BY: BR. DANIEL P. SULMASY, OFM, MD, PhD
Dr. Sulmasy is Sisters of Charity chair in ethics, St. Vincent's
Hospital Manhattan, and professor of medicine and director, Bioethics Institute,
New York Medical College, Valhalla, NY. His article is adapted from a talk he
gave at the Commonweal Winter 2002 Colloquium, February 2002, Malibu, CA.
For Two Reasons, Catholic Universities Should Continue Sponsoring
Catholic hospitals and Catholic medical schools have much in common, but they
are also very different. The mission and purpose of Catholic hospitals was clear
and purposeful from the outset in a way that has not been historically true
of Catholic medical schools. By and large, American Catholic hospitals were
founded by orders of religious women who were spiritually inspired to respond
to God's call in their lives by caring for the sick. Sociologically, these were
generally poor women who found in nursing opportunities for educational advancement
and professionalism. They came to the United States largely to escape poverty
such as that in Ireland or oppression like that of the Kulturkampf in
Germany. They responded to the emerging needs of a growing American nation for
nurses and hospitals during the Civil War and then afterwards in recurring epidemics
of cholera, typhoid, and tuberculosis, in the Western expansion, and in Eastern
urban poverty. These Catholic women essentially shaped the American nursing
profession and hospital care, and they grew and adapted as medical science grew.
While there were struggles along the way, there was also, until recent years,
a synergy between what nursing sisters offered and what America needed and wanted.
Their care for the sick was their prayer and their preaching, and for 150 years
it was resoundingly American, Catholic, and professional.1
American Catholic medical schools, by contrast, grew up rather accidentally.
American Catholics originally founded colleges to train seminarians, eventually
expanding their purposes to teach advanced catechesis and apologetics and to
provide social opportunities for Catholic immigrants. In time, they added professional
schools, providing a quick way for the college to become a university while
serving the needs of Catholic students (who otherwise faced discrimination)
with possibilities for professional advancement.2
Nine U.S. Catholic colleges have had medical schools, four of which have been
closed or sold.3 One of these (Niagara) lasted only two years (1888-1900).
Another (Fordham) closed in 1921. Seton Hall's medical school opened in 1956
and was purchased by the state of New Jersey in 1965. Marquette's medical school
became the Medical College of Wisconsin in 1967. Four Jesuit institutions (Saint
Louis, Georgetown, Creighton, and Loyola Chicago) still operate medical schools.
The newest, New York Medical College, became affiliated with the Archdiocese
of New York in 1978, making it the lone non-Jesuit U.S. Catholic medical school
still in existence.
The students and faculty of the first eight of these medical schools were,
by and large, culturally Catholic. The students came from Catholic undergraduate
institutions where the work of catechesis was assumed to have been completed.
The mission of these schools was never really so much to train doctors to be
Catholic as it was to train Catholics to be doctors. There never really were
any clergy on the faculty of Catholic medical schools. Canon law at the time
prohibited priests from performing surgery.4 A token Jesuit taught
the requisite brief course on medical morals. But there has never been any such
thing as a distinctively Catholic approach to histology. So these schools just
taught histology and concentrated on producing competent physicians.
Over the last few decades, however, the students and faculty at all of the
five extant U.S. Catholic medical schools have become increasingly diverse and
the cultures of these schools have become increasingly secularized. All of these
schools are struggling financially—three have been forced to sell their university
hospitals; one, which never owned its teaching hospital, simply employs strong
teaching affiliation agreements. None of these is ranked among the top 25 U.S.
medical schools. And, when companied with Catholic hospitals and nursing schools,
these medical schools have been a sideshow in the history of U.S. Catholic health
So the question why the church should sponsor medical schools is genuine.
With increased opportunities for Catholics at secular medical schools, one of
the major historical reasons for their existence has become obsolete. And the
historical basis of the Catholicity of these schools has also become a thing
of the past: Large minorities or even majorities of the student bodies and faculties
at Catholic medical schools are no longer even nominally Catholic. Keeping any
medical school open these days is hard work. Keeping a medical school open and
Catholic is even harder.
Perhaps the best thing to do for the sake of the church would be to empower
lay Catholic men and women to go to secular schools and to live the Gospel.
At least it seems that the burden of proof has shifted to those who would keep
Catholic medical schools going.
