Equality in health care: Christian engagement with a secular obsession.

A frenetic search for equality lies at the center of much secular and even "Christian" bioethics. In a secular world, if one does not believe in God, if this life is one's whole existence, it would seem that one could not settle for less than equal approbation, especially equality before the risks of suffering and death, which medicine promises to ameliorate. Yet, the concern for equality in health care is puzzling. After a modest level of access to health care there is little difference in average life expectancy. Are concerns for equality in health care even vaguely Christian? The pursuit of Christian perfection has never been correctly equated with state-imposed egalitarianism. Furthermore, an all-encompassing, secular, egalitarian health care system may provide equal access to significantly immoral medical treatments. In contrast to secular thought, the call of Christianity is a call to holiness, not a call to an egalitarianism that superficially resonates with certain elements of Christian thought.     

Health care, equality, and inequality: Christian perspectives and moral disagreements.

Equality is a concept that is often used in health care discussions about the allocation of resources and the design of health care systems. In secular discussions and debates the concept of equality is highly controverted and can take on many different specifications. One might think that Christians hold a common understanding of equality. A more careful study, though, makes it clear that equality is just as controversial among different Christian communities as it is in the secular world.     

The bioethics of care: widows, monastics, and a Christian presence in health care.

At the beginning of the twenty-first century, with vocations to the Christian religious orders of the West in marked decline, an authentic Christian presence in health care is threatened. There are no longer large numbers of women willing to offer their life labors bound in vows of poverty, chastity, and obedience, so as to provide a real preferential option for the poor through supporting an authentic Christian mission in health care. At the same time, the frequent earlier death of men leaves a large number of widows, some in need of care and some able to provide care. Drawing on the role of widows sketched in 1 Timothy 2, one can envision Christian widows entering a life of prayer and service in health care settings. As female monastics, such widows could reintroduce a salient Christian presence in health care. How one ties this response to the message of 1 Timothy 2 will depend on one's understanding of the status of Scripture, the significance of tradition, the nature of theological epistemology, the meaning of theology, the nature of the Church, and the ontology of gender. The position taken on these issues will define the character of a Christian bioethics of care.     

Ethical issues in managed care: a Catholic Christian perspective.

A Christian analysis of the moral conflicts that exist among physicians and health care institutions requires a detailed treatment of the ethical issues in managed care. To be viable, managed care, as with any system of health care, must be economically sound and morally defensible. While managed care is per se a morally neutral concept, as it is currently practiced in the United States, it is morally dubious at best, and in many instances is antithetical to a Catholic Christian ethics of health care. The moral status of any system of managed care ought to be judged with respect to its congruence with Gospel teachings about the care of the sick, Papal Encyclicals, and the documents of the Second Vatican Council. In this essay, I look at the important conceptual or definitional issues of managed care, assess these concerns over against the source and content of a Catholic ethic of health care, and outline the necessary moral requirements of any licit system of health care.     

The future of Catholic health care: observations from an Orthodox Christian perspective.

The author reflects on the future of Catholic health care by looking at the essays in this volume by Dennis Brodeur, Clarke E. Cochran, and Christopher J. Kauffman. The author argues that (1) Roman Catholic teaching on the Trinity is defective, yielding an inadequate model of society, (2) Roman Catholic teaching on the Incarnation is defective, yielding an impoverished understanding of the "sacramental," and (3) the institutional orientation of Roman Catholicism combined with the lack of true sacramental vision makes it nearly impossible for Roman Catholic theory to criticize the current structure of health care financing.     

Universal health care, American style: a single fund approach to health care reform

With increasing momentum for health care reform, attention is shifting to finance reform that will provide for direct methods for controlling health care spending. This article outlines the two principal paths to direct cost control and outlines a national plan that retains our multiple sources of payment, yet also contains a powerful direct cost control technique: a single fund to finance all health care.     

Sociotechnical systems in health care: a field experiment.

