Pope Francis and the Transformation of Health Care Ethics

Todd A. Salzman, Michael G. Lawler

• Publisher: Georgetown University Press
• Year: 2021
• ISBN:
  9781647120726
• Topic: Théologie et religion
• Subtopic: Déontologie et religion

Inspired by the teachings of Pope Francis, Salzman and Lawler provide the first extended critical commentary on the 2018 Ethical and Religious Directives for Catholic Health Care Services ( ERD ), proposing new ways forward for US Catholic health care ethics that prioritize human dignity as their guiding principle.

CHAPTER ONE

The Sources of Ethical Knowledge and Tensions in the ERD

In this chapter we explore the traditional sources of ethical knowledge and how their selection, interpretation, prioritization, and integration (SIPI) lead to different perspectives on the teachings and directives of the revised ERD. Before we embark on our critical analysis of the ERD’s selection of the sources of ethical knowledge and its ethical method, however, we preface an important caveat. The ERD’s preamble specifies that the document has “been refined through an extensive process of consultation” that included bishops, theologians, physicians, administrators, sponsors, and other health care providers. It further specifies that the ERD provides “standards and guidance” but does not “cover in detail all of the complex issues that confront Catholic health care today.” It commits the ERD to periodic review “in light of authoritative Church teaching, in order to address new insights from theological and medical research or new requirements of public policy” (ERD, 4). The primary objective of the ERD is not to be a systematic reflection on ethical method or the SIPI of ethical sources but to provide moral and pastoral guidelines for Catholic health care institutions based on Church teaching. In our critical analysis, therefore, we can only deduce the ethical method of the ERD and its SIPI of the sources of ethical knowledge on the basis of Church ethical teaching in general. We review the case of Bishop Thomas J. Olmsted of Phoenix to evaluate the SIPI of the Catholic sources of ethical knowledge in the ERD and to demonstrate why future revisions of the ERD ought to include additional methodological clarifications on how to interpret and apply the ERD when conflicts between bishops arise.

THE SOURCES OF ETHICAL KNOWLEDGE AND ETHICAL METHOD

We begin our exploration of the sources of ethical knowledge and ethical method with a definition. Theologian Bernard Lonergan defines method as “a normative pattern of recurrent and related operations yielding cumulative and progressive results.”¹ Operations comprise such processes as gathering evidence, understanding, marshaling, and evaluating the evidence, making judgments, and deciding to act. To construct a normative pattern, ethical method must account for both epistemic claims about how we know ethical truth and normative claims about how we justify the content of that truth and apply it in specific cases. Catholic ethical method is a theological method that proposes both an epistemology for reaching ethical truth and a normative pattern for reaching a definition of human dignity and formulating and justifying norms for its attainment. The epistemology we follow in this work, as discussed in the introduction, is perspectivism that recognizes plural claims for the definition of human dignity. By common theological agreement, the sources of Christian ethical knowledge to construct and justify a normative ethics are found in what is known as the Wesleyan Quadrilateral, four established sources of Christian ethical knowledge, namely, scripture, tradition, science, and human experience.

More than fifty years ago the Second Vatican Council’s Gaudium et Spes wisely instructed all people of good will to discern “the signs of the times” (GS, 4) and to interpret them in light of the Gospel. Although the content of this scrutiny has changed and evolved over fifty years, especially in health care ethics, the sage advice remains an ongoing invitation and challenge. Some of the tools suggested to guide us in this discernment process are “the experience of past ages, the progress of the sciences, and the treasures hidden in the various forms of human culture, by all of which the nature of [humanity] . . . is more clearly revealed and new roads to truth are opened” (GS, 44). Science and experience, which always includes culture, along with scripture and the Christian tradition, comprise the Wesleyan Quadrilateral.

We use the Quadrilateral to respond to the call from the Second Vatican Council for the renewal of Catholic theological ethics and to explain a Catholic ethical method in health care for the twenty-first century. We do so for five reasons. First, the Quadrilateral includes the sources of ethical knowledge we judge essential for doing Christian ethics, sources highlighted in various ways in Church teaching in general and in the documents of the Second Vatican Council in particular. Second, these four sources are essential to any Christian discernment of what is right or wrong, good or bad, though particular perspectives, as we shall see, select, interpret, prioritize, and integrate the sources in different ways. Third, there is a growing appreciation for and specific reference to these sources in Catholic ethical literature from divergent perspectives, though there remains the need for dialogue to investigate how the sources are to be selected, interpreted, prioritized, and integrated.² This dialogue will clarify the use of the sources and illuminate plural perspectives. Depending on their SIPI of the sources, different people may well reach different normative conclusions on medical ethical issues. Some will conclude that removing Terri Schiavo from artificial nutrition and hydration (ANH) was wrong; some will conclude it was right. Some will conclude direct sterilization is always wrong; some will conclude it can, on occasion, be right. Perspectivism accounts for these plural judgments.