Mark Sargent, the dean of Villanova Law School, has stated that the purpose
of a Catholic law school is to be a vehicle by which the church "confronts in
creative dialogue the world's different truth claims."5 Whether such
a mission is strong enough to carry the Catholic identity of a law school can
certainly be debated. However, there is no debating the fact that such a statement
would seem senseless to the faculty of a Catholic medical school. What purposes
can there be for having Catholic medical schools?
Professionalism and Catholic Identity
By and large, the demands for technical and professional excellence have caused
Catholic medical schools to lose sight of their Catholic missions and religious
sensibilities more completely than either Catholic undergraduate institutions
or Catholic hospitals. This leads one to wonder whether the demands of professionalism
are in essential tension with the demands of Catholic education, or whether
the present situation has simply been an accident of history.
There are many definitions of professionalism. However, the criteria set forth
by Abraham Flexner, the great reformer of American medical education, seem especially
relevant since the five extant U.S. Catholic medical schools survived his careful
scrutiny and initially flourished because of his famous report.6 Flexner
set forth six criteria that distinguish professions from other human enterprises.
He suggested that professions:
- Are intellectual operations with large individual responsibility
- Depend upon science and learning
- Put their learning to a practical and definite end
- Possess an educationally communicable technique
- Engage in self-organization and self-regulation
- Tend to become increasingly altruistic in motivation7
The first four of these criteria do not, it seems, raise any immediate issues
for Catholic professional education that are not true of Catholic higher education
in general. Science and the church have certainly had their struggles, especially
over physics. But the church does not claim the competence to declare the function
of the pituitary gland. Gaudium et Spes (nos. 36 and 59) explicitly reserves
such pronouncements for the proper sciences. Ex Corde Ecclesiae (no.
29) states that, "The Church, accepting 'the legitimate autonomy of human culture
and especially of the sciences,' recognizes the academic freedom of scholars
in each discipline in accordance with its own principles and proper methods,
and within the confines of the truth and the common good." So, at least in medicine,
the issue does not seem to be one of competing claims about empirical truth.
However, Flexner's last two criteria are very interesting. I think that the
fifth, the mandate of professions to engage in self-organization and self-regulation,
does pose significant tensions for Catholic professional schools, while the
sixth, altruism, points to what Catholicism can best give to our desperately
needy professions. Out of the tensions involving the church and these two defining
characteristics of genuine professions, I will suggest, arise the best reasons
one can hope to give for having Catholic professional schools in the 21st century.
First, one should pay attention to the similarities between a profession such
as medicine and an organization such as the Catholic Church. Both are self-organizing,
self-regulating, monolithic, powerful, and inherently conservative social institutions.
They function as societies within society and at the same time are inherently
international. They have rituals, rules, and expected patterns of behavior.
Both demand sacrifice from members, and the members of both take oaths. Both
are practical and service oriented. Both have tremendous influence over society
at large and exercise socially sanctioned authority over quite intimate aspects
of the lives of individuals. Both have structures for coming to internal consensus
about how best to serve society, based on the application of their own most
fundamental principles and established methods of reason and analysis. Although
other academic disciplines might have hints of this sort of structure, these
features are far truer of the professions, such as law and medicine, than they
are of other disciplines, such as English literature or mathematics.
And so, when there is a conflict between the church and a profession, it becomes
a conflict between titans. Since the beginning in the late 20th century, the
nature of these conflicts has become not one of competing scientific truth claims,
but one of clashing claims about the moral use of scientific truth. When medicine
decides, for example, as a profession, that abortion is a medical procedure
for which there are legitimate medical "indications," one monolith sets itself
against another that says that the practice is always morally wrong. Two self-organizing
and self-correcting international institutions are set against each other. There
is no established social mechanism for adjudicating such conflicts in modern
society. And this sort of tension inevitably strains the relationship between
the professions and a church that sponsors professional schools.
Second, despite Flexner's perhaps exhortatory description of a professional
tendency toward altruism, most observers think that the professions in the 21st
century are approaching the nadir of their altruistic calling. At the same time,
dissatisfaction among medical professionals is very high,8 and physicians
may be said to be suffering from a sort of spiritual malaise.9 Unmoored
from any religious source of spirituality or moral guidance, professionals are
adrift on a sea of market forces and nihilism where dark undercurrents seem
to threaten the meaning of their professions.
