Holiness, virtue, and social justice: contrasting understandings of the moral life.

Being a Christian involves metaphysical, epistemological, and social commitments that set Christians at variance with the dominant secular culture. Because Christianity is not syncretical, but proclaims the unique truth of its revelations, Christians will inevitably be placed in some degree of conflict with secular health care institutions. Because being Christian involves a life of holiness, not merely living justly or morally, Christians will also be in conflict with the ethos of many contemporary Christian health care institutions which have abandoned a commitment to Christian spirituality. In this regard, managed care raises the special question of how Christian institutions can act morally under financial constraints and maintain their character while under the control of secular managers. This question itself raises the further question as to why health care institutions need even pose this query when there are Christian physicians and nurses who could work for less, or Christian men and women who could become sisters and brothers and work for nothing. Contemporary challenges to Christians to maintain their integrity in a post-Christian world have much of their force because Christians have failed to maintain traditional Christian sprituality. In the face of that failure, Christian physicans and nurses will find themselves in greater conflict with health care institutions, because few will any longer understand the requirements of traditional Christianity. In its place, they will have put a generic spirituality, a value-neutral understanding of the role of the health professional, and an anonymous commitment to social justice.     

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.     

SOCIAL JUSTICE

Social justice (which includes retributive and distributive justice) is most clearly satisfied by a system of Divine rewards and punishments: an omnipotent, omniscient, perfectly just Being could determine in each case how much effort was made and effect the appropriate distribution of rewards and punishments. A correct understanding of social justice naturally leads us to suppose that there is an afterlife, a God, a free choice — though it is logically possible at least that social justice could be satisfied in some future (very advanced) human society. There will still be those who have their doubts about the correctness of any view according to which justice cannot be attained by fallible creatures who have an incomplete knowledge of one another's behaviour. But, surely, these doubts are not sufficient to discredit my view. There is no a priori reason for rejecting such a view. There is nothing about our use of the term ‘justice’ and its cognates which implies that such a view is mistaken. (Otherwise the statement “There is no justice in this world’ would be meaningless.) To the contrary, there are widely held religious views, Christian as well as non-Christian, which take this view quite seriously. If there is no a priori reason for rejecting this view, then there must be some independent reason for rejecting it. In other words, we need some independent reasons for believing that social justice can be attained by fallible creatures with limited knowledge. The mere fact that we might feel uncomfortable with my theory is not reason enough to reject it. Finally, those who do experience this discomfort might ask themselves whether such discomfort stems from their moral experience or whether they are simply intent on finding justice in imperfect human institutions.     

我国医疗卫生改革中的伦理缺席

“中国的医疗卫生体制改革从总体上说是不成功的”结论的发表在社会上引发了对卫生改革的种种议论,从卫生改革的设计、实施和评估三方面论述了由于政府的缺位和伦理学的缺席,将卫生改革引向功利主义的死胡同,使得卫生改革背离了公正的目标而导致失败。但退回计划经济体制下的办医模式同样没有出路,在今后的深化改革中,必须强调医学目的,贯彻以人为本的指导思想,加大政府的投入,围绕公正目标,建立覆盖全民的医疗保障体制。     

Gratuity,Embodiment, and Reciprocity

Protestant Christian ethicist Timothy Jackson and secular feminist philosopher Eva Feder Kittay each explore the relationship between love or care and justice through the lens of human dependency. Jackson sharply prioritizes agape over justice, whereas Kittay articulates a more complex and integrated understanding of the relationship of care and distributive justice. An account of Christian love and its relation to justice must account for the gratuity, mutuality, and reciprocity that pervade human existence. Such an account must integrate provision for another's basic needs, a feature of agape, with a distributive justice that fairly allocates the material prerequisites of care and the burden of caring labor. Kittay's treatment of care and justice is more adequate to the realities of human embodiment and the social organization of care than Jackson's, but neither offers a fully adequate ground for the moral personhood of all human beings, including deeply dependent persons.     

