BY: PHILIP J. BOYLE, PhD
Dr. Boyle is vice president for ethics, Catholic Health East, Newtown
Leaders of Catholic health care organizations, as they address the issue of
diversity and work to build inclusive cultures, are often overwhelmed, perhaps
stymied, by the immensity of the task ahead. Sponsors, board members, and senior
executives search for ways to sort out the sometimes conflicting moral obligations
concerning an issue such as affirmative action. Catholic social teaching is
probably not the first place that perplexed leaders look for answers. However,
Catholic social thought offers principles for reflection, provides criteria
for judgment, and, in some cases, suggests guidelines for action. In fact, Catholic
social teaching can uniquely inform an understanding of the health care ministry's
need for greater diversity and inclusion.
It is useful, in coming to understand how the tradition applies to diversity
and inclusion, to identify the potential scope of moral questions that fall
under that rubric. As everyone notes, no consensus exists concerning the definitions
of "diversity" and "inclusion." They vary with each interpreter. Nonetheless,
when people think about the two words, they usually have practical questions
in mind. Among these questions are:
- How does a health care institution go about creating a level playing field
for job opportunities, and how far need it go in doing so?
- How does a health care institution go about balancing the need to repair
past social injustices with the need to create a community of inclusion that
leaves no one out?
- How does a health care institution ensure that its workforce mirrors differences
found in the local population?
- How does a health care institution go about eliminating sexism, racism,
ageism, and all the other isms from its workplace?
- How does such an institution foster acceptance of and reverence for the
members of all races, ethnicities, religions, languages, genders and sexual
orientations, and people affected by various conditions—economic (e.g., the
poor), social (e.g., the undereducated), and mental and physical (e.g., those
- How does a health care institution foster diversity and inclusion and,
at the same time, meet its financial obligations?
These questions and the practical problems they represent—all of which are
part of an expanding fabric of diversity and inclusion—concern not just employees
but also patients, vendors, unions, and, in fact, anyone with whom a Catholic
health care institution forms a relationship. How does a health care institution
overcome and rectify barriers that have impeded inclusion? And how does such
an institution create a culture in which its policies foster inclusion?
Catholic Social Teaching
It is useful, before considering the particular details of diversity and inclusion,
to consider first the origins, content, and importance of the relevant Catholic
social teaching. The church's social teaching was developed during the 19th
century, a period in which the Gospel encountered modern industrial society
with its new structures for the production of consumer goods, its new concepts
of state and society, and its new forms of labor and ownership. However, the
roots of the social teaching are biblical: the Hebrew prophets announced God's
special love for the poor and called God's people to a covenant of love and
justice. The social teaching is also founded on the life and words of Jesus
Christ, who came "to bring glad tidings to the poor . . . liberty to captives
. . . recovery of sight to the blind" (Lk 4:18-19) and who identified himself
with "the least of these," the hungry and the stranger (Mt 25:45). As the theological
tradition emerged from the truths revealed to us by God, it emphasized the triune
God, whose very nature is communal and social in its interrelatedness. Therefore,
we who are made in God's image share this communal, social nature.1
The social tradition covers an array of principles concerning practical moral
issues, all of which affect humans in their social lives. There is no official
list of the principles governing the social teaching, but one scholar has suggested
that 10 principles essentially undergird the teaching. These are the principles
of human dignity, respect for life, association, participation, preferential
protection of the poor, solidarity, stewardship, subsidiarity, equality, and
the common good. The number of the principles is not important; what is important
is how they are used. The scholar who suggested them put it nicely: "Principles,
once internalized, lead to something," he writes. "They prompt activity, impel
motion, direct choices. A principled person always has a place to stand, knows
where he or she is coming from and likely to end up. Principles always lead
the person who possesses them somewhere, for some purpose, to do something,
or choose not to."2 Therefore, the principles of social teaching
should act as a compass concerning the particular issues that Catholic health
care institutions must address, including diversity and inclusion.
Over the past 150 years, Catholic social teaching addressed specific issues
that fall under the umbrella of diversity, such as those concerning economic
justice,3 racism,4 sexism,5 and the dignity
of the human worker.6 Many, if not all, of the practical conclusions
reached by the social teaching have counterparts in an ethics of common human
morality that is accessible to all people. Catholic social teaching, emerging
from Scripture and tradition, builds on common human morality.
In what follows, I will discuss diversity and inclusion as they are touched
upon by three of the 10 social teachings: on human dignity, the common good,
and the preferential option for the poor.
