If asked to name the most prominent item on the Catholic bioethics agenda, most people in the United States, including Catholics themselves, would no doubt name abortion, closely followed by biomedical uses of embryos, such as stem cell research and cloning. Everyone knows that the Catholic Church prohibits all of the above because of the sanctity of life from conception, and everyone expects Catholic voters and Catholic public figures to respect and follow the church’s leadership on these issues.
For instance, in its 1987 instruction on reproductive technologies, Donum Vitae, the Vatican invoked the inviolability of the person to assert that embryos have a right to life from conception. During a visit to the Vatican in July 2001, President George W. Bush was exhorted by Pope John Paul II to resist proposals for the creation for research purposes of human embryos, destined to destruction in the process.
In the spring of 2004, the U.S. Catholic leadership debated whether to forbid Catholics from supporting candidates who did not conform to what the press called the litmus test issues of abortion and stem cell research. Some even proposed the excommunication of the presumptive Democratic presidential candidate, John Kerry, who had voted against a bill making it a crime to harm a fetus during an assault on its mother.
Catholics and others are rightly concerned about the prevalence of ill-considered, immature or desperate abortion choices, especially when these reflect a lack of other alternatives and support for pregnant women and girls. We should also be concerned about the treatment of early life simply as research material, especially when prospects of patents and profits drive advocacy for increasingly permissive policies and more ample funding. But protection of prenatal life is only one part of Catholic bioethics. Catholics also have a responsibility to stress the importance of a more just distribution of health care resources because they are essential to the common good, nationally and worldwide.
Pope John Paul II’s warnings to President Bush about stem cell research were widely reported in the U.S. media. How many people, however, read or recall the papal words that preceded the remarks on the right to life? The pope exhorted Mr. Bush to a greater sense of responsibility for the effects of globalization, deploring a tragic fault line between those who benefit from new opportunities and those who are cut off from them: Respect for human dignity and belief in the equal dignity of all the members of the human family demand policies aimed at enabling all peoples to have access to the means required to improve their lives....
This certainly includes basic health careas well as food, shelter, clean water and safety from violence, all of which are essential constituents of human health. The previous year, the pope had addressed a meeting of Catholic doctors in Rome, where he made this connection even more explicit: As we enter the third millennium, men and women, especially in the poorest countries, are unfortunately still deprived of access to health services and the essential medicines for their treatment. Many of our brothers and sisters die each day of malaria, leprosy and AIDS, sometimes in the midst of the general indifference of those who could or should offer them support.
In his 2004 Lenten message, John Paul II focused on the condition of children worldwide. Mentioning the suffering caused by war, lack of food and water, forced immigration and other forms of injustice, he asked, What too of the tragedy of AIDS and its devastating consequences in Africa? It is said that millions of persons are now afflicted by this scourge, many of whom were infected from birth. Humanity cannot close its eyes in the face of so appalling a tragedy! At an accompanying press conference, Archbishop Paul Cordes, president of the Vatican’s charitable organization Cor Unum, elaborated on the pope’s words. He accused international pharmaceutical companies of allowing millions of poor children to die by denying them life-saving drugs in order to protect patent rights. There should be public pressure to convince drug companies to lower the prices of drugs to treat the victims of AIDS, he said.
In coordination with the Lenten message, the Vatican issued a special postage stamp, the proceeds from which will go to support a clinic and orphanage for children with AIDS, in Nairobi, Kenya. The director of the orphanage, Angelo D’Agostino, S.J., said that although 400 people die of AIDS every day in Kenya alone, it is no longer an immediately fatal disease in Europe and North America. Why the difference? he asked. It is the genocidal action of the pharmaceutical cartels, who refuse to make the drugs affordable in Africa even after they reported a $517 billion profit in 2003.
Have any bishops considered denying Communion to Catholic C.E.O.’s and boards of drug corporations, or to government officials who advocate for tighter patent protections, or who obstruct larger U.S. donations to the Global Fund to Fight AIDS, Tuberculosis and Malaria? This fund was established in 2001 with the support of U.N. Secretary General Kofi Annan and the participation of the World Health Organization. Its aim is to solicit, receive and distribute public and private donations to ameliorate the global disease burden of the poor, and especially to facilitate the purchase by poor countries of lower-cost generic medicines instead of expensive brand-name ones. The fund needs a minimum of $3 billion a year. The United States, with a national income of $10,000 billion, has refused to commit more than $200 million a year, because the fund is a multilateral agency over which the United States does not have control.
According to the W.H.O.’s World Health Report 2003, H.I.V./AIDS has cut life expectancy by as much as 20 years for millions in sub-Saharan Africa. Only 5 percent of those who require antiretroviral treatment receive it. In developing countries, communicable diseases still represent seven out of the ten major causes of child deaths. In Africa, malaria is the number one killer of children under five. The leading causes of death for adults, besides AIDS, are respiratory infections, diarrhea and malaria. Some 500 million people in Africa, Asia and Latin America are infected by malaria each year, which causes more than 1.2 million deaths. The risk of dying in childbirth is 250 times greater for women in poor countries than in rich ones, amounting to more than 500,000 maternal deaths a year.
