Ethics - Stewardship and Catholic Health Care

March-April 2017

BY: FR. THOMAS NAIRN, OFM, PhD

There is an ethical issue closely related to philanthropy that also is a core value for many Catholic health care systems and included in the "Shared Statement of Identity for the Catholic Health Care Ministry."1 That value is stewardship. Some have suggested that "stewardship is the recurring theme in the Catholic social tradition that speaks most clearly to how and why people should care about the commons."2 Yet, it would actually be difficult to find the term stewardship mentioned at all in the Catholic social tradition.3 And often in the more general literature (and likely in the minds of many in health care), stewardship has been limited to the notion of good financial management.

This characterization, though obviously partly true, does not do justice to the robust religious nature of Christian stewardship. Investigating the biblical roots of this term, one needs only to remember the prophets denouncing the lack of appropriate stewardship for the house of Israel, or Christ's parable commending the steward who has been "faithful over a little" and given much more.4 There is thus a spiritual element at the basis of Christian stewardship that relates it to God, to those we serve and to the larger society.

The U.S. Catholic bishops have suggested stewardship is a way of life that consists of four movements:

  • Receiving the gifts of God with gratitude
  • Cultivating them responsibly
  • Sharing them lovingly in justice with others
  • Standing before the Lord in a spirit of accountability.5
  • By analyzing these movements, we can formulate a more adequate understanding of stewardship for those in Catholic health care.

RECEIVING THE GIFTS OF GOD WITH GRATITUDE In an article on the medieval mendicant religious orders (see page 9), I mention that part of the spirituality of mendicancy is a belief that everything we have is gift from God. Stewardship begins with a similar recognition. The Pontifical Council for Justice and Peace (now part of the dicastery for Promoting Integral Human Development), in a document that reflects upon the responsibilities of business leaders, explains:

"The first act of the Christian business leader, as of all Christians, is to receive; more specifically, to receive what God has done for him or her. This act of receptivity, particularly for business leaders, can be particularly difficult. As a group, business leaders tend to be more active than receptive. … Yet without receptivity in their lives, business leaders can be tempted … to regard themselves as determining and creating their own principles, not as receiving them.6

The idea that receptivity is foundational to stewardship discloses a rather different attitude from what is found in many discussions of stewardship prevalent today. True Christian stewardship — like all Christian spirituality — begins with one's knowing that one is being gifted by God. Pope Benedict XVI has clarified the basis of this spirituality by stating, "Gift by its nature goes beyond merit, its rule is that of superabundance. … The principle of gratuitousness and the logic of gift … can and must find their place within normal economic activity."7

If this is the case for economic activity in general, it is especially true for stewardship.

CULTIVATING GIFTS RESPONSIBLY Although stewardship often has been described in terms of "time, treasure and talent," that description does not do justice to the rich theological foundation of stewardship. In considering the responsible cultivation of the gifts God has given us, the Catholic social tradition often has referred to the Book of Genesis, especially where God places Adam in the Garden of Eden "to cultivate and care for it."8 The tradition speaks of the reverential use of what God has created. The Pontifical Council for Justice and Peace explains, "Scripture teaches that good stewards are creative and productive with the resources placed in their care. They do not merely take from creation's abundance; instead they use their talents and skills to produce more from what has been given to them."9

The recent tradition has taken this a step further, however, by suggesting that humans actually cooperate in God's work of creation. The Second Vatican Council spoke of humans as being "a partner in the work of bringing God's creation to perfection."10 Similarly, Pope John Paul II has maintained that the human person "in a sense continues to develop that activity [of the Creator], and perfects it as he advances further and further in the discovery of the resources and values contained in the whole of creation."11

This places a lot of responsibility on Christian stewards. The Pontifical Council for Justice and Peace explains, "Business leaders must be able to ‘see' this world in a way which allows them to make judgments about it, to build up its goodness and truth, to promote the common good, and to confront evil and falsehood."12

SHARING GIFTS LOVINGLY IN JUSTICE WITH OTHERS If all is gift and not the result of our own effort, Christian stewardship demands that we use the gifts given us wisely, not simply for ourselves or even our institutions, but for the good of all, the common good. One moves to the third element of the spirituality of stewardship, that of sharing gifts in justice. Pope John Paul II spoke of injustice within the context of the social structures of sin.13 For him, the antidote to social sin is the virtue of solidarity, that all are really responsible for all.14

