Are Catholic Acute Care Hospitals Worth the Effort?

For over one hundred fifty years, the Catholic Church has sponsored acute care hospitals in the United States. These institutions have been considered an integral and vital part of the Church’s effort to bring the healing presence of Christ to people. At present, in light of the changes in health care, many question whether this activity should continue. Is it truly an apostolic activity; does it bring the message of Christ to people, or are these many health care institutions simply part of a secularized and commercialized industry? Should the Church continue to sponsor these institutions? Is it worth the effort? Would it be more in accord with the spirit of Christ to sell these institutions and use the proceeds for health care projects for the poor? This presentation will consider the factors in our society which make it difficult to continue to sponsor acute care hospitals in the name of the Church, what benefits should result from this activity, and whether continuing this work is worth the effort.

I. Statement of the Problem

A few years ago, in a talk given at Georgetown University entitled “The Catholic Hospital Today, Mission Impossible?”, Father Richard McCormick lauded the past efforts of Catholic health care but questioned whether or not acute care hospitals should be continued as part of the apostolic life of the Catholic church in the United States. He queried whether the heart of Catholic health care is gone, and whether the people involved in Catholic health care are only performing a job rather than being involved in a ministry to carry on the healing work of Christ. He listed eight elements that prompted his question. In sum, he thought these eight elements “have weakened and sometimes dissolved the culture of the Catholic Health Care facility, the strength and transforming power of its vision.” Among the main elements that McCormick mentioned were depersonalization and secularization of health care in the United States and the emergence of public morality that is the increasing influence of institutions which have other interests than the immediate good of the patient. In this regard, he cited the loss of autonomy on the part of physicians and a market driven health care system. It was clear he tended to give an affirmative answer to the question he asked in the title of his presentation. In an article in Hospital Progress, I sought to respond to the questions he asked, mainly by stating that some of his reflections seemed to predicate a “golden age” of health care which no longer existed, if it ever did. Moreover, I maintained that some of the elements from the past which are no longer present are the result of improvement in the provision of health care. For example, loss of autonomy on the part of physicians is mainly the result of outcome oriented medicine and an effort to control costs. In sum, it was my contention that though many of the elements that McCormick mentioned are present in health care in the United States, that Catholic health care facilities have a mission that is still worthwhile.

A point of interest is that McCormick did not explicitly mention the lack of religious women as one of the elements for a weakening of the Catholic health care mission. However he intimated that this factor was a prime reason for “a gap between institutional purpose and aim and personal conviction and involvement” on the part of both administrators and clinical personnel involved in Catholic health care. Indeed, lack of religious is cited by many as a convincing reason for giving up acute care hospitals. But as we shall see, the Catholic health care ministry can be carried on without a critical mass of religious women dedicated to this work.

Another questioning voice in regard to the future of Catholic acute care facilities was raised more recently by Bishop Joseph Sullivan, a long time leader in the effort of the Catholic Church to provide social services, especially the poor. He proposed a retreat from acute care facilities under the auspices of the Church because of increased technology involved in health care and problems of funding. He recommended that the Church focus its activity in health care upon long term care facilities and other methods of caring for people which do not involve a heavy investment in technology and financial assets. Bishop Sullivan seemed to be saying also that health care in acute care settings is no longer a person centered apostolate.

Other observers of the health care scene question whether Catholic health care can survive the effort of local land state governments to tax property and income of these facilities. Moreover, another element threatening the continuance of Catholic health care facilities is the effort on the part of some, which seems to have more support than in the past, to declare that Catholic health care facilities must offer medical information and procedures deemed to be legal in the United States, even though offering this information and services is prohibited by the Ethical and Religious Directives. Hence, the moral Code of the Catholic Church which prohibits procedures such as contraceptive sterilizations, abortions, and euthanasia in Catholic health care facilities, is under attack.

Finally, it seems the most significant challenge to health care on the part of the Church is the trend to conceiving of health care as an industry or business. In this regard there is a proliferation of investor-owned for-profit health care corporations. Entities of this nature change the entire purpose of health care. The ultimate purpose becomes profit for investors rather than the well being of patients. Though Catholic acute care hospitals remain not-for-profit in name, the danger is that they will adopt some of the for-profit practices which are contrary to their expressed purpose. Recently, the Chicago Tribune recounted the efforts of some Catholic hospitals to collect debts from people without insurance in an oppressive and unjust manner.

Most of the some six hundred acute care facilities which are sponsored by the church could survive financially if they were not Catholic. But can they survive in the future as Catholic in the face of the aforementioned difficulties? There is no doubt that some people who sponsor these facilities in the name of the Catholic church believe the Church and religious Congregations would be better off if the health care facilities were sold and the proceeds used for other apostolic activities in the general field of health care, especially for the economically destitute. But before throwing in the towel, it would be only fair to investigate what Catholic health care can do to promote the work of the Church, and what benefits result when this work is carried on in the proper manner.

