Health care as an essential building block for a free society: the convergence of the Catholic and secular American imperative

As the twentieth century closes, marked by triumphal strides in medical advances, the American society has yet to ensure that each person has access to affordable health care. To correct this injustice, this article calls on the nation's political and corporate leaders, providers, and faith-based groups to join all Americans in a new national conversation on systemic health care reform. The Catholic faith tradition is one that compels both a proclamation to ministry values and a commitment to speak out against the challenges or threats to what are essential to the well-being of individuals and society. The Catholic health ministry must therefore be both a voice for the voiceless and an agent of transformation. The nation's goal should be to "reposition" health care from its status as an important, but ultimately optional building block to one that is essential.     

Rationing just medical care

U.S. politicians and policymakers have been preoccupied with how to pay for health care. Hardly any thought has been given to what should be paid for--as though health care is a commodity that needs no examination--or what health outcomes should receive priority in a just society, i.e., rationing. I present a rationing proposal, consistent with U.S. culture and traditions, that deals not with "health care," the terminology used in the current debate, but with the more modest and limited topic of medical care. Integral to this rationing proposal--which allows scope to individual choice and at the same time recognizes the interdependence of the individual and society--is a definition of a "decent minimum," the basic package of medical treatments everyone should have access to in a just society. I apply it to a specific example, diabetes mellitus, and track it through a person's life span.     

Judaism, justice, and access to health care

This paper develops the traditional Jewish understanding of justice (tzedakah) and support for the needy, especially as related to the provision of medical care. After an examination of justice in the Hebrew Bible, the values and institutions of tzedakah in Rabbinic Judaism are explored, with a focus on legal codes and enforceable obligations. A standard of societal responsibility to provide for the basic needs of all, with a special obligation to save lives, emerges. A Jewish view of justice in access to health care is developed on the basis of this general standard, as well as explicit discussion in legal sources. Society is responsible for the securing of access to all health care needed by any individual. Elucidation of this standard of need and corresponding societal obligations, and the significance of the Jewish model for the contemporary United States, are considered.     

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.     

Do the bishops have it right on health care reform?

The National Conference of Catholic Bishops has argued for significant government involvement in health care in order to assure respect for what they regard as the right to health care. Critics charge that the bishops are wrong because health care is not a right. In this article, it is argued that these critics are correct in their claim that health care is not a right. However, it is also argued that the premise that health care is not a right does not imply that the market is the most equitable and just system for providing health care. Natural law arguments in the tradition of Roman Catholic social teaching lead to the conclusion that a just and prosperous society has a moral obligation to provide health care even if there is no such right. Further, there are strong moral grounds for concluding that the bishops are correct in their claim that health care ought not to be considered a market commodity. It is argued that if health care ought not to be considered a commodity, then national health insurance is the best available alternative for fulfilling the social obligation to distribute health care resources justly and fairly at this time in American history. The bishops' case for government involvement can be made on the strength of the Catholic tradition in theological argumentation, independent of the claim that health care is a right.     

Catholic health care: rationale for ministry.

This essay attempts to describe contemporary Catholic sponsored health care in the United States and to describe the purpose and structure of these particular Christian charitable organizations within the broader society. As health care has become more complex, critics claim that there is not a need for Catholic sponsored health care any longer. The author attempts to evaluate critically whether Catholic health care has a place in contemporary society. He reviews some salient biblical, ecclesial, and justice teachings of the Church to demonstrate why religious institutional presence is still needed. The author reviews contemporary health care structures to show how this is accomplished. He also uncovers additional issues which need to be addressed in order for these charitable institutions to carry on the ministry of the Church, to shape social structures, and to proclaim the reign of God.     

Catholic hospitals and Catholic identity.

Catholic hospitals seek to offer health care in accord with the example of Christ. They have several models to assist in this effort. The first model is the values portrayed in the Gospels. The Catholic Church has sought to embody these Gospel values in specific teachings. These teachings have been further specified for hospitals in the United States by the National Conference of Catholic Bishops in the Ethical and Religious Directives. Finally, the Gospels values are also expressed for individual Catholic health care systems in mission statements and statements of Catholic identity. This article examines the worth of mission and identity statements, and explains that the statements must be put into practice through a process of internalization before they will be able to be of worth to the Catholic health care apostolate.     

