Anticipating the Changes That Will Touch Us All

November-December 2015


This article is adapted from a presentation at the 2014 Contemporary Catholic Healthcare Ethics Conference at the Neiswanger Institute for Bioethics, Loyola University Chicago's Stritch School of Medicine.

Almost three years ago, Cardinal Jorge Mario Bergoglio, former Archbishop of Buenos Aires, stepped on to that little balcony at St. Peter's Basilica and asked for our prayers. The unprecedented gesture of humility, plus his nationality — in 2,000 years, he is the first Latin American to be elected pope — his Jesuit identity, his choice of a Franciscan name, all raised hopes for a new day in the Catholic Church. But before we analyze some of the changes Pope Francis has made and others he may still have on his to-do list, let's look at how much potential a new leader has to change a large organization.

I live in Cincinnati, where we have our share of Fortune 100 companies with international influence. Among the largest is Procter & Gamble Co., with annual sales of more than $84 billion, manufacturing in 70 countries and hundreds of thousands of employees. Everything P&G does makes the daily news, especially the appointment of a new leader. How much can the new leader change that behemoth?

Another example: The President of the United States leads the wealthiest country in the world, with more than 300 million citizens and the best trained and equipped standing military in history. What can he change?

In comparison, the leader of the Roman Catholic Church presides over 1.2 billion Catholics from a postage-stamp-sized country called Vatican City. There are approximately 3,000 dioceses, with their own bishops and priests, deployed worldwide. What can he change?

You might observe that these comparisons make no sense.

The president of P&G is constrained by his shareholders, represented by a board of directors. Deliver a profit or you're out.

The President of the United States is answerable to the voters and, increasingly, is foiled by a dysfunctional Congress in his attempts to make changes. The U.S. president's mandate lasts no more than eight years.

The pope, in contrast, is sovereign, theoretically answerable to no one and is entitled to hold his role until death, unless he chooses to resign. Even though he doesn't have P&G's bankroll or the U.S. military at his disposal, he should be able to change anything he wants. Right?

Here's where it gets interesting. What kind of organization is the Catholic Church? What can change? How does change happen, that is, what are the levers? How important is the pope to this process and, specifically, what can we expect or hope from him during his tenure? In particular, what changes would impact our ministry of health care?

The Catholic Church clearly is not a multinational corporation like P&G, nor a world power like the United States. The simplest definition I've come to, over the years, is that the church is the life and mission of Jesus Christ extended in time and space.

This definition is inherently Trinitarian, because to know Jesus is to know his Father and the Spirit who sent him. The story of what Jesus did and taught during his lifetime on Earth is contained in the Scripture, but there's more. He promised to be with us until the end of time, specifically in the community known as his body, which he promised to nourish with his own body and blood. Through membership in Christ's body known as the church, through reception of the Eucharist, through our good works, we continue Jesus' life and mission today, not only in the traditionally Catholic countries but in every corner of the world.

Who belongs to that body? All the baptized, born anew in Christ, as well as others who, through no fault of their own, are ignorant of the Gospel but are led in ways known to God alone.1 Made up of human beings, animated by the divine life, the body we call church has both visible and invisible aspects. According to the Gospel narrative, Jesus Christ's followers included a large number of disciples, from among whom he named 12 apostles, and one he called to the key leadership role: "You are Peter, and upon this rock I will build my church." (Matthew 16:18)

The Acts of the Apostles and the Epistles describe a gradually evolving, visible structure with specific roles designed to meet the needs of the communities in Jerusalem, Ephesus, Corinth and elsewhere as the infant church grew. We read of elders, presbyters (Acts 20:17), deacons (Acts 6) and bishops (1 Timothy 3:1).

Well it's a long way from Corinth to your parish, but the essential nature of Christ's body that we call the church is unchanged: a community of men, women and children, of all races and nationalities, animated by Christ's spirit, committed to extending his work into today's world through their daily lives and good works. It is a community united by a visible structure, a common set of beliefs and a common worship, all stemming from the Gospel.

