IMPLICATIONS OF CANON LAW
FOR CATHOLIC HEALTHCARE LEADERS AND ORGANIZATIONS
Toronto, ON Catholic Health Sponsors of Ontario February 21, 2018
INTRODUCTION
I am delighted to be able to be with you today. I hope that what we will cover here will be both helpful for you and interesting.
I was asked to review with you some of the issues relating to the application of Canon Law in today’s world, especially as it refers to Catholic healthcare leaders. While I do not have any pretension of bringing up new concepts, I thought that by putting various notions together in the context of a law that is changing, this might open some windows (and even also some doors) for future possibilities.
As you can certainly appreciate, the themes I wish to consider are quite vast. I intend to begin by looking at the state of canon law in the Church today, particularly in the light of Pope Francis’ “revolution” and his numerous messages to healthcare providers. Then, we can focus our attention on some canonical criteria to be applied when identifying an institution, such as a hospital, or a charitable work, as “Catholic”. Moving on, we can look at the relationship between the work and the representatives of the Church, and consider what is meant by the “sponsorship” of these works. Since there are different models and possibilities, the next part will review, briefly, the evolution of some of the sponsorship models to show how canon law can adapt to changing situations. In a sixth section, we will look at some of the duties of “ministry leaders”, using the term in the broadest sense possible. We will also make mention of some of the requirements relating to accountability. Then, some final thoughts will try to looks towards the future and sum up what we will have covered.
So, we have lots of work to do today!
I. CANON LAW IN THE CHURCH TODAY
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You will not be surprised, I presume, to see throughout the day that I’ll be basing myself on the Code of Canon Law for the Church and on subsequent official documents. In fact, there are two Codes – one for the Latin Church, and the other for the Eastern Churches. Both Codes could truly be described as exceptional, especially for their time. They renewed pastoral practice, especially in regard to the Sacraments; they set out challenges and goals for church leadership; they enabled Church authorities to establish structures that would help prevent the arbitrary – the worst form of dictatorship – and take initial steps to ensure that individual and collective rights would be duly protected against abuse. By doing so, they also enabled the vision of the Council – that the Church is the People of God – to become part and parcel of daily ecclesiastical life and administration in many parts of the world. Of course, the Codes did not replace the doctrinal teachings of the Council which served and continue to serve as the sound basis upon which any type of Church law is to be evaluated and eventually applied.
Although the 1983 Code answered an obvious need in the Church at the time, we must nevertheless recognize that the world has evolved at a frenetic pace in the past thirty-five years and the 1983 legislation now has to be adjusted to respond to new situations.
A. SOME CHANGES IN THE WORLD TODAY WHICH AFFECT CANON LAW
Since the 1983 Code was promulgated, and merely as examples:
(a) The Iron Curtain fell, and Catholics in many parts of the world were free once again to practice their faith as they so desired.
(b) The internet had not yet been created, with the instant communications it established, and the new ways of reaching others through the “social media”. The potential for sound evangelization is almost unlimited, although the fact that some self-designated people proclaim themselves as the sole “orthodox” teachers of the truth on so-called “Catholic” websites, can lead others into error.
(c) The scandals of sexual abuse had not yet raised their ugly head – at least publicly – within society and within the Church, and, when they did, it was found that both the Church’s law and the civil legislation did not provide adequate or appropriate means of addressing a most urgent situation because they had not been designed for this type of crisis.
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(d) Public inquiries into financial operations – as we now see in a number of countries – had not yet begun, and, in relation to church finances, the practice of suing the Church before the secular tribunals was relatively unheard of at the time.
(e) There has been a growing concern for the protection of rights of individuals and of societies, with new emphasis placed on social justice and the promotion of peace, the protection of the environment, and preserving the integrity of creation. The phenomenon of the “Arab Spring” in Egypt, Tunisia, Yemen, Libya, Syria, Sudan, and so forth, showed how peoples are yearning for the recognition of their fundamental human rights, even though the outcome has not been as expected. At the same time, the latest project in Quebec relating to having one`s face uncovered in public places, raises serious problems in relation to religious liberty. Likewise, the Federal Government’s requirements in relation to summer employment applications...
(f) In many parts of the world, the influence of secularism has meant that the religious and spiritual values cherished by so many in the past, no longer hold the same attraction for people, and a number of persons have begun to develop their own form of spirituality – perhaps based on a “cafeteria” approach of taking what they like and leaving the rest aside. People no longer act in such and such a way simply because “authority” says that this is the way to do things. They expect to find authenticity in their political and religious leaders.
