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James F. KeenanMay 18, 2018

Throughout the first five years of his pontificate, Pope Francis has made it clear time and again that he will not change any doctrinal teachings of the church. He is inclined, however, to expand further our understanding of those teachings. One area where Pope Francis has begun to advance Catholic teaching rather remarkably is health care.

With 649 hospitals, 1,614 continuing-care facilities, 523,040 full-time employees and yearly totals of more than five million hospital admissions, 105 million outpatient visits, 20 million emergency room visits and 527,000 new births, Catholic health care comprises the largest group of not-for-profit health care providers in the United States. Every day, one in six patients is treated in a Catholic health care facility.

To guide those works both here in the United States and elsewhere, the Catholic Church provides teachings and directives for employees working in its own facilities as well as for Catholics working in other health care facilities. These teachings seek to affect not only the practices in Catholic hospitals around the world but also practices in other health care facilities.

In order to appreciate the Pope Francis effect, we need to examine the legacy of his two predecessors. John Paul II influenced health care in a number of ways during his papacy on three significant issues. First, he insisted on a sanctity-of-life argument that highlighted the inviolability of human life. From this teaching, best expressed in his encyclical “The Gospel of Life (“Evangelium Vitae”), he underlined that unborn human life could not be directly compromised under any circumstances. Following from that same sanctity-of-life teaching, he similarly held that there could be no assistance in the direct ending of a patient’s life. Though Catholic teaching had opposed both abortion and euthanasia for centuries, these two teachings were given lucidity, urgency, priority and political force by John Paul II in a way not found in previous papacies. Moreover, such was his form of leadership that his bishops followed with the same level of commitment and focus.

Third, during his papacy a major new teaching emerged on the unresolved matters of reproductive technology, ranging from artificial insemination to in vitro fertilization and surrogacy. This teaching was determined by then-Cardinal Joseph Ratzinger, the prefect for the Congregation of the Doctrine of the Faith, with the clear approval of John Paul II. These three teachings on abortion, euthanasia and reproductive technologies are central to appreciating the effect of Pope John Paul II and Pope Benedict XVI on health care.

Pope Francis: "The church’s pastoral ministry cannot be obsessed with the transmission of a disjointed multitude of doctrines to be imposed insistently."

The concerns and emphases that Pope Francis brings to health care extend beyond these matters. Yet before we enter into how he extends these teachings, we need to note his pastoral style with regard to matters related to health care, because this style provides an idea of the originality of his contribution.

In an interview just six months after his election in 2013, the pope made a remarkable statement about the the church’s pastoral ministry:

We cannot insist only on issues related to abortion, gay marriage and the use of contraceptive methods…. The church’s pastoral ministry cannot be obsessed with the transmission of a disjointed multitude of doctrines to be imposed insistently. We have to find a new balance; otherwise even the moral edifice of the church is likely to fall like a house of cards, losing the freshness and fragrance of the Gospel.

As opposed to the prioritization of challenges that his predecessors developed, Pope Francis suggests no sustained set of priorities. The challenges he recognizes are multitudinous: immigration, sustainability, throwaway cultures, refugees, unemployment and global inequities, to name a few. And these issues are “connected,” as he reminds us repeatedly in “Laudato Si’”; they cannot be addressed in isolated ways.

The challenges Pope Francis recognizes are multitudinous: immigration, sustainability, throwaway cultures, refugees, unemployment and global inequities, to name a few.

One area where this interconnection of issues can be clearly seen is on the matter of sanctity of life. Before Pope Francis, the late Cardinal Joseph Bernardin, archbishop of Chicago, insisted on the interconnectedness of the challenges presented in sanctity-of-life concerns. Last year the present archbishop of Chicago, Cardinal Blase Cupich, celebrated the “consistent ethic of life” formulation of his predecessor:

In reading the signs of his times, Bernardin was concerned about the futility of treating issues like abortion, capital punishment, nuclear proliferation, and the use of military force as discrete topics. He understood how these issues were divisive in themselves. But he was convinced that a comprehensive commitment to respecting life as a principle connecting these issues would benefit them all.

Recognizing the connection among these teachings prompts a fairly expansive pastoral style for Pope Francis, different from Pope John Paul II’s clear, focused and repetitive critiques on abortion, euthanasia and reproductive issues that had the cadence of a drum roll. Still, in style Francis is as forthright as John Paul II. We can recall, for instance, his comments on President Donald Trump’s ending of the DACA program that protects undocumented young people from deportation: “I have heard it said that the president of the United States presents himself as a man who is pro-life, and if he is a good pro-life [man] then he will understand that the family is the cradle of life, and that it must be defended as a unit.” During the U.S. presidential election in 2016, he even seemed to question Mr. Trump’s Christianity: “A person who thinks only about building walls...and not building bridges is not Christian.”

For Pope Francis, sanctity of life must be protected wherever and whenever it is threatened. In this way we can say he becomes the strongest papal advocate for a consistent life ethic in the church.

