Institutional integrity in Roman Catholic health care institutions.

Issues of institutional identity and integrity in Roman Catholic health care institutions have been addressed at the level of individual institutions as well as by organizations of Catholic health care providers and at various levels in the Church hierarchy. The papers by Carol Taylor, C.S.F.N., Thomas Shannon, Kevin O'Rourke, O.P., Gerard Magill in this volume provide a significant contribution to concerns of Roman Catholic health care institutions as they face the challenges of providing health care in a secular, pluralistic, market-driven economy. One way to understand institutional integrity is as a measure of the coherence between what an institution identifies as its commitments (its stated moral character), what an institution does (its manifest moral character) and an institution's fundamental moral commitments (its deep moral character). The essays in this volume support this model of integrity. Although it is not their explicit focus, the four essays together provide a vision of institutional integrity for Catholic health care institutions. Each author focuses on one of the three central aspects of integrity: what one identifies as one's commitments (Taylor), how one's actions reflect one's values (Shannon and Magill), and what one is or what one values at a deep level (O'Rourke). I will offer a brief overview of the ways in which the integrity of Catholic health care institutions has been addressed. Then I will consider the four essays and show how each offers an analysis of one of the three critical elements of integrity.     

Faith and the practising analyst

Abstract: In this brief essay, I reflect on three questions: What is ‘faith’ in a modern and post‐modern cultural context? Do I, a Jungian analyst, have ‘faith’ or do I not? Does having ‘faith’ or not make a difference in the practice of analysis? I make reference to Jung's understanding of ‘faith’ and his frequent disclaimers about making metaphysical claims. I conclude that a post‐credal ‘faith’ is possible for contemporary Jungian analysts, that I do have such a faith personally, and that in my experience this makes a significant difference in analytic practice at least with some patients. Traditional faith statements must be translated into depth psychological terms, however, in order for them to be applicable in post‐modern, multicultural contexts.     

The relationship between space and mutual interaction: Kant contra Newton and Leibniz

Kant claims that we cannot cognize the mutual interaction of substances without their being in space; he also claims that we cannot cognize a ‘spatial community’ among substances without their being in mutual interaction. I situate these theses in their historical context and consider Kant’s reasons for accepting them. I argue that they rest on commitments regarding the metaphysical grounding of, first, the possibility of mutual interaction among substances-as-appearances and, second, the actuality of specific distance-relations among such substances. By illuminating these commitments, I shed light on Kant’s metaphysics of space and its relation to Newton and Leibniz’s views.     

A blessing in disguise? Empowering Catholic health care institutions in the current health care environment.

Health care institutions, including Roman Catholic institutions, are in a time of crisis. This crisis may provide an important opportunity to reinvigorate Roman Catholic health care. The current health care crisis offers Roman Catholic health care institutions a special opportunity to rethink their fundamental commitments and to plan for the future. The author argues that what Catholic health care institutions must first do is articulate the nature of their identity and their commitments. By a renewed commitment to the praxis of health care on their own distinctive terms, Roman Catholic health care institutions may reestablish a vision of human nature and human service in an increasingly secular society. Health care could then reclaim its place as a powerful setting for the expression of Roman Catholic faith, life and witness.     

Education,queer theology,and spiritual development: disrupting heteronormativity for inclusion in Jewish,Muslim and Christian faith schools

Voices critiquing heteronormativity in faith schools often rely on an understanding of such schools as arbiters for heteronormative religious orthodoxies. Many proponents of Jewish, Muslim and Christian schools offer compelling responses to such claims by providing inclusive perspectives on faith schooling. By applying a queer reading of temporality to a critique of the latter body of work, this paper will argue that these perspectives, despite their commitments to inclusion, have affinities with logics of heteronormativity through their appeal to a language of hospitality that reproduces adherence to heteronormative binaries and identity frames as originary and normative. From here, the paper will suggest that queer theology’s understanding of the transcendent in relation to immanence offers resources for reframing discussions around heteronormativity and faith schools in ways that speak to the inclusive commitments of those critiqued in this paper, while also eschewing reproductive determinism as a basis for understanding spiritual development.     