As we reflect upon the relationship between stewardship and justice, we see the necessity of expanding our vision beyond the individual or organization. This, however, calls for conversion. Pope Francis emphasizes that "the word ‘solidarity' is a little worn and at times poorly understood, but it refers to something more than a few sporadic acts of generosity. It presumes the creation of a new mindset which thinks in terms of community and the priority of the life of all over the appropriation of goods by a few. … Solidarity must be lived as the decision to restore to the poor what belongs to them. These convictions and habits of solidarity, when they are put into practice, open the way to other structural transformations and make them possible."15

SPIRIT OF ACCOUNTABILITY Like "stewardship," "accountability" is a word that is not typically used in Catholic social teaching. The tradition's preferred term is "responsibility." Sr. Judith Merkle, SNDdeN, PhD, professor of religious studies at Niagara University, New York, suggests that accountability is the organizing of responsibility in such a way that "marks a community vision with structures and procedures for holding decision makers accountable."16 Accountability challenges individuals and institutions to reflect upon their possible contributions to the structures of sin and the need for conversion.

Accountability also acknowledges the tensions among our various responsibilities. John Glaser, the late ethicist at St. Joseph Health System of Orange, California, has noted that there is an ethical difference between benevolence (wishing another good or wishing to do good) and beneficence (doing good for another). He calls the latter "love within limits." He explains:

"With love as beneficence, things are leaner, more severe. Beneficence is wholeheartedly directed to doing good but beneficence knows severest limits; limits of knowledge, imagination, time, space, ability, resources. Essential to beneficence is its characteristic of love-within-limits. … The good is sought under the conditions of finitude. It is our nature as finite creatures, not a narrowness of heart, that fundamentally accounts for the limits of beneficence. It is precisely this characteristic of wholehearted love, but love within limits, that sets a major agenda for an ethics of beneficence."17

It is in this context of beneficence that Christian stewardship begins to look more like its secular sibling, good financial management. But it is important to recognize that for Christian stewardship, this is the final step, not the first. One must understand stewardship within the context of love within limits, but one can only do this — in a Christian way — after one has moved through the other steps. One can only understand "love within limits" within the framework of ongoing conversion.

FR. THOMAS NAIRN, OFM, PhD, is senior director, theology and ethics, the Catholic Health Association, St. Louis.

NOTES

  1. Catholic Health Association, "A Shared Statement of Identity for the Catholic Health Care Ministry," www.chausa.org/mission/a-shared-statement-of-identity.
  2. Elizabeth W. Collier, "Stewardship and the Educated Consumer," in Good Business: Catholic Social Teaching at Work in the Marketplace (Winona, Minnesota: Anselm Academic, 2014), 87.
  3. The word is not mentioned at all in the index of the 440-page book produced by the Vatican's Pontifical Council for Justice and Peace, Compendium of the Social Doctrine of the Church (Washington D.C.: USCCB Publishing, 2005).
  4. See, for example, Isaiah 1:1-31, Zechariah 7:8-12 and Matthew 25:21
  5. United States Conference of Catholic Bishops, Stewardship and Young Adults (Washington DC: USCCB Publishing, 2003). This eight-page booklet was produced by the bishops' conference to aid discussion of the topic by young adults in parish or campus settings. However, the framework that the short essay provides is appropriate for all forms of stewardship, including that of Catholic health care.
  6. Pontifical Council for Justice and Peace, Vocation of the Business Leader: A Reflection, par 66.
  7. Benedict XVI, Caritas in Veritate, par 34, 36.
  8. Genesis 2: 15.
  9. Vocation of the Business Leader, par 52. The Scripture reference is to Matthew 25: 14-30.
  10. Second Vatican Council, Gaudium et Spes, par 67.
  11. John Paul II, Laborem Exercens, par 25.
  12. The Vocation of the Business Leader, par 16.
  13. See John Paul II, Sollicitudo Rei Socialis, par 37.
  14. See John Paul II, Sollicitudo Rei Socialis, par 38.
  15. Francis, Evangelii Gaudium, par 188-89.
  16. Judith A. Merkle, From the Heart of the Church: The Catholic Social Tradition (Collegeville, Minnesota: Liturgical Press, 2004), 250.
  17. John W. Glaser, "Conflicting Loyalties: Beneficence — Love within Limits," in Theological Analyses of the Clinical Encounter (Dordrecht, Netherlands: Kluwer Academic Publishers, 1994), 111. See also Glaser, Three Realms of Ethics (New York: Sheed and Ward, 1994.)

 

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