Text: Health Care Ethics USA

Literature Review

Fall 2021

Reviewed by Jacquelyn Harootunian-Cutts,
Ph.D. Student

Darbyshire, Philip, Leanne Patrick, Shaun Williams, Nichole McIntosh, and Robin Ion. "The Culture Wars, Nursing, and Academic Freedom." Journal of Advanced Nursing 76, no. 11: 2786–89. Accessed October 19, 2021. doi:10.1111/jan.14507.

In a searing critique of the contemporary Culture Wars, Darbyshire et al. pose a charter for nursing education that resists the forces restricting academic freedom. The authors are concerned that the excesses of the current climate of fear restrict good nursing education from multiple political angles. Faced with potential professional consequences of engaging contentious topics or challenging the opinions of students, faculty have the choice to weather efforts to have them "cancelled" or shy away from debate. Since nurses would do a disservice to their trainees and patients by ignoring many of the topics at the heart of good care, the authors believe that it is time to restate the importance of academic freedom. The authors seem to presume a definition of academic freedom that is both negative — the freedom from interference in their confrontation of polemic — and positive — the freedom to form their students in critical thinking by challenging beliefs and offering alternative critiques.

The call for challenging the beliefs of students, modeling critical thinking, and engaging controversial issues in health care is robust. Darbyshire et al. note that nurses engage people on many levels in the provision of care and stress the need of nurses to learn how to respond with empathy and, if needed, respectful disagreement. These are especially important skills at a time when misinformation and extreme positions regarding COVID-19, public health interventions such as masks, and vaccines are the loudest voices in some areas of American life.

Ironically, even though the authors call for "nuanced discussion and collegiate debate" (p.2786), they take a totalizing view of those who would challenge the status quo of hegemony in academic discourse. While the features of "cancel culture" that Darbyshire et al. have identified are a worrisome feature of the current Culture Wars, they seem to miss the more balanced critiques that arise even in this polarized climate on the same topics.

Reichberg, Gregory M. "Scholastic Arguments for and against Religious Freedom." Thomist: A Speculative Quarterly Review 84, no. 1 (January 1, 2020): 1 – 50.

Reaching back to the Scholastic period of Catholic thought, Reichberg explores three views of religious freedom: those of St. Thomas Aquinas, Francisco de Vitoria, and Francisco Suarez.

For Aquinas, true faith must be voluntary. Therefore, one cannot compel nonbelievers into the Christian faith; compulsion cannot create the necessary movement in the will. Aquinas does hold that the medieval church does have power to compel apostates and heretics back into orthodoxy. Reichberg clarifies this position by showing how Aquinas links this power of enforcement back to baptismal vows. Additionally, Christians are, in Aquinas's view, free to defend their faith and faith expression from attack. However, Aquinas does not permit Christians to wage war to force others to become Christian.

Vitoria takes a stronger and more nuanced stance opposing compulsion and coercion in matters of faith. Vitoria is highly suspicious that even indirect coercion within Christian countries will be effective, even if it can be justified. Vitoria also notes that outside the borders of Christendom, Christians can only oppose sinful religious practices with force when it violates natural law and harms others. Within Christendom, Vitoria operates under the assumptions of the day that temporal power and spiritual power are closely tied, forming an ecclesial body together, and that measures to preserve Christianity are also measures to preserve temporal order.

Lastly, Reichberg dissects the arguments offered by Suarez. Suarez also holds that force outside of Christendom is unjustified unless there are sinful practices which harm others, such as human sacrifice, or prevent Christians from living their faith. Similarly, Suarez allows for the outlaw of public pagan practices within Christendom, though only by official temporal power. Here he differs from Vitoria in offering minimal protection for the religious practice of the other Abrahamic faiths. Suarez also allows for a form of Christian exceptionalism wherein Christian temporal powers may use force to protect the practice of Christianity beyond its borders, but other temporal powers may not do the same on behalf of other faiths.

While Reichberg does not take a strong normative view of how these trends relate to the view of religious freedom taken by Vatican II and Dignitas Humanae, the investigation of Scholastic views is useful for considering a Catholic response to new trends in American political life regarding religious freedom.

McGovern, Thomas W., Anthony T. Flood, and Paul J. Carson. "COVID-19 Policy-Making in a Country Divided: Catholic Social Teaching as a Path to Unity." The Linacre Quarterly 87, no. 4 (November 2020): 407 –- 24.

McGovern, Flood, and Carson offer an analysis of the various approaches to nonpharmaceutical interventions (NPI) used to curb the spread of COVID-19. In this piece, the authors chart a middle way between utilitarian indefinite suspension of civil liberties and libertarian extreme individual freedom by way of Catholic Social Teaching (CST). These positions have frequently been situated in the multi-layered American COVID-19 responses as competing goods. This article responds to both the goods sought by each position as well as the faults of each position. NPIs are not without their risks, so balancing the risks and benefits of NPIs with the risks and benefits of normal human interaction during a pandemic is key.

The morbidity and mortality associated with COVID-19 should be something that people are free from. Equally, people should be free to participate in religious, social, and economic activities that help contribute to human flourishing. CST provides a valuable lens because it unites the dignity of the human person with a specific conception of the common good. In the Catholic tradition, the common good is not merely the sum total of all individual good, so a rejection of libertarian freedom is key. A Catholic conception of the common good encompasses both the individual good rooted in individual dignity, but also collective or shared goods that cannot be achieved without others. This framework implies that we cannot be shut down forever and that we each have responsibilities to the common good rooted in dignity. As we continue to face changing circumstances, such as debate over vaccine mandates, this framing of CST can keep the debate in terms that respect the dignity of the human person and the common good.

Synthesis
The COVID-19 pandemic has in some ways inflamed the polarization of the United States. From the curtailment of academic freedom via the Culture Wars, to the difficulties of respecting and protecting freedoms during pandemic — especially religious freedoms — debate has been fierce at every turn. This collection of articles demonstrates the resources that are available to try to imagine what people are attempting to articulate when invoking concerns about freedom. At first blush, contemporary concerns regarding religious freedom may not resemble what the Scholastics had in mind, but we can model our responses on their arguments. The Scholastics provide a framework for allowing temporal power to step in when practices harm other people and for restraining force for compelling unbelievers to belief. We can use these ideas now to animate our efforts to help as many people to become vaccinated as possible, or keep the community safe if there are practices that contribute to serious harm to others. Similarly, our current NPIs and vaccine efforts need to reflect the middle way of CST and respect deeply the dignity of each human person while also asking each person to take responsibility for contributing to the common good; this balanced approach can help all people exercise their freedom more fully. Finally, we can learn from the excesses of pandemic debate and try to encourage more constructive manners of engaging with those who disagree with us while understanding that power dynamics sometimes require confrontation and a prophetic calling out of sin. Despite this, we should remain humble in our efforts and join with educators to encourage those currently training to enter the field of health care to learn and practice critical thinking.

Jacquelyn Harootunian-Cutts
Ph.D. Student
Saint Louis University

jacquelyn.cutts@slu.edu