Contemporary scientific, social, economic, and legal forces have driven the
medical profession into a genuine identity crisis. A new movement has arisen
to try to re-articulate what professionalism means for physicians today. This
has led to the rediscovery of altruism as an essential element of professional
identity.10 But this has, in turn, left many physicians wondering
what reasons can be given for this requirement, how one can strive for altruism
in medical finance systems built upon the presumption of physician self-interest,
and whether professionalism itself has any higher purpose. Further, over the
last five to 10 years, patients have begun to express increasing interest in
spirituality and health care, and physicians are now searching for a spirituality
of their own. If the church has anything to say to medicine, this should be
where the conversation begins.
Yet it must also be acknowledged that such a conversation begins in a setting
of fierce internal opposition within the profession. Medicine is the last bastion
of positivism, and many medical scientists and physician educators have reacted
with vitriolic attacks upon anything that smells like religion in medicine.11
To add to the complexity of the situation, all of this tension between the
church and medicine, when played out in a medical school, is also plunged into
the controversies surrounding academic freedom at a university. The academy
is generally suspicious of any and all claims to legitimate authority. On campus,
there is a tendency to avoid hostile conflict by pushing religion to the periphery
as the simplest solution to the challenges raised by pluralism and freedom.
Finally, in an increasingly secular society, medicine now directly competes
with the church for the role of transnational moral authority, supervening beyond
all governments. The increasing medicalization of personal and social life provides
a kind of alternative to the church. Those who mourn now see psychiatrists,
not priests. Firearms in the home have become a medical issue. "Doctors without
Borders" constitutes the new form of the medical missionary. And only a high-cholesterol
piece of chocolate cake is truly sinful. Medicine is thus becoming something
of an all-encompassing secular religion, competing for adherents.
Why Catholic Medical Schools?
In the face of so much tension, why should Catholic universities continue to
sponsor medical schools? I see two reasons, arising from these conflicting claims
to authority and unacknowledged needs. First, Catholic professional schools
are in the best position possible to exert the leadership necessary to give
the professions the spirituality they so desperately need, both for the sake
of the professions themselves and for the society they serve. Second, Catholic
professional schools will best serve the church and society at large by giving
the church a direct, insider's voice in the moral and social issues through
which the professions so deeply affect the lives of the people of God.
Although the church must be humble, it does, after all, serve that higher
authority that the professions must ultimately somehow embrace if they are to
be fully human enterprises. It is precisely when the professions threaten to
substitute for the church that the church must stand in and point out that the
God for whom the church exists is also the ultimate right reason for the professions
But given all that I have said, it would be profoundly naïve to think that
there will be a simple solution to the problematic question of Catholic medical
education. On the one hand, unilateral assertions of authority by the church
fail to recognize the legitimate authority that the professions must have. On
the other hand, pious pronouncements of "values" that amount to nothing more
than the intersection of Catholic social teaching with the standard canons of
political rectitude amount to a mere charade.
How might Catholic medical schools accomplish such a mission? First, there
are some obvious and relatively uncontroversial ways. Catholic medical schools
should cease trying to hide their identity and its symbolic representation.
They should emphasize ethics in practice, teaching, and research. They should
develop programs that cultivate spirituality within the professions. And they
should emphasize service to the poor.
More controversially, I think they should consciously and explicitly recruit
Catholic faculty. Very little of this is currently done. Recruitment is always
of "the best" according to the standards of the professions, with little effort
to reach out to entice "the best" professionals who happen to be Catholic. And
this should happen in all subspecialties— anatomy and nephrology as well as
medical ethics. The ethos of a school is embodied in its faculty. If a Catholic
ethos is established, Catholic students will come. And other-than-Catholic students,
treated in a manner respectful of their beliefs, will also benefit.
Another very important but little discussed suggestion is that Catholic philanthropy
must be engaged in this mission. Catholic philanthropy has traditionally given
admirably to direct service to the poor and to people involved in very narrowly
conservative social issues. But there must be a way to engage increasingly wealthy
Catholics in giving to professorial chairs and centers of ethics and spirituality
in Catholic professional schools. There must be a way to persuade someone to
establish a type of "Catholic Public Health Service," offering scholarships
in exchange for working with Catholic Charities or overseas missions. Carefully
placed money can do a great deal of good.
In a particular way, Catholic medical schools ought to become centers of excellence
in the sort of research that does not conflict with church teaching.12
Why can't we, for example, rather than grumbling about not being able to use
stem cells from frozen embryos, leapfrog the scientific community and work on
creating continuous cultures of stem cells derived from sources that raise moral
problems for no one? Instead of grousing about not being able to do in vitro
fertilization (IVF), why not become the pioneers in the repair of the underlying
causes of infertility that lead patients to seek IVF as a substitute?
