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.     

Catholic social justice and health care entitlement packages.

This paper explores the implications of Roman Catholic teachings on social justice and rights to health care. It argues that contemporary societies, such as those in North America and Western Europe, have an obligation to provide health care to their citizens as a matter of right. Moral considerations provide a basis for evaluating concerns about the role of equality when determining health care entitlements and giving some precision to the widespread belief that the right to health care requires equal entitlement to health care benefits.     

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.     

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.     

Catholic health care in the United States: American pluralism and religious meanings.

This essay chronicles the development of Catholic health care in the United States during the Nineteenth and Twentieth Centuries. The author points to the religious pluralism and the respect for that pluralism as well as to the evangelical drive for conversion evident in Catholic hospitals. This essay is a phenomenological study of this commitment to pluralism and the evangelical impulse within the contexts of health care.     

Sterilization, Catholic health care, and the legitimate autonomy of culture.

Disagreement over the legitimacy of direct sterilization continues within Catholic moral debate, with painful and at times confusing ramifications for Catholic healthcare systems. This paper argues that the medical profession should be construed as a key moral authority in this debate, on two grounds. First, the recent revival of neo-Aristotelianism in moral philosophy as applied to medical ethics has brought out the inherently moral dimensions of the history and current practice of medicine. Second, this recognition can be linked to Catholic morality through Vatican II's affirmation of the legitimate autonomy of culture, including the sciences. A partial precedent for understanding the moral authority of medicine can be found in the recent history of Catholic medical morality, and we further argue that a full contemporary recognition of that authority would weigh against an absolute prohibition of direct sterilizations. Institutionally, we propose the allowance of direct sterilizations in cases where the clinically perceived biomedical good of the patient is at stake.     

Review of quantity and types of spirituality research in three health care databases (1962-1999): implications for the health care ministry

Using computer technology to identify the term "spiritual," these researchers present results of the 2306 citations and compare five criteria discovered with research reported in four pastoral counseling journals. The authors note the limitations of such a search and the possible implications of the findings for health care ministry.     

Pastoral care and miscarriage: A ministry long neglected

Ministers often are estranged from the loss experience of women who miscarry. This paper gives medical information about such spontaneous abortions, describes several factors that shape the woman's experience, and explores possible pastoral response.Swanee Hunt is a candidate for Th.D. in pastoral care and counseling at Iliff School of Theology, Denver, Colorado. She is part of an ecumenical ministry team that serves both a Presbyterian church community and a Catholic church community.     

Jewish and Roman Catholic approaches to access to health care and rationing

In addressing issues of access to health care and rationing, Jewish and Roman Catholic writers identify similar guiding values and specific concerns. Moral thinkers in each tradition tend to support the guarantee of universal access to at least a basic level of health care for all members of society, based on such values as human dignity, justice, and healing. Catholic writers are more likely to frame their arguments in terms of the common good and to be more accepting of rationing that denies beneficial and needed health care to some persons. Jewish writers are more likely to consider individual responsibility for illness in allocation decisions and to accept differences in health care that different members of society receive. The article considers the relevance of both shared and complementary perspectives for deliberations in nations such as the United States.     

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.     

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.     

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.