II. Goals and Benefits of Catholic Health Care

In order to ensure the continuance of his mission, Christ founded the Church. In the Second Vatican Council, the Church sought to describe its mission by stating two goals: 1) to bring women and men the message and grace of Christ; 2) to permeate the temporal order with the Spirit of Christ. Thus, the church exists to bring Christ to the minds and hearts of people, and to instill in the culture of the world the values which Christ preached and for which he died. The Church seeks to accomplish the first aspect of its mission through the ministry of word and sacrament. The second aspect of its mission is accomplished through works of charity; sometimes called the works of mercy. One of these works of mercy is heal persons when they suffer from disease or illness, and when unable to heal them, to help them die in as members of Christ’s body. In general then, the purpose of Catholic health care is to carry on the healing mission of Jesus Christ. The document On the Laity of the Second Vatican Council spoke about this second aspect of Christ’s mission in the following words:

Seeking to carry on their endeavors in a manner that corresponds to the healing mission of Christ, Catholic health care corporations and individual health care facilities formulate mission statements. These documents seek to express core values and behavioral goals which should characterize and inspire the activities of the persons who are responsible for the administration of the hospital and for the members of the staff who are responsible for the clinical land pastoral care of patients. These are often called statements of Catholic identity. The key elements in these statements are similar. A study group of the Catholic Health Association (CHA) recently listed the following as constitutive elements of Catholic identity: promote and defend human dignity; care for the whole person; care for the poor and vulnerable persons; promote the common good; act on behalf of justice; steward resources; act in communion with the Church. As many, including Father McCormick, have observed, the key element in ensuring that Catholic health care is truly Catholic is found in transferring the mission statements from the plaque on the wall to the hearts and minds of the people who are affiliated with the facility.

Rather than discuss the various core values and goals that should characterize the activities of the personnel of Catholic Health care facilities in detail, I would like to consider a parable that Jesus used to describe his ministry. If we take this parable seriously, it will provide some insight into the way in which people in Catholic acute care hospitals should be cared for.

You recall the parable of the Shepard that Jesus used to describe the Kingdom of God (Mt.8:12) It goes something like this: A Shepard had one hundred sheep under his care. One night, one of the sheep strayed off and got lost. Jesus said that the Shepard left the ninety-nine and went in search of the one that was lost, and searched until he found the one lost sheep. Jesus implied that this is how a good Shepard acts in the Kingdom of Heaven. Now I submit that in secular society this is not the way in which a Shepard would act. Remember, that the reason why a Shepard is guarding sheep in the first place is because there are several wild animals that will seek to attack the sheep, kill them, and use them for their own sustenance. Moreover, sheep are very dumb animals; (have you ever heard of a sheep being trained to catch a Frisbee); it is foolhardy to leave them alone. They are liable to wander into dangerous canyons or off steep cliffs. Think of it, the Shepard is there to protect them, to ward off wild animals and make sure the flock does not stray into dangerous territory. If I were a Shepard guarding one hundred sheep, and one of them got lost, I think I would stay and protect the ninety-nine who were not lost, and write off the one who was lost. Why endanger the ninety-nine in order to bring the one who is lost safely home? But you see what Jesus is trying to tell us is this; those who care for others in a manner similar to Him act differently because they act as God does. God has loving concern for each person whether the person is in the fold or not. Each person is significant; each person counts! Jesus tried to demonstrate this truth to us by associating with prostitutes and tax collectors.

Every person counts not because each person has an attractive personality or “fits in” with our community, but rather because God loves each person. And if we seek to carry on the mission of Christ, who is the human personification of God, we love and serve people in the way that God loves people. Could Each Person Counts become the mission statement for Catholic acute care facilities? Most statements of Catholic identity are much longer, but are they more expressive?

In order to instill the core values and behavioral goals into the hearts and minds of the personnel, each acute care facility should have a process in place. Given the goals and values expressed in the mission statement, members of each administrative and clinical department should discuss together how these values and goals can become part of the daily activity of the people in a particular service. Physicians should not be exempt from this discussion. Often being aware of “the little things” will humanize service. A recent series in the New York Times stated that waiting and lack of information are the most obnoxious parts of health care. Explaining why delays occur in hospitals should be a concern of care givers. Two years ago I was in the hospital for observation. After two days of medical tests, I was released about 11 in the morning. Ready to go home, I still had an IV in my arm. I was impatient that it be removed until a nurse explained that the person who could remove the device was in surgery caring for another patient. In a nice way she made me aware that there were many other patients who needed care, some more than I did.

Administrators and even members of the board of trustees should be a part of the on going educational process concerning the Catholic identity of the hospital. Having served on board of trustees of Catholic acute care hospital and Catholic colleges, I can testify that the discussion of “what makes our hospital or school Catholic” is daunting at the beginning, but makes clear in no other way possible the task of being a board member of a Catholic institution. In this way, it becomes clear to the members of the board and the administration of the institution, that they are doing more than “helping the sisters or the fathers” carry on their work. Rather they realize that in a very real sense “they own the work.” Because of a Christian’s baptismal charism, he or she is fully qualified to carry on the apostolic mission of the Church. While religious or priests have been the primary members of the Church involved in these apostolic endeavors, this will not be true in the future if the mission of the Church is to survive in secular society. Discussing what the mission means insofar as daily activity, planning and strategy, and marketing are concerned is the way in which that a Catholic institution becomes truly Catholic; it takes the Identity Statement off the wall and puts it in the hearts and minds of people responsible for health care.