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.

     

Good writers,bad Jews: the “Jewish Question” among Hungarian Jewish intellectuals of the interwar period

This paper investigates the perceived place of the Jewish writer in interwar Hungarian Jewish literature. Post-World War I Hungary suffered from the effects of a short-lived communist regime, and the Trianon Treaty by losing two-thirds of its territories and more than half of its population. Though previously Jewish communities had thrived in the country, these events caused resentment that manifested itself in the creation of anti-Semitic laws in 1920. Within this new context, assimilated liberal young Jewish writers posed the question of “what is a Jew,” reflecting on their Jewishness and Hungarianness at the same time and pondering about the value of each. They answered the question in their creative works, where they indirectly explored issues such as whether Jews are able to write Hungarian novels or whether only a Hungarian can do so; whether Jewish Hungarians could write Hungarian Jewish novels; whether Hungarianness and Jewishness are compatible or whether writing literature is preconditioned on identity. Through the lens of Aladár Komlós, this paper examines the way in which liberal and assimilated young Hungarian Jewish writers interpreted their place in Hungarian culture and society within the framework of these questions.     

Living the vision: health care, social justice and institutional identity.

This paper will examine the topic of identity in Roman Catholicism from the perspective of topics contained in or absent from mission statements of 25 Catholic health care institutions. In particular, I will look at these from the perspective of social justice as well as how this and other topics such as human dignity, sanctity of life, stewardship, pastoral care and the likelihood of mergers with other institutions will affect the healing ministry of Catholic health care providers. The article will conclude that there are three key dimensions to Catholic health care: leadership in advocating reform of the current health care system, care for the marginalized and under-insured, and the provision of pastoral care in all institutions.     

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.     

Saint and Countersaint: Catholic Triumphalism and Jewish Resistance in Baroque Prague’s Abeles Affair

In late seventeenth-century Prague, Simon Abeles, a Jewish boy of about eleven or twelve, left the Jewish quarter, studied for conversion to Christianity, returned home without converting, and then died. The boy’s father, Lazar Abeles, was charged with his murder and hanged himself in jail. Löbl Kurtzhandl, a young man who had lived with the family, was accused of being an accomplice and sentenced to death. The case became a cause célèbre as the boy came to be regarded as an unofficial local saint acclaimed in broadsides, pamphlets, and even music. A single Yiddish source, a historical song, tells the story from a Jewish point of view but, surprisingly, does not take up the question of the guilt or innocence of either Kurtzhandl or the elder Abeles, focusing instead on Kurtzhandl’s actions in his final days, hours, and moments. Burning polemics between local Christians and Jews centered on this very question, each population seeking saint-like heroes for its young members to emulate. On the Catholic side, such activity fit within a much broader context of Catholic renewal and triumphalism that capped a decades-long process of ridding Bohemia of Protestant influence. On the Jewish side, it represented active resistance against such trends.     

Decisions at the end of life: Catholic tradition.

Medical decisions regarding end-of-life care have undergone significant changes in recent decades, driven by changes in both medicine and society. Catholic tradition in medical ethics offers clear guidance in many issues, and a moral framework accessible to those who do not share the same faith as well as to members of its faith community. In some areas, a Catholic perspective can be seen clearly and confidently, such as in teachings on the permissibility of suicide and euthanasia. In others, such as withdrawal of nutrition and hydration, the Church does not yet speak with one voice and has not closed out the discussion. Yet, it is not in the teaching on individual issues that a Catholic moral tradition offers the most help and comfort, but in its account of what it means to lead a life in Christ, and to prepare for a Christian death. As in the problem of pain and suffering, it is the spiritual support more than the ethical guidance that helps both patients and physicians bear the unbearable and fathom the unfathomable.     