Witnessing to Christ Today

The global health situation at the beginning of the third millennium is alarming. 1 While countries in the global North spend huge amounts of money providing high‐tech medicine for their citizens, many people in resource‐limited settings still do not have access to basic health care. These people bear an unjust burden of disease, and tens of thousands die every day of diseases that can be treated and often cured. In this regard, the contribution of Christian churches to health care is sorely needed. Already, churches and faith‐based organizations are important health providers in many countries. This is especially the case with regard to people in remote areas and in resource‐limited settings, and with marginalized groups in these and other places. In addition to the engagement by Christian bodies in health care, in many churches, especially the fast‐growing churches of the global South, spiritual healing is becoming increasingly important. These churches seek to provide healing through prayer, blessing, the laying on of hands, and anointing with oil. However, many inside and outside the churches are not so confident that the churches' engagement in the field of health and healing is essential to their mission. Some argue that the churches should only be involved in health care provision if there are no secular health providers available. Also, whilst others insist on the use of exclusively “spiritual” means to overcome illness, many question whether Christians today should still seek to overcome illness through this approach. Against this background, the World Council of Churches (WCC) and the German Institute for Medical Mission (DIFAEM) wish to contribute to an understanding of the healing mission of the church today. Both organizations are engaged in the field of mission and healing, and have a long history in dealing with questions about the Christian healing ministry. 2 Since its inception, the WCC has regarded issues related to health as part of its core work. Health care and theological questions on health and healing have been on the agenda of WCC programmes on mission, as well as those dealing with justice and diakonia. For many years, the WCC's Christian Medical Commission guided the organization's work on health and healing. DIFAEM has been a partner with the WCC in worldwide discussions on the healing mission of the churches since the mid‐1960s, and a leader in the promotion and implementation of the concept of primary health care. In 2005, the world mission conference in Athens, Greece, considered the theme, “Come Holy Spirit, Heal and Reconcile: Called in Christ to Be Reconciling and Healing Communities,” and strongly reaffirmed the healing mission of the church. In 2007, the WCC and DIFAEM jointly called for a “study group on mission and healing” to follow up the Athens mission conference. This study group was subsequently mandated to work on the Christian understanding of the healing mission of the church, and to promote Christian engagement in the field of health. The members of the group are theologians and medical professionals from four continents and various denominations. 3 The objectives of the group include:

• to clarify the holistic and integrated nature of Christian mission and healing, based on biblical theology;
• to demonstrate ways in which Christian communities can contribute towards health and healing in contemporary contexts.

In this article, the study group offers a summary of the ecumenical discussions on health, healing and wholeness that were documented in WCC publications issued between 1965 and 2005. The main insight of these discussions was that health is not only physical and/or mental well‐being but includes the social and spiritual and other dimensions as well. This is reflected in the definition of health approved by the WCC in 1989: “Health is a dynamic state of well‐being of the individual and society, of physical, mental, spiritual, economic, political, and social well‐being – of being in harmony with each other, with the material environment and with God.” 4 This expanded definition of health leads us to the Christian understanding that healing is not only and not primarily medical. Healing then includes, for instance, addressing the spiritual needs of sick persons as well as working for justice, peace and the integrity of creation. Moreover, the role of congregational and non‐congregational communities and faith‐ based and governmental organizations as well as individual Christians in the field of health and healing becomes obvious. Faith communities/congregations in particular are called to practise healing in various ways. They contribute to healing as social networks, as places of teaching and learning together, and as advocates for justice, peace and the integrity of creation. Healing is practised in liturgical acts and through nurturing and practicing charismatic gifts, through counselling and caring, and through creating safe and open spaces. Faith communities have a role in promoting primary health care, and can become vital partners of the formal health sector. This contribution aims to reaffirm the healing mission of the church, and to encourage churches, plus Christian communities and organizations, to engage in this ministry, and thus take part in God's mission of transforming the world. 5 Beate JAKOB     

Physician-assisted suicide reconsidered: dying as a Christian in a post-Christian age.

The traditional Christian focus concerning dying is on repentance, not dignity. The goal of a traditional Christian death is not a pleasing, final chapter to life, but union with God: holiness. The pursuit of holiness requires putting on Christ and accepting His cross. In contrast, post-traditional Christian and secular concerns with self-determination, control, dignity, and self-esteem make physician-assisted suicide and voluntary active euthanasia plausible moral choices. Such is not the case within the context of the traditional Christian experience of God, which throughout its 2000 years has sternly condemned suicide and assisted suicide. The wrongness of such actions cannot adequately be appreciated outside the experience of that Christian life. Traditional Christian appreciations of death involve an epistemology and metaphysics of values in discordance with those of secular morality. This difference in the appreciation of the meaning of dying and death, as well as in the appreciation of the moral significance of suicide, discloses a new battle in the culture wars separating traditional Christian morality from that of the surrounding society.     

Prioritizing Rights in the Social Justice Curriculum

The biggest problem facing schools having social justice curricula, beyond implementation of a programme, I claim, is the problem of justification: what grounds what in social justice and how do we make this manifest to ourselves and to the curricula? If we cannot address this, then social justice curricula are doomed to begging the question. I claim that a ranking of human rights is not only necessary to adjudicate competing claims for social justice and at the same time, thwart interference with already agreed-upon human rights: it is necessary for any curriculum of social justice for schools. That is to say, curricular programs of social justice cannot justify social practices that interfere with human rights, nor can they teach otherwise than this. Due attention to the violation of human rights is necessary, I shall argue, and must be central in the discussion of education for social justice.     