Which brings us to our second question: What can change? Obviously the first answer is that externals change in response to historical and cultural developments. Compare your parish church to the upper room where Jesus first gave his followers his body and blood to eat. And yet we celebrate the same reality today. Going beyond externals, we can note that some of the church's teachings have changed: We no longer regard loaning money at interest as the sin of usury; we no longer countenance any form of slavery, although it took more than a thousand years to come to that insight.

Changes in church teaching can come very unevenly over time. Periods of very little change can go for centuries, followed by an ecumenical council such as Vatican II in the 1960s that made numerous significant changes in church teaching and practice. There are two significant characteristics of the change process. The first is that there is a hierarchy of truths: Some teachings are more central to our faith than others. Changing a moral teaching in response to new scientific learnings is easier than redefining the Eucharist.

Second, the process of changing church teachings, which we could describe as the development of doctrine, admits of various roles. The first is that of the faithful who are sincerely striving to live the Gospel in today's world. We call their Spirit-guided instinct the sensus fidei. You might say it is where change begins. At the same time, consulting the faithful is not a matter of taking a vote of practicing Catholics and declaring the majority opinion to be the new teaching. The sensus fidei is a characteristic of the whole church, not just in the United States or North America.

There is another role, that of theologians. They bring an in-depth knowledge of the tradition and an ability to test new ideas against that measure, as well as an ability to synthesize new thinking into clear proposals. Much of the creative work that we associate with the Second Vatican Council was drafted by the periti, or theological experts, that the bishops brought with them to the council. We remember names like Karl Rahner, Yves Congar and Henri de Lubac.

The third role is what we call the magisterium, the teaching office exercised by the bishops in their own dioceses and by the ecumenical council and the pope for the universal church. They have the necessary authority to pronounce on a proposed new teaching. The participation of all the bishops in the direction and governance of the church is what is meant by collegiality. Then, backing off and taking a longer view, there is a process of reception of new teaching. Here again, all three groups come together. What will stand the test of time, and what will be found wanting in light of newer insights and circumstances?

One of the ways these three voices — laity, theologians, and bishops — come together is in the experience of a synod. The Synod on the Family, with its two sessions, in October 2014 and October 2015, brought together representative bishops from around the world, Vatican officials and some papal appointees, and numerous observers, chiefly married couples. The preparation for the 2014 session was unprecedented, with bishops around the world invited to consult widely with the laity, i.e., to ascertain the sensus fidei. Some took the invitation quite literally; others seemed to view the invitation as more of a suggestion that they could respond to in a more modest fashion. The input received, however, was enough to indicate the wide nonreception of some current teachings and the concern for a merciful posture toward persons in "irregular situations" such as those excluded from Holy Communion because they are divorced and remarried. The 2015 synod is expected to continue the 2014 work and prepare guidelines for the pastoral care of the person and the family. Whatever the consensus of the synod participants, the authoritative word will be that of the pope's apostolic exhortation, which usually follows a synod by six months or a year.

In August 2015, Pope Francis responded to the long-standing desire of many bishops for a simplification of the procedures for marriage annulments, by issuing a motu proprio document on the reform of the canonical procedure for the annulment of marriage in the Code of Canon Law.

So after this long introduction, we're ready for the important question:

What changes can we expect from Pope Francis?

There is probably no one in the world who hasn't seen a picture of this pope. Wherever he goes, he seems to radiate kindness, openness, compassion and joy. He embraces babies, walks up and down the aisle of the papal plane answering questions and makes quotable comments to every group he meets. He has appointed a council of nine cardinals to advise him on reorganizing the Curia. His smiling countenance alone presages changes in the church.