This article describes an intervention that employed sociotechnical systems (STS) analysis in the laboratory of a major health care institution in the Midwest. The analysis was performed on two departments of the laboratory to determine opportunities for improving effectiveness, facilitating the introduction of new technology, and enhancing the work experience of technologists. The authors measured the results of the intervention by conducting a survey of technologists before and after the change effort and through follow-up interviews with a sample of physicians, supervisors, and technologists. The intervention did not achieve the results intended, and the authors present their explanation for why this occurred and suggest implications and recommendations for future STS applications to health care settings.     

Mental health in Christian life

Conclusion The influence of mental health upon the perception, assimilation, and expression of religious values is very apparent. As the precision of our knowledge increases, there is no lack of evidence for an affirmative answer to the question posed for the second part of this report.If the proper methods for studying the influence of religion on mental health have seemed to us to be full of ambiguity, it has also seemed to us that the future development of our scientific knowledge relative to the influence of mental health upon religion is entirely feasible and highly desirable.To work for better mental health is to permit believers (and this is equally valid for all religions and all faiths) to gain better understanding of the call of their religion in all its authenticity. The very perception of the religious message, in its richness and complexity, would be enhanced if one could raise the level of balance and of psychological maturity in a population. Mental health does not automatically make men more religious (we have no interest in an automatic, conditioned religion), but it prepares a better background in which the word of God may be heard, received, and more fully assimilated.It is in this perspective that we all must work together—doctors, psychologists, educators, priests—toward improvement of mental health. Let us, however, avoid unenlightened enthusiasm; let us keep ourselves from undertakings of which the practical applications would be directed toward illusory purposes. An effective program demands precise objects: these can be formulated only on the basis of methodically conducted research and scientifically established conclusions.     

The responsiveness and equality of mental health care to Chicanos and Native Americans

An examination was made of the services received by Chicano and Native American clients in 17 community mental health facilities. Although these minority clients differed from Anglos in demographic variables, there was no evidence that they were rendered inferior or discriminatory services. However, failure to return for therapy was much higher among minority clients. Possible reasons for this failure to return are discussed. It is suggested that for ethnic group clients, equality of services may not mean responsive services.     

An approach to supervision in health care settings

This article describes a flexible approach to supervision which allows for the fact that integration may mean different things to different people under different circumstances. In the health contexts described the clinical mix which was found most helpful in the supervisory work combined psychodynamic, Jungian and humanistic perspectives. The application of this particular mix of clinical techniques is demonstrated with reference to the work with two supervisees. It is felt that the methods employed are consistent with the current notions of difference in counselling and psychotherapy.     

A Christian Faith-Based Recovery Theory: Understanding God as Sponsor

This article reports the development of a substantive theory to explain an evangelical Christian-based process of recovery from addiction. Faith-based, 12-step, mutual aid programs can improve drug abstinence by offering: (a) an intervention option alone and/or in conjunction with secular programs and (b) an opportunity for religious involvement. Although literature on religion, spirituality, and addiction is voluminous, traditional 12-step programs fail to explain the mechanism that underpins the process of Christian-based recovery (CR). This pilot study used grounded theory to explore and describe the essence of recovery of 10 former crack cocaine-addicted persons voluntarily enrolled in a CR program. Data were collected from in-depth interviews during 4?months of 2008. Audiotapes were transcribed verbatim, and the constant comparative method was used to analyze data resulting in the basic social process theory, understanding God as sponsor. The theory was determined through writing theoretical memos that generated key elements that allow persons to recover: acknowledging God-centered crises, communicating with God, and planning for the future. Findings from this preliminary study identifies important factors that can help persons in recovery to sustain sobriety and program administrators to benefit from theory that guides the development of evidence-based addiction interventions.     

Migrant mental health: a model for indicators of mental health and health care consumption.

OBJECTIVE: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. DESIGN: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. MAIN OUTCOME MEASURES: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" RESULTS: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. CONCLUSIONS: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups.