guidance on specific ethical issues in health care delivery ERDs Are For - Those entrusted with governance, administration Day-to-day operations Recipients of health care 7
The Parts General Introduction Part One: Social Responsibility Part Two: Pastoral Responsibility Part Three: Professional-Patient Relationship Part Four: Beginning of Life Part Five: Care for the Seriously Ill and Dying Part Six: Forming New Partnerships Approaching the ERDs Not an answer book requires interpretation and application to concrete situations Not exhaustive of teachings or issues Different concrete conclusions are possible Bishop has the final say 8
Ethical and Religious Directives for Catholic Health Care Services General Introduction General Introduction: Who Should We Be? The reason for Catholic health care: Continuing God s life-giving and healing work (p. 5/4) By imitating Jesus service to the sick, suffering and dying (p. 4/3) By responding to Jesus challenge to Go and do likewise (p. 33/16) By carrying on Jesus radical healing (p. 4/3) 9
General Introduction: Who Should We Be? We ought to be Christ s healing compassion in the world (p. 33/16) We ought to restore and preserve health and serve as a sign of final healing (p. 33/16) We are a ministry of the Church (p. 4/3): we do what we do in the name of the Church and authorized by the Church as a visible sign Laity and the Ministry of Health care the [lay] faithful are invited to a broader and more intense field of ministries by virtue of their baptism, the lay faithful are called to participate actively in the Church s life and mission 10
Part One: Social Responsibility Rooted in the broader tradition of Catholic Social Teaching Part One: Social Responsibility Introduction (pp. 7-8/4-5) Common values that should distinguish Catholic health care: Human dignity Care for the poor Contribution to the common good Responsible stewardship of resources Reflection of Catholic Social teaching 11
Human Dignity Created into the image and likeness of God. Dignity is inherent, not earned or bestowed Human dignity protects not just the right to life but the means to full human development Part One: Social Responsibility #1: We are a community of care animated by the Gospel and respectful of the Church s moral tradition. #2: We act in a manner characterized by mutual respect among caregivers and serving with compassion of Christ. 12
The Common Good: A Counter-Cultural View of Society and Human Life The sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily. First, the common good requires respect for the person as such. Second, it requires the social well-being and development of the group itself. Finally, the common good requires peace. Responsible Stewardship All we have is gift Use of resources (time, talent, treasure) Equity of care Requires dialogue with others in society Involves subsidiarity Empowering others Decision-making at fundamental levels 13
Subsidiarity The more participatory the workplace, the more likely each worker will be to develop This fosters initiative, innovation, creativity and a sense of shared responsibility. The Vocation of the Business Leader by the Pontifical Council for Justice and Peace #3: A catholic health care organization should distinguish itself by advocacy for the marginalized and vulnerable 14
Part One: Social Responsibility #6: We are to use health care resources responsibly. #7: We treat employees respectfully and justly. Non-discrimination in hiring Employee participation in decision-making A workplace that ensures safety and wellbeing Just compensation and benefits Recognition of the right to organize Note on Culture and Organizational Ethics Culture is a pattern of shared meanings and values, embodied in a network of symbols, myths, and rituals, created by a particular group as it struggles to adjust to life s challenges and educating its members about what is considered to be the orderly and correct way to feel, think, and behave. Fr. Gerald Arbuckle 15
Organizational Ethics Intersection of clinical, business, legal, economic and social aspects of organizational life Grounds decisions in the values and identity of the organization and the broader Catholic health care ministry Social Economic Clinical Business Organizational Values and Identity Legal Assumes that organizations have moral freedom and can be moral actors Organizational Ethics Shapes work culture rooted in Gospel values Corporate discernment and mission-based decision making Values and principles of Catholic health care Moral assumptions of organization Helps shape a just working environment 16
Part Six: Forming New Partnerships Collaboration for the sake of the common good Part Six: Forming New Partnerships Introduction (pp.29-31/14-15) Primarily concerned with outside the family (i.e., non-catholic) arrangements Concern: Some potential partners may be engaged in wrongdoing How does the Catholic party maintain integrity? 17
Part Six: Forming New Partnerships Principle of Cooperation Consult reliable theological experts Catholic health care organizations should avoid cooperating in wrongdoing as much as possible Part Six: Forming New Partnerships Key Directives #67: Consult with diocesan bishop or liaison if partnership could have serious impact on the Catholic identity or reputation of the organization, or cause scandal. #68: Proper authorization should be sought. Maintain respect for Church teaching and authority of diocesan bishop 18
Part Six: Forming New Partnerships #69: Must limit partnership to what is in accord with the principles governing cooperation (POC), i.e.: POC helps determine whether and how one may be present to the wrongdoing of another To determine whether cooperation is morally permissible, one must analyze the cooperator s intention and action. Part Six: The Principle of Cooperation Intention: Intending, desiring or approving the wrongdoing is always morally wrong (formal cooperation) Action: Participating in the wrongdoing or providing conditions for the evil to occur (material cooperation) Proximity to wrongdoing 19
Part Six: The Principle of Cooperation #70: Forbids Catholic health care institutions from engaging in immediate material cooperation in intrinsically evil actions (e.g., sterilization, abortion, euthanasia). Immediate material cooperation with regard to partnerships would include ownership, governance, management, financial benefit, material and personnel support. Part Six: The Principle of Cooperation Being present to the wrongdoing of another in a nonessential way (i.e., the cooperator s act assists in the performance of the wrongdoing but is not itself essential) can be morally licit when there is a proportionately grave reason (mediate material cooperation). Cooperator s action should be as distant (in causal terms) as possible from wrongdoer s action. The more proximate (in causal terms) the cooperation, the more serious the reason. 20
Part Six: Forming New Partnerships #71: Scandal must be considered when applying the principle. Does not mean, in theological sense, causing shock or discomfort Means leading others into sin May foreclose cooperation because of appearances even if licit May often be avoided by good explanation The bishop has final responsibility for assessing and addressing scandal Part Six: Forming New Partnerships #72: Periodically, the Catholic partner should assess whether the agreement is being properly observed and implemented. 21
Conclusion (pp. 33/16) The ERDs are a valuable document for understanding better who we ought to be (identity) They also help us to understand what we ought to do (integrity) in light of our identity Ultimately, they call upon us to walk our talk Understanding and Applying the Ethical and Religious Directives Introduction and Parts I and VI Social Responsibility and Partnerships FR. CHARLES BOUCHARD, OP, S.T.D. Senior Director, Theology and Ethics Catholic Health Association 22