Ethics - The Gift of Health Care

January-February 2020
By: Brian M. Kane, Ph.D.

BY: BRIAN M. KANE, PhD

In her book, A Life Everlasting, Sarah Gray writes movingly of her experience of becoming pregnant with twins, and then receiving the news that one of her sons, Thomas, had anencephaly.1 Her memoir focuses on finding meaning in these tragic circumstances. After delivering both children, she and her husband cared for Thomas for six days before he died. They then donated his organs, eyes and blood to medical research.

Two years after, a new chapter unfolded for her as she decided to trace exactly how the donations had been used. Her journey took her to some of the most prominent medical research facilities in the United States, where she learned about the significance of her son's donations to work fighting blindness, anencephaly and liver disease.

THE SIGNIFICANCE OF GIFT
At the core of her book is the significance of donation, or gift. While, of course, there is the tangible gift of her son's organs, there are multiple other ways in which the book demonstrates the power of gift in health care, both in the way that individuals are present to one another and ways in which they sometimes fail to do that.

The significance of "gift" lies at the heart of our health care ministry. In his 2019 Message for the Twenty-Seventh World Day of the Sick, Pope Francis wrote, "Amid today's culture of waste and indifference, I would point out that ‘gift' is the category best suited to challenging today's individualism and social fragmentation, while at the same time promoting new relationships and means of cooperation between peoples and cultures. … ‘Gift' means more than simply giving presents: it involves the giving of oneself, and not simply a transfer of property or objects. ‘Gift' differs from gift-giving because it entails the free gift of self and the desire to be connected with another person."2 So to "gift" should not be reduced to giving something to someone. Instead, it is a personal act. It is something that we do, because of who we are.

CHARITY IN TRUTH
In Caritas in Veritate, Pope Benedict XVI contrasted this Christian concept of gift with another, contractual model. He wrote, "Charity in truth places man before the astonishing experience of gift. Gratuitousness is present in our lives in many different forms, which often go unrecognized because of a purely consumerist and utilitarian view of life. The human being is made for gift, which expresses and makes present his transcendent dimension."3 Some of the richness of his language here is lost in translating the Latin word caritas into the English word charity. We might better express it as love. So, our love must be understood in the light of the truth that God is love, and that he gifts himself to us. The opposite view is one where one only gives out of self- interest.

We often speak of professionalism in health care. One interpretation of the term equates it with technological competence. In other words, one is a "professional" because the person's work requires a great deal of skill. This view often is described as a contract. The one who does the work performs at a superior level because the person has made an agreement to provide goods or services to a customer. Both parties seek a benefit for themselves from the contract.4 One's obligation is to do the work competently. When contracts are reduced to their basest form, they lead to what Pope Francis identified as "individualism and social fragmentation," and what Pope Benedict referred to as a "consumerist and utilitarian view of life." For both, the meaning of gift is more complex and personal than a contract.

COVENANT IN HEALTH CARE
There is a more ancient understanding of professionalism that better reflects this Christian understanding of "gift," and that is covenant. Covenants create a permanent relationship between persons. They are each identified with each other, and their actions are personal expressions of that identity.

In this model, one became a professional through a three-part process. First, there was "an original experience of a gift by the soon to be covenanted partners."5 While that exchange could be symbolized by something tangible, like wedding rings, fundamentally it is the mutual giving of oneself and the receiving of another person. It is an act. Secondly, because of that gift, promises are mutually professed. Finally, there is ontological change, or a change in being by those who enter into the covenant. In short, they are permanently transformed. What they do after entering into a covenantal relationship is now fundamentally an expression of who they now are.

One can easily see that structure in the ceremonies that we have when health care students transition into their professional roles. The first step is the gift of knowledge that is shared by those who are already professionals. The students reciprocate by their presence in classrooms and clinical settings, learning. Then promises are exchanged, which take the forms like the Nightingale Pledge and the Hippocratic Oath. Then, there is a change in identity. Being a physician or a nurse, or other health professional is not simply what they do, but who they are.

This understanding means that health care professionals care for others in a profoundly personal way. There are several implications. First, the professional seeks excellence not just as an end in itself, but because not to do so would be a denial of their own humanity. The "gift" that they give is themselves.

Secondly, the relationship that the professional has with the person who seeks health care from them is particular, permanent and reciprocal. When we promise to be present with those whom we serve from birth until natural death, we do so through the care of the person who is in front of us. It is not repetitive care performed mindlessly. Health care is also not something that we do to another person. Instead it is something that we do with another person. We receive as well as give. Our encounters with our patients establish a sacred communion with them.

For Catholic health care in particular, the origin of this meaning is found in baptism and in our covenantal relationship with God. The church from its origins understood baptism as a covenantal act that changes us. In baptism, God gives us his love and healing, and our reciprocal gift to God is ourselves. Once baptized, we live out this new identity through the ongoing gift of ourselves both to God and to others. By virtue of baptism, Christians are called to the self- giving love of the stranger who bears the image of God.

For centuries, the parable of the Good Samaritan has exemplified this covenantal model for the care of the sick and other vulnerable persons. When asked the question, "What must I do to inherit eternal life?" Jesus affirmed that the answer was that "You shall love the Lord, your God, with all your heart, with all your being, with all your strength, and with all your mind, and your neighbor as yourself." (Luke 10:27) For those who live their lives in covenant and gift, love of God and neighbor are not tasks to be completed, but are instead a life that is fully lived.

BRIAN M. KANE, PhD, is senior director, ethics for the Catholic Health Association, St. Louis.

NOTES

  1. Sarah Gray, A Life Everlasting: The Extraordinary Story of One Boy's Gift to Medical Science (New York: Harper One, 2016).
  2. Francis, "Message of His Holiness Pope Francis for the XXVII World Day of the Sick 2019," http://w2.vatican.va/content/francesco/en/messages/sick/documents/papa-francesco_20181125_giornata-malato.html.
  3. Benedict XVI, Caritas in Veritate 34, http://w2.vatican.va/content/benedict-xvi/en/encyclicals/documents/hf_ben-xvi_enc_20090629_caritas-in-veritate.html.
  4. William F. May, "Code, Covenant, Contract, or Philanthropy" Hastings Center Report 5, no. 6 (December 1975): 29-38. See also Juliana Casey and Richard F. Afable "Contract or Covenant," Health Progress 85, no. 6 (November-December 2004) 25-27, 60.
  5. May, "Code, Covenant."

 

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