BY: SR. DORIS GOTTEMOELLER, RSM, PhD
Sr. Gottemoeller is senior vice president, mission and values
integration, Catholic Healthcare Partners, Cincinnati.
The Catholic Church in the United States today can boast
of a body of social thought and a body of social works unparalleled by any other
denomination. Obviously the development of social teachingsbeginning with Rerum
Novarum and continuing through the great social encyclicals up through Centesimus
Annus, augmented by the documents of the Second Vatican Council, of the
synods of bishops, and of the U.S. bishopsis not a distinctively American achievement.
But these teachings have been embraced, interpreted, and applied by American
bishops and scholars and the faithful in such a way as to make them "our own."
At the same time, the U.S. Catholic Church has founded and continues
to oversee a vast array of social service and health care organizations, institutions,
agencies, and services. Visits to the Web sites of Catholic Charities USA and
the Catholic Health Association (CHA) will reveal the enormous range of services,
some of them stretching back into the 19th century, others founded in recent
years in response to previously unrecognized or unmet needs.
One might imagine that this evolution of the social teaching
tradition, on one hand, and ministerial commitment, on the other, proceeded
in a tidy and logical way from principle to practice. In fact, the story is
much more complicated. The church launched many of the works that continue to
thrive today out of a sense of compassion, with no thought of trying to change
the social structures that generated the problems in the first place. At times,
the principles enunciated or remedies proposed for social ills were insufficiently
in touch with the personal dimensions of human suffering and dysfunction.
We will leave to historians of the U.S. church the task of illuminating
all the stages in the rich history of Catholic social thought and ministry development.
Today it is probably safe to say that bishops, scholars, ministry leaders, and
church members in generalto the extent they think about itappreciate both
the social teachings and the multiple and varied ministries. I would suggest,
however, that our appreciation of both dimensions of Catholic life would be
enriched enormously by reflecting on five areas of intersection. These are areas
in which social principles such as human dignity, concern for the common
good, and participation come to life in both the organization and
the care it provides, and in which, conversely, the daily work of ministry is
renewed and invigorated through the application of principles of social justice.
Human Well-Being
The first area of intersection is the interpretation of human
well-being. The foundation of Catholic social teaching is that every human being
has an inherent dignity as created in the image of God. Because this is so,
we believe that all people deserve respect and the opportunity to preserve and
enhance their well-being and that of their dependents. When we move beyond this
principle into practice, the experience of the helping and healing ministries
illuminates what well-being entails. We are keenly aware today of the interdependence
of health status, education, housing, and public safety. One's health, in turn,
has physical, psychological, and spiritual dimensions. Human dignity and well-being
can be threatened or eroded in any of these areas.
This awareness prompts collaboration (such as that exemplified
by Phase IV of the New Covenant initiative; see Bishop Joseph M. Sullivan,
"Ministering Together," p. 42) among health care providers, social service agencies,
schools, and similar service organizations. In health care settings, pastoral
care ministers are being integrated into the care-giving team. The ministry
is moving away from "silos" of service toward a more integrated approach to
the fostering of well-beingwhich will, in turn, strengthen our understanding
of the basic principle.
Community Benefit
A second area of intersection involves the interpretation of "community
benefit." Every health care facility calculates its annual community benefit,
using a methodology similar to that promoted by CHA.* The data are then published
as an expression of accountability for the tax exemption that not-for-profit
institutions enjoy. However, a deeper reason for investment in programs that
benefit the community is the desire to live out the principles of human solidarity,
participation, and accountability for the common good. Solidarity connotes
the interdependence of members of the human community; participation implies
involvement in decisions that affect one's well-being; the common good refers
to social conditions that allow people to realize their human dignity.
*See Community Benefit Program: A Revised Resource for Social Accountability,
Catholic Health Association, St. Louis, 2001.
Implementing programs to benefit the community is more difficult
than it might seem. It is easy to launch health screening programs that pay
a dividend to the hospital in terms of public relations. It is more difficult
to involve the community in a needs assessment and design of serviceseven though
needs assessment and design of services, because they require genuine community
participation, are likely to be more beneficial in the long run. Helping the
needy can be done within a philanthropic, almsgiving framework, without acknowledging
or addressing the underlying causes of poverty. Many charitable works were initiated
out of benevolent motives that are paternalistic by today's standards. Today
we recognize that, to be of lasting benefit to a community, an initiative must
take into consideration the social conditions that promote problemsfor example,
teenage pregnancy, lack of prenatal care, and unemploymentand then address
them in partnership with those who experience them.