(g) The world population has changed significantly. There are nearly 3 billion people under 25, and another one and a half billion between 25 and 40. These were all born either after the promulgation of the Code, or after Vatican II. Only a little over 2 billion people are over 40. This means that when we are referring to Vatican II and the like, many people have not lived that experience and cannot really relate to it. The Catholic population is well over one billion at this time. Using the same proportions, it is likely that some two-thirds of the Catholics in the world would have been born after Vatican II began.
All of these developments, many of them being quite positive, as well as many other movements in society, have changed the way in which people expect Church law to be applied today. We must not forget that because the members of the Church are also profoundly influenced by the world around them, they – rightly or wrongly – expect to find within the Church the same standards of fairness and justice as they want to find in secular society. They do not hesitate to call church leaders to task for their actions and attitudes. -4-
B. SOME CHANGES WITHIN THE CHURCH WHICH AFFECT CANON LAW
Furthermore, and not surprisingly, in addition to these changes in society as a whole, there have been numerous internal developments within the Church itself over these past thirty some years. Some of these could be noted here:
(a) The number of lay persons who are now working for the Church on a full-time basis, whether in parishes or in other works of the apostolate, continues to grow exponentially – especially in those areas where there is a relative shortage of ordained priests.
This leads to a certain number of pastoral decisions that have to be taken regarding the way ministry is carried out in the Church. It also has a great influence on the way priests are expected to interact with lay men and women in their ministry. Likewise, it has serious implications for the various types of parish communities, starting with the so-called base communities, moving to parishes as we have traditionally known them, and then to new forms of clustering and coordinated services.
(b) The permanent diaconate is gradually coming into its own in many places with numerous possibilities for new ministries. The “service” dimension (“diakonia”) of the Church is one that deacons can fulfill in exceptional ways.
(c) The number of Catholics who belong actively to one or more of the new movements and associations in the Church is astounding. They are now counted in the hundreds of thousands in all parts of the world. This was one of the unexpected outpourings of grace following Vatican II.
(d) The results of the R.C.I.A have been such that many parishes have been radically renewed by members who now have a keen sense of parish community and what it should stand for. The hundreds of thousands of people who, over the years, have been baptized as adults, or made their profession of faith in the Church, show that the Church’s message is still being heard, and in unexpected places.
On the other hand, we cannot overlook the fact that certain parishes are languishing for lack of population or finances and have to be closed or radically restructured. In parts of the world, people are leaving their parishes in relatively large numbers to find spiritual consolation elsewhere – particularly those who have moved towards the so-called “evangelical Christianity”. Others have simply, at least for now, abandoned any external form of religious practice. This poses quite a challenge for church leaders who, at times, seem to be “a voice crying in the wilderness” (see Mt. 3:3).
-5- As an example: the Archdiocese of Quebec, on January 1, 2018 reduced the number of parishes from 130 to 64. In 2011, there were 216 parishes. It is proposed to have just 37 parishes by 2020 (Comunications services, Archdiocese of Quebec, January 17, 2018).
(e) The blossoming of the Church in Africa and in certain parts of Asia will inevitably lead us to move away from a law centred rather exclusively on first world traditions and customs.
(f) Religious institutes are experiencing a steady decline in numbers, as we see today in many parts of the world.
To illustrate this, in Canada, in 1975, there were 55,180 religious men and women (with 1,173 in initial formation). In 2004, there were 22,471 religious men and women (with 131 persons in initial formation). In 2010, there were 19,235 men and women religious in Canada. January 2013: a total of 16,626 religious men and women in Canada. January 2014, 16,115 religious; January 2015, 15,488; January 2016, 13,890; January 2017, 13,126; January 2018, 12,220.
But, perhaps because of this phenomenon, we also note greater collaboration between dioceses and religious institutes in undertaking the works of the apostolate. At times, even the pooling of assets is now a familiar phenomenon, at least in certain parts of the world. At the same time, though, as some of the older religious institutes are dying, there is new birth around the world. It seems that more than 200 new groups that eventually hope to become recognized as some form of consecrated life in North America have been identified and are in various stages of growth. Some of these will last; perhaps others might not be successful; but, at least, we see that the desire for consecrated life is still very strong – although perhaps not always in the forms in which it was traditionally lived in years gone by.