There is no doubt that these statistics should cause as much concern to Catholics as abortion rates, methods of researching stem cell potential in this country and keeping comatose persons alive indefinitely. The global common good, including participation in the good of health care, is an indispensable moral criterion for evaluating policies and politics, as well as for our personal investments of votes, dollars and time.
A first defining characteristic of the tradition of Catholic social teaching, then, is that it provides a moral framework to balance individual needs and rights with the solidarity of all in the common good, difficult though this may be to accomplish in the concrete. A second characteristic, equally important, is that Catholic social tradition is activist, interventionist and hopeful. Countercultural separatism, despairing of the power of religious commitment and moral values to right social wrongs, is not the Catholic way. The very raison d’etre of the modern papal social encyclicals is to make a difference in the real world. In the words of Pope Leo XIII, author of the first of these encyclicals, all agree, and there can be no question whatever, that some remedy must be found, and quickly found, for the misery and wretchedness which press so heavily at this moment on the large majority of the very poor (Rerum Novarum, 1891, No. 2).
There is surely reason to observe, well over a century later, that the amelioration of world poverty has not been as quick as Pope Leo may have hoped. Yet there is also evidence that emerging international practices of democracy, human rights, women’s rights, basic education, vaccines and antibioticsand even communications technologies and other aspects of globalizationhave helped relieve the plight of the poorest of the poor.
The real enemy of Catholic bioethics and social ethics is not internal Catholic dissent, religious pluralism among cultures or modern secularism as such. It is, rather, the stance of what might be called moral and political realism. Political realism is the view that world affairs are governed primarily by self-interest, that the interests of the powerful always result in the domination of the weak, and that nothing can be done to change this situation on any significant scale. To the contrary, Catholic bioethics must attack health care inequities at home and abroad with energy and confidence, always concerned about individual rights and the dignity of persons, but equally conscious that the common good requires more equitable sharing of benefits. But is this in fact a realistic goal? And how can it be achieved?
The practical optimism of Catholic bioethics requires appreciation of a third characteristic: on-the-ground embodiment of the Catholic vision through a multitude of national, international and transnational institutions. Catholic bioethics has always had a strong institutional presence in civil society through the church’s care ministries. In the United States alone, the Catholic Church operates almost 15 percent of community hospitals, and hundreds of clinics and nursing homes are run under Catholic auspices. The historic mission of Catholic health care providers has been to the poor and underserved, even when it threatens their own financial viability. More than simply a provider of charity care, however, Catholic health care often partners with non-Catholic medical facilities and local and federal operations and agencies to enhance access for the underserved. Catholic health care providers also seek out ways to bring about state and federal policy changes, mobilizing broad-based social action. The Catholic Health Association, for example, an independent professional organization for health care systems and facilities, sponsors a Web site with an eAdvocacy option for concerted grass-roots action on issues like proposed Medicaid cuts.
Catholic bioethics also has an international and transnational presence through institutions like Catholic Charities, Caritas International, the Catholic Agency for Overseas Development (commonly known as Cafod), the Jesuit African AIDS Network and the All-Africa Conference: Sister-to-Sister. The latter is a new collaborative project between the Sisters of Mercy and African women’s religious congregations, aimed at developing responses to the AIDS crisis as it affects women. Men’s and women’s religious orders also provide health care through clinics in the so-called two-thirds worldthe two-thirds of the world’s population that does not enjoy most of the benefits of the globalized market economy. The international Catholic university system provides another network through which to educate and engage on behalf of health justice.
The universality of Catholicism is usually envisioned institutionally, as the ecclesial structures linking local bishops and their dioceses to the pontiff in Rome. Not only the pope, but also local bishops’ conferences can be influential voices. For instance, the U.S. bishops issued an important statement on universal health coverage in 1993 (A Framework for Comprehensive Health Care Reform), and the African bishops produced a position paper in 2003 on AIDS. Dioceses and parishes sponsor programs through which members can invest time and resources that reflect their commitments in such areas. Yet beyond the formal ecclesial structure, other flexible and overlapping institutions are just as essential in constituting Catholicism as a global presence and in making possible what it can accomplish.
Catholics in Boston, San Antonio, Omaha or San Diego may feel too distant from people dying of malaria to make a difference. Lamentably, we may even feel that uninsured immigrants in our own hometowns live outside the world our actions touch. Catholic bioethics as social ethics makes the connection clear. The humanity of such persons calls us to recognize their dignity. The concept of the common good alerts us to the structural changes required to make that dignity meaningful. Confident hope that change is possible inspires us to action. Catholic links among local and global realities provide vital institutional means to bring our ideals to reality.