The Poor and Most Vulnerable
Our ministry's bias for the poor and most vulnerable is another
example of social principle and practice coming together. Our country continues
to enjoy an unprecedented prosperity, but a significant and growing percentage
of people do not share in it. Jesus proclaimed that he was sent "to bring glad
tidings to the poor." Therefore, the poor have the first claim on our services.
"Whatsoever you do for the least of these, my brothers and sisters, you do for
me." Our hospitals and agencies regularly subsidize services for the disadvantagedMedicaid
recipients, people with AIDS, delinquent teenagers, drug abusers, homebound
elderly, and others. This daily experience with "the least" among us removes
the principle from the realm of romantic generality, thereby ensuring that our
services are respectful of the dignity and desires of those served.
In our management sessions we struggle with the question "How
much is enough?" We do that because we must maintain a healthy bottom line if
we are to continue the mission to the poor and underserved. In such instances,
the principles of good stewardship and preferential option for the poor are
sometimes in conflict. But these tensions can be salutary. On one hand, investment
in plant and personnel ensures that we will be able to meet future needs; on
the other, the difficulties we experience in meeting today's needs warn
us against "empire building."
Design of Work
The church employs hundreds of thousands of people in its work
of human service. Its role as employer gives it a significant opportunity to
model social justice principles in the design of work. Probably the best-known
dimension of the church's social teaching is that concerning the rights and
duties of workers and employers.
When the foundation documents of this teaching were published,
their focus was on industries such as manufacturing and mining. Workers in those
days usually found unions to be the most effective means of promoting subsidiarity
and participation in setting the conditions of their employment. In recent decades,
the service industries, including health care, have come to occupy a larger
role in the economy. Do unions remain the best way to foster worker participation
in these areas? Most dioceses, agencies, and health care systems would maintain
that a union is not necessary, and, to the extent that it might promote a disruption
of essential services, is an inappropriate vehicle for worker participation.
Given that view, the church finds itself challenged to maintain a fair and just
workplace with appropriate wages and benefits and participation in designing
the conditions of the workplace.
Health insurance is an example of experience illuminating theory
in this regard. Most Catholic organizations want to provide affordable health
insurance to all their employees, especially the lowest paid. However, workers
are free to decline such coverage and may do so for a variety of reasons. The
employer is then challenged to somehow promote this benefit without coercing
workers or invading their privacy.
Commitment to Advocacy
A commitment to advocacy is a fifth point of intersection between
social principle and practice. Human dignity can only be maintained and guaranteed
in the context of human society. Society, in turn, is regulated by laws, policies,
and institutions designed to promote the common good. Legislators and rule makers
need to hear from the broad community, especially from those who are in touch
with the interests of the poor and needy. With our vast array of institutions
and services, Catholic health care and social service providers have an opportunity
and obligation to promote social justice through their public advocacy. Our
experience and longevity in ministry give us a credibility that we can then
bring to the public debate on issues such as welfare reform and health care
reform. Our advocacy is most effective when it is not seen as self-serving (i.e.,
enhancing Medicare reimbursement), but as giving voice to the voiceless.
Outcomes Measurement Is Needed
These five areas of intersection illustrate how experience can
inform reflection, and vice versa. The measurement of outcomes can be a tool
for this dialogue. It is tempting to assume that good intentions or large expenditures
always guarantee beneficial results, but the evidence for such an assumption
may be lacking. In recent years, the continuous quality improvement movement
in health care has focused attention on the importance of identifying and measuring
the outcomes of specific interventions.
The great principles of Catholic social teaching find their roots
in the Gospel, but their application takes different forms in different times
and different settings. Applying the techniques of measurement, we might ask
whether these applications, these interventions, are achieving the desired results
in terms of our guiding principles. For example, what would subsidiarity look
like if it were really practiced in this situation? How would it affect a commitment
to stewardship or to the common good? Trying to answer these questions in terms
of measurable behaviors would be a valuable discipline and contribute to the
integrity of a health care or social service agency. Some health care systems
routinely use methodologies that integrate the claims of social justice into
corporate decision making. A habit of measurement can ensure that the development
of social consciousness, as evidenced by both reflection and action, is tested
by reality. Measuring the congruity of policies with principles of social justice,
as well as service excellence and client and patient outcomes, will create a
higher standard for our organizations than that published by any accrediting
agency.
At bottom, reflecting on social justice principles and providing
social programs are activities that spring from the same sourcea belief in
God's love for us and a desire to respond in love to our neighbors. Catholic
health care and social services constitute a community of moral agency, whose
root and foundation is Christian charity. This love, which has its horizon in
the future, is never content with what is, but always striving to bring the
fullness of God's reign closer to our time and space.
Copyright © 2002 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.