Some of the newer groups wish to espouse norms that, in law, are presently not legitimate, in the mind of Church leaders, for members of religious institutes. For instance, these groups often want to form a community of men and women living together, they do not want perpetual commitment, they are open to Christians of other denominations, and so forth. At the present time, such groups cannot be recognized as institutes of consecrated life; they can, though, be recognized as public associations of the Christian faithful.
(g) Another point that cannot be overlooked is the fact that, each year, throughout the Church, many men and women – bishops, priests, religious, seminarians, catechists, lay missionaries, and workers for social justice – give their lives for the Gospel and suffer violent death. The number of martyrs in the world today shows, time and again, that so many Christians are willing to make the supreme sacrifice to proclaim who Christ is. -6-
To illustrate this, see Agenzia Fides website: “Martyrology” per year. For instance, in 2010, 25 bishops, priests, religious, lay workers were martyred; in 2011, 26; in 2012, 12; in 2013, 22; in 2014, 26; in 2015, 22; in 2016, 28; in 2017, 23 (see Agenzia Fides, Information Service, December 28, 2017).
At the same time as this remarkable form of witness is happening, the Church might nevertheless have to reconsider some of its missionary policies, particularly in regard to dialogue with non-Christian religions.
(h) The developments in ecumenical dialogue that we witness today would not have been possible thirty years ago. Slow but steady progress is being made, although, of course, there are setbacks along the way. The current Vatican “conversations” with representatives of the Muslin community are certainly an opening that could not have been easily foretold even ten years ago.
(i) The phenomenon of “World Youth Days” and the on-going involvement of youth in the life of the Church raise a number of fascinating challenges, as to how to keep the interior fires burning in the years ahead.
C. NECESSARY REVISIONS IN CANON LAW TO RESPOND TO THESE CHANGES
These developments, and many like them, have inevitably brought tension to the Church’s laws and canonists have struggled to apply legal principles and norms to situations which these laws were not designed to address. They have even brought to light a certain number of deficiencies in ecclesiastical legislation, which, hopefully, will be corrected before too long. Pope John Paul II, in an address given to the Roman Rota on January 22, 1996 had already called for “corrective measures by the legislator or for specific norms for the application of the code.” Then, in January 2008, an international conference of canonists was held in Rome under the auspices of the Pontifical Council for Legislative Texts to determine what are some of the legislative issues that would have to be re-examined today. On that occasion, January 25, 2008, Pope Benedict XVI spoke about the on-going adaptations required in canon law:
If canon law is to fulfil this invaluable service it must first of all be a well-structured law. In other words, on the one hand it must be bound to the theological foundation that gives it reasonableness and is an essential title of ecclesial legitimacy; on the other, it must keep up with the changing circumstances of the historical reality of the People of God. Furthermore, it must be formulated clearly, without ambiguity, and must always be in harmony with the rest of the Church's laws.
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It is therefore necessary to abrogate norms that prove antiquated; to modify those in need of correction; to interpret - in light of the Church's living Magisterium - those that are doubtful, and lastly, to fill possible lacunae legis. As Pope John Paul II said to the Roman Rota: "The very many expressions of that flexibility which has always marked canon law, precisely for pastoral reasons, must be kept in mind and applied" (Address to the Roman Rota, 18 January 1990, n. 4). It is your task in the Pontifical Council for Legislative Texts to ensure that the work of the various bodies in the Church that are required to dictate norms for the faithful always reflects, all together, the unity and communion that are proper to the Church.
In fulfillment of this, Bishop J.I. Arrieta, Secretary of the Pontifical Council for Legislative Texts, December 4, 2010, announced that a draft text of a revised Book VI of the Code of Canon Law, on Delicts and Penalties, would be distributed for discussion. The Canadian Bishops and others have examined and presented their observations to the Holy See. We are now awaiting the promulgation of this new document. But, given the fact that Pope Francis wishes first to review the entire operations of the Roman Curia, it is quite possible that this project will be delayed.
And so, this continually changing context brings us to the specific role of Pope Francis, something that was totally unexpected.
II. THE INFLUENCE OF POPE FRANCIS ON THE INTERPRETATION OF CANON LAW
Before looking at the actual contribution of Pope Francis, perhaps a few words on the interpretation of canons themselves might be in order.
A. THE INTERPRETATION OF CANON LAW
Canon 17: Ecclesiastical laws are to be understood according to the proper meaning of the words considered in their text and context. If the meaning remains doubtful or obscure, there must be recourse to parallel places, if there be any, to the purpose and circumstances of the law, and to the mind of the legislator.
Canon 17 provides a general principle: besides interpreting laws according to their text and context, we are also to keep in mind the intentions of the legislator. -8-
Since the Pope is the legislator for the entire Church, his vision of the law necessarily colours our interpretation of the legislation. Even though the words remain the same, they can take on a new or a revised meaning according to the context.
Canon 19 complements this general norm:
Canon 19: If on a particular matter there is not an express provision of either universal or particular law, nor a custom, then, provided it is not a penal matter, the question is to be decided by taking into account laws enacted in similar matters, the general principles of law observed with canonical equity, the jurisprudence and practice of the Roman Curia, and the common and constant opinion of learned authors.
When canon 19 refers to the general principles of law, it is speaking of the universal and fundamental principles evolved from the law of nature. Many general principles are found in the "Rules of Law", axioms whose use facilitates the interpretation and the application of Canon Law.
Illustrations of the Rules of Law:
- it is fitting to extend favours; - odious things are to be restricted; - in penalties a more benign interpretation is to be followed; - no one is bound to the impossible, etc.
The Rules of Law were part of the "Corpus Iuris Canonici" (AD 1234) and were in effect until 1918. Since then, they have been a constant source of interpretation and application of law – the result of the wisdom of the ages.
In Canon Law, "jurisprudence" is the term used to describe the decisions given by various courts and offices of the Holy See. It corresponds to "precedents" in other legal systems. In the Anglo-Saxon Common Law system, "jurisprudence" would refer more to the philosophy of law, than to the precedents themselves.
I am mentioning this because, in many instances, the Pope is not referring directly to one of the existing canons, but, rather, is basing himself on a general philosophy of law, which sees legislation at the service of truth and at the service of the people. His vision must now be taken into account, particularly in those areas where the canons do not address the issue directly.
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B. THE CONTEXT OF POPE FRANCIS’ MINISTRY
There is no doubt that the Church, and, indeed, the entire world, has in one way or another been affected by Pope Francis’ teachings and attitudes. Cardinal W. Kasper’s book, Pope Francis’ Revolution of Tenderness and Love, released on February 18, 2015, shows clearly how, within a few months, the new pope succeeded in bringing a breath of fresh air to the Church.
To date, he has officially changed only the canons relating to marriage nullity procedures and a number of norms relating to inter-ritual issues, but there is no doubt that it is no longer “business as usual” when it comes to applying the law.
Even within days after assuming the role of Bishop of Rome (the title he seems to prefer), Pope Francis began letting the world know that he had a new vision for the Church and would be taking steps to bring this vision to reality. He was looking for a Church of mercy and compassion, and not one identified with power and control. I don’t think it would be difficult, moving beyond Canon Law a bit, to see how these two – mercy and compassion – are to be two characteristics of any healthcare worker. It is interesting to note how often he uses healthcare metaphors to illustrate his point.
Yet, as Cardinal Kasper noted, "A considerable number of people do not trust the new enthusiasm, are exercising genteel restraint and have adopted a wait and see attitude. What for most people seems a new Spring, is for them a passing cold spell -- not a new beginning but just an intermezzo."
Nevertheless, in spite of this quiet opposition, we note readily that the Pope is even encouraging people to express their opinions, not only within church circles, but also in the secular press. Some people are scandalized by this freedom of expression, but, if the members of the Church cannot think and express their thoughts, we risk becoming a very closed group, one that it turned in onto itself, and which is then governed by an ideology, rather than by an on-going search for the truth.
The 2015 Synod on the family was certainly a watershed moment for the Pope’s vision. Obviously, there were differing opinions among the participants as to the direction the Church should be taking. With time, and with the guidance of the Holy Spirit, however, the way will become clearer. Amoris laetitia is a beautiful example of this new spirit in church legislation.
As persons involved more directly in one of the Church’s essential ministries, the delivery of quality health care, we cannot remain indifferent to the calls we are receiving from the Pope. I am taking for granted that, as individuals, it is our desire and intention to foster and promote the renewal that Pope Francis wishes to put in place. Of course, -10- this cannot come about overnight, but, slowly and surely, various steps can be taken to lead us on the way.