But to get a little more precise hold on his thinking, we can go to his apostolic exhortation, Evangelii Gaudium, published in 2013. It is his follow-up to the October 2012 Synod of Bishops summoned by Pope Benedict XVI to address the topic "The New Evangelization." With this document, Pope Francis invites "all Christians, everywhere, at this very moment, to a renewed personal encounter with Jesus Christ, or at least an openness to letting him encounter them; I ask all of you to do this unfailingly each day. No one should think that this invitation is not meant for him or her, since 'no one is excluded from the joy brought by the Lord.'"2

With boldness and originality and even some humor, Pope Francis goes on to lay out his plan for an evangelizing community. Using Evangelii Gaudium, as well as a few other public interviews as sources, I'd like to identify four areas where we may expect, indeed we already are experiencing, changes in teaching or practice within the church, changes that have implications for the ministry of health care. No, I am not going to predict which of the Ethical and Religious Directives for Catholic Health Care Services will change, but I think you will sense some implications in the directions Pope Francis is taking.

The four areas are the welcoming nature of the church, its focus on the poor, its ecclesial structures and the role of the lay faithful.

In recent years some church leaders, recognizing the impact of some of the ills characteristic of contemporary society, have called for a smaller, purer church. Let's eliminate those who are half-hearted in their practice of their religion, they say, and focus on the fervent and the faithful. In their view, a smaller church might be a good thing. Forget about the Easter-and-Christmas-only Catholics!

In Evangelii Gaudium, Pope Francis turns this around 180 degrees. He describes a church that goes forth radiating joy, whose doors are open to the fringes of humanity. He says the sacraments are not prizes for the perfect, "but a powerful medicine and nourishment for the weak." He condemns a "narcissistic and authoritative elitism" which threatens to turn the church "into a museum piece."

In an interview published in America magazine, the pope says: "This church with which we should be thinking is the home of all, not a small chapel that can hold only a small group of selected people. We must not reduce the bosom of the universal church to a nest protecting our mediocrity."3

Christians should be so full of joy, says the pope in Evangelii Gaudium, that they cannot not tell the story and share what they have received with others. This is what is meant by an evangelizing church. "Jesus did not tell the apostles to form an exclusive and elite group. He said, 'Go and make disciples of all nations.'"

At the same time, Francis is a realist. He acknowledges our pain and the shame at the sins of some church members, and he publicly describes himself as a sinner. He attributes bureaucratic, unwelcoming approaches in administering parishes and dioceses as a reason some Catholics lack a sense of belonging to the church, and he points to the pastoral consequences of preaching that emphasizes some teachings out of proportion to others, speaking more about law than grace, more about the church than Christ and more about the pope than about God's word.

Instead, Pope Francis emphasizes the integrity of the Gospel message, where all truths are united in a harmonious whole, and each illuminates the other.

Evangelii Gaudium contains beautiful passages on the significance of diverse cultures and on practices conducive to a life of joyful service, of "bringing light, blessing, enlivening, raising up, healing and freeing. All around us we begin to see nurses with soul, teachers with soul, politicians with soul, people who have chosen deep down to be with others and for others."

Some implications for our hospitals, clinics and workplaces become clear. What we can offer to every employee is an opportunity to grow in this spirit of joyful service through formative experiences that enrich him or her. Further, our sensitivity to cultural diversity in our employee ranks and patient population is another opportunity. And Pope Francis' focus on balance in church teachings, framing everything in light of the love of God, is a way of articulating the importance of the hierarchy of truths.

The next characteristic of the church, in Pope Francis' view, is one that should resonate with all of us, although we may not give it the centrality he does. Specifically, Francis urges us to go first to the poor. While the Gospel message is for everyone, he envisions a church that is bruised, hurting and dirty because it has been out on the streets, rather than a church that is unhealthy from being confined and from clinging to its own security . . . caught up in a web of obsessions and procedures. Leave behind outmoded structures and habits that make us feel safe, he says, while people are starving at our door. "How can it be," he asks, "that it is not a news item when an elderly homeless person dies of exposure, but it is news when the stock market loses two points?"

We can see Francis' love and empathy for the poor in his own behavior, his choice of a living situation, the car he chooses to use, his outreach and physical presence to the poor in multiple settings. He shows us that love for the poor is not something that can be achieved in the abstract, without actually seeing, touching and conversing with those in that situation. Appealing to our deepest identity, he says, "The church is not an NGO, and when the church becomes an NGO, she loses her salt, she has no savor, she is only an empty organization … the value of the church is living by the Gospel and witnessing to our faith."

