Healthcare Needs to Ask Itself Tough Questions, Particularly Whether Its Power Derives from a Fear of Death
In her keynote address, Margaret O'Brien Steinfels outlined the complex issues embedded in the struggle to achieve justice. But, she warned, "life is unfair," and part of the maturation process means learning to live with certain inequities and injustices in our lives that cannot be redressed.
Institutions have played a critical role in establishing and ensuring justice, even as political forces are dismantling and weakening institutions. Steinfels, editor of Commonweal, cited Martin Luther King Jr.'s leadership in making the black church in America an instrument of justice for the whole country. "When Martin Luther King Jr. came along, the equation changed, the balance shifted. He exposed the enormity of these injustices and gave voice to justice," she said. Basing his message on the Bible, the Declaration of Independence, the U.S. Constitution, and the Bill of Rights, King made a compelling case: "If you believe in these things, then segregation must end. Americans, Christians, and Jews could no longer go on living a lie."
Institutions have the power to surface the deepest beliefs of collective conscience and "make us see things differently." But, Steinfels warned, the struggle for justice is potentially delusional, and she asked assembly-goers to consider some tough questions about the healthcare delivery system. "When market criteria govern the way you organize and run your hospitals," she said, "does the demand for efficiency always trump the claims of justice? Do the least powerful people in your institutions get a fair shake when the budget is put together, when personnel policies are formulated? Do the most powerful always have the final say on disputed questions?"
Steinfels deplored the healthcare delivery system's constant refrain of "limited resources and near bankruptcy" when it represents nearly one-fifth of the gross national product. Instead of questioning why they are so weak and on the verge of collapse, healthcare institutions should be questioning why they are so powerful.
"More than any other institution in America, except, perhaps, the prison system, the medical care system commands enormous resources and can compel legislators, regulators, and insurers to do a good deal of your bidding. You may feel besieged, but you are privileged in ways that many others are not," she told assembly-goers.
Fear of death gives the delivery system its enormous resources and power, Steinfels suggested. "It is a fear you can never assuage. Is this a power you really want?"
For Catholic institutions to truly redress the inequities in the healthcare system, they must confront the "idea that medicine will make us immortal. In the Catholic scheme of things, death is not the end of life; death is part of life," she said. This belief challenges Catholic institutions to rethink how they care for persons whom medicine cannot help and to incorporate care of the soul as thoroughly as care of the body.
"Just as Americans changed their minds and practices about race, we can change our minds and practices about how we live the end of life," she said. "Our deepest beliefs . . . must begin to penetrate our consciousness and guide our actions. Both life and death are part of God's creation. We need to recover and reappropriate that profound biblical sense that God gives and God takes away, that our efforts to bring justice are but echoes of the justice and mercy which God has already given us."
Copyright © 1999 by the Catholic Health Association of the United States
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