Nuala P, Kenny, OC, MD, FRCP(C)Department of Bioethics, Dalhousie

Faith, Justice and Health Care: Catholic Contributions

National ‘Crises’

Developing countries-provision of basic health care

Developed countries• Canada – Preservation and expansion of

universal coverage, costs & privitization

• U.S. –Uninsured; insurance dependent on work (economy) & costs

Faith and Health Care

Health care has its grounding in religious/moral beliefs

There has been a secularization of health care institutions

Modern health care:• Scientific ‘objectivity’, dominance of

technology, rampant individualism, loss of the notion of the common good and a ‘fair share’

Key Catholic Values

Every person enjoys human dignity Justice and compassionHealth care an element in the common goodHealth care is a service to personsThere is a special duty to the poor and

vulnerableResponsible stewardship of resources

Health is of Moral Importance

It protects our opportunity to pursue goals It reduces pain and suffering It helps prevents premature loss of life It’s loss has profound moral meaning

Public Policy is a Moral Endeavor

It is a decision for “others” who are not at the decision-making table

Policy creates possibilities for some & excludes others

Policy must respect diversity but find enough values agreement to make a decision for the common good

Citizens have a duty to promote good policy

Our Faith Brings A Moral Imagination

Respect for persons and for life Understanding limits, grace & inter-dependence The medicalization of life The dependence on technology Death-denying; death defying culture Balancing individualism with community and the

common good Balancing Canadian needs with others

Catholic Social Teaching and Justice

Provides a moral framework to balance individual needs with the solidarity of all in the common good

This tradition is activist, interventionist and hopeful

Concerned with distributive &social justice It is not countercultural separatism

Medicine and the Individual

“Profound changes are affecting the traditional structures of a society that is increasingly globalized and has difficulty in relating to the individual, while medicine is involved in developing diagnostic and therapeutic methods which are ever more complex and effective, but often available only to limited groups of people.”

John Paul II, November 2000

The Common Good in Health and Health Care

Health need brings forth fundamental moral/religious questions• Control and dependence• Fear and suffering• Fidelity and care• Reasonable hope for benefit, risk, harm• A ‘fair share’ of common resources

The Common Good

“…the sum total of social condition which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily.”

Gaudium et Spes (Para 74)

Requirements for the Common Good

Respect for personsSocial well-being and development of the

groupPeace

Catechism #1907-1909

Each human community possesses a common good which permits it to be recognized as such; it is in the political community that its most complete realization is found

Catechism # 1910

The Context for Reflecting on the Common Good

Failure of ‘democratic deliberation’Liberalism’s limit on the ends of societyGlobalization and dominance of the marketDecline of religion; politicization of religionChallenge to public good of health careThe technological imperative!

Solidarity

…is not a feeling of vague compassion or shallow distress at the misfortunes of so many people (but)…a firm and persevering determination to commit oneself to the common good; that is to say to the good of all and to each individual, because we are all really responsible for all

Pope John Paul II

Sollicitudo Rei Socialis

December, 1987, # 38

Commitment toThe “Seamless Web of Life”

BirthOrdinary human lifeVulnerable human life IllnessA ‘good death’

Life is a Penultimate Good

Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good.

Catechism #2288

If morality requires respect for the life of the body, it does not make it an absolute value.

Catechism #2289

The Schiavo Tragedy

Inherently a complex situation• “Bad cases make bad laws”

Has confused many re our tradition of moral judgment re ‘balancing reasonable hope of benefit with risks and harms’• Think of Pope John Paul II’s death as exemplar

of a ‘good death’ in our tradition

Health Care & Justice

The health and healing concerns of the Christian community are not limited to, and much less exhausted by its focus on the health of individuals as such; it extends also to the physical and social environment in which the community lives and works…. Working to promote health and well-being is not only about curing symptoms, it also means confronting the social and political causes of suffering and injustice.• Pastoral Letter –CCCB Permanent Council2005

Socio-economic Determinants of Health and Stewardship

Social inequalityPoverty and marginalization

. Nutrition . Housing

Meaningful workEducation opportunityGender

A Catholic Response to Health Systems in ‘Crisis’

Affordable, sustainable systems for all Timely and fair access to efficient, efficacious,

compassionate and respectful health care based on need not ability to pay

Improve outcomes; decrease health inequities Focus on the entire continuum of health (from

promotion to palliative care) Re-claim the importance of the socio-economic

determinants of health

What do these goals require?

Reclaim the notion of the common good Agreement about the public good of health care in

a just and fair society Recognition of the limits of medical science Clarification regarding the moral nature of illness

and the appropriate role of the market Reflection on the meaning of a ‘fair share’ Meaningful citizen participation

• Formation of conscience

The Canadian Supreme Court Decision

4-3 decision –prohibition on private insurance violates the “right to life” under s.1 of the Quebec Charter- when a patient cannot get reasonable access to public services

Court activism Privileges the individual over the common

good/public interest Privileges the market ; rejects the policy evidence

Challenges

IndividualismSeduction by technologyThe difficulty of sharing health resourcesFormation of Christian conscienceMeaningful citizen engagementChallenges for ‘public Catholics’