C. POPE FRANCIS’ VISION OF THE CHURCH, AS A CHURCH OF MERCY AND COMPASSION
On February 5, 2015, in his morning homily, the Pope, in very few words, described how he sees the Church’s mission:
This is the mission of the Church: the Church that heals, that cares [for people]. I sometimes describe the Church as a field hospital. True, there are many wounded, how many wounded! How many people who need their wounds to be healed! This is the mission of the Church: to heal the wounded hearts, to open doors, to free [people], to say that God is good, God forgives all, that God is our Father, God is tender, that God is always waiting for us.
The reference to a “field hospital” can show how practical his approach can be. Although he is using the term “wounded” in a non-medical sense, there is no reason why it cannot also be applied more directly to those we serve.
In a BBC report, September 19, 2013, he had already used medical terminology:
The church's pastoral ministry cannot be obsessed with the transmission of a disjointed multitude of doctrines to be imposed insistently. We have to find a new balance; otherwise even the moral edifice of the church is likely to fall like a house of cards, losing the freshness and fragrance of the Gospel. Instead, the Catholic Church must work to heal the wounds of its faithful and seek out those who have been excluded or have fallen away. It is useless to ask a seriously injured person if he has high cholesterol and about the level of his blood sugars. You have to heal his wounds. Then we can talk about everything else. The Church has become tied up in small-minded rules and risks losing its true purpose. The most important thing is the first proclamation: Jesus Christ has saved you. And the ministers of the Church must be ministers of mercy above all.
1. EVANGELII GAUDIUM
Notwithstanding the insights just noted, it is in the Apostolic Exhortation, Evangelii gaudium, that we find outlined – at least at this point in time in the present Pontificate – -11- the Pope’s more complete vision for the Church. In certain ways, as we shall see, it is to be complemented by some of the insights of Amoris laetitia.
This first document, dated November 24, 2013, is certainly a masterpiece of thinking. This doesn’t mean that it is easy to grasp all the subtleties of thought that we can find in the various passages. Inevitably, any commentary on a document portrays the commentator’s personal biases and interests. For this reason, if you have not already done so, I exhort each of you to read the document carefully and slowly, picking out points that touch you more directly. And, of course, the same applies to Amoris laetitia.
The Exhortation is a call to reflection, one that spells out new and exciting possibilities for the Church today. The Pope writes to fulfill his office as universal shepherd, to bring the Good News of the Gospel to all who have ears to hear, and eyes to see.
He is looking for a Church that is:
– “At the service of this world by being faithful to Christ and his Gospel";
– "Free from all mundane spirituality";
– "Free from the risk of being concerned about itself, of becoming middle-class, of closing in on self, of being a clerical church";
– Able to "offer itself as an open space in which all of us can meet and recognize each other because there is space for dialogue, diversity and welcome in it";
– A church that pays "just attention and gives importance to women in both society and its own institutions” (see National Catholic Reporter, April 21, 2014).
As he says:
Within the church countless issues are being studied and reflected upon with great freedom. Differing currents of thought in philosophy, theology and pastoral practice, if open to being reconciled by the Spirit in respect and love, can enable the church to grow, since all of them help to express more clearly the immense riches of God's word. For those who long for a monolithic body of doctrine guarded by all and leaving no room for nuance, this might appear as undesirable and leading to confusion. But in fact such variety serves to bring out and develop different facets of the inexhaustible riches of the Gospel (EG, 40).
When we consider the various debates on issues relating to medical ethics today, we could keep these insightful words in mind.
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It follows, then, that the Church should be characterized by a missionary heart:
A missionary heart is aware of these limits and makes itself "weak with the weak ... everything for everyone" (1 Cor 9:22). It never closes itself off, never retreats into its own security, never opts for rigidity and defensiveness. It realizes that it has to grow in its own understanding of the Gospel and in discerning the paths of the Spirit, and so it always does what good it can, even if in the process its shoes get soiled by the mud of the street (EG, 45).
All of this can lead to a new understanding of what we mean by the mission of “the church”, a mission in which we all share, in one form or another.
I prefer a church that is bruised, hurting and dirty because it has been out on the streets rather than a church that is unhealthy from being confined and from clinging to its own security. I do not want a church concerned with being at the centre and then ends by being caught up in a web of obsessions and procedures.
