BY: JOHN W. GLASER, STD
Dr. Glaser is senior vice president, theology and ethics, St. Joseph
Health System, Orange, CA.
As late as 1866 the Holy See declared: "Slavery itself . .
. is not at all contrary to the natural and divine law. . .
. For the sort of ownership which a slave owner has over a slave
is understood as nothing other than the perpetual right of disposing
of the work of a slave for one's own benefit."1 Only
in 1891 did the Vatican formally condemn the institution of
slavery as a moral evil. Imagine how differently the reality
of slavery would have been understood — and how much more quickly
it would have been condemned — if slaves had been empowered partners
in that discernment process.
A tendency to accept the de facto empowered group as adequate for ethical
and values decisions haunts us humans when we face complex issues. Why is this?
I think a central cause is what I call "constricted and stratified consciousness."
Our consciousness is unavoidably constricted — we don't know important things,
but we don't know that we don't have this knowledge. Furthermore, this
constricted consciousness is stratified — the systems and structures of life tend
to cluster us together with others who share our ignorance and the ignorance
of our ignorance. Being a community with compassionate but unaware constricted
consciousness, we experience few reservations about the depth or breadth of
our vision and little urgency to expand the community of discernment. The cause
of such "darkening of the intellect" is probably Adam, but the solution is most
certainly in our hands.
If we aim to improve the ethical culture of our organization, we will achieve
success by recognizing, first, the fact of our constricted consciousness and
our strong tendency to be untroubled by it and, second, by building a culture
in which decision makers at all levels live by the following credo: In this
organization, decisions start with defining and gathering the community of concern.
If these steps are taken, organizations will go far in strengthening the integrity
of decisions and in compensating for subsequent mistakes along the way. If they
are not taken, the ethical process will be hobbled at every stage.
Organizational Ethics Defined
Catholic tradition has no single definition of a moral/ethical
decision that trumps all others. But I believe the following
definition is strongly present throughout our tradition and
is one of moral theology's more practical definitions: Moral/ethical
decisions are those that have a notable impact on human dignity.
The popular understanding of ethical issues clearly is much narrower than
this Catholic understanding, and noting this difference is vital. Building on
this Catholic understanding, we can describe organizational ethics as the
organization's deliberate and systematic effort to promote and protect human
dignity — of those it serves, its staff, and its community.
Combining the concept "constricted consciousness" with this definition of
organizational ethics, we can formulate an essential maxim of organizational
ethics: Good ethics starts with gathering the community of concern.
Defining the Community of Concern
Who constitutes the community of concern? No single community of concern exists
for all value or ethical issues. Gathering the community of concern requires
people who command essential perspectives on the issue at stake and also share
an overarching concern for the common good.
Essential Perspective Each complex issue has a number of essential
perspectives. To carry on a fruitful discernment process, we need the vital
presence of all these essential dimensions. The first issue is to identify both
these essential dimensions and the persons who can bring detailed, first-hand
experience and knowledge to the process.
The de facto empowered group may indeed be an ideal community of concern
for a given issue. Even then, the time spent reviewing the group is far from
wasted. (Pilots don't declare their preflight checklists a waste of time when
everything is found to be in order.) Ensuring that the fundamentals are in place
is essential, not marginal. This explicit review also deepens our communal awareness
of our inescapable constricted consciousness.
Shared Common Perspective Robust ethical decision making is not a tug-of-war
between special interests, but a synergy of essential components serving a larger
integrated common good. The members of the community of concern share this larger
vision and purpose.
Members of the community are double advocates: They bring to the process the
living and detailed presence of a unique, essential perspective and simultaneously
intend a larger common good — the accomplishment of which may well entail some
sacrifice in terms of their special perspective.
Defining the community of concern for a given issue falls somewhere on a continuum
ranging from simple to complex; it should be the first issue of business and
revisited at key points in the process. Take the time to do this thoroughly
and thoughtfully; no other single element in organizational decision making
will return your investment of time as richly as this one.
Primary and Secondary Communities of Concern
A further distinction helps us understand the community of concern. The primary
community of concern is composed of persons who are indispensable to the process
because they possess detailed experience and knowledge of the essential elements
and are committed to the common good.
Outside this inner circle is another possible circle of groups and individuals
who could enrich the process by establishing a relationship to it. We can think
of them as the secondary community of concern. The task is to identify
these others and determine the type and frequency of contact needed for them
to enhance the decision-making process.
Second Vatican Council: A Striking Example of Community of Concern
In preparation for the Second Vatican Council, a small group of officials and
theologians drafted documents to guide the deliberations of the council fathers.
This body of material was expected to be modified and improved, but it would
essentially constitute the teachings of the council. When one compares these
documents with the final documents issued by the full community of council fathers,
a stunning example of moral wisdom emerges from the fuller community of concern.
