Managed Care, Catholic Vision, and the Claims of Justice

There are numerous challenges posed to Roman Catholic healthcare institutions by recent developments in health care delivery.Some are practical, involving the acceptable limits of accommodationto and collaboration with secular networks of health care delivery.Others, quite often implicated in the first set, are explicitlytheological. What does it mean to be a distinctively Roman Catholichealth care institution? What are the nature and the scope ofRoman Catholic institutional identity? More broadly, what isthe moral relevance of themes in Roman Catholic social teachingto the provision of health care? This issue of Christian Bioethicsaddresses these questions with a spirited exchange among itsauthors. They offer noticeably different perspectives on thegeneral cogency of Roman Catholic social teaching and differentstrategic recommendations for Roman Catholic institutions tomaintain, or recover, their distinctive presence in health caredelivery.     

THEOLOGICAL ETHICS, THE CHURCHES, AND GLOBAL POLITICS

Several discourses about theology, church, and politics are occurring among Christian theologians in the United States. One influential strand centers on the communitarian theology of Stanley Hauerwas, who calls on Christians to witness faithfully against liberalism in general and war in particular. Jeffrey Stout, in his widely discussed Democracy and Tradition (2004), responds that religious people ought precisely to endorse those democratic and liberal American traditions that join religious and secular counterparts to battle injustice. Hauerwas, Stout, and many of their interlocutors envision liberal U.S. culture as the context of Christian social ethics. The ensuing debate rarely incorporates Catholic scholars, feminist scholars, scholars of color, or international and liberationist voices. Their inclusion could enhance an understanding of the role of the church in society, and support a common morality in the face of global pluralism. More importantly, it could broaden the scope of discourse on religion and politics to envision global Christian social ethics.     

Putting on Virtue Without Putting Off Feminists

Mary Wollstonecraft's account of virtue discourse and formation, which deploys ancient and medieval ethical resources for modern purposes, challenges a prevalent narrative in Christian ethics today. Several prominent Christian virtue ethicists have left the false impression that serious reflection on the virtues depends on pre‐modern traditions and the eschewal of modern resources. Troubled by skeptical quandaries and the difficulty of adjudicating conflicting claims about virtue, they are concerned with securing a pre‐modern court of appeals. Many feminists worry that these appeals unduly constrain because they naturalize what is contingent and fix what should be open to debate. Wollstonecraft does not share the skeptical concerns and so has no need for metaethical appeals. Adapting Edmund Burke's moral philosophy, her use of virtue discourse deploys his metaphor of “the wardrobe of the moral imagination” to more religious, radical, and democratic ends. This way of proceeding signals the possibility of a rapprochement between feminists of various stripes and those interested in deploying the discourse of the virtues for contemporary Christian ethics.     

THE EVOLUTIONARY BASIS OF RELIGIOUS ETHICS

Abstract. I propose that religious ethical traditions can be understood as cultural expressions of underlying evolutionary processes. I begin with a discussion of evolutionary theories of morality, specifically kin selection and reciprocal altruism, and then discuss some recent work on the evolution of religion, setting out those features of religion that prepare it to take on a moral function in society. Having established the theoretical framework for the thesis, I turn to a close reading of early Jewish and Christian ethical teachings, as found in the Bible, in order to set out preliminary support for the proposal. My goal is to argue for the plausibility of the thesis and to indicate how, if correct, it provides new insight into Judeo‐Christian moral traditions and into the phenomenon of religious violence. Such an approach to religious ethics has important metaethical implications. In the last section I consider issues such as the foundation of ethics and the possibilities and limitations of a secular ethics.     

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.     

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.     

BRICOLAGE AND THE PURITY OF TRADITIONS: Engaging the Stoics for Contemporary Christian Ethics

This essay is a response to C. Kavin Rowe's critique of my 2011 argument that certain dimensions of Roman Stoic ethics are at work in Jonathan Edwards's moral thought. Rowe raises questions about the act of selectively retrieving ideas from a philosophical tradition to support constructive work in another tradition. I argue for the importance of acknowledging how Christian thought has been shaped by what Jeffrey Stout describes as moral bricolage, the selective retrieval of ideas from various traditions, and I contend that this bricolage can continue to be a fruitful means through which Christian ethics engages external traditions. Moreover, the importance of Stoicism's retrieval in early modern philosophy makes the work of eighteenth‐century theologians such as Edwards a particularly valuable resource for exploring the plausibility of Christian engagement with the Stoics.     

