Nuala P, Kenny, OC, MD, FRCP(C) Department of Bioethics, Dalhousie Faith, Justice and Health Care: Catholic Contributions

National ‘Crises’  Developing countries-provision of basic health care  Developed countries Canada – Preservation and expansion of universal coverage, costs & privitization U.S. –Uninsured; insurance dependent on work (economy) & costs

Faith and Health Care  Health care has its grounding in religious/moral beliefs  There has been a secularization of health care institutions  Modern health care: Scientific ‘objectivity’, dominance of technology, rampant individualism, loss of the notion of the common good and a ‘fair share’

Key Catholic Values  Every person enjoys human dignity  Justice and compassion  Health care an element in the common good  Health care is a service to persons  There is a special duty to the poor and vulnerable  Responsible stewardship of resources

Health is of Moral Importance  It protects our opportunity to pursue goals  It reduces pain and suffering  It helps prevents premature loss of life  It’s loss has profound moral meaning

Public Policy is a Moral Endeavor  It is a decision for “others” who are not at the decision-making table  Policy creates possibilities for some & excludes others  Policy must respect diversity but find enough values agreement to make a decision for the common good  Citizens have a duty to promote good policy

Our Faith Brings A Moral Imagination  Respect for persons and for life  Understanding limits, grace & inter-dependence  The medicalization of life  The dependence on technology  Death-denying; death defying culture  Balancing individualism with community and the common good  Balancing Canadian needs with others

Catholic Social Teaching and Justice  Provides a moral framework to balance individual needs with the solidarity of all in the common good  This tradition is activist, interventionist and hopeful  Concerned with distributive &social justice  It is not countercultural separatism

Medicine and the Individual “ Profound changes are affecting the traditional structures of a society that is increasingly globalized and has difficulty in relating to the individual, while medicine is involved in developing diagnostic and therapeutic methods which are ever more complex and effective, but often available only to limited groups of people.” John Paul II, November 2000

The Common Good in Health and Health Care  Health need brings forth fundamental moral/religious questions Control and dependence Fear and suffering Fidelity and care Reasonable hope for benefit, risk, harm A ‘fair share’ of common resources

The Common Good “…the sum total of social condition which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily.” Gaudium et Spes (Para 74)

Requirements for the Common Good  Respect for persons  Social well-being and development of the group  Peace  Catechism #

 Each human community possesses a common good which permits it to be recognized as such; it is in the political community that its most complete realization is found  Catechism # 1910

The Context for Reflecting on the Common Good  Failure of ‘democratic deliberation’  Liberalism’s limit on the ends of society  Globalization and dominance of the market  Decline of religion; politicization of religion  Challenge to public good of health care  The technological imperative!

Solidarity … is not a feeling of vague compassion or shallow distress at the misfortunes of so many people (but)…a firm and persevering determination to commit oneself to the common good; that is to say to the good of all and to each individual, because we are all really responsible for all Pope John Paul II Sollicitudo Rei Socialis December, 1987, # 38

Commitment to The “Seamless Web of Life”  Birth  Ordinary human life  Vulnerable human life  Illness  A ‘good death’

Life is a Penultimate Good  Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good.  Catechism #2288  If morality requires respect for the life of the body, it does not make it an absolute value.  Catechism #2289

The Schiavo Tragedy  Inherently a complex situation “Bad cases make bad laws”  Has confused many re our tradition of moral judgment re ‘balancing reasonable hope of benefit with risks and harms’ Think of Pope John Paul II’s death as exemplar of a ‘good death’ in our tradition

Health Care & Justice  The health and healing concerns of the Christian community are not limited to, and much less exhausted by its focus on the health of individuals as such; it extends also to the physical and social environment in which the community lives and works…. Working to promote health and well- being is not only about curing symptoms, it also means confronting the social and political causes of suffering and injustice. Pastoral Letter –CCCB Permanent Council2005

Socio-economic Determinants of Health and Stewardship Social inequality Poverty and marginalization. Nutrition. Housing Meaningful work Education opportunity Gender

A Catholic Response to Health Systems in ‘Crisis’  Affordable, sustainable systems for all  Timely and fair access to efficient, efficacious, compassionate and respectful health care based on need not ability to pay  Improve outcomes; decrease health inequities  Focus on the entire continuum of health (from promotion to palliative care)  Re-claim the importance of the socio-economic determinants of health

What do these goals require?  Reclaim the notion of the common good  Agreement about the public good of health care in a just and fair society  Recognition of the limits of medical science  Clarification regarding the moral nature of illness and the appropriate role of the market  Reflection on the meaning of a ‘fair share’  Meaningful citizen participation Formation of conscience

The Canadian Supreme Court Decision 4-3 decision –prohibition on private insurance violates the “right to life” under s.1 of the Quebec Charter- when a patient cannot get reasonable access to public services  Court activism  Privileges the individual over the common good/public interest  Privileges the market ; rejects the policy evidence

Challenges  Individualism  Seduction by technology  The difficulty of sharing health resources  Formation of Christian conscience  Meaningful citizen engagement  Challenges for ‘public Catholics’