"Here Comes the..."

As I read the article by Thomas Sweetser, S.J., (7/2) on behalf of his 50 fatigued pastors, I couldn’t help but feel sad that this group apparently can no longer differentiate between a job and a vocation. A job can be quantified by the hours, but a vocation—a life responsibility—cannot be boxed in that way.

No one I know would begrudge any priest needed time off, nor oppose the application of reasonable time-management practices in parish administration. A few of the suggestions in the article have potential. But trying to wiggle out of sacramental obligations, such as anointing the sick, which we all thought they had signed on for with ordination, is disillusioning, to say the least.


"Back to the drawing board, guys." That’s what I would advise, since they don’t seem to grasp the ineluctable concept of fathering, spiritual or otherwise. On the other hand, though, it could be a hoot to watch them cope with the practicalities of, for instance, scheduling weddings during regular weekend Masses—one of the time-saving recommendations.

It would provide truly high comedy for an invisible observer standing by while they try to persuade couples to plan a formal 8:00 a.m. Saturday wedding ceremony before a scattering of grungily-dressed pewfolks on their way to weekend sports outings. Even more so would be the dealing with such ceremonies during regular Sunday Masses with the parking snafus, the battles over "suitable" music, the competing priestly and bridal processions, the guests-versus-parishioners ushering nightmares, the question of whether or not wedding guests should have the collection basket passed under their noses. And that’s not even mentioning the terrible wrath of the mothers of the brides.

Once upon a time, the grade school nuns (remember them?) used to teach us how admirable it was for young men to throw themselves into the lifelong task of being "other Christs." That’s not at all the same as being other C.E.O.’s. Alas!

Mary Margaret Carberry

Flossmoor, Ill.


Individual Dignity

The cover of the recent issue (7/16) promising a discussion of "The Purposes of Medicine in Society" sent me racing for my reading glasses. To the layperson, the answer seems obvious, and I was wondering if a bioethicist and philosopher would go on the record. In the age of globalization, the purpose seems to be limited to the promotion of a sufficiently healthy population, as measured statistically, to ensure economic vitality, national security and social stability. Politicians might add election or re-election to the short list. While the author spoke more to the conflict among various models of medicine, one is left wondering how the dignity of the individual will be preserved.

Thomas P. Kilcoyne

Camp Hill, Pa.


I, for one, respectfully and adamantly disagree with Thomas Sweetser, S.J., and his 50 collaborators in their open letter to our bishops (7/2). Having been a priest for 34 years and worked in tremendously large parishes, I have not witnessed what is so dramatically portrayed in the picture of the downtrodden priest. To me, it is at best an exaggeration and at worst a self-serving and self-fulfilling prophecy. Francis Xavier and John Vianney would not have signed such a declaration. They would have done the best they could and relied on God’s grace.

For far too long have we listened to this kind of talk and even believed it. I am sure these priests love the church, and I am equally sure their bishops do not expect the impossible. Common theological sense indicates that bishops cannot delegate deacons to anoint the sick, nor can they permit the ordination of anyone who is not deemed capable or suitable for priestly ordination by the church. I hardly think Father Sweetser’s approach will help the church or her priests.

(Msgr.) James M. McDonald

Dix Hills, N.Y.

Strange Notions

Your issue on vocations and ministry (7/2) stirred an old memory that continues to delight our family of three sisters and two brothers.

It was 1946. My mother was serving lunch to an elderly friend of my father’s, a carpenter who was doing repairs in our North St. Louis home. Mama let it be known that she had two sons—both later ordained—studying for the priesthood. The worthy craftsman—a Catholic but not a fanatic—mulled this over for a few moments and then said, "They do get strange notions, don’t they?"

George Ratermann, M.M.

Maryknoll, N.Y.


Ongoing Love

In his article "The Church and Psychiatry" (7/30), Ralph A. O’Connell, M.D., pointed out that several studies "have shown a relationship between religious practice and improved health outcomes, including lower blood pressure, recovery from depression and healthier immune systems."