As the American bishops who edited the Ethical and Religious Directives declared, the Catholic health care community must help people prepare for death in a holy atmosphere, that is, in a manner befitting human fulfillment. Is it too much to say that Catholic hospitals should have the reputation as being “a good place to die.” Seeing suffering and death as a means of human fulfillment is counter-cultural in our society, but this commitment of a Catholic hospital flows from a commitment of faith as expressed in the New Catechism:

Our society’s growing approval of physician-assisted-suicide exemplifies the rejection of the idea that suffering can be in any way beneficial. On the face of it, if all values are merely pragmatic, it is difficult to justify suffering. But as followers of Christ, we realize that suffering is an integral way of accomplishing the providence of God, and we believe that the joining human suffering to the suffering of Christ will lead to salvation. Catholic health care facilities then, have the responsibility and opportunity to teach the implications of Christ’s death.

III. Is it Worthwhile?

Some have offered the opinion that Catholic health care has only a minimal role insofar as health care in the United States is concerned and thus it is not worth the effort. When discussing the works of Church that bring about a willingness on the part of people to accept the teaching of Christ and to live by it, and to influence the cultures of the world with Christian values it is well to remember that these changes do not happen in the manner of thunderbolt, especially in so far as influencing culture is concerned. Jesus said that bringing into reality the attitudes and values of His Kingdom was like the growth of a mustard seed (Mt. 13:31), silent, and gradual, but ultimately significant.

The words of Pope Paul VI are noteworthy in this regard. In his first encyclical he stated that the church should be a leaven in civil society. The dictionary describes a leaven as something that modifies or lightens. The Second Vatican Council stated: “Thus, the Church, at once a visible organization and spiritual community, travels the same journey as all humanity and shares the same earthly lot with the world: It is the leaven and the soul of in its renewal by Christ.” Thus Catholic health care should not seek to dominate health care in the United States. Above all, it should not be thought of or designed as a system separate from the other health care facilities in the United States. The value of Catholic health care should not be judged by the prominence of its voice, but rather by the quality of its contribution to the common good. Was it a sign that Catholic health care has made a significant impact upon health care in the country when the recent series of articles on the shortcomings of health care in the United States was entitled “The Person becomes a Patient: A Degrading Experience”? Doesn’t this indicate caring for the whole person and not dehumanizing them is very important, something that Catholic health care has long professed as a goal. Keeping the health care community in the United States aware of the dignity of human persons is worth the effort.

Another factor that speaks for the Church remaining active in the provision of acute care is that it enables the Church to speak with a persuasive voice about health care in the public forum. Unless the Church has an institutional presence in health care its voice in the public forum will be ignored. Calling attention to the health care needs of the deprived, often called the preferential option for the poor, is much more effective if the Church is involved in this service. At present, this option is pursued by Catholic health care in various ways. Individual Catholic hospitals provide pro bono or charity care. But more significantly, Catholic hospitals, through the Catholic Health Association, have been a significant voice in seeking to reform health care in the United States. At least 40 million people in the United States are without the opportunity of obtaining health care because of inadequate funding. Some kind of universal funding plan is essential if fairness and justice will characterize health care in the United States. The Church must have an active role in fulfilling this need.

Finally, a ministry of health care supplies a vital good to people in need. Health is the basis upon which many other human goods depend. Acute care hospitals are an essential link in the provision of the services needed to help people strive for health. To continue this service in the name of the Church is a privilege, in a very real sense of the term. The various health care services provided by the Church have a significant impact in the Church’s effort to contribute to the common good by bringing the spirit and service of Christ to people in need.

There is no doubt that seeking to bring the message of Christ to the hearts and minds of people is difficult; the life and death of Christ reminds us vividly of this truth. Even more difficult is bringing the values and attitudes of Christ into the provision of health care. Catholic health care will be a farce if the goals and values contained in our mission statement are given only lip service. But in a certain sense, this has always been the case. Being a follower of Christ, especially in the public forum has always been an arduous task. But given the good that can be achieved and the example of pioneers in this apostolate, it is worthwhile.

About the Author

Kevin O’Rourke, O.P., J.C.D., S.T.M. is a professor at the Neiswanger Institute for Bioethics and Health Policy at Loyola University Chicago. Father O’Rourke has authored several textbooks and published over a hundred journal articles. His more recent articles examine the ethical issues of genetic testing, surrogate decision making, and physician assisted suicide. Father O’Rourke is currently involved in research on decision making in the Catholic tradition, and the use of hydration and nutrition for patients in a persistent vegetative state (PVS).