Michael R. Panicola

Catholic health care is a ministry whose deep roots can be traced back to the healing works of Jesus and to the compassionate care of religious women and men and laypersons around the world over many centuries. Though never easy, working in this ministry has become increasingly difficult with the rise of diverse business relationships, government and third-party involvement, and socioeconomic constraints. Today, Catholic health care is confronted by several challenges: to respect the ministry itself, seeing health care as a sacred trust in a market-driven environment that often views it as a commodity; to promote human dignity and the common good in the face of cultural and social forces that seek to subvert these basic values; to balance fiscal demands with ministerial objectives at a time when it is tempting to sacrifice the latter to meet the former; to provide holistic care to all persons, with special concern for those on the margins of society; and to witness to the ethical and spiritual dimensions of health care in an era when technology and technological solutions reign supreme.

Several individuals have recently questioned whether Catholic health care will be able to meet these challenges without deviating greatly from the vision established by the women and men who continued Jesus’ healing ministry to the sick and marginalized. Perhaps the most notable and forthright among this group of skeptics is the late Richard A. McCormick, S.J., who wrote movingly about the menacing aspects of contemporary society that threaten Catholic health care.

Father McCormick doubted that Catholic health care could maintain its identity and integrity in the current environment, which is dominated by managed care with the following characteristics: medicine as business, depersonalized care, cuts in Medicare and Medicaid, impoverished public hospitals, mergermania and competition, obsolescence of the hospital and threatened pastoral care (Am., 7/11/98). Given this culture’s corruptive influence, Father McCormick predicted that Catholic health care would not be able to remain true to its mission and core values and still compete in a tough marketplace.

Father McCormick’s reflections on the future of Catholic health care have rightly given many who work in this ministry cause for concern. He accurately described the plight of Catholic health care and raised the level of awareness regarding the forces that threaten the moral and spiritual existence of the ministry. But the real genius underlying his work in this area, which has gone largely unnoticed, is that he called our attention not only to the external factors impinging on Catholic health care but also to more internal factors. The challenges from managed care, governmental groups, regulatory bodies, political activists, right-wing conservatives and the market troubled him greatly, but the loss of the traditional mission-bearers in Catholic health care may have been the fundamental reason for his pessimistic predictions.

Father McCormick knew well that Catholic health care has always experienced difficulties in trying to bring a faith-based mission to a secular world and that, as such, its success depended largely on courageous leaders who were able to bring the mission to bear on practical matters. What seems to lie beneath Father McCormick’s assessment of the future of Catholic health care is fear that some of today’s ministry leaders do not fully understand what our mission entails and do not recognize that our mission is the primary reason for our existence and the lens through which we evaluate all our activities.

While several commentators have responded to Father McCormick’s articles on the future of Catholic health care, none to my knowledge have picked up on this point embedded in his work. This is unfortunate, because while external factors may threaten the ministry, the survival of Catholic health care ultimately rests squarely on the shoulders of ministry leaders. Given today’s challenges, these leaders must have great imagination and an even greater sense of mission. If Catholic health care is going to survive more than just financially in the current marketplace, then ministry leaders will have to form a moral vision and a strategic plan that enables us to act with integrity in the face of adversity. As harrowing a task as this may be, ministry leaders must show us how to compete while remaining true to our identity as Catholic health care providers.

My intention here is not to point the finger at the leaders of Catholic health care. Rather, it is to highlight the critical role leadership plays in helping us maintain fidelity to our mission and core values. When times are tough, it is easy to lose sight of what is truly important and engage in self-destructive behavior.

I was reminded of this recently while reading George Orwell’s classic allegory, Animal Farm. Experts in the field of literature and political science may gasp at the suggestion, but in this book I find a cautionary tale for today’s leaders in Catholic health care.

In the story, the animals of Manor Farm found themselves oppressed by their depraved and gluttonous master, Mr. Jones. No longer willing to tolerate injustice, the animals liberated themselves by taking control of the farm. Once the farm was securely in their possession, the animals gathered as equals, agreed never to resort to human ways and ironed out a vision for the farm, which they renamed Animal Farm. This vision was codified in seven commandments: No animal shall sleep in a bed, No animal shall kill any other animal, All animals are equal and so on. These commandments were posted in the large barn for the animals to see and were to be followed by all animals without exception.