If something should rightly disturb us and trouble our consciences, it is the fact that so many of our brothers and sisters are living without the strength, light and consolation born of friendship with Jesus Christ, without a community of faith to support them, without meaning and a goal in life. More than by fear of going astray, my hope is that we will be moved by the fear of remaining shut up within structures that give us a false sense of security,
Of course, this does not mean proselytizing, but it does entail having a specific attitude – something that we will return to momentarily.
When it comes to the various canonical structures we find in the Church, his message is also most clear:
There are ecclesial structures that can hamper efforts at evangelization, yet even good structures are only helpful when there is a life constantly driving, sustaining and assessing them. Without new life and an authentic evangelical spirit, without the church's "fidelity to her own calling," any new structure will soon prove ineffective (EG, 26).
He then goes on to say:
I dream of a "missionary option," that is, a missionary impulse capable of transforming everything, so that the church's customs, ways of doing things, times and schedules, language and structures can be suitably -13- channeled for the evangelization of today's world rather than for her self-preservation. The renewal of structures demanded by pastoral conversion can only be understood in this light: as part of an effort to make them more mission-oriented, to make ordinary pastoral activity on every level more inclusive and open, to inspire in pastoral workers a constant desire to go forth and in this way to elicit a positive response from all those whom Jesus summons to friendship with him (EG, 27).
I believe that this shows us how our existing canons must be subject to a new and refreshed interpretation and application.
2. SOME INSIGHTS FROM AMORIS LAETITIA
We certainly have not heard the last word on Amoris laetitia (March 19, 2016) . In particular, Chapter VIII speaks of three attitudes to be developed by those responsible for evaluating situations: (1) accompanying, (2) discerning and (3) integrating weakness. These will provide the background for this part of our presentation.
Since the document addresses the situation of marriage and family life, we should not be surprised to note that all the examples the Pope gives here are related to marriage and the eventual adjudication of marriage nullity cases.
However, since this is an important dimension of the Church’s pastoral governance, it is worthwhile to consider them here in the context of this particular presentation.
a. ACCOMPANYING PERSONS
One of the themes developed in the first part of Chapter VIII is that of “gradualness in pastoral care”. As par. 293 states,
The fathers also considered the specific situation of a merely civil marriage or, with due distinction, even simple cohabitation, noting that "when such unions [1] attain a particular stability, [2] legally recognized, are characterized by [3] deep affection and [4] responsibility for their offspring, and demonstrate an [5] ability to overcome trials, they can provide occasions for pastoral care with a view to the eventual celebration of the sacrament of marriage."
On the other hand, it is a source of concern that many young people today distrust marriage and live together, putting off indefinitely the commitment of marriage, while yet others break a commitment already made and -14- immediately assume a new one. As members of the church, they too need pastoral care that is merciful and helpful.
It seems obvious that the various situations mentioned – civil marriage, cohabitation. no commitment to marriage – are distinct in their nature, and the same pastoral approach would not be appropriate for each of these situations:
Entering into pastoral dialogue with these persons is needed to distinguish elements in their lives that can lead to a greater openness to the Gospel of marriage in its fullness. In this pastoral discernment, there is a need to identify elements that can foster evangelization and human and spiritual growth.
In some countries, for instance, people avoid entering into what they call “the white man’s marriage” because of the expense involved. As the Pope says: “These couples need to be welcomed and guided patiently and discreetly” (par. 294).
The “gradualness” mentioned here “is not a ‘gradualness of law’ but rather a gradualness in the prudential exercise of free acts on the part of subjects who are not in a position to understand, appreciate or fully carry out the objective demands of the law” (par. 295).
For the law is itself a gift of God that points out the way, a gift for everyone without exception; it can be followed with the help of grace, even though each human being advances gradually with the progressive integration of the gifts of God and the demands of God's definitive and absolute love in his or her entire personal and social life (par. 295).
In other words, “one size does not fit all”, and to treat all situations as the same is to overlook their particular characteristics, with the risk of ending up with an erroneous pastoral approach.
b DISCERNING SITUATIONS
The key to understanding this section can be found in its opening paragraph:
The synod addressed various situations of weakness or imperfection. Here I would like to reiterate something I sought to make clear to the whole church, lest we take the wrong path: There are two ways of thinking that recur throughout the church's history: [1] casting off and [2] reinstating. The church's way, from the time of the Council of Jerusalem, has always been the way of Jesus, the way of mercy and reinstatement. ... The way of the church is not to condemn anyone forever; it is to pour -15- out the balm of God's mercy on all those who ask for it with a sincere heart. ... For true charity is always unmerited, unconditional and gratuitous.