Catholic medical schools should also strive to assert and preserve the notion
of institutional conscience as the sole guarantor of true diversity in American
professional education. And they should strive, wherever possible, to work with
Catholic hospitals as their teaching hospitals, their natural allies in almost
all these endeavors. Even so, I think there might be a role for Catholic medical
schools even if there were no Catholic hospitals. I hope we will not need to
face that day.13
Gaudium et Spes challenges believers to "integrate human, domestic,
professional, scientific, and technical enterprises with religious values, under
whose supreme direction all things are ordered to the glory of God" (no. 43).
I think that Catholic professional schools, if they do things right, will do
- See Christopher J. Kauffman, Ministry and Meaning: A Religious History
of Catholic Health Care in the United States, Crossroad, New York City,
1995; and Sioban Nelson, Say Little, Do Much: Nurses, Nuns, and Hospitals
in the Nineteenth Century, University of Pennsylvania Press, Philadelphia,
- See Philip Gleason, "American Catholic Higher Education: A Historical Perspective,"
in Robert Hassenger, ed., The Shape of Catholic Higher Education, University
of Chicago Press, Chicago, 1967, pp. 15-53; Andrew Greeley, From Backwater
to Mainstream: A Profile of Catholic Higher Education, McGraw-Hill, New
York City, 1969, pp. 13-14; Andrew Greeley, The Changing Catholic College,
Aldine, Chicago, 1967, pp. 21-54; and Kenneth M. Ludmerer, Time to Heal:
American Medical Education from the Turn of the Century to the Era of Managed
Care, Oxford University Press, New York City, 1999, pp. 63-64.
- Most of this history can be found in: Edward J. Power, A History of
Catholic Higher Education in the United States, Bruce, Milwaukee, WI,
1958, pp. 243-248. I have updated this with searches of these websites: Seton
Hall College of Medicine and Dentistry Records; Marquette
Medical Alumni Association.
- For an interesting history of how this happened, see Darrell Amundsen,
"Medieval Canon Law on Medical and Surgical Practice by the Clergy," Bulletin
of the History of Medicine, 1978, vol. 52, pp. 22-44.
- Mark Sargent, "Catholic
Social Thought and Professional Education," a paper read at the Commonweal
Winter 2002 Colloquium, Malibu, CA, February 24, 2002.
- Abraham Flexner, Medical Education in the United States and Canada: A
Report to the Carnegie Foundation for the Advancement of Teaching, 1910,
reprinted by the Heritage Press, Buffalo, NY, 1973.
- Abraham Flexner, "Is Social Work a Profession?" School and Society,
1915, vol. 1, pp. 901-911.
- Jack Hadley, Jean M. Mitchell, Daniel P. Sulmasy, and M. Gregg Bloche,
"Perceived Financial Incentives, HMO Market Penetration, and Physicians' Practice
Styles and Satisfaction," Health Services Research, 1999, vol. 34,
- Daniel P. Sulmasy, The Healer's Calling: A Spirituality for Physicians
and Other Health Care Professionals, Paulist Press, Mahwah, NJ, 1997.
- See, for example, The ABIM Foundation, American Board of Internal Medicine,
ACP-ASIM Foundation, American College of Physicians-American Society of Internal
Medicine, and the European Federation of Internal Medicine, "Medical Professionalism
in the New Millennium: A Physician Charter," Annals of Internal Medicine
2002, vol. 136, pp. 243-266.
- Richard P. Sloan, Emilia Bagiella, T. Powell, "Religion, Spirituality,
and Medicine," Lancet, 1999, vol. 353, pp. 664-667; see also Relman's
commentary in Arnold S. Relman and Andrew Weil, "Is Integrative Medicine the
Medicine of the Future?" Archives of Internal Medicine, 1999, vol.
159, pp. 2,122-2,126.
- Daniel P. Sulmasy, "The Fullness of Life: Integrating Patient Care, Teaching,
and Research," Health Progress, January 1993, vol. 74, pp. 76-78.
- Daniel P. Sulmasy, "Catholic Health Care: Not Dead Yet," The National
Catholic Bioethics Quarterly, 2001, vol. 1, pp. 41-50.
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.