Paying for medical care: a Jewish view

According to Jewish law, there is a clear obligation to try to heal, and this duty devolves upon both the physician and the society. Jewish sources make it clear that health care is not only an individual and familial responsibility, but also a communal one. This social aspect of health care manifests itself in Jewish law in two ways: first, no community is complete until it has the personnel (and, one assumes, the facilities) to provide health care; second, the community must pay for the health care of those who cannot afford it as part of its provision for the poor. The community, in turn, must use its resources wisely, which is the moral basis within the Jewish tradition for some system of managed care. The community must balance its commitment to provide health care with the provision of other services.     

Widows, women, and the bioethics of care.

Widows, women, and the bioethics of care must be understood within an authentic Christian ontology of gender. Men are men and women are women, and their being is ontologically marked in difference. There is an ontology of gender with important implications for the role of women in the family and the Church. The Christian Church has traditionally recognized a role for widows, deaconesses, and female monastics, which is not that of the liturgical priesthood, but one with a special relationship to care and therefore with particular implications for health care and a Christian bioethics of care in the twenty-first century. In the shadow of early male mortality, women as wives should turn to support their husbands and as widows to support those in need. Widows, in becoming authentic Christian monastics, can bring into the world an icon of rightly ordered women providing rightly ordered Christian care for those in need. They can enter the moral vacuum created by misunderstandings of the place of women and the service vacuum created by a disappearance of religious nuns in Western health care facilities with a presence that is at one with the Church of the Fathers.     

Health care and the prospective Pareto principle

Issues of social justice in access to health care are examined from the standpoint of the "prospective," or "ex ante," Pareto principle, an ethical principle which holds that one policy is to be preferred over another if it betters the prospects of some persons while the alternative betters no one's prospects. It is suggested that this principle may validate a form of utilitarianism in health policy decisions, with equity demanding that everyone have access to a decent minimum of care but not necessarily to all highly expensive treatments.     

论影响卫生资源分配公平性的因素

公平分配卫生资源是促进社会公正的重要方面.观念、体制与政策是影响卫生资源公平分配的重要因素.重医疗、轻预防的观念使宏观卫生资源分配失去公平,而城市尤其是大中城市优先的制度安排、按医疗项目付费方式的弊端、医疗保障体制的不公平等体制与政策因素则使微观卫生资源分配失去公平.从观念因素、体制与政策因素两个方面入手,改进卫生资源分配的公平性,是我国提高全民健康水平、促进社会公正的必由之路.     

PESSIMISTIC UNIVERSALISM: RETHINKING THE WIDER HOPE WITH BONHOEFFER AND BARTH

This article considers Christian universalism. Responding to the charge that this universalism arises from an overly optimistic view of humanity that fails to take seriously evil and sin, or that it has an overly optimistic view of the omnipotence of God's love which impugns God's righteousness and undermines God's justice and holiness, the article advocates a pessimistic approach to Christian universalism, grounding the argument for universal salvation in the sin and unbelief of the Christian. The article draws on Karl Barth and Dietrich Bonhoeffer to support this case, and concludes by pointing to non‐absolute actualistic anthropology as a means for making sense of the Christian life alongside the co‐sinfulness of the Christian and the non‐Christian.     

不同高血压治疗指南的比较与分析

为了更好的控制高血压的发病率和死亡率,达到对高血压患者的最佳和规范化治疗,各国家和地区的医疗机构均制定了相应的治疗指南,并及时进行更新和修正.由于这些指南之间存在着不同程度的差异,导致医疗工作者在学习和实践中产生了一定的困惑,通过运用哲学的思维和方法论对四种主要的高血压治疗指南的异同点进行比较和分析,有利于我国临床医师更好地将其运用于临床,从而更好地控制高血压患者的病情.     

Solidarity,justice, and recognition of the other

Solidarity has for a long time been referred to as the core value underpinning European health and welfare systems. But there has been debate in recent years about whether solidarity, with its alleged communitarian content, can be reconciled with the emphasis on individual freedom and personal autonomy. One may wonder whether there is still a place for solidarity, and whether the concept of justice should be embraced to analyse the moral issues regarding access to health care. In this article, I will answer this question by analysing the normative foundations of the concept of justice, followed by a deeper examination of the concept of solidarity in continental philosophy. More specifically, I will compare the philosophical traditions rooted in Kant (with emphasis on autonomy and individual rights) to approaches rooted in Hegel (with emphasis on individual relations of recognition). In addition, I will present the work of Avishai Margalit on the decent society to criticize a predominantly liberal approach to access to health care. The importance of solidarity lies particularly in its emphasis on relational aspects and the role of recognition in care practices, which are usually ignored in liberal approaches to justice. However, the article will argue that solidarity is not an alternative to a rights-based concept of justice, but must be considered as a necessary complement to it.     

