Catholic Health Care in the Age of Obama
What happens when government regulations conflict with Catholic ethics?


Democrat-sponsored health-care legislation currently before Congress could require violations of Catholic teaching in such areas as abortion, contraception, euthanasia, assisted suicide — even infanticide. Leonard J. Nelson III, a professor at the Cumberland School of Law at Samford University, has been studying these issues for years and discusses them in his new book, Diagnosis Critical: The Urgent Threats Confronting Catholic Health Care (OSV 2009). Recently he fielded questions from National Review Online’s Kathryn Jean Lopez.



KATHRYN JEAN LOPEZ: Why should anyone who is not Catholic care about the future of Catholic health care in America?


JACK NELSON: Catholic hospitals are the primary alternative to government-owned and for-profit hospitals in the United States. There are approximately 600 Catholic hospitals in the United States. At their best, Catholic hospitals offer a distinctive product by combining traditional health-care services with a commitment to serving the poor and promoting the sanctity of life. If Catholic hospitals disappear, there will be even a greater likelihood that health care in the United States will become a unitary governmental system. This would lead to a vast increase in the power of the federal government and a concomitant decline in the role of intermediate groups that enhance social cohesion and humanize health care. It would also deprive consumers of an attractive option in the health-care marketplace: quality health-care services provided within the normative framework established by the Ethical and Religious Directives for Catholic Health-Care Services (ERDs).


LOPEZ: Are there people in Catholic hospitals who seriously consider the issues posed by the culture of life vs. a culture of death? Don’t they worry the stakes are just too high?


NELSON: There are certainly persons working in Catholic hospitals who are concerned about the threats to Catholic health care posed by a pervasive culture of death, but there are also others who would rather elide that conflict. The stakes are very high for Catholic health care and for our society. There is already a prevalent view among post-Christian elites in the West that the sanctity-of-life ethic is archaic and should be replaced by a utilitarian framework that would be used to allocate health-care services at both the beginning and the end of life. As we move into an era of increased demands on health-care resources due to the aging of the baby-boomer generation, it is likely that there will be proposals to ration health care through physician-assisted suicide and euthanasia. At the other end of the spectrum, abortion and even infanticide of handicapped babies will be advanced as humanistic alternatives to reduce the costs of health care.



LOPEZ: Are all bets off when a Catholic hospital is sold?


NELSON: Some Catholic facilities have been sold subject to an agreement by the non-Catholic purchaser to follow some of the norms contained in the ERDs after the sale. Typically the purchaser agrees to refrain from providing elective abortions in the formerly Catholic facility. But usually it is left up to the discretion of the purchaser to determine which abortions are elective and which are therapeutic. Thus it may be difficult to enforce even this restriction, much less a ban on other procedures that would be impermissible under the ERDs, such as direct sterilizations.



LOPEZ: What do you mean when you cite the quote, “In the last 50 years, secularism has come to dominate much of medical ethics”?


NELSON: Even though the term “bioethics” was not coined until 1971, the discipline of secular bioethics has already largely supplanted religiously based approaches to ethical issues in medicine. There has been an attempt by some secular bioethicists to construct a cross-cultural, universal morality to facilitate consensus on bioethical issues, but this endeavor has not generally been deemed a success. The field of secular bioethics has been dominated by an academic discourse evincing skepticism and ethical relativism. Rejection of moral absolutes has been coupled with an emphasis on patient autonomy or, particularly in the case of debates about rationing, various forms of utilitarianism. Sometimes, as in the case of Peter Singer, there has been a very explicit rejection of Christian values, i.e., the rejection of a sanctity-of-life ethic in favor of a quality-of-life ethic.