At first, the commandments were observed, and the animals of Animal Farm lived in relative peace. But, as the pigs came into powerbecause of their superior intelligence and knack for running the farmthey started to exert dominance over other animals. Gradually, the pigs altered the original commandments under the pretense that they were doing this for the sake of the farm and the other animals. Thus, the commandment No animal shall sleep in a bed became No animal shall sleep in a bed with sheets; the commandment No animal shall kill any other animal became No animal shall kill any other animal without cause; and the commandment All animals are equal became All animals are equal but some animals are more equal than others. Seeking personal gain and responding to the mounting challenges of running the farm, the pigs modified the commandments, and Animal Farm came to deviate significantly from its utopian vision. Even worse, the pigs ultimately became indistinguishable from the iniquitous humans whom the animals had vowed never to resemble. One night some animals looked inside the farmhouse where the pigs were hosting a dinner party for their neighboring farmers, and the creatures peering in through the window looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which.

How does this story relate to Catholic health care? Without reaching too much, it appears to me that in the current context the danger is always present that ministry leaders could lose sight of our mission and core values, much as the pigs of Animal Farm lost sight of theirs. Signs of this may already be present in that the commandments handed down from Jesus and the pioneers of Catholic health have been inadvertently modified by some of today’s leaders in their attempt to preserve the viability of Catholic health care while meeting the pressing demands of the marketplace. Of course, Catholic health care never really adopted a set of commandments, but if it had they might read something like: Mission before margin, not Margin before mission, as though we are free to compromise our mission for financial stability; or Always care for the poor, not Always care for the poor if we receive adequate reimbursement, as though some individuals are excluded from our ministry based on their ability to pay; and Prudential judgments outweigh laws and regulations, not Prudential judgments outweigh laws and regulations so long as we are not sued or stripped of our identity or accreditation, as though morality yields to lawyers, the Joint Commission or right-wing conservatives. If leaders of Catholic health care continue to alter our foundational commandmentseven for the best of reasonsnot only will this lead inexorably to a change in their countenance but also to the end of Catholic health care as we knew it. (I say knew and not know because it seems we have already diverged slightly from the Gospel vision.)

Have ministry leaders excessively compromised the moral and spiritual existence of Catholic health care in their valiant efforts to meet the mounting challenges of the marketplace? Have they taken Catholic health care to the point of no return? I do not think so, at least not yet. Unlike Father McCormick, I still hope that ministry leaders can right the ship, find their moral compass and guide us through today’s choppy waters. I meet daily with too many good people in the ministry who put our mission before or at least on a par with other weighty concerns to think that the demise of Catholic health care is imminent or inevitable. I know a nurse, for example, who tirelessly implored and successfully persuaded reluctant hospital administrators to provide her with limited funds to start a palliative care program; a hospital president who consulted his employees and the community, not just his administrative council, about how to resolve divisive issues around cutting jobs and limiting services; and a chief financial officer who emphasized the mission imperative over public relations perks to her colleagues when it came time to improving social accountability. These leaders are the human faces of our mission and the hope for the future of Catholic health care.

The challenge as we move forward is to select ministry leaders wisely, choosing only those who, like the individuals mentioned above, believe that Catholic health care should be more than simply a viable competitor in the health services industry. In addition, we have to develop ministry leaders so they can respond to the day-to-day challenges with prudence and courage, always mindful of our deeper moral commitments as Catholic health care providers.

Yet no matter how morally upright and well prepared ministry leaders may be, in these difficult times it will be tempting for them to set aside our mission and core values in the interest of other, seemingly more important issues. Given this reality, ministry leaders must always guard against the type of reasoning that leads them to believe they are doing things for the sake of the ministry when in fact their actions harm the ministry in the long run. They must bear in mind that if they sacrifice our soul just to stay in the game, Catholic health care has gained nothing and might as well cease to exist anyway.

Michael R. Panicola is the ethicist for S.S.M. Health Care in Saint Louis, Mo., and an adjunct professor of theological studies and public health at Saint Louis University.