Recognition and Social Justice: A Roman Catholic View of Christian Bioethics of Long-Term Care and Community Service

Contemporary Christian ethics encounters the challenge to communicategenuinely Christian normative orientations within the scientificdebate in such a way as to render these orientations comprehensible,and to maintain or enhance their plausibility even for non-Christians.This essay, therefore, proceeds from a biblical motif, takesup certain themes from the Christian tradition (in particularthe idea of social justice), and connects both with a compellingcontemporary approach to ethics by secular moral philosophy,i.e. with Axel Honneth's reception of Hegel, as based on Hegel'stheory of recognition. As a first step, elements of an ethicsof recognition are developed on the basis of an anthropologicalrecourse to the conditions of intersubjective encounters. Theseconditions are then brought to bear on the idea of social justice,as developed in the social-Catholic tradition, and as systematicallyexplored in the Pastoral Letter of the United States Conferenceof Catholic Bishops, Economic Justice For All (1986). Proceedingfrom this basis, aspects of a Christian ethics of communityservice with regard to long-term care can be defined.     

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.     

How Christian upbringing divides the religious nones in Britain: exploring the imprints of Christian upbringing in the 2016 EU referendum

ABSTRACT

Over the last few decades, Britain has witnessed a significant decline in Christian affiliation and the corresponding growth in the number of religiously unaffiliated individuals. Relatively little attention has, however, been paid to ‘former Christians’ who were brought up in a Christian household but now identify as having no religion. This study focuses on the effects of Christian upbringing on the voting behaviour of religious nones in the EU referendum of 2016. Using data from the 2016 British Social Attitudes survey, the empirical analysis in this article examines the socio-cultural characteristics of Anglican, Catholic, and ‘Other Christian’ households as well as their role in shaping the voting turnout and the voting intentions of individuals who are religiously unaffiliated. The results suggest that Anglican upbringing and Catholic upbringing serve as salient proxies for national identities among the secular groups. Additionally, in the EU referendum, the voting behaviour of religious nones with different kinds of Christian upbringing was very distinct. This reveals that religious upbringing is a source of within-group variety among British religious nones and that Britain’s Christian heritage still has important socio-political implications despite the decrease in the country’s Christian population.     

Bioethics and natural law: the relationship in Catholic teaching.

In the discipline of Catholic moral theology, bioethics (traditionally described as medical ethics) has held a major place. The systematic development of bioethics has drawn principally upon a natural law ethic, supported by broader religious arguments. The purpose of this essay is to examine the status and role of natural law in Catholic teaching as it bears upon bioethics.     

Renegotiating Aquinas

While Roman Catholic feminist ethicists typically endorse moral realism and crosscultural standards of justice, they also have been influenced by the postmodern interrogation of abstract reason and moral universalism. As theologians writing after the Second Vatican Council, they are increasingly sensitive to the communal and ecclesial dimensions of morality and of Christian ethics, and to the integral relation of Christian faith and ethics. This essay will consider two approaches to Catholic feminist ethics that differ in the relative weight they give to constructive work for social justice (realist gender justice ethics), or to the grounding of ethics in prayer and mysticism (postmodern gendered faith ethics). Using critical feminist reappropriations of the theology and ethics of Aquinas as examples, this essay will argue that the two approaches are overlapping and interdependent.     

When the Common Good Takes the Grand(est) Stage The Cosmic Common Good: Religious Grounds for Ecological Ethics,Daniel P. Scheid,Oxford University Press, 2016 (ISBN 978‐0‐19‐935943‐1), xvi + 248 pp., hb £19.99

Rooting itself in Catholic social teaching rather than theology of creation, this book develops a novel approach to Catholic ecological ethics. It argues that the traditional conception of the social common good should be fully broadened to encompass all creation, including abiota. Furthermore, the book suggests a comparative‐theological approach to ecological ethics through careful conversations with Buddhist, Hindu, and American Lakota conceptions and practices. While its vision of the cosmic common good at times appears too inclusive and perhaps ‘too good to be true’, this book is a valuable contribution to Christian ecological ethics and includes a fresh comparative‐theological take on ecological questions.     