We don't have to go far in our own society to find the kind of "unjust social structures" he decries. He urges us to say no to an economy of exclusion and inequality, and to adopt "a new mindset which thinks in terms of community and the priority of the life of all over the appropriation of goods by a few."

It seems to me that Francis is calling us to go far beyond the care of the poor that conforms to our legal obligations as not-for-profit organizations. This is a call not only to love and honor and welcome those who find their way to our doors, but also to seek out the poor as our most welcome clients. "The worst discrimination the poor suffer," he says, "is the lack of spiritual care." This has implications for our advocacy and for our organizational planning — are the poor at the table? — as well as for our participation in larger community efforts.

Some of what prevents the church from being seen as a welcoming community are outmoded customs and structures. Some customs may be beautiful and have deep historical roots, but they no longer serve as means of communicating the Gospel. There are rules and precepts, Francis suggests, that may have been effective in their time, but are no longer useful in directing people's lives. He doesn't give specific examples of what he means, I suspect because customs and rules vary in different countries and cultures, but you can create your own list.

The pope's vision also includes a renewal of ecclesial structures, from the parish to the central structures of the universal church and ultimately to the papacy. The current "excessive centralization, rather than proving helpful, complicates the church's life and her missionary outreach," he says. There is a need for a greater appreciation of local and regional elements, for increased collegiality and solidarity.

It may be time to change the methods associated with the synods of bishops. Presently they are advisory to the pope but without any authority beyond that. The offices of the Roman Curia should be at the service of the pope and bishops, but sometimes they are seen as institutions of censorship. "It is amazing to see the denunciations for lack of orthodoxy that come from Rome,"4 Francis said in the America interview.

In a section on ecumenism and interchurch relations in Evangelii Gaudium, Francis mentions that one of the things we could learn from the Orthodox churches is the meaning of episcopal collegiality and their experience of synodality.5 In his reflections on pastoral ministry, Francis urges us to abandon the complacent attitude that says: 'We have always done it this way." He invites "everyone to be bold and creative in this task of rethinking the goals, structures, style and methods of evangelization in their respective communities."6

Some questions to be addressed include how much autonomy could each bishop have in his own diocese without undermining the fundamental unity of the church? How much authority should the periodic synods, convened to examine questions such as the family, have? What will be the role of episcopal conferences going forward?

As we know, each bishop is currently the authoritative interpreter of the Ethical and Religious Directives for Catholic Health Care Services in his diocese. Will this change as the role of episcopal conferences changes?

We already have mentioned the Council of Cardinals that Pope Francis appointed to examine the church's structures. Their work will influence the direction of change. The proposed new dicastery for charity, justice and peace might concern itself with health care. Another sign of a new direction may be in the appointment of bishops characterized as much by pastoral zeal and skill as by administrative prowess.

As the Pope remarks, lay people are the vast majority of the people of God. "The minority — ordained ministers — are at their service," he says. Unfortunately, however, in some places "an excessive clericalism" prevents lay people from speaking and acting. "Even if many [lay persons] are now involved in the lay ministries, this involvement is not reflected in a greater penetration of Christian values in the social, political and economic sectors," he says.7

The work of the Spirit within the baptized bears fruit in a holiness of the people of God and a certain infallibility in belief. "This means that it does not err in faith, even though it may not find words to explain that faith. … As part of his mysterious love for humanity, God furnishes the totality of the faithful with an instinct of faith — sensus fidei — which helps them to discern what is truly of God."8

Part of the role of pastors is to listen and discern what the Spirit is speaking within the people of God. In the pope's characteristically optimistic view:

