Introduction
Healthcare represents a unique institution that helps to manage and treat illnesses and predict diseases. Church and religion play a crucial role on ethical and moral; principles followed by medical professionals and social workers. The Catholic lay associations the church chose to execute its policies are not as submissive as it probably expected. Quite often, they object to serve merely as tools of the healthcare, insisting upon their own interpretations of what action is needed in given cases.
They tend to develop their own identity. In other situations they are suppressed by governments. Occasionally, the church finds it impossible to preserve the strictly Catholic character of an organization, for instance a labor union or a cooperative. Many times the religion has to come to terms with the fact that its monopoly of dealing with diseases and illnesses ceases, so that Catholic and non-Catholic agencies begin to cooperate on a secular plane more than the church finds necessary.
Catholic principles
Following Lammers and Verhey (1998) underline that the medical agencies enable an individual to be simultaneously a faithful member of the universal religion and a good citizen in regional political processes. They are a good channel to political power in nations where a party system prevails. In the Third World, all too often parties represent merely narrow elites so that the usefulness of Catholic or Christian Democratic parties are severely limited.
As, moreover, Catholic principles are in many respects conservative while other parties are more progressive and aggressive, many Catholic followers could give their votes to these secular parties without betraying their Catholic moral principles. Sometimes, on the contrary, the failure of the church in many social institutions to dissolve alliances with the most conservative sections of the ruling groups, a Catholic conscience would drive followers and believers to secular radical parties as better qualified to produce social change than the Catholic principles. This, in turn, adds the difficulty from the standpoint of the church that the leaders of these parties disagreed with the church.
They built their own power base within the party, ignoring or even rejecting suggestions coming from the church. Another major agency is Catholic Action. It has had a checkered career in regard both to its nature and its relationship with the church. It started out during the nineteenth century as one of the many Catholic associations of the most diverse kind which proliferated when political and social conditions in Europe facilitated the growth of nongovernmental organizations and associations.
Christian moral principles applied to healthcare filed vary in character from place to place and over time. The one stable factor, whether they are political parties, workers’ associations, educational institutions, charitable organizations, or social clubs, was their Catholic orientation.
Even this ranged from overemphasis and exclusiveness to under emphasis and openness regarding Catholic membership. Gradually, Catholic Action outgrow other organizations in importance and become something like an umbrella organization with a presence in almost all parts of the world. The church singles it out as of great usefulness and gives it special attention. It plays a significant role in the attempt to apply social doctrine in all aspects of healthcare life. It is, like all other executive agencies of the religion, composed exclusively of laypersons.
Morality of medicine
Following Lammers and Verhey (1998) medicine should be moral. Greater morality in medical sphere and healthcare are unquestionably desirable. The call for community, solidarity, and the socially responsible use of private property with a simultaneous rejection of those socialist features most likely to achieve these ends, appears puzzling, even to churchmen. It appears all the more puzzling as many of the ends suggested in recent encyclicals coincide with those suggested by socialism.
Equally puzzling appears the resistance of the church to governments holding the better promise for changes in sinful structures than many of those, especially in the Third World, with whom the official church is in collusion. That the church could do little more than aim at conversion of sinful people, provide guidance for highly moral behavior, and call on states to help it achieve its aims rested in the nature of its traditional doctrine, organization, and means.
But since it has now chosen to enter into some very detailed analyses of social evils, it can hardly avoid a corresponding duty to suggest its social structures designed to eliminate the evils it found. The least one might expect is that it give free rein to those who are trying to bring about change in the spirit of Catholicism. The Liberation theologians have shown that more than appeals, some activism in conformity with the Bible is possible.
The broader question is whether the undefined structural changes demanded by the church can be brought about by states now controlled by the very people against whom the changes are directed. The erection of new structures preventing sinful people from continuing their sinful behavior might better be left to those now suffering from the sinful structures. Nowhere, however, does the church discuss specific means beyond education by which those intended to benefit most from the changes could participate in their own liberation. The paternalism characteristic of the age of alms still influences the thinking of the official church.
The broader question is whether the undefined structural changes demanded by the church can be brought about by states now controlled by the very people against whom the changes are directed. The erection of new structures preventing sinful people from continuing their sinful behavior might better be left to those now suffering from the wicked structures.
Promoting healthcare education
There is a widespread and general concern to promote healthcare education for personal and professional benefit. The church lent help by suggesting education of the clergy in social affairs. It was felt that the lack of educational opportunities for the workers facilitated their exploitation. Education, so the argument ran, would make the workers aware of their rights, their own strength, their ability to participate in politics and their entitlement to share in government.
Consequently, many of those who agreed used every political device to provide education for the workers. A dilemma was envisaged, however. Raising the status of the workers in a capitalist system might sharpen class conflict. Yet violence was condemned as un-Christian. The alternative was to be mediation by the church, a proposal which also had approval from Christian Socialists.
The role of private property was an inevitable subject in a discussion of capitalism. It apparently created no difficulty among those evaluating the Social Question from the Catholic standpoint. They took for granted that property was a gift from God and had to be used in conformity with His will. With the arrival of the twentieth century, the Social Question moved into the background. The worst results of industrialization were being overcome.
