By Stewart Clem
When your car breaks down, you take it to a mechanic. After diagnosing the problem, the mechanic gives you an estimate. You consider your options and decide whether to proceed with the repair. When the repair is completed, you pay the mechanic and drive away.
But imagine instead that your mechanic tells you, “It looks like you’ve got a head gasket leak.” “Okay, how much does that cost to repair?” you ask. “Well, we can’t repair head gaskets here. We’re a Sikh auto repair shop, and we have rules against certain repairs. You might try to find a secular auto mechanic in town who would be willing to do it.”
This Kafkaesque thought experiment is not far removed from the way most Americans think about contemporary medicine. In our public discourse about healthcare — even before everyone’s attention turned to the possibility of Roe v. Wade being overturned — there is no shortage of written and verbal commentary on religious regulations and “restrictions” on the practice of healthcare.
For example, on YouTube one can find “How Religious Restrictions Interfere,” a video created by the ACLU, in which a physician explains, “When a doctor is told by the hospital they work for that they cannot provide all the treatment options or cannot even tell their patients about all of the possible treatment options, it gets in the way of the patient making the informed decision that they need to make, that they have the right to make, about their own health.”
The video is just over two minutes long, and there is no additional context, such as the procedure being considered, the religious affiliation of the hospital, or the restriction being implemented. But the message is clear: healthcare providers have a job to do, and religion had better stay out of it.
This of course assumes that the definition and purpose of healthcare are perspicuous. They are not. While going to the ER with a broken bone might be analogous in some ways to asking to a mechanic to fix your car’s CV joint, there are fundamental differences. The practice of healthcare demands that we reflect on certain moral and metaphysical questions that simply do not arise for the mechanic. (I don’t deny that auto repair has philosophical considerations, but that’s the topic of a different essay.) For one, automobiles are made by humans, for humans. They are artifacts. Human beings are — well, what are they? And what are they for? These are profoundly philosophical questions. And that is the point.
The problem with our public discourse about healthcare is our myopic focus on policy. We assume, either through naiveté or willful ignorance, that we all know what healthcare is and what it is for. We proceed to talk past one another and (all too frequently) assume the worst about our interlocutors.
I have seen this in many cases in which a Catholic hospital refused to perform a procedure that involves direct sterilization. Although more than one in seven patients in the United States are cared for in Catholic hospitals, many people do not realize that those hospitals follow the Ethical and Religious Directives for Catholic Health Care Services, developed by the United States Conference of Catholic Bishops. The directives prohibit direct sterilization of any kind. It is true that the Catholic Church’s teaching on procreation and contraception is at odds with the views of most Americans — even most American Catholics. But there is an important lesson here, and that lesson is that the meaning of “healthcare” is not simply a given. Human civilizations have developed their various understandings of healthcare through complex matrices of practice, reflection, and public debate.
It is beyond dispute that Christianity has profoundly shaped the meaning and scope of healthcare in contemporary Western societies. This includes what many would now consider a neutral or secular conception of healthcare. The very idea of the hospital — a place where hospitality is shown to the weak and vulnerable members of society — grew out of monastic practices and was grounded in a Christian understanding of human dignity. Many of the basic moral principles that underlie contemporary medicine were once unpopular and only became mainstream with the spread of Christianity.
The most important questions about the end or purpose of healthcare are not empirical. They are not even exclusively “religious.” They are philosophical questions about the nature of human beings and human bodies, and they remain subjects of debate among physicians and medical ethicists of all persuasions.
Victoria Sweet, in her fascinating memoir God’s Hotel, recalls her time as a doctor at the Laguna Honda Hospital in San Francisco, the last remaining almshouse in the country and a descendant of the Hôtel-Dieu that cared for the sick in the Middle Ages. As a student of medical history, Sweet describes how she applied her research on Hildegard of Bingen to her medical practice. Hildegard described the human body as a plant, whereas the dominant metaphor for the body in contemporary medicine is a machine. These competing metaphors lead to vastly different approaches to medicine, and Sweet writes in vivid detail about the ways in which contemporary medicine could benefit by incorporating both approaches.
Any approach to healthcare will rely, implicitly or explicitly, on assumptions about the nature of human beings and the nature of reality. Would it not be better for these to become articulated commitments rather than unexamined assumptions?
The fact of the matter is that any articulated vision of healthcare — any vision that does not fall prey to the myth of neutrality or assume that the ends of healthcare are plainly obvious — will provide guidance about what its practitioners (and patients) should and should not do.
As the director of a graduate program in healthcare mission, I try to help my students think beyond religious “restrictions” to healthcare and instead focus on a vision of healthcare informed by the gospel. One implication of such a vision, as the Ethical and Religious Directives explain, is that
[T]he biblical mandate to care for the poor requires us to express this in concrete action at all levels of Catholic healthcare. This mandate prompts us to work to ensure that our country’s healthcare delivery system provides adequate healthcare for the poor. In Catholic institutions, particular attention should be given to the healthcare needs of the poor, the uninsured, and the underinsured.
Healthcare informed by Christian principles cannot simply be reduced to a set of restrictions. Any robust vision for healthcare will entail certain commitments, and these will inevitably be disputed by those who affirm competing visions. But there is no neutral conception of healthcare with which religion might interfere. There are simply competing visions of healthcare. This should come as no surprise to those of us living in a pluralistic society, with its many competing visions of the ideal human society and what it means to live a good life.
Christians are called to bear witness to Christ in all areas of life, and the domain of healthcare is no exception. But bearing witness can take many forms, and in our increasingly post-Christian society, sometimes it may take the form of simply reminding the world that healthcare is a human enterprise. Healthcare providers are not mere technicians.
Farr Curlin, a hospice and palliative care physician and professor at Duke Divinity School, writes, “In seven years of medical school and residency training, I do not recall a medical educator ever encouraging me or my fellow trainees to consider what medicine is for.”
If our physicians in training are not even encouraged to consider the raison dêtre of their profession, it’s no wonder our debates about policy seem futile. I wonder how much more fruitful our public discourse might be if we allowed ourselves to argue not only about policy but about the very nature and purpose of healthcare.
The Rev. Dr. Stewart Clem is assistant professor of moral theology and director of the Ashley-O’Rourke Center for Health Ministry Leadership at Aquinas Institute of Theology, St. Louis.