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FALL 2018 volume 26, number 4 Health Care Ethics USA A quarterly resource for the Catholic Health Ministry USA QUARTERLY FEATURE | 1 FROM THE FIELD | 20 Christian Anthropology Ethics Recruitment and and Health Care Role Awareness: What We’re Hearing Darlene Fozard Weaver, Ph.D. Jenna Speckart, D.Be. FEATURE | 7 ETHICAL CURRENTS | 23 Opportunistic Risk Reduction Salpingectomy Medicaid Makes It Possible and Ovarian Cancer Fr. Charles Bouchard, O.P., S.T.D. G. Kevin Donovan, MD, MA, Kevin FitzGerald, SJ, Ph.D., Ph.D., and Daniel Sulmasy, MD, Ph.D. RESPONDEO | 28 FROM THE FIELD | 14 Theology and Ethics: Reflections on the Revisions Ethics, Public Policy to Part Six of the ERDs and Care of Individuals with John A. Gallagher, Ph.D. Intellectual Disability Peter Smith, MD, MA LEGAL LENS | 35 Copyright © 2018 CHA. Published quarterly by the Catholic Health Association of the United States (CHA) and the Albert Gnaegi Center for Health Care Ethics (CHCE) at Saint Louis University. Permission granted to CHA-member organizations and Saint Louis Universiry to copy and distribute for educational purposed. ISSN 2372-7683 FALL 2018 FEATURE ARTICLE chausa.org/hceusa Christian Anthropology Christian Anthropology and Health Care Darlene Fozard Weaver, Ph.D. Human persons are not only creatures but sinners. Sin designates the disruption of proper An inventory of contributions of the Catholic relationship with God and others.4 Sin disrupts moral tradition may not include theological our relationships because it corrupts the 1 anthropology on that list, but it should. agential capacities by which we perceive, think, Reflection on human persons through a affectively respond to stimuli, and choose. Sin theological lens yields a number of normative therefore undermines our ability to perceive insights. In particular, it can nuance Catholic and respect others’ moral worth and our understanding of human dignity—a willingness to make choices that affect others. foundational principle for health care ethics— Importantly, these consequences of sin cannot in a way that yields fruit for health care and be corrected simply by stipulating that others health care ethics. have an equal and irreducible moral status. Sin may even operate in the ways we defend others’ THEOLOGICAL ANTHROPOLOGY moral worth, influencing the way we describe what it means to be human, what a good Understood theologically, human persons are human life looks like, and how we should creatures, sinners, and adopted children and respond to moral failures. siblings in the Holy Spirit. As embodied creatures, human beings share physical needs Grace is a name for the gift of being drawn into (like a need for water) and experiences (like dynamics of right relationship with God, self, growth, anger, illness, and play).2 Human and others. Put theologically, grace is a share in persons are composite creatures, having bodies God’s own life. Our capacities as moral agents but also the stuff of transcendence and agency, need to be healed from the corrupting influence like consciousness, freedom, and memory. of sin. Grace allows us to recognize ourselves Moreover, we are formed within social and others in light of God, who recognizes our networks—many of which we do not choose— creatureliness as good, who loves us despite our in better and worse ways. We are irreducibly sinfulness, and who is committed to reconciling social creatures and our flourishing cannot be and sanctifying us. Grace enables us to had in isolation. Yet we are also ultimately recognize the moral worth of others in more responsible for ourselves. The shared and more inclusive circles of regard. It dimensions of human existence are interpreted empowers us to choose to act in a fashion and actualized in culturally and historically consistent with that regard. Another way to put diverse ways, but they provide a basis for a this is to say that grace makes us adopted Christian humanism that is important in children of God and therefore siblings of one Catholic ethics.3 another in God’s spirit. To be adopted by God 1 Copyright© 2018 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes. FALL 2018 FEATURE ARTICLE chausa.org/hceusa Christian Anthropology is to receive God’s Spirit (Romans 8:15), and therefore, to receive an interior transformation A theological anthropology that that makes new things possible for us as creatures and for our social relations. Adoption is attentive to creaturely incorporates us into a new family that is more capacities, sin, and grace can inclusive and more rightly ordered. And yet we must acknowledge that we are living between help us view dignity not only as the “already and the not yet.” The a stipulation of human worth reconciliation that grace will accomplish is not yet complete. but as a practice of inclusive regard. HUMAN DIGNITY What might the broad features of such a consistent with that dignity, what Gaudium