The conviction that human dignity is innate because people are made in the
image of God is one example of Catholic social teaching. This teaching addresses
three realms of existence: personal, societal, and institutional. When one is
assigning priorities in moral obligations, the promotion and protection of the
personal realm should be first. The societal and institutional realms exist
to protect the personal one; as Pope Leo XIII noted in Rerum Novarum,
"Persons precede the state." Injunctions to affirm the dignity of the human
person are found throughout the social teaching and are unequivocal: Human dignity
arises from who humans are, not from what they do or have. This transcendent
view of human dignity is tied to the scriptural notion that all people are made
in the image of God (Gn 1:27). "We believe that the person is sacred—the clearest
reflection of God among us," write the U.S. bishops. "Dignity comes from God,
not from nationality, race, sex, economic status, or any human accomplishment.7
In Pacem in Terris, Pope John XXIII is emphatic: "It is not true that
some human beings are by nature superior and others inferior. All persons are
equal in their natural dignity."8
This faith perspective is not foreign to common human morality. The Declaration
of Independence, for example, states that all people are created equal. This
tenet—natural equality, implying the innate dignity of each citizen—is the foundation
of a free society. Put negatively, the tenet suggests that when society tolerates
unequal treatment for even one person, it may end by tolerating unequal treatment
for all. Catholic social teaching builds on the equality/dignity perspective
and bolsters reverence for persons because they are made in the image of God.
Where inequality exists, Catholic social teaching is clear about the positive
steps that should be taken to rectify it. "With respect to the fundamental rights
of the person, every type of discrimination, whether social or cultural, whether
based on sex, race, color, social condition, language, or religion, is to be
overcome and eradicated as contrary to God's intent."9
The U.S. Bishops recommend further positive steps:
Discrimination in job opportunities or income levels on the basis of race,
sex, or other arbitrary stands can never be justified. It is a scandal that
such discrimination continues in the United States today. Where the effects
of past discrimination persist, society has the obligation to take positive
steps to overcome the legacy of injustice. Judiciously administered affirmative
action programs in education and employment can be important expressions of
the drive for solidarity and participation that is at the heart of true justice.
Social harm calls for social relief. The nation should renew its efforts to
develop effective affirmative action policies that assist those who have been
excluded by racial or sexual discrimination in the past.10
Although the bishops say that society has a positive obligation to promote
justice, they do not make it clear how far private institutions must go in the
drive for true justice. Most people would agree that private institutions are
responsible for rectifying harm they have caused, especially if the harm is
the result of discrimination and the victims of it can be identified. Take,
for example, Catholic Hospital A, which is situated in an area with a high concentration
of poor people or minorities even though its historical pattern of services
is directed to the affluent. Hospital A's leaders might want to examine whether
they have an obligation to act with restorative justice by focusing services
on those against whom their facilitys' may have discriminated.
The Common Good
Another keystone Catholic social teaching that sheds light on obligations of
diversity and inclusion arises from notions of the common good. A common human
morality, dating back to Aristotle, considers the existence of society—and the
state in particular—as essential to human flourishing. "A state exists for the
sake of the good life, and not for life only," Aristotle wrote.11
The common good requires not only that individuals have life but that they also
The Catholic social tradition adds to this view of common human morality a
definition of the common good as "the sum total of the conditions of social
living, whereby persons are enabled to achieve their own perfection."12
This means that a society should put in place structures that aid the flourishing
of all of its members, by, for example, eliminating structures that cause discrimination.
The common good is only realized when the dignity of each person is realized.13
Conversely, when the dignity of one individual is diminished, the potential
for the flourishing of the common good is impeded.
We might cite here the example of Hospital B. This institution has not fully
attended to ethnic differences in its patient population, which includes a high
concentration of Indian Muslims. It is difficult to maintain, when differences
of race, ethnicity, and religion are not attended to, and, as a result the special
needs of Muslim female patients are slighted, that the common good is being
promoted. And if Hospital B also retains subtle, historical barriers to advancement
because of gender, race, or disability, it is difficult to maintain that the
core value of the common good is truly protected and promoted.
The concept of inclusion is woven into the principles of the common good and
participation. In speaking directly of Catholic social teaching, the U.S. Bishops
recently said: "We believe people have a right and a duty to participate in
society, seeking together the common good and well-being of all, especially
the poor and vulnerable."14 Unless a person enjoys full rights of
participation, he or she will be unable to realize the benefits available from
society's institutions. The human person has a right not to be excluded from
participation in the institutions necessary for human fulfillment.
This principle applies in a special way to conditions associated with work.
"Work is more than a way to make a living; it is a form of continuing participation
in God's creation. If the dignity of work is to be protected, then the basic
rights of workers must be respected—the right to productive work, to decent
and fair wages, to organize and join unions, to private property, and to economic
initiative."15 Participation means, not merely inclusion in work,
but, more importantly, being allowed to perform work that fits one's abilities.
St. Augustine held that the common good ultimately reflects God's own self,
and on that basis humans will never reach fulfillment in God until everyone
is included. Diversity is a way of enriching the common good by increasing the
number of elements or ingredients. To the extent that we exclude anyone from
full participation, we weaken and thin the common good.
The Preferential Option for the Poor
Knowing something about the Catholic social teaching on the preferential option
for the poor is essential to understanding the moral obligations of diversity
and inclusion. The notion of a preferential option for the poor is solidly rooted
in Scripture. God heard the cry of the oppressed and brought them out of bondage
and slavery (Ex 8:1). Jesus' ministry brought "good news to the poor, to proclaim
liberty to captives" (Lk 4:18-20). Jesus had a special concern for the rejected
and outcasts of society— lepers, the crippled, and the sick.
