| (cont.)
III. The Consistent Ethic of Life and "Contemporary"
Social Justice Issues
The second challenge which
the consistent ethic poses concerns "contemporary"
social justice issues related to health care systems.
The primary question is: How does the evangelical
option for the poor shape health care today?
Some regard the problem
as basically financial: How do we effectively allocate
limited resources? A serious problem today is the
fact that many persons are left without basic health
care while large sums of money are invested in the
treatment of a few by means of exceptional, expensive
measures. While technology has provided the industry
with many diagnostic and therapeutic tools, their
inaccessibility, cost and sophistication often prevent
their wide distribution and use.
Government regulations
and restrictions, cut-backs in health programs, the
maldistribution of personnel to provide adequate services
are but a few of the factors which contribute to the
reality that many persons do not and probably will
not receive the kind of basic care that nurtures life—unless
we change attitudes, policies and programs.
Public health endeavors
such as home care, immunization programs, health education
and other preventive measures to improve the environment
and thus prevent disease, have all served as alternate
means of providing care and improving the health of
the poor and isolated populations. In the past, if
patients from this sector of society needed hospitalization,
institutions built with Hill-Burton funds were required
to provide a designated amount of "charity care"
to those in need.
In some instances, hospitals
continue to follow this procedure. However, access
to these alternate, less expensive types of health
care is becoming more difficult. Cuts in government
support for health programs for the poor, for persons
receiving Medicare or Medicaid benefits, are making
it increasingly more difficult for people who need
health care to receive it.
Today we seem to have
three tiers of care: standard care for the insured,
partial care for Medicaid patients, and emergency
care only for the 35 million Americans who are uninsured.
Do we nurture and protect life when there appears
to be an unjust distribution of the goods entrusted
to our stewardship? How can Catholic hospitals continue
both to survive and to implement a preferential option
for the poor?
This is not merely a
theological or pastoral issue. Access to standard
health care is largely nonexistent for about half
of the poor and very limited for the other half who
are eligible for Medicaid or Medicare. The United
States has the worst record on health care of any
nation in the North Atlantic community and even worse
than some under-developed nations.
Judith Feder and Jack
Hadley, currently co-directors of the Center for Health
Policy Studies at Georgetown University, have conducted
research on uncompensated hospital care. Some of their
findings are particularly disturbing. They concluded,
for example, that non-profit hospitals—including Catholic
facilities—do very little more for the poor than for-profit
hospitals (which is very little, indeed). Free care
provided by private, nonprofit hospitals averaged
only 3.85% of all charges (gross revenues) in 1982.
I am aware that some dispute the accuracy of these
findings in regard to Catholic hospitals, but I have
not yet seen data which shows that, overall, these
institutions provide substantially more free care
than their counterparts.
I must also affirm,
of course, that there are some inner city and other
Catholic hospitals which do a great deal for the poor.
Nonetheless, as the research seems to indicate, hospitals
average less than 5% of patient charges for uncompensated
care. Much of this is for deliveries to women who
appear in heavy labor at our emergency rooms and the
subsequent neonatal intensive care for their infants
born with severe problems because of the lack of care
given their mothers during pregnancy.
Our national resources
are limited, but they are not scarce. As a nation
we spend more per capita and a higher share of our
Gross Domestic Product (GDP) on health than any other
country in the world—nearly twice as much as Great
Britain, for example. Yet our system still excludes
at least half the poor. In 1982 the U.S. share of
GDP devoted to health care was 10.6% against 5.9%
within the United Kingdom, which has universal access
to health care and a lower infant mortality rate than
the U.S.
The basic problem of
health care in the U.S. is managerial: the effective
allocation and control of resources. The key is the
underlying philosophy and sense of mission which motivates
and informs managerial decisions.
As a nation, we spend
enormous amounts of money to prolong the lives of
newborns and the dying while millions of people don't
see a doctor until they are too ill to benefit from
medical care. We allow the poor to die in our hospitals,
but we don't provide for their treatment in the early
stages of illness—much less make preventive care available
to them.
These facts are disturbing
to anyone who espouses the sacredness and value of
human life. The fundamental human right is to life—from
the moment of conception until death. It is the source
of all other rights, including the right to health
care. The consistent ethic of life poses a series
of questions to Catholic health care facilities. Let
me enumerate just a few.
-
Should a Catholic hospital transfer
an indigent patient to another institution unless
superior care is available there?
-
Should a Catholic nursing home
require large cash deposits from applicants?
-
Should a Catholic nursing home
transfer a patient to a state institution when
his or her insurance runs out?
-
Should a Catholic hospital give
staff privileges to a physician who won't accept
Medicaid or uninsured patients?
If Catholic hospitals and
other institutions take the consistent ethic seriously,
then a number of responses follow. All Catholic hospitals
will have outpatient programs to serve the needs of
the poor. Catholic hospitals and other Church institutions
will document the need for comprehensive pre-natal
programs and lead legislative efforts to get them
enacted by state and national government. Catholic
medical schools will teach students that medical ethics
includes care for the poor—not merely an occasional
charity case, but a commitment to see that adequate
care is available.
If they take the consistent
ethic seriously, Catholic institutions will lead efforts
for adequate Medicaid coverage and reimbursement policies.
They will lobby for preventive health programs for
the poor. They will pay their staffs a just wage.
Their staffs will receive training and formation to
see God "hiding in the poor" and treat them with dignity.
I trust that each of
you has an opinion about the importance or viability
of responses to these challenges. My point in raising
them is not to suggest simplistic answers to complex
and difficult questions. I am a realist, and I know
the difficulties faced by our Catholic institutions.
Nonetheless, I do suggest that these questions arise
out of a consistent ethic of life and present serious
challenges to health care in this nation—and specifically
to Catholic health care systems.
Medical ethics must
include not only the "classical" questions but also
contemporary social justice issues which affect health
care. In a 1983 address to the World Medical Association,
Pope John Paul II pointed out that developing an effective
medical ethics—including the social justice dimension—fundamentally
depends on the concept one forms of medicine. It is
a matter of learning definitely whether medicine truly
is in service of the human person, his dignity, what
he has of the unique and transcendent in him, or whether
medicine is considered first of all as the agent of
the collectivity, at the service of the interests
of the healthy and well-off, to whom care for the
sick is subordinated.
He went on to remind
his listeners that the Hippocratic oath defines medical
morality in terms of respect and protection of the
human person.
The consistent ethic
of life is primarily a theological concept, derived
from biblical and ecclesial tradition about the sacredness
of human life, about our responsibilities to protect,
defend, nurture and enhance God's gift of life. It
provides a framework for moral analysis of the diverse
impact of cultural factors—such as technology and
contemporary distribution of resources—upon human
life, both individual and collective.
The context in which
we face new health care agendas generated both by
technology and by poverty is that the Catholic health
care system today confronts issues both of survival
and of purpose. How shall we survive? For what purpose?
The consistent ethic of life enables us to answer
these questions by its comprehensiveness and the credibility
which derives from its consistent application to the
full spectrum of life issues.
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