The question about Catholic health care is not so much whether the church should do it as how the church can do it, according to the final speaker at a conference on "Catholic Health Care Ethics: the Tradition and Contemporary Culture."
Michael Panicola, vice president for ethics at SSM Health Care in St. Louis, spent much of his talk on the challenges to Catholic health care discussing the myriad issues that make it difficult for institutions to provide health care in accord with Catholic values in contemporary American society.
His comments came at the end of a three-day conference sponsored by the Neiswanger Institute for Bioethics and Health Policy at the Loyola University Chicago Stritch School of Medicine and the Catholic Health Association of the United States, in conjunction with the Chicago Medical Society.
Challenges include working in a "morally diverse" society where even many Catholics do not understand church teachings, especially on the beginning and end of life; a growing anti-Catholic sentiment, in which Catholic health care institutions have been attacked by groups that support a right to abortion and state attorneys general; and an aging population that will require more care combined with a trend toward lower reimbursements for providing that care, Panicola said.
Those issues combine with what Panicola described as a sense of mistrust between health care administrators and some bishops, whom he sees as more conservative than in decades past and more narrowly focused on a limited palette of issues, especially those having to do with reproduction.
All of those issues are in addition to the tension between the Catholic value of the common good and the American emphasis on the individual, rising health care costs, and the growing population of uninsured patients.
Nevertheless, Panicola said, the church has little choice but to try to make and keep people healthy if it wants to follow in Jesus' footsteps.
"If it's about human flourishing, we need our physical and mental health," he said. "We (in Catholic health care) exist for people, to make them whole so they can pursue their own flourishing in the context of community. We can't turn our backs on health care because it is so fundamental."
It's difficult, Panicola acknowledged, to provide health care as a ministry in a world in which it is most often treated as a commodity.
"The circumstances are such that it's making it more difficult to be true to who we say we are," he said. "What are we meant to be as Catholic health care providers? The dominant themes in Catholic vision are human dignity and justice. It forces us to look at ourselves critically and be honest with ourselves."
To continue to exist, Panicola said, Catholic health institutions may have to take on a different form, one that competes less with for-profit and secular not-for-profit institutions and that hews more closely to the example of the religious men and women who founded so many Catholic hospitals.
"What were the founding sisters and Jesus trying to do?" Panicola asked. "They were responding to the most basic and urgent needs."
Perhaps Catholic health care now should focus itself on such needs, Panicola said, suggesting work providing care to the uninsured and the poor, and offering preventive and primary health care services, psychosocial and spiritual care and end-of-life care in clinics, home care, hospice and counseling centers.
Catholic health care institutions might stay in the business of providing acute care --- the kind typically provided in a hospital setting --- in an effort to make enough money to pay for its primary work, he said.
Several participants challenged that notion, suggesting that many Catholic health care organizations already are effectively doing that --- and, with decreasing reimbursements for acute care, such services often do not pay for themselves, let alone raise enough money to pay for other efforts.
Disaster preparedness: 'Woefully inadequate'
Preparation, response and follow-up to disasters, man-made and natural, is woefully inadequate in the U.S., and Catholic health care must help bring the social justice aspects of that situation to light, a physician and educator said March 2.
Dr. Erin Egan, who is also an attorney and teaches both bioethics and internal medicine at Loyola University Chicago, addressed a workshop session on "Preparing for the Worst: Issues in Disaster Planning," one of 10 workshops offered on the final day of the three-day conference.
"Ten years ago most of us wouldn't have cared about any of this," Egan said. "We weren't thinking about them then and I'm not sure we're thinking about them well now."
But more than 18 months after Hurricane Katrina hit, "so many horrible things are still happening in New Orleans, and it's off our radar," she said. "We in Catholic health care have to keep the faith that we'll be there until the problems are resolved."
Egan divided types of disasters into four categories: natural geological disasters such as Hurricane Katrina; natural infectious disasters such as avian flu; man-made explosive disasters such as the bombings of the World Trade Center's twin towers or the Oklahoma City federal building; and man-made infectious disasters such as anthrax.
She said she had undergone emergency preparedness training through the Illinois Medical Emergency Response Team but did not know any other colleague at Loyola who had done so.
Although she said such training is needed, she added, "I don't understand how it's going to work well."
In addition there are ethical problems with "too much money" for disaster planning going to frivolous things or allocated for political reasons and too much influence by the pharmaceutical industry on which drugs are stockpiled.
"Someone needs to be superimposing an ethic of social justice on this," Egan said. "If Catholic health care is not going to do it, I don't know who is."
Disaster planning also is needed to help people decide who should be allowed into the immediate area when a tragedy strikes and who must be kept out, she said. "Everyone wants to rush in and help but they can't and they shouldn't," she said.
Egan said someone wanting to help after the Oklahoma City bombings brought 160 pizzas for the first responders and other volunteers. But because there was no way to store them, half the pizzas became tainted with salmonella and many of the volunteers became ill, Egan said.
Catholic health care also should play a leading role in responding to any future bioterrorism threat, much as Catholics of the past ministered to those with leprosy or the plague, she said.
"The Catholic health care mission is to treat the suffering, under any circumstances," she said. "We have to start teaching people in our medical schools that these are the obligations they are taking on."
She noted that 30 percent of those who died in the first two Ebola outbreaks in Africa were Catholic nuns.
But the duty to treat is not absolute and must sometimes be weighed against other obligations, such as when a physician has young children or is the caregiver of an elderly relative, Egan said.
"We need to decide ahead of time what are our moral obligations," she added. "I'd expect that we in Catholic health care would do something differently" than others in the medical profession.
She also encouraged families to "discuss concretely what they would do in the event of a disaster."
---CNS |