Fourth, Christian ethics is grounded in faith in a God of love, compassion, and justice, and from this God we can derive meaning in life and find inspiration to realize a pacific resolution of conflict. The four sources of ethical knowledge, scripture, tradition, science, and experience, can guide us in our analysis, evaluation, and response to complex medical ethical issues that confront us on a daily basis and can invite a comprehensive and comprehensible response. Fifth, use of these four sources combined informs Catholic ethics to construct a normative pattern for a comprehensive, credible, and consistent ethical method to guide both the Church’s teaching in health care ethics and individuals’ formation of their well-formed consciences. The sources are methodological components facilitating a perspectivist and developing understanding of human dignity and of the norms that facilitate its attainment. Gaudium et Spes and, as we shall see in chapter 3, Pope Francis’s Amoris Laetitia and Laudato Si’, provide revolutionary methodological insights that serve as “manifestos” for Catholic ethics to aid all people of good will and institutions in the search for ethical truth.³

THE SOURCES OF ETHICAL KNOWLEDGE

Catholic ethics draws on four sources: scripture, tradition, science, and human experience. We consider each in turn.

Scripture

The Second Vatican Council’s Decree on Priestly Formation prescribes that the scientific exposition of moral theology “should be more thoroughly nourished by scriptural teaching” since scripture is the “very soul of sacred theology.”⁴ Any Catholic ethical method must integrate scripture and demonstrate how it functions in its method. When using scripture, two things must be kept in mind. First, when investigating the role of scripture in a particular ethical method, it is important to recognize that contemporary readers of scripture bring their own perspectives and presuppositions to the text. A crucial part of any investigation of Catholic ethics is to bring these perspectives and presuppositions to the fore in order to comprehend a particular method more fully.⁵ Second, the attempt to incorporate scripture into an ethical method is akin to coherently integrating the full mystery of the divine reality to which scripture attests. Sacred scripture, a collection of diverse books from diverse times and cultures, seeks to reveal the mystery of God, but this mystery is so incomprehensibly rich that it can never be grasped in a single citation or perspective.⁶ Saint Augustine teaches this most firmly in his theological statement, “Si comprehendis non est Deus,” if you understand, it is not God you understand.⁷

The fullness of revelation, Christians believe, is not contained in a scriptural book. It is contained in a person, the person of Jesus the Christ, who even after his incarnational revelation remains a mystery. The project of developing an ethical method cannot be content with mystery, and as a result, there is a fundamental tension between the truths contained in scripture and how those truths are used in Christian ethics. Christian ethics will never contain the fullness of revelation, no more than does Christian scripture, though it can reflect certain parts of that revelation that, while no doubt important and foundational, do not tell the whole story. The use of scripture in Catholic ethics is similar to the viewers at fourth-story, thirteenth-story, and twenty-first-story windows of the Empire State Building; each gets a different but no less partial view. The richness of scripture and the mystery to which it attests defy full human comprehension, though there are methodological guidelines from magisterial documents for interpreting it.

In his encyclical Divino Afflante Spiritu, Pope Pius XII laid the foundation for the methodological integration of scripture into ethical method by endorsing the historical-critical method for its interpretation. This method was reaffirmed by the Second Vatican Council’s Dei Verbum, which prescribes that scriptural texts are to be read in the “literary forms” of the writer’s “time and culture.”⁸ The Pontifical Biblical Commission’s The Interpretation of the Bible in the Church continues in this line, teaching that “Holy Scripture, in as much as it is ‘the word of God in human language,’ has been composed by human authors in all its various parts and in all the sources that lie behind them. Because of this, its proper understanding not only admits the use of [the historical-critical] method but actually requires it.” The commission insists that “the scientific study of the Bible requires as exact a knowledge as possible of the social conditions distinctive of the various milieus in which the traditions recorded in the Bible took shape.”⁹ An authentic Catholic approach to reading biblical texts could not be clearer: it is to be done using a historical-critical methodology.

Of particular relevance to this book is the commission’s application of its principles for biblical exegesis to Catholic theological ethics. The Bible is God’s word to the Church, but “this does not mean that God has given the historical conditioning of the message a value which is absolute. It is open both to interpretation and being brought up to date.” It follows, therefore, that it is not sufficient for ethical judgment that the scripture “should indicate a certain moral position,” the moral legitimacy of slavery or the prohibition of homosexual acts, for example, “for this position to continue to have validity.” We have to undertake a process of understanding the text in its sociohistorical context and of discerning its contemporary relevance “in the light of the progress in moral understanding and sensitivity that has occurred over the years.”¹⁰ It is for these reasons that Jesuit Joseph Fuchs can assert correctly that what Augustine, Aquinas, and the Council of Trent said about ethical behavior cannot exclusively control what theological ethicists say today.¹¹ We must understand, judge, and apply scripture according to the “signs of the times,” in dialogue with the other sources of ethical knowledge, all in a particular historical-cultural context.

Discovering what scripture says about ethics, therefore, is never as straightforward as simply reading a scriptural text. The reader must get behind the text to understand how the Church and its theologians interpret it and apply it to contemporary ethical issues. The Second Vatican Council issued instruction on how the scriptures of both Testaments are to be read:

To search out the intention of the sacred writers, attention should be given, among other things, to “literary forms.” For truth is set forth and expressed differently in texts which are variously historical, prophetic, poetic, or of other forms of discourse. The interpreter must investigate what meaning the sacred writer intended to express and actually expressed in particular circumstances by using contemporary literary forms in accordance with the situation of his own time and culture.¹²

It is never enough simply to read a scriptural text to find out what it says about contemporary Christian ethics. Only after its original sociohistorical context is clarified can the text be translated, interpreted, and applied in a contemporary context.

Tradition

The second source of ethical knowledge is tradition, and it is intrinsically related to scripture. Scripture and tradition are but one source of divin...