Engaging with Faith Councils to Develop Stoma-specific Fatawās: A Novel Approach to the Healthcare Needs of Muslim Colorectal Patients

Intestinal stomas are common. Muslims report significantly lower quality of life following stoma surgery compared to non-Muslims. A fatwā is a ruling on a point of Islamic law according to a recognised religious authority. The use of fatawās to guide health-related decision-making has becoming an increasingly popular practice amongst Muslims, regardless of geographic location. This project aimed to improve the quality of life of Muslim ostomates by addressing faith-specific stoma concerns. Through close collaboration with Muslim ostomates, a series of 10 faith-related questions were generated, which were posed to invited local faith leaders during a stoma educational event. Faith leaders received education concerning the realities of stoma care before generating their fatawās. The event lead to the formulation of a series of stoma-specific fatawās representing Hanafi and Salafi scholarship, providing faith-based guidance for Muslim ostomates and their carers. Enhanced communication between healthcare providers and Islamic faith leaders allows for the delivery of informed fatawās that directly benefit Muslim patients and may represent an efficient method of improving health outcomes in this faith group.     

“Can One Put Faith and Work in the Same Sentence?” Faith Development and Vocation of a Female Leader in the Engineering Profession

Faith has been pointed out as a possible resource in strengthening individuals’ health and well-being at work. The aim of this article is to gain in-depth knowledge of the faith development and vocation of a selected female leader in a male-dominated work context. The article contributes to research on faith development in women leaders, based on Fowler’s faith development theory. This is a single case study grounded in a qualitative research design. In-depth qualitative data were gathered through observation and interviews over 18 months. Findings showed the development of faith across a women leader’s life span and highlight that faith and vocation are important resources that provide strength, meaningfulness and a vision.     

Emotional Well-Being Following Religious Conversion Among Women in Northeast Thailand

Religious conversion can have a profound impact on individual mental health and emotional well-being. These changes may need specific nursing care. In this article, we describe the lived experiences of 21 women who converted from Buddhism to Islam and who live in Isan, the northeast region of Thailand. The data derive from in-depth interviews, natural conversations, and observations. Thematic analysis revealed two dominant themes: women’s sense of happiness in their new faith, and their suffering following from and as a result of their conversion. To provide appropriate care to and prevent mental health problems among Isan women who convert from Buddhism to Islam, and other women in similar contexts, health providers need to enhance their understanding of conversion and to be aware of life experiences that impact on their emotional well-being.     

System of Care Development in Children’s Mental Health: Lessons Learned from a Process Evaluation

Despite ongoing public calls for reform, the mental health needs of many children with psychological, emotional and behavioral disorders remain unmet. In response, providers continue to seek effective alternatives to institutional treatment by implementing comprehensive systems of care. The Children’s Enhancement Project (CEP) is a collaborative effort to provide holistic, community-based mental health services for children with an individualized, flexible, family-driven approach. We conducted a process evaluation of CEP’s early stage development and implementation utilizing both qualitative stakeholder interviews and quantitative survey components. The current article describes that evaluation and highlights the challenges and potential solutions encountered in developing a system of care. The lessons learned regarding system of care development, including the importance of a shared vision, establishing programmatic guidelines, achieving collaboration, and addressing sustainability concerns, are discussed.     

Care,Commitment and Moral Distress

Moral distress has been the subject of extensive research and debate in the nursing ethics literature since the mid-1980s, but the concept has received comparatively little attention from those working outside of applied ethics. In this article, I defend a care ethical account of moral distress, according to which the phenomenon is the product of an agent’s inability to live up to one of her caring commitments. This account has a number of attractions. First, it places a greater emphasis on the importance of the relationship between the caregiver and her cared-for than that found in previous accounts. Second, it does not make problematic assumptions about the correctness of a caregiver’s moral judgments, as has been claimed in relation to previous accounts of moral distress. Finally, my account allows for a clear conceptual distinction to be drawn between moral distress and other forms of negative moral emotion such as guilt and regret. Earlier accounts draw this distinction by appealing to the causal aetiology of moral distress, but as I show here, such appeals are ultimately unsuccessful unless they are made from an explicitly care ethical starting point. One of the implications of my account is that moral distress has the potential to occur in the context of any caregiving relationship. This claim is explored in the final section of the paper, in relation to student-teacher and parent-child caregiving.     