Thinking theologically about modern medicine

In the last century the dictates of modern science and technology have gained an unprecedented authority, sometimes heeded with a religious fervor once directed at religious bodies. Meanwhile, on many subjects, mainline Protestantism has withdrawn from the conversation. This is particularly the case when church and academy have tried to think theologically about the highly technical and at times dramatically nontheological problems of physical health. I propose to look at the ways in which this decline from dominance affects 1) mainline attitudes toward healing; 2) Protestant reflections on moral dilemmas in medicine; 3) religious ideals of ministry to the sick and the poor. After attending to the problems in each arena and then noting promising developments, I conclude with suggestions about reviving a vibrant theological witness in medical ethics and health care.     

The Invention of Modern Moral Philosophy A Review of The Invention of Autonomy by J. B. Schneewind

This review essay assesses the significance of J. B. Schneewind's The Invention of Autonomy for the history of moral thought in general and for religious ethics in particular. The essay offers an overview of Schneewind's complex argument before critically discussing his four central themes: the primacy of Immanuel Kant, the fundamentality of conflict, the insufficiency of virtue, and community with God. Whereas Schneewind argues that an impasse between modern natural law and perfectionist ethics revealed irresolvable tensions withing Christian ethics and thus encouraged the emergence of secular moral thought, this author suggests that these tensions were specific to a voluntarist strand of Christian moral thought form which even antivoluntarists of the modern period were unable to break free.     

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.     

Religious education programme of the Catholic Church in Hong Kong: Challenges and responses since 1997

The Catholic Church, the largest school-sponsoring body in Hong Kong, is a major provider of religious schools and educational programmes. In 2006, the Catholic Diocese released its first centralised and comprehensive curricular document concerning religious and moral education (RME) in Catholic schools. Taking this programme as a reflection of the Church’s response to the challenges of a changing social milieu, severed church–state relations and shortcomings in Catholic education in post-1997 Hong Kong, this article reviews the framework and principles of the new curriculum. While retaining strong religious elements in its curriculum, the Catholic Church has widened and re-oriented its programme, and re-designed the contents and pedagogical methods. The new programme is characterised by adjustment and differentiation, upholding Christian faith, and selective absorption of Chinese culture. This article also discusses problems in the implementation of the new programme, including organisational compartmentalisation and an underdeveloped political dimension in the content.     

CATHOLIC ETHICS AS SEEN FROM PADUA

During the summer of 2006, over four hundred Catholic ethicists from around the world gathered for four days in Padua, Italy. About sixty of the conference papers have become available in two edited collections, Catholic Theological Ethics in the World Church: The Plenary Papers from the First Cross‐cultural Conference on Catholic Theological Ethics, and Applied Ethics in a World Church: The Padua Conference. As the conference was marked by a distinctive and creative tension—between the diversity which characterized the nationalities and cultural identities of the participants, on the one hand, and the commonness of their religious heritage, on the other—these essays can tell us much about contemporary Catholic ethics in its response to global pluralism. The following develops four reflections. First, the conference papers pursue a style of scholarship that is at once critically creative and ecclesially rooted. Second, the conference raises new concerns about the importance that Christian formation must have in a pluralist world. Third, the participants affirm and defend the ultimate universality of moral goods while also arguing that these goods are expressed and embodied in unavoidably particular ways. Finally, the most important contribution that Catholic ethics can make to public conversations about issues of common concern is through its articulation and defense of key human values.     

Attitudes toward religious diversity among American exemplars of Christian virtue

An important concern within contemporary Western societies is how religious adherents view and engage religious diversity. This study attempts to further understandings regarding religious diversity in contemporary society through the accounts of American Christian religious exemplars whose religious identification spans the conservative evangelical, liberal Protestant and Roman Catholic traditions. Ninety‐six in‐depth interviews were conducted with individuals recognized by their congregational leadership as exemplifying Christian virtues and thereby Christian commitment. Weak denominational allegiances, accompanied by salient identification with broad Christian religious traditions were found. Mainline/liberal Christians tended to identify conservative/evangelical Christians as ‘others’, while conservative/evangelical Christians identified Mormons as ‘others.’ Also, a shift in attitudes toward Catholics was found among Protestants, and attitudes toward non‐Christian religions were respectfully civil across a range of theological understanding of these religions. The implications of these findings for religious identity in contemporary society are explored with particular attention to religious diversity.