Organizational ethics in Catholic health care: honoring stewardship and the work environment.

Organizational ethics refers to the integration of values into decision making, policies, and behavior throughout the multi-disciplinary environment of a health care organization. Based upon Catholic social ethics, stewardship is at the heart of organizational ethics in health care in this sense: stewardship provides the hermeneutic filter that enables basic ethical principles to be realized practically, within the context of the Catholic theology of work, to concerns in health care. This general argument can shed light on the specific topic of non-executive compensation programs as an illustration of organizational ethics in health care.     

Families and therapists achieve clinical outcomes,systems of care mediate the process

Conclusion The values articulated in the system of care philosophy (Stroul & Friedman, 1994) have been necessary elements of local, state, and national efforts to reform mental health care for children. The importance of the values of family collaboration, cultural competence, interagency coordination, individualized care, and use of the least restrictive treatment setting articulated by the system of care philosophy has been affirmed by practitioners, policy makers, and mental health services researchers. Such values, however, are likely not sufficient to achieve clinical outcome. Clinical outcomes are more likely to be achieved by family members and therapists when clinical practices are changed to reflect the demanding and comprehensive work of changing child and family social ecologies.     

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.     

Latvian Baptist Traditions in Transition

I intend not so much to write about Latvian Baptist traditions in the past as to reflect on the challenges Baptists in Latvia face as part of a society which is in the process of being integrated into Western Europe. It is important to try to avoid stereotypes: as others have pointed out the declaration that 'such and such is the Baptist tradition' may mean only that 'we have done it thus ever since I can remember' or 'this is how it was done in the Baptist circles where I used to live'. Although by no means the largest denomination in Latvia, the Baptist Church occupies a distinct place in society. Statistics show that it is growing: in 1985 there were 60 congregations with 4,852 members; in 1998 the Baptist Union included 76 churches with 6,180 members. In 1998 membership grew in 33 congregations. The Baptists are now considered to be a 'traditional religion' and together with representatives from the Catholic, Lutheran, Orthodox, Old Believer and Jewish religious associations they are members of the Consultative Council for Religious Affairs of the Ministry of Justice. With other denominations, in 1988 the Baptists signed an agreement with the state on military chaplaincy, and they are one of the denominations which have a legal right to teach in state schools on religion (the Baptists and Lutherans have worked out a joint curriculum for these classes).     

Inequalities in health, inequalities in health care: four generations of discussion about justice and cost-effectiveness analysis

The focus of questions of justice in health policy has shifted during the last 20 years, beginning with questions about rights to health care, and then, by the late 1980s, turning to issues of rationing. More recently, attention has focused on alternatives to cost-effectiveness analysis. In addition, health inequalities, and not just inequalities in access to health care, have become the subject of moral analysis. This article examines how such trends have transformed the philosophical landscape and encouraged some in bioethics to seek guidance on normative questions from outside of the contours of traditional philosophical arguments about justice.     

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.     

Religious traditions as contexts of historical creativity: patterns of scientific and artistic achievement and their stability

Because fragmentary evidence linking outstanding intellectual achievement to Protestant and Jewish family background has left unclear how far any general relationship between religious background and historical creativity holds across arts and sciences, the relative fruitfulness of western religious traditions was explored by regression analysis on a data-base of nearly 1,400 notable 19th and 20th century achievers in six science-related and three arts domains.It was hypothesized that (1) religious traditions are each equipotential across countries, national totals of exceptional achievers in any domain depending simply on the numerical strength of each tradition; (2) Protestant fruitfulness is greater in the sciences, Catholic in the arts and (3) differences will have declined over time.The first two hypotheses were confirmed. More variance was explained by Protestant and Catholic totals separately than by overall population size and Protestant fractions were more productive in all sciences than Catholic, which fared better in the arts. However, no reduction was found in these differences over time. Jewish fractions showed the highest incidence of creativity, but less equipotentiality and no general arts–science difference.It is concluded that creativity in arts and sciences depends strongly on increasingly hidden cultural roots in western society.