The Future of the Church as a Primary Health Place

ABSTRACT

There is a critical need for change in America's Health System, and religious organizations can facilitate not only the redefining of what health is but also the shaping of what the primary health services of the future should look like, function as, and be. The vision presented here is that the local parish or some extension of it be seen by the average citizen as a primary health place. The model proposed is that faith based living in community become the core health concept, defining what it means to be human and healthy become the core teaching, and that healing such that no illness need dominate become the goal. Within that context, health information, education, prayer, care, and support for most chronic illness, lifestyle change, and end of life concerns would begin at one's community of faith and only within that context to specially trained persons. This health system will compliment the sophisticated and complex acute medical care system that now exists.     

Heaven and Health: How Black,Latino, and Korean Christians View the Relationship Between Faith and Health

Religious congregations have increasingly been viewed as potential access points to health care in underserved communities. Such a perspective stems from a robust literature identifying the unique civic role that churches potentially play in African American and Latino communities. Yet, research on congregational health promotion has often not considered how congregants view the connections between religious faith, physical health, and the church community. In order to further interrogate how congregants view the church’s role in health promotion, we compare views on the relationship between faith and health for two groups that are overrepresented in American Christianity and underrepresented in medical careers (African Americans and Latinos) with a group that is similarly religious but comparatively well-represented in medical professions (Korean Americans). Drawing on data from focus groups with 19 pastors representing 18 different congregations and 28 interviews with church members, we find that churches across all three groups promote initiatives to care for the physical health of their members. Nonetheless, notable differences exist in how each group frames the interface between religious faith and physical health. African Americans and Latinos highlighted the role of faith in providing physical healing while Korean Americans saw the support of the religious community as the main benefit of their faith. Distrust of medicine was primarily articulated by members of African American churches. The results offer important implications for the future potential and nature of health initiatives in racial minority communities.     

“Big Momma Had Sugar,Imma Have It Too” Medical Fatalism and the Language of Faith Among African–American Women in Memphis

This essay offers a theological exploration of the relationship between medical fatalism and religious belonging among African–American women in Memphis. Drawing on the work of black and womanist theologians and on conversations with participants in a diabetes intervention program administered by a faith-based community health provider, I argue that how we narrate the meanings of our bodies is irreducibly religious. The language we use to interpret and communicate the meaning of our bodily existence emerges from a set of assumptions, often unarticulated, about what is of ultimate value to us. The essay focuses on three interlocking features that link faith with fatalism or hope: (1) The idea that if “I don’t claim that” disease cannot enter my body; (2) the role of faith-based clinics in re-establishing trust with marginalized communities; and (3) how nuanced attention to the social location of health seekers can re-frame our understanding of patient compliance. Disrupting fatalism can only be done from within a health seeker’s own narrative, and therefore, healthcare providers who learn these narratives and respect their holiness will develop more effective interventions.     

The Reconciliation of Religious and Secular Reasons as a Form of Epistemic Openness: Insights From Examples in the Philippines

Addressing the debate inspired by John Rawls's restrictive idea of the political role of religion, Jürgen Habermas proposes the institutional translation proviso as an alternative that corrects an overly secularist notion of the state. Maeve Cooke has suggested that religious arguments can be allowed without translation in the institutional level as long as they are non‐authoritarian. However, her definition of non‐authoritarianism requires an acceptance of the fallibility of the truths acquired by faith, which I argue is unnecessary. Instead, I propose that non‐authoritarianism is realized in the recognition of the reconcilability of religious and secular reasons. I demonstrate the viability of this form of non‐authoritarianism using particular examples from the Philippine context. I conclude that these attempts constitute an alternative form of epistemic openness to the more stringent forms that Habermas and Cooke have proposed.     