(We can only imagine the differences had this community included both council
fathers and mothers!)
I believe that each of us has our own historical gallery of decision-making
processes that went well because we had the right persons involved, and decision-making
processes that did not because we did not take the care and time to gather the
right community for discernment. Visiting that gallery with our colleagues to
discuss what we've learned from our successes and failures is very worthwhile.
Why Emphasize Something So Obvious?
We all know that two heads are better than one, so why such extensive elaboration
about something that appears to be nothing more than common sense? Because,
as with many other insights of common sense, this one is not practiced enough.
Often the function of moral theology is analogous to poetry. Poetry does not
tell us the news of the day or truths we would not otherwise know. It tries
to bring fresh life to realities that are already treasured in our hearts but
that have become stale with lack of use. A renewed awareness is more likely
to translate into behavior and habit.
Karl Rahner has described the history of theology as "the rediscovery of forgotten
truths." I believe that the indispensable role and power of the community of
concern is a forgotten truth — in practice if not in concept — and that it deserves
to be rediscovered.
However, sometimes two or three heads are worse than one. When these heads
unknowingly share a constricted consciousness, when they unwittingly reinforce
each other's blinders, then they are worse off than they would be alone. By
being "many heads," they give the impression to themselves and others of a wide
and internally correcting vision. People who are aware know they are dealing
with a constricted consciousness; when two or more heads suffer from the same
constriction, they can lose that fact in the appearance of diversity.
The Nature of Ethical Decision Making Calls for a Community of Concern
Beyond the problems created by constricted consciousness, a second and even
deeper reason exists for looking to the community of concern for moral wisdom.
This deeper reason derives from the very nature of ethical and values decision
making.
In Catholic understanding of morality, ethical decisions are practical applications
of the law of love. Romans 13 sketches the anatomy of this moral world. "If
you love your neighbor you have carried out your obligations. All the commandments:
You shall not commit adultery, you shall not kill, you shall not steal, you
shall not covet and so on, are summed up in this single command: You must love
your neighbor as yourself."
St. Augustine offers a distinction that helps us make this
law of love useful in daily life: "All persons are to be loved
equally [benevolence], but since you cannot be of service [beneficence]
to everyone equally, those are most your responsibility who
are bound more closely to you through time, proximity, or other
circumstances."2
Benevolence is inner love of mind and heart that bows in reverence
to universal goodness and human dignity. It does not make distinctions or set
limits. The horizon of benevolence is boundless.
But beneficence — the love of our hands — is where moral
decision making lives. This is the world of actual loving service
that necessarily and unavoidably forces us to decide which of
the many possible goods deserves to be realized and which must
remain unrealized. The Second Vatican Council emphasizes, with
strong language, two characteristics of beneficence: we must
renounce some values to realize others, and we do this constantly.
"Called by multiple values, we are constantly forced to choose
among these values and renounce some."3
Moral choice entails "renouncing some values" to realize others. The spiritual
crucible in which this prudential judging of values — this process of weighing
burdens and benefits — can best occur is the community that embraces both the
diverse values at stake and the greater good that requires sacrifice of some
of these values at the cost of realizing others. This spiritual crucible is
the community of concern.
This issue is directly applicable in two major areas in an organization: in
putting together the right group for a pending decision, and in evaluating existing
groups and processes that have ongoing responsibility for organizational decisions.
Organizations continuously form ad hoc groups to deal with challenges
to the mission and vision of the organization. Whether these deal with money,
people, facilities, or services — if we look carefully, we will see that these
are issues of beneficence — we are struggling to decide which are values to realize
and which are values to renounce.
Evaluating Existing Groups/Processes
Most facilities have standing groups (for example, senior management,
governance, and medical staff leadership) that are essentially stable in their
composition and whose main responsibility consists of making major beneficence
decisions — realizing some values at the price of renouncing others. We should
ask the question of whether changes in the composition of this group would make
it a better community of concern. The executive management team that I am part
of significantly improved its community-of-concern quotient by adding a physician
to its membership. In the same way, implementation of a diversity program at
the management and governance level would represent attention to the community
of concern. A commitment to diversity says, among other things, that our decision-making
bodies are chronically missing some essential perspectives and therefore lack
adequate gender, cultural, and racial balance.
Routine organizational systems and processes are also, in substance, mechanisms
of beneficence. For example, budgeting and planning are essentially major activities
of beneficence — renouncing select values to realize others. Being beneficence
mechanisms, they will benefit from being evaluated from the perspective of the
community of concern: To what extent are all the essential perspectives of these
major value trade-offs effectively and adequately present to the budgeting and
planning processes at key points?