During the first half of the century social legislation was progressing. The problem of poverty was handled by governments and political parties (including Catholic parties) Theology could and did devote itself to other social problems. The appalling condition of the poor in colonial areas and Latin America were practically ignored by theologians. The lower clergy and missionaries took care of the poor with customary charity and education.
They developed an intense activity in establishing new organizations, study and research groups, educational associations, and, most important, political parties. These activities were useful. But they reached relatively small sections of the population, relative, that is, to secular movements of the time–foremost socialism and socialist organizations.
These activities were not based on an inspiring social doctrine that could have competed successfully with the appeals of Marxism and, later, other sociopolitical ideologies and activities. The Christian social movement lacked a great theorist who could formulate Christian principles to attract the society at large, it did not lack the principles for the correction of the capitalist abuses.
Because of the novelty and complexity and multifaceted and legalistic character of all these problems it is very difficult for ordinary people in the community to come to grips with them. Again, these issues cannot be discussed fruitfully in the political hurly-burly of parliamentary debate. The tendency has therefore been to set up expert committees or commissions to consider the issues in the hope that they will be able to put them into some kind of perspective, reach a consensus about them and then make recommendations to government and policymakers.
In one sense this is a Platonic or elitist idea in that it assumes that most of the life and death issues we have been discussing cannot be settled by general community debate or in the political forum. Again, there is always the danger that governmental committees will, rather like the media, engage in a certain amount of self-censorship. Members of such committees usually find it easy to discern what result the minister or the governmental authority to whom one reports, would like the committee to reach. There is then, a difficulty in reconciling the need for some degree of expertise in discussing and deciding about novel and complex bioethical issues with the need for community consultation and input.
From the fact that a majority of people is opposed to a certain development in biotechnology we cannot conclude that it is therefore morally wrong; nor, vice versa, can we argue from the fact that a majority of people accepts a practice that it is therefore morally right. People’s beliefs and attitudes are, of course, extremely relevant to determining the kind of legal control one might wish to put in place–it is, for example futile to have strict and severe laws against surrogate motherhood if most people in the community think that surrogate motherhood, duly regulated, is acceptable. But on the other hand, majority beliefs and attitudes do not settle the ethical question.
There is therefore a good deal of pressure on these committees or commissions to come up with some kind of unanimous report which will provide clear and unambiguous answers even on issues where there is public controversy and divided opinion, and which will provide the basis for governmental implementation and action. Within these moral principles also there is a very strong tendency to seek unanimity so that their views will be more persuasive to those outside.
One can understand the wish to achieve consensus among the members of a bioethics committee or commission if that is at all possible; no one wants disagreement just for the sake of disagreement and these committees are set up with practical ends in view; they cannot be debating societies or academic seminars in which all possible points of view are given an airing and no practical guidance for decision-making is indicated.
Again, there is the fear that a lack of unanimity in a report will give policymakers who wish to maintain the status quo a good excuse for doing nothing. Nevertheless, it is wholly to be expected that on the difficult and complex moral and social and legal issues posed by the new biotechnology there will be deep differences of view among even the most informed and rational people. People who argue for such a public morality in our society usually attack the excesses of individualism according to which everyone is free to pursue their own lives in their own way, so that the notion of any kind of common moral consensus or common good almost vanishes.
Translating love through charity
The medial professionals are asking the religion to live up to her demands for social and economic changes. This emphatic request is not tantamount to reducing the Gospel to a purely “earthly principles,” but merely reminding the church to practice what she is preaching. Possible political risks are of no great relevance to them. Most of them find political action desirable and inevitable, as well as a part of salvation history.
Charity is not considered equal to alms giving. Alms giving is described as inadequate because it does not cover many aspects of poverty, because it is provided on an individual basis and does not touch the social root of the evil. What is needed, the theologians say, is social charity: charity referring to a person in the economic, social, cultural, racial environment. When so interpreted, charity cannot be accomplished by conversion alone, certainly not when it is restricted to alms giving. Catholics and their church are committed to more comprehensive action. This broader kind of charity requires a committed love that translates into the preferential option for the poor. Reaching this goal requires action to eliminate the broadly conceived poverty and this, in turn, requires changes in the society.
The views of the Liberation theologians on private property are determined by the role it plays in sustaining those aspects of the system they believe need change. Very few not very prominent theologians favor the abolition of private property altogether. Most subscribe to the proposition of the late encyclicals that private property must be used in a socially responsible way and that there is a social mortgage on it.
Conclusion
In sum, healthcare should be based on moral principles and dogmas followed by the church. The use of healthcare philosophers in public sphere concerned with bioethical issues has been an unusual and, to philosophers at any rate, a welcome development over the last years. In the past, university philosophers, at least in the Anglo-American world, have been considered to be rather ‘remote and ineffectual’ and, apart from some notable exceptions, have not been seen as having much to offer in the discussion of healthcare public issues nor in the formulation of policy about those issues.
Bibliography
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Jones, L. Gregory. “A Pathology of Medical Ethics: Economic Medical Rationing in a Morally Incoherent Society.” Linacre Quarterly 57, no. 2 (1990): 59–67.
Pence, G. Medical Ethics: Accounts of the Cases that Shaped and Define Medical Ethics. McGraw-Hill Humanities/Social Sciences/Languages; 5 edition, 2007.
Veatch, R. M. Basics of Bioethics, The (2nd Edition). Prentice Hall; 2 edition, 2002.