Understanding equality in health care: a Christian free-market approach.

This paper examines the arguments presented by the Roman Catholic Bishops in their 1993 Pastoral Resolution, Comprehensive Health Care Reform: Protecting Human Life, Promoting Human Dignity, Pursuing the Common Good, concerning health care reform. Focusing on the meaning of equality in health care and traditional Roman Catholic doctrine, it is argued that the Bishops fail to grasp the force of the differences among persons, the value of the market, and traditional scholastic arguments concerning obligatory and extraordinary health care. To attempt to equalize the distribution of health care would be ruinous. A more traditional understanding of Christian thought reveals an acceptance of inequality in health care distribution and a bias against using the secular state to coerce a solution to such concerns for social justice.     

On the Christian in Christian bioethics.

What is Christian about Christian bioethics? And is an authentically Christian bioethics a practical possibility in the world in which we find ourselves? In my essay I argue that personhood and the personal are so fundamental to the Christian understanding of our humanity that body, soul, and spirit are probably best understood as the components of a triune (as opposed to dual) aspect theory of personhood. To confess to a Christian bioethics is to admit that Christians cannot pretend fully to understand either cures or their meaning. However effective and "knowledge-based" contemporary medical interventions are, a Christian must humbly and honestly confess a lack of complete knowledge on both levels. At the same time, a Christian bioethicist must express a total personal commitment to Christian Faith.     

The Lost Voice: How Libertarianism and Consumerism Obliterate the Need for a Relational Ethics in the National Health Care Service

This article analyzes the contribution Christian ethics mightbe able to make to the ethical debate on policy and caregivingin health and social care in the United Kingdom. The articledeals particularly with the concepts of solidarity and subsidiaritywhich are essential in Christian social ethics and health careethics, and which may be relevant for the ethical debate onhealth and social caregiving in the United Kingdom. An importantargument in the article is that utilitarian and market-drivenpolicies in the National Health Service (NHS) and the socialcare system have marginalized the position of the elderly andhave seriously impoverished the quality of care for the elderly.The neglect of the elderly and other vulnerable groups is alsothe result of widespread consumerist attitudes among patientsand of libertarian models of noninterference which are affirmedby a public ethos of self-sufficiency and counter-dependency.Those who need care dare not make their need known to othersand ask for help, while simultaneously those who could helpare so intimidated by the public affirmation of privacy andnegative rights that they do not dare to offer help except ifthis is explicitly demanded. This distant and standoffish attitudeis in an important way responsible for the fact that the voiceof those in need is altogether lost to the public forum. Christianethics puts much emphasis on responsibility and solidarity withthe needy other but is not able to have much impact on the deliveryof care in a secularized society and health care system likethe NHS. Nonetheless, Christianity still has a powerful andrespected voice, by speaking up for those who cannot speak forthemselves, such as the elderly and the handicapped. Christianscan find allies in the ethics of care and other relational approachesin health care ethics in order to combat libertarianism, consumerism,and utilitarianism.     

Religion and Public Health: Moral Tradition as Both Problem and Solution

Despite strong religious influence in the development of medicine and medical ethics, religion has been relatively absent in the rise of preventive medicine and population health. Episodic, clinical medicine has a powerful hold on the religious imagination in health care. Nevertheless, Hebrew Scripture, elements of rabbinical teaching, and modern concepts of social justice all can be used to inspire action in health care that goes beyond clinical medicine. The Christian tradition can call upon the corporal works of mercy, virtue ethics, and Catholic social teaching, as well as the modern history Catholic sisters in the U.S. to do the same. By considering the moral imperative for public health, Jewish and Christian individuals and organizations reaffirm the notion that the human person is both sacred and social. This article suggests a need for religious traditions to consider their moral traditions anew with an eye toward prevention and population health.

     

Called to be holy: the transformative potential of Christian service programmes in Catholic schools

This is the second in a series of four papers which seeks to articulate theologically and practically the consequences of the ecclesial identity of the Catholic school. The series is based on the principle that the ‘marks’ of the Church – one, holy, catholic, and apostolic – are also marks of the Catholic school, since the Catholic school is within the Church and derives its ecclesial identity from the Church. Each paper analyses one of these ‘marks’, discerning what it means theologically and practically for the Catholic school. In this paper, the second of the marks of the Church and therefore of the Catholic school – holiness – is discussed in terms of what it means to be, and to continually become, holy. In reference to a current research project, Christian service programmes in Catholic schools are analysed in regard to what they already contribute to the formation in holiness of Catholic students, but also in terms of what more they may become. It is argued that for their potential for growth in holiness for teachers and students to be fully realised, Christian service programmes need to be more than just charitable works, and that they need to engage critically with inequity and injustice in keeping with the Church’s radical social teaching.