Not Everything, but an Indispensable Foundation
Saying that the community of concern is the most predictable source of ethical
wisdom, and defining and gathering this community as the indispensable foundation
of high-quality organization ethics, still leaves many other essentials undiscussed.
We need to be clear about this — gathering the community of concern makes life
more difficult, not more simple. It promises a significantly higher level of
ethical decision making, but only if we attend to and compensate for the increased
complexity that we have now put in place.
The simple gathering of the community of concern does not alone make it an
effective community of discernment. It has been facetiously observed that a
group with individual IQs of 120 quickly collapses to a group IQ of 50. Group
discernment involves the right group, bonded by trust and respect and empowered
with the necessary tools, skills, and processes. Almost none of this happens
spontaneously or easily. The right group is not automatically an effective
group. For effectiveness, we need focused effort as well as processes, tools,
and infrastructure.
An illustration of this is how we must attend to the social forces that distribute
power unevenly. In a medical culture, the views of nurses, physicians, and pharmacists
do not carry equal weight. This uneven distribution of power must be recognized.
Deliberate and effective steps must be taken to compensate for these deficits
of the larger culture that bleed into the community of concern. Many disciplines
may contribute to this effectiveness. The tools and structures of moral theology
will be essential. The behavioral sciences, especially sociology and psychology,
will provide indispensable contributions.
Another aspect of gathering the community of concern is both
exciting and disturbing: the possibility of the community coming
to a conclusion that is "out of sync" with current teachings
of the church. We could employ a historical example to illustrate
this. Imagine that a discerning community came to the conclusion
of Pope John XXIII concerning freedom of conscience, which declared
that everyone has the right to "worship God in accordance with
the dictates of one's own conscience and to profess one's religion
both in private and in public."4 This position was
of course further elaborated and established in the Second Vatican
Council document Dignitatis Humanae.5 The
exciting part is the wisdom that emerges from community discernment.
But what if this happened 100 years earlier, when Pope Pius
IX condemned in Quanta Cura that "erroneous opinion which
is especially injurious to the Catholic Church and the salvation
of souls — called by our predecessor Gregory XVI insane raving — namely,
that freedom of conscience and of worship is the proper right
of each man, and that this should be proclaimed and asserted
in every rightly constituted society."6 If the community
of concern sees itself as arriving at valid but institutionally
premature wisdom — what then?
This article is not the place to attempt the theology of authority and ecclesiology
that might address such a situation. But regarding the community of concern,
two things deserve mention. First, many historical examples exist of the Holy
Spirit moving moral insight forward through unofficial communities of concern
(e.g., emancipation and women's suffrage). Second, dealing with the new moral
situation created by such conflicting moral insight (for example, John XXIII's
insight occurring in the age of Pius IX), would probably require the gathering
of a different community of concern. Because now we are not dealing with the
moral question of religious freedom, but with the moral question of conflicting
moral insight in the church. The community of concern adequate for the first
question is probably not the same as that appropriate for the second question.
These are only some examples of further issues and complications that are
raised when we begin to explore the moral importance of the community of concern.
They deserve thorough consideration and study. But, in my judgment, despite
all the difficulties they bring, they in no way challenge the central importance
of the community of concern as a source of moral/ethical wisdom.
NOTES
- Maureen Fiedler and Linda Rabben, eds., Rome Has Spoken, Crossroad
Publishing, New York City, 1998, p. 84.
- St. Augustine, De Doctrina Christiana, I, #29, cited in Bruno Schueller,
Die Begruendung Sittlicher Urteile, Patmos Verlag, Duesseldorf, 1980,
p. 70.
- "Gaudium et Spes," # 10, Walter Abbott, Documents of Vatican II, America
Press, New York City, 1966.
- John XXIII, Pacem in Terris, 1963, cited in Fiedler and Rabben,
p. 49.
- "Dignitatis Humanae," Abbott, pp. 675-696.
- Pius IX, Quanta Cura, 1864, cited in Fiedler and Rabben, p. 48.
Summary
1. Always begin by asking explicitly and methodically: Who else would make
this a more adequate community of concern?
2. Remember that the need for the community of concern flows from two considerations:
the unavoidable presence of constricted consciousness and the nature of moral
choice as beneficence — difficult choices concerning human dignity.
3. Pay special attention to the community of concern at the beginning and
at key points throughout the process.
4. Define the primary community of concern so that relevant issues
include:
- The decision's impact on the public, and on values, functions, and relationships
- Expertise needed
- Buy-in and implementation
- Existing commitments
- Individuals at the margin who are consistently forgotten
5. Define the secondary community of concern so that relevant issues
include:
- This primary group will enrich the process
— With input
— In implementation
— In mitigating the harm that results
- In what ways and how frequently should these individuals/groups be involved?
Copyright © 2002 by the Catholic Health Association of the United States
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