<Emphasis Type="Italic">Justice for Hedgehogs</Emphasis>, Conceptual Authenticity for Foxes: Ronald Dworkin on Value Conflicts

In his 2011 book Justice for Hedgehogs, Ronald Dworkin makes a case for the view that genuine values cannot conflict and, moreover, that they are necessarily mutually supportive. I argue that by prioritizing coherence over the conceptual authenticity of values, Dworkin’s ‘interpretivist’ view risks neglecting what we care about in these values. I first determine Dworkin’s position on the monism/pluralism debate and identify the scope of his argument, arguing that despite his self-declared monism, he is in fact a pluralist, but unusual in denying conflict between plural values. I then set out the structure of his interpretive theory of value relations and present a case of value conflict which I think interpretivism cannot deal with. Following this I argue that there are structural reasons why cases like this are liable to occur and suggest that interpretivism will frequently fail to properly reflect people’s moral commitments because reinterpretation of values has the side effect of excluding important moral commitments from our conceptions of values. While, as Dworkin argues, there are no brute moral facts concerning values, moral psychology constrains the range of acceptable conceptions of values. Given the shortcomings of interpretivism I conclude that we should acknowledge that values may conflict.     

Toleration,Religion and Accommodation

Issues of religious toleration might be thought dead and advocacy of religious toleration a pointless exercise in preaching to the converted, at least in most contemporary European societies. This paper challenges that view. It does so principally by focusing on issues of religious accommodation as these arise in contemporary multi‐faith societies. Drawing on the cases of exemption, Article 9 of the ECHR, and law governing indirect religious discrimination, it argues that issues and instances of accommodation are issues and instances of toleration. Special attention is given to issues that arise when the claims of religious belief conflict with those of other legally protected characteristics, especially sexual orientation. The paper uses a concept of toleration appropriate to a liberal democratic political order—one that replaces the ‘vertical’ ruler‐to‐subject model of toleration that suited early modern monarchies with a ‘horizontal’ citizen‐to‐citizen model appropriate to a political order that aims to uphold an ideal of toleration rather than itself extend toleration to those whose lives it regulates.     

Provider Perspectives about Latino Patients: Determinants of Care and Implications for Treatment

Primary care settings are the gateway through which the majority of Latinos access care for their physical and mental health concerns. This study explored the perspectives of primary care providers regarding their Latino patients, particularly, issues impacting their patients' access to and utilization of services. Interviews were conducted with eight primary care providers-and analyzed using consensual qualitative research methods. In addition, observations were conducted of the primary care setting to contextualize providers' perspectives. Providers indicated that care for Latinos was impacted by several domains: (a) practical/instrumental factors that influence access to care; (b) cultural and personal factors that shape patients' presentations and views about physical and mental health and treatment practices; (c) provider cultural competence; and (d) institutional factors which highlight the context of care. In addition to recommendations for research and practice, the need for interdisciplinary collaboration between psychology and medicine in reducing ethnic minority disparities was proposed.     

Cultural Considerations for Psychologists in Primary Care

Many health concerns in the United States (e.g., diabetes) are routinely managed in primary care settings. Regardless of the medical condition, patients’ health is directly influenced by factors such as healthcare providers and cultural background. Training related to how behaviors influence health, coupled with training on how cultural diversity intersects with mental health, allows psychologists to have the relevant expertise to assist in the development of primary care behavioral health interventions. However, many psychologists in primary care struggle with how to integrate a culture-centered paradigm into their roles as behavioral health providers. This paper provides an introduction on how three culture-centered concepts (providers’ cultural sensitivity, patient–provider cultural congruency, and patients’ health literacy) can be applied in primary care using the Five A’s Organizational Construct and a model of cultural competence. In addition, the paper includes a section on integration of cultural considerations into consultation and training and concludes with a discussion of how the three culture-centered concepts have implications for health equity.     

Total quality management and the silent patient

This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total Quality Management, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system.     

Hospitable Hospitals in a Diverse Society: From Chaplains to Spiritual Care Providers

The chaplain’s role in health care services has changed profoundly within the contexts of managerial and fiscal constraints, and increasingly pluralistic and secularized societies. Drawing from a larger study that examined religious and spiritual plurality in health care, we present findings regarding the contributions of chaplains or spiritual care providers (SCPs) as they are referred to more recently, in Canadian institutional health care contexts. Qualitative analyses of interviews with 14 employed SCPs and 7 volunteers provided insights about legitimizing and crafting the role of SPCs, becoming part of the health care team, and brokering diversity. Implications are discussed in relation to role clarification and policy development for truly hospitable health care.