The Throwaway Culture

Having looked at his “interconnected” style, let us now begin to look closer at its content. While Pope John Paul II looked at contemporary society as a “culture of death,“ Pope Francis identifies it as “a throwaway culture” that places humanity and the environment in danger. While the identification is a constant theme in his 2015 encyclical, “Laudato Si’,” it appears time and again from the beginning of his papacy. We can see it particularly when he gives us a glimpse of his broadly inclusive understanding of the sanctity of life. This is from an address in December 2013:

The victims of this [waste] culture are precisely the weakest and most fragile human beings—the unborn, the poorest, the sick and elderly, the seriously handicapped, et. al.—who are in danger of being “thrown away,” expelled from a system that must be efficient at all costs.

One month later we hear him again:

Unfortunately, what is thrown away is not only food and dispensable objects, but often human beings themselves, who are discarded as “unnecessary.” For example, it is frightful even to think there are children, victims of abortion, who will never see the light of day; children being used as soldiers, abused and killed in armed conflicts; and children being bought and sold in that terrible form of modern slavery which is human trafficking, which is a crime against humanity.

In both instances, we see that he bases his argument concerning the consistent life ethic on two of his most fundamental platforms: the Gospel and the social doctrine of the church. When he invokes the Gospel, he identifies it with mercy: “One cannot understand a true Christian who is not merciful, just as one cannot comprehend God without his mercy. This is the epitomizing word of the Gospel: mercy. It is the fundamental feature of the face of Christ.” For Pope Francis, mercy requires accompaniment. This can be seen in the most important Gospel parable, the story of the good Samaritan, about a foreigner who responds to an injured person when others do not and accompanies the person both to an inn and then afterward.

While Pope John Paul II looked at contemporary society as a “culture of death,“ Pope Francis identifies it as “a throwaway culture” that places humanity and the environment in danger.

When Pope Francis invokes the social doctrine of the church, he focuses on our understanding of human dignity and the common good. He calls us to be attentive to subsidiarity and solidarity, maintaining a priority on the preferential option for the poor. The social doctrine of the church, rooted in the Gospel and made manifest in the Catholic tradition, is that which makes for a consistent life ethic: Sanctity of life read through the Gospel of mercy and the social doctrine of the church gives us an all-embracing view of the needs of human life.

Pope Francis has a third source for his teachings, the Argentine “Theology of the People.” Though some think of this theology as akin to “liberation theology,” it is closer to the popular piety and lived faith of the common people. This theology is a considered respect for the way the People of God have received and expressed their faith: the sensus fidelium, as it is traditionally called, or the wisdom of the believers who receive the Gospel in the way they, in conscience, live out their lives. Appreciating this third foundation of his thought, we can understand why this pope is so remarkable in respecting the consciences of the laity. As he writes in “The Joy of Love,” “We are called to form consciences not to replace them” (37). This respect has brought him to address directly such issues as a gay man who understands himself to be called to priesthood, or a divorced and remarried Catholic couple seeking Communion.

The key insights of his teachings on health care are from a consistent understanding of the sanctity of life that stands in contradiction to a throwaway culture, that demands mercy and accompaniment as it champions human dignity and the common good, and that is always mindful of the option for the poor, while never disregarding the integrity of the personal conscience and the need to discern moral issues through that conscience.

A Developed and Consistent Application

Several months ago Pope Francis delivered a major address to members of the World Medical Association. I close this essay with a close analysis of this significant but overlooked text, because I believe it gives us a clear view of his fundamental concerns about health care along with its own “interconnected” logic.

After greeting his audience, he turns in the second paragraph to surgeries and other medical interventions that are not always beneficial, and other treatments that do not “serve the integral good of the person.” Then, in the third paragraph, he refers us to an important teaching by Pope Pius XII, later developed by Cardinal Ratzinger in the “Declaration on Euthanasia,” that “that there is no obligation to have recourse in all circumstances to every possible remedy and that, in some specific cases, it is permissible to refrain from their use.”

Here he proposes that we need to consider “the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources.” He concludes by saying, “It thus makes possible a decision that is morally qualified as withdrawal of ‘overzealous treatment’.” By using the term “overzealous,” he not only affirms that a decision to cease such treatment is permitted, but also implies that to continue it might not be right.

The fourth paragraph calls us “to responsibly [acknowledge] the limitations of our mortality” and suggests that when we do, we restore “humanity to the accompaniment of the dying, while not attempting to justify the suppression of the living.” He adds, “It is clear that not adopting, or else suspending, disproportionate measures, means avoiding overzealous treatment.” Palliative care that accompanies the dying is the model being proposed here.

In the fifth paragraph, Francis recognizes both the difficulty in appraising relevant factors in end-of-life health care and that “the mechanical application of a general rule is not sufficient.” He then turns to the primacy of the patient’s conscience: “The patient, first and foremost, has the right, obviously in dialogue with medical professionals, to evaluate a proposed treatment and to judge its actual proportionality in his or her concrete case, and necessarily refusing it if such proportionality is judged lacking.”

Pope Francis: “Access to healthcare risks being more dependent on individuals’ economic resources than on their actual need for treatment.”

In the sixth paragraph, he brings in economic inequities, in particular “the growing gap in healthcare possibilities.” Here he introduces a fairly significant factor into our understanding of end-of life issues: “Increasingly sophisticated and costly treatments are available to ever more limited and privileged segments of the population, and this raises questions about the sustainability of healthcare delivery and about what might be called a systemic tendency toward growing inequality in health care.” In the international press, this was the most frequently cited sentence from the discourse. After it, the pope reiterates his concern about shifts in the delivery of care both nationally and worldwide, saying, “access to healthcare risks being more dependent on individuals’ economic resources than on their actual need for treatment.”

In the seventh paragraph, he turns to the good Samaritan parable and insists on solidarity, specifying that “the categorical imperative is to never abandon the sick.” He concludes with a nod toward “palliative care, which...opposes what makes death most terrifying and unwelcome—pain and loneliness.”

In the eighth paragraph, Francis summons democratic societies to find legal solutions for these matters respecting “differing world views, ethical convictions and religious affiliations, in a climate of openness and dialogue.” But then he turns to human dignity and asserts that “the state cannot renounce its duty to protect all those involved, defending the fundamental equality whereby everyone is recognized under law as a human being living with others in society. Particular attention must be paid to the most vulnerable, who need help in defending their own interests.” He argues that the “recognition of the other...is the condition for all dialogue” and concludes, “Legislation on health care also needs this broad vision and a comprehensive view of what most effectively promotes the common good in each concrete situation.”

Convinced of the clarity of the church’s opposition to the “act” of euthanasia, the pope has called us beyond that stance so as to attend to the most vulnerable, who might be dying with inadequate care or without accompaniment. He pricks our consciences, asking us whether, in our disproportionate use of technology, we delude those who can afford it that “overzealous treatment” is the best means by which to show they are cared for—while at the same time, having expended those resources on technology, we become distracted from the needs of those with fewer resources.

Pope Francis also pricks our consciences on a larger spectrum of health care issues when he asks whether the health care industry furthers the economic divide that already makes a disproportionate number of resources available to those who can afford them without any mindfulness of those who cannot. In a word, he brings to health care an extraordinarily developed and consistent application of the sanctity of life argument.

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JR Cosgrove
6 years ago

One might ask where has Catholic Social teaching helped the people? Latin America was traditionally the most Catholic part of the world but is one of the poorest and most violent areas too.

The expansive American Catholic health care system appeared in the land of mostly free market capitalism. An example where Catholic moral teaching and freedom mix extremely well.

JR Cosgrove
6 years ago

As an addendum. Catholic moral teaching and Catholic Social teaching are not the same thing. It may be that in places they are actually contradictory. One emphasizes a prescription for voluntary action leading to salvation. The other tries to impose and force a solution with unknown consequences.

Luis Gutierrez
6 years ago

One example of disjointed doctrines is the pro-life doctrine about abortion and euthanasia, on one hand, and the pro-death doctrine about female vocations to the priesthood and the episcopate on the other hand. It seems clear to me that the pro-death doctrine about female priestly vocations is effectively a mandate to abort such vocations. To rationalize such practice under the New Law by invoking the selection of 12 male apostles under the Old Law is a pathetic absurdity that effectively diminishes the credibility of Church doctrines about many other issues of human sexuality.

Charles Erlinger
6 years ago

Brash as it probably appears to be, I propose a different way of talking about one aspect of Catholic social teaching that applies, not only to healthcare concerns in our communities but also to the way of talking about enhancing or enriching pro-life efforts. In both of these areas, one of the pillars of the teaching is expressed by the phrase “preferential option for the poor.” I know that this phrase has a distinguished pedigree, dating from a well-known Jesuit superior general, through Pope St. John Paul II, and down through its usage by the Church leaders and faithful in our own southern hemisphere, thence, throughout the latter half of the last century, right on to our own current time and place.

I suggest that the phrase, at least as we are exposed to it in the English language, is so abstract and equivocal that it can be used justifiably by any preacher, politician or protester, not to mention opinion writers and broadcasters, to mean whatever they want it to mean. Plus, in common English usage at least, it contains words that are really different from the meaning of the teaching according to its truly distinguished origin, namely, the Gospels and Epistles. When I hear the word “preferential” I form an image of a host asking: “Would you prefer red wine or white?” or a waiter asking: “Would you prefer cracked pepper on your Caeser salad?” When I hear the word “option” I understand the opportunity to make a choice among several possible decisions, each of which might have advantages or disadvantages relative to the others, but none of which is decisively catastrophic.

When I read or hear proclaimed the scriptural references to our interactions with the poor, on the other hand, they seem to describe quite unequivocal prescriptive behaviors. Perhaps we should make an effort to communicate that in our preaching, writing and the legal language of any laws that may be proposed to fulfill our obligations. Certainly many of us insist upon the Christian nature of our nation. With that lofty pretension, shouldn’t there be a non-optional obligation?

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