et theological anthropology contribute to health spes calls “a genuinely human life.”8 Fourth, in care ethics? Let us consider its import for the Catholic moral tradition, dignity operates as a principle of human dignity, which both founds moral expression of Christian humanism. a right to health care and morally informs the Dignity is therefore emblematic in meaning. practice of health care. Emblematic dignity assumes human embodiment, sociality, and agency, and thereby In Catholic moral tradition one can pick out resists reductionistic views of humanity. four inter-related meanings or functions for dignity: inherent dignity, consequent dignity, In Catholic tradition, dignity also takes its normative dignity, and emblematic dignity.5 meaning from the revelation of humanity in First, dignity refers to the inherent worth of Jesus Christ. Jesus’ life and death clarify dignity human beings.6 Inherent dignity is something as a moral criterion, yoking it to inclusivity, humans have, regardless of abilities or mercy, and a preferential option for vulnerable aptitudes. Yet Catholic tradition also speaks of human beings.9 Importantly, Jesus’ public dignity as though it can be diminished or ministry includes stories in which he challenged forsaken. Gaudium et spes, for example, says that prevailing ideas about good and evil and the we attain dignity “through spontaneous choice social caste systems aligned with those of what is good.”7 So, a second sense of dignity judgments. Those moments of critique and is as a mark of human flourishing or fruit of a subversion are powerful reminders that moral rightly ordered life. We may call this judgments and norms can themselves be tools consequent dignity. Third, human dignity serves that contract our regard for the dignity of as a normative criterion that informs moral others. judgment. We evaluate the moral quality of choices, relationships, and institutions based on A theological anthropology that is attentive to how they align with or violate dignity. creaturely capacities, sin, and grace can help us Normative dignity also has positive moral view dignity not only as a stipulation of human force. It entitles human persons to the worth but as a practice of inclusive regard. conditions necessary for a manner of life 2 Copyright© 2018 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes. FALL 2018 FEATURE ARTICLE chausa.org/hceusa Christian Anthropology According to Steven Pinker, dignity is a matter flourishing) waxes or wanes as I nurture of human perception.10 There is some truth to inclusive regard for the inherent dignity of his claim. Even though all human persons have others.12 The theological anthropology sketched dignity by virtue of being human (the inherent earlier helps us to appreciate that dignity is a dignity described above), the challenge we commitment to attribute equal moral worth to confront is that we too often fail to perceive their our fellow human beings. Doing so is a worth and act on it accordingly. Dignity necessary aspect of discerning their inherent concerns the recognition or misrecognition of value (inherent dignity); a condition for human moral worth within social dynamics of realizing the human good (consequent dignity); vulnerability, power, deception, and and applying dignity as a moral criterion truthfulness.11 To be clear, I am not claiming (normative dignity). Attending to dignity as a that human persons only have worth if others practice of inclusive regard is also important for attribute it to them. That would be a denial of emblematic dignity, as a moral expression of the first sense of dignity. Rather, the argument Christian humanism. Because sin can operate here is that: 1) the perception or denial of even in moral accounts of what it means to be dignity is a social process, and 2) dynamics of human and what a good life looks like, it is sin or grace affect our capacities and our essential to engage in self-criticism and to willingness to recognize or reject the moral include and attend to critical voices, particularly worth of others. Dignity, then, cannot be from vulnerable populations.13 reduced to a stipulation or affirmation of human moral worth, or a consequence of a IMPLICATIONS FOR HEALTH CARE ETHICS rightly ordered life, or a normative criterion for evaluating choices and structures, or an emblem Christian anthropology and its illumination of of a larger Christian humanism. The perceptual human dignity give rise to multiple character of dignity means that we must also commitments that are important for health care understand dignity as an active form of regard. ethics. Commitments to respect, justice, mercy, Claims about dignity are exercises in expanding and the common good, for example, flow from or contracting the scope of our moral concern. and also provide an essential context of respect Because sin affects our capacities and for human dignity.

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