Other studies have shown a similar relationship between lower blood pressure and quiet time with a spouse or significant other. Still other studies have shown similar health benefits from mutually caring relationships. Dr. O’Connell thinks the health benefits of religion are not related to theology but are instead the result of factors like the structure and support derived from belonging to a religion. But I wonder. Doesn’t religious practice for many of us involve spending quiet time with God, a significant other with whom we have an ongoing personal love relationship?

Marilyn Kramer

Wausau, Wis.

Theological Perspective

The brief article "Patients No More," by Kevin Wildes, S.J., (7/16) is important to us all, but it only scratches the surface of a huge problem. The Golden Age of medicine was not golden for patients in part because of major access problems to health care. A shortage of doctors and lack of insurance, before Medicaid and Medicare, placed many individuals beyond the pale. Lack of doctors has diminished. When I started practice in my community, there was about one pediatrician for 6,000 kids; now there is one for 1,000. Lack of insurance still remains problematic and a constant threat.

Is the physician-patient relationship paternalistic? Acting in the best interest of the patient against the wishes of the patient is not the goal. There is a mutual interaction. Doctoring is also teaching. Only the most naïve physician thinks that patients follow advice. Even with children, the fierce advocacy of parents introduces a mediating variable. With teens, bargaining is almost always an element. The patient always has choices.

High-tech is good. The first article I ever read on CAT scanning was an economic analysis condemning it as expensive and wasteful. The second was about how the technique worked.

Market concepts have taken over medicine, first in insurance. Originally, health insurance was "community rated." All the risks were put in a pot and shared by the community. With experience rating, the profit motive has taken over: decrease outlays, increase profit. Second, the industrialization of medical care—quotas, dollar incentives, bonuses, etc.—and the massive incomes of administrators who take no oath, Hippocratic or otherwise, except to the almighty dollar, have turned patients into consumers, and physicians into providers.

Ultimately, medicine is too hard a way to make a living unless you have a theological perspective.

John J. McNamara, M.D.

Brockton, Mass.

Responsive System

Kevin Wildes, S.J., in "Patient No More" (7/16) states "...the only way to go back to an idealized view of the physician-patient relationship would be to roll back the development of scientific medicine." I don’t agree. He implies that the rapid advances made recently in medicine have as a concomitant side effect poor doctor-patient relationships. Somehow we should be happy with this sorry state of medical administration in the interests of scientific advancement. I believe this attitude is misguided.

His view that "we have come to desire the curing and technological interventions of modern medicine...shaped by the merger of clinic and laboratory" forgets the miracle cures of penicillin and the Salk vaccine, just two examples of interventions implemented well before the current mess in medical care. It is not "Rockwellian" to demand hospital staffs who are at least somewhat attentive to the needs of patients. It is not "Rockwellian" to believe that physicians should put the needs of patients before their own profits. It is not "Rockwellian" to expect a medical system that is responsive to the concerns of patients and their families.

Cost control is not only key to current medical practice; it is king. The cost of medical services can be controlled, but should not include profits made at the expense of patient care. While I agree that past practices will probably never return, there needs to be more recognition of patients’ rights and less emphasis on the "bottom line."

Edward J. Thompson

Farmingdale, N.Y.

Guided Choices

The essay by Kevin Wildes, S.J., (7/16) on the design of a model for health care deserves a great deal of thought, but I fear he sets up a straw man or two in his discussion. Yes, the Hippocratic tradition may be excessively paternalistic, but sometimes the doctor really does know best. That does not necessarily deprive the patient of the right to make a decision. The consumer model has a serious (but probably not fatal) flaw. It assumes equality. It assumes that a patient can equal the physician’s knowledge of the subtleties of the topic at hand. This playing field is not level. Some form of paternalism is appropriate. It would be an inappropriate abandonment of professionalism simply to list the choices without offering guidance.

Further, Father Wildes remarks that scientific medicine crowds out religious language from clinical experience. That may be true in academia or in the board room of the insurance company, but it is not true in the consulting room or at the bedside. Clinical medicine has a good deal in common with pastoral care, and I suspect that most of us look for some paternal guidance from our pastors.

A. Sidney Barritt III, M.D.

Roanoke, Va.

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