Within the Church countless issues are being studied and reflected upon with great freedom. Different currents of thought in philosophy, theology and pastoral practice, if open to being reconciled by the Spirit in respect and love, can enable the Church to grow, since all of them help to express more clearly the immense riches of God's word. For those who long for a monolithic body of doctrine guarded by all and leaving no room for nuance, this might appear as undesirable and leading to confusion. But, in fact such variety serves to bring out and develop different facets of the inexhaustible riches of the Gospel.9

In this work of listening to the faithful, care must be taken to solicit the voices of the poor. Furthermore, the pope urges a greater role for women. Acknowledging the present contributions of women in pastoral roles and in theological reflection, he urges, "We need to create still broader opportunities for a more incisive female presence in the Church,"10 and "a specific place of women in those places where the authority of the Church is exercised."11

I hope to live to see the time when women occupy significant leadership roles in the Curia, for example, as head of the Congregation for Institutes of Consecrated Life and Societies of Apostolic Life. There is nothing in these chief administrative roles that requires ordination.

In one sense, Catholic health systems have led the way in incorporating the voices of the laity in planning and leading church ministries. The organization and recognition of new models of sponsorship and the extensive formation programs offered for sponsors, trustees, executives and employees are a response, not only to the reduced number of religious women and men, but also, and more positively, a recognition of the vast reservoir of gifts that the laity bring.

Francis' vision and words flow from a sense of interior joy, of confidence in the work of the Spirit within the life of the community. In one Evangelii Gaudium passage, he says, "I dream of a 'missionary option,' that is, a missionary impulse capable of transforming everything, so that the Church's customs … can be suitably channeled for the evangelization of today's world rather than for her self-preservation."12 At the same time, he reminds us that the integrity of the Gospel message must not be deformed: "Each truth is better understood when related to the harmonious totality of the Christian message; in this context all of the truths are important and illumine one another."13

To return, then, to the question with which we began: What changes can we expect from Pope Francis?

The answer is none from Francis alone. The church is led by the Spirit, which works in the faithful, in the theologians and in its leaders, including Francis. On the other hand, we can expect, indeed we have already seen signs of, a church that is more welcoming and less likely to condemn categories of sinners without the individual medicine of mercy; a church that seeks to serve the poor as our most welcome brothers and sisters; a church that eliminates outmoded customs and outdated structures; a church that relies more on the insights of an evangelized laity.

Francis radiates joy and a humble confidence that, as a church, we can do more and be more if we open ourselves to a loving God who walks with us. Will these changes impact the church's institutional ministries, especially health care? It seems to me that when we serve in the name of, and within the guidance of, the Catholic Church, we cannot help but be affected.

We do not belong to the church as shareholders or voters, free to disagree or walk away at will. Our baptismal birthright incorporates us into the body of Christ. Our insights gained through prayer and good works constitute the sensus fidei, potentially the impetus for change in church practice and interpretation of Gospel truths.

It is our task to voice our concerns and offer our insights so that the theologians and bishops can play their roles, enlightened by this source of truth. Perhaps we can create new venues for dialogue with our bishops to achieve greater shared understanding of and commitment to the ministry, which it is our privilege to lead. Fortunately, we have a wise and generous leader in Pope Francis who invites us to embrace our mission with joy.

SR. DORIS GOTTEMOELLER, RSM, is vice chair of Partners in Catholic Health Ministries, Cincinnati.


  1. John Paul II, Redemptoris Missio, no. 10.
  2. Francis, Evangelii Gaudium, no. 3.
  3. Antonio Spadaro, "A Big Heart Open to God," America, Sept. 30, 2013. http://americamagazine.org/pope-interview.
  4. Spadaro.
  5. Evangelii Gaudium, no. 246.
  6. Evangelii Gaudium, no. 33.
  7. Evangelii Gaudium, no. 102.
  8. Evangelii Gaudium, no. 119.
  9. Evangelii Gaudium, no. 40.
  10. Evangelii Gaudium, no. 103.
  11. Spadaro.
  12. Evangelii Gaudium, no. 27.
  13. Evangelii Gaudium, no. 39.

Anticipating the Changes that Will Touch Us All

Copyright © 2015 by the Catholic Health Association of the United States

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