The Community of Concern

March-April 2002

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

  1. Maureen Fiedler and Linda Rabben, eds., Rome Has Spoken, Crossroad Publishing, New York City, 1998, p. 84.
  2. St. Augustine, De Doctrina Christiana, I, #29, cited in Bruno Schueller, Die Begruendung Sittlicher Urteile, Patmos Verlag, Duesseldorf, 1980, p. 70.
  3. "Gaudium et Spes," # 10, Walter Abbott, Documents of Vatican II, America Press, New York City, 1966.
  4. John XXIII, Pacem in Terris, 1963, cited in Fiedler and Rabben, p. 49.
  5. "Dignitatis Humanae," Abbott, pp. 675-696.
  6. 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
For reprint permission, contact Betty Crosby or call (314) 253-3477.