The preferential option for the poor was given a modern interpretation in
1971 when the Synod of Bishops issued Justice in the World a document
that addressed all those of the world's population who are marginalized or in
some way barred from participation in society's benefits. "Marginalization"
was made a primary criterion in judging whether human dignity had been violated;
the marginalized person was understood to be anyone who had been treated as
a second-class citizen, such as women and minorities. In a 1990 speech, Pope
John Paul II cautioned that the preference for the poor should not exclude people
who had previously been favored by society.
An "option for the poor" has come to mean opposing structural injustice wherever
it is, and includes solidarity and compassion that shares to some extent the
plight of those left behind. For some commentators, the practical institutional
applications of the option include:
- Conducting a careful analysis to understand the roots of the structural
- Distancing oneself from collusion with the groups or forces that are responsible
for the injustice
- Executing a carefully planned and concerted challenge to the injustice
- Designing realistic institutional alternatives to the unjust structures16
In the case of Hospital C, for example, this means that its leaders should
seek to understand possible barriers to the full participation of minorities
in the hospital workplace. In examining such barriers, the leaders might come
to see that simple inertia is frequently among them. Having identified this
and other barriers, Hospital C's leaders should develop, refine, and execute
a careful plan to foster inclusion. Once that plan was carried out, Hospital
C could truthfully claim that it had expressed the value of the preferential
option for the poor.
The principles of Catholic social teaching articulated above should not be
thought of as rules requiring conformance. Rather, they should be seen as goals
toward which the health care ministry aspires. Catholic health care's mission
is clear—namely, thatit is a community of persons committed to being a transforming,
healing presence in the communities served. As the Catholic social teaching
prophetically notes, being a transforming and healing presence is not limited
to medical care and can be attained by protecting and promoting human dignity
through a culture of inclusion.
As in all moral life, immediate change is often impossible in the face of
structurally complex problems. But a Catholic health care organization that
has expressed an intention to better align itself with those goals has already
taken a significant step in the pursuit of our mission.
- See the National Conference of Catholic Bishops, Sharing
Catholic Social Teaching: Challenges and Directions, U.S. Catholic
Conference, Washington, DC, 1999.
- William J. Byron, "Ten
Building Blocks of Catholic Social Teaching", America, October
- National Conference of Catholic Bishops, Economic
Justice for All: Pastoral Letter on Catholic Social Teaching and the U.S.
Economy, U.S. Catholic Conference, Washington, DC, 1986, para. 13;
and World Synod of Catholic Bishops, Justice
in the World, 1971.
- National Conference of Catholic Bishops, Brothers
and Sisters to Us: Pastoral Letter on Racism, U.S. Catholic Conference,
Washington, DC, 1979.
- National Conference of Catholic Bishops, To
Do the Work of Justice U.S. Catholic Conference, Washington, DC, 1978.
- Pope Leo XIII, Rerum Novarum,
- National Conference of Catholic Bishops, Economic Justice for All,
- Pope John XXIII, Pacem
in Terris, 1963, para. 89.
- Second Vatican Council, Gaudium
et Spes? 1965, para. 29.
- National Conference of Catholic Bishops, Economic Justice for All,
paras. 73 and 167.
- Aristotle, Politics, Trevor J. Saunders, trans., Penguin, London,
1980, para. 128b.
- Pope John XXIII, Mater
et Magistra, 1961, para. 65; and Second Vatican Council, para. 26.
- Pope John XXIII, Pacem in Terris, para. 9.
- National Conference of Catholic Bishops, Sharing Catholic Social Teaching:
Challenges and Directions, U.S. Catholic Conference, Washington, DC, 1999,
- National Conference of Catholic Bishops, Sharing Catholic Social Teaching.
- See Donald Dorr, "Preferential Option for the Poor," in The New Dictionary
of Social Thought, Judith Dwyer, ed., Liturgical Press, Collegeville,
MN, 1994, p. 755.
A Texas Diocese on Diversity
In paragraph 11 of its Synod
Recommendations on Social Justice adopted November 21, 1999, the Diocese
of Beaumont, TX, said:
The Church in Southeast Texas has great diversity. Among the things that
make us different, one from the other, are ethnic and cultural heritage. We
are: African Americans, Vietnamese, Filipinos and a rapidly growing Spanish
speaking population as well as Caucasians of Cajun and Italian descent. We
are not all identical, some of us are different personally, emotionally, physically.
Some persons have like-gender sexual orientation. Some persons are unable
to enter the mainstream of society and are jobless and homeless. Some persons
struggle with addictions. Although we are all sisters and brothers, no one
of us is identical to the other. Awareness of diversity can lead to supporting
individuals and enriching the faith community or it can lead to prejudicial
behaviors. . . . Our call to follow Jesus' example asks all of us to be open
and accepting of the differences in others and to come together as a community
Copyright © 2003 by the Catholic Health Association of the United States
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