Consequently, there is a need to avoid judgments that do not take into account the complexity of various situations and to be attentive, by necessity, to how people experience distress because of their condition (par. 296).
There are numerous situations calling for different answers. For instance, six in particular call for attention because those divorced persons who have entered a new union, for example, can find themselves in a variety of situations that should not be pigeonholed or fit into overly rigid classifications leaving no room for a suitable personal and pastoral discernment (see par. 298).
[1] One thing is a second union consolidated over time, with new children, proven fidelity, generous self-giving, Christian commitment, a consciousness of its irregularity and of the great difficulty of going back without feeling in conscience that one would fall into new sins. The church acknowledges situations "where, for serious reasons, such as the children's upbringing, a man and woman cannot satisfy the obligation to separate."
[2] There are also the cases of those who made every effort to save their first marriage and were unjustly abandoned, or [3] of "those who have entered into a second union for the sake of the children's upbringing and are [4] sometimes subjectively certain in conscience that their previous and irreparably broken marriage had never been valid."
[5] Another thing is a new union arising from a recent divorce, with all the suffering and confusion that this entails for children and entire families, or [6] the case of someone who has consistently failed in his obligations to the family.
It must remain clear that this is not the ideal that the Gospel proposes for marriage and the family. The synod fathers stated that the discernment of pastors must always take place by adequately distinguishing with an approach that carefully discerns situations. We know that no easy recipes exist.
In view of this, the words of the Pope taken on particular significance:
If we consider the immense variety of concrete situations such as those I have mentioned, it is understandable that neither the synod nor this exhortation could be expected to provide a new set of general rules, -16- canonical in nature and applicable to all cases. What is possible is simply a renewed encouragement to undertake a responsible personal and pastoral discernment of particular cases, one that would recognize that since the degree of responsibility is not equal in all cases, the consequences or effects of a rule need not necessarily always be the same (par. 300).
One most important consequence of this discernment is mentioned in footnote 336: “This is also the case with regard to sacramental discipline, since discernment can recognize that in a particular situation no grave fault exists.” What he says is so important that the Pope repeats it in par. 301:
Hence it is can no longer simply be said that all those in any "irregular" situation are living in a state of mortal sin and are deprived of sanctifying grace. More is involved here than mere ignorance of the rule. A subject may know full well the rule, yet have great difficulty in understanding its inherent values, or be in a concrete situation that does not allow him or her to act differently and decide otherwise without further sin. As the synod fathers put it, "Factors may exist that limit the ability to make a decision."
A little later on, Pope Francis mentions some of these “factors”:
Imputability and responsibility for an action can be diminished or even nullified by [1] ignorance, [2] inadvertence, [3] duress, [4] fear, [5] habit, [6] inordinate attachments, and other [7] psychological or [8] social factors. In another paragraph, the catechism refers once again to circumstances that mitigate moral responsibility and mentions at length "[9] affective immaturity, [10] force of acquired habit, [11] conditions of anxiety or other psychological or social factors that lessen or even extenuate moral culpability."
For this reason, a negative judgment about an objective situation does not imply a judgment about the imputability or culpability of the person involved. On the basis of these convictions, I consider very fitting what many synod fathers wanted to affirm:
"Under certain circumstances people find it very difficult to act differently. Therefore, while upholding a general rule, it is necessary to recognize that responsibility with respect to certain actions or decisions is not the same in all cases. Pastoral discernment, while taking into account a person's properly formed conscience, must take responsibility for these situations. Even the consequences of actions taken are not necessarily the same in all cases" (par. 302).
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c. INTEGRATING WEAKNESS
As for the third pastoral attitude – integrating weakness – a special pastoral rule is presented in paragraphs 304 and 305:
It is true that general rules set forth a good that can never be disregarded or neglected, but in their formulation they cannot provide absolutely for all particular situations. At the same time, it must be said that precisely for that reason, what is part of a practical discernment in particular circumstances cannot be elevated to the level of a rule. That would not only lead to an intolerable casuistry but would endanger the very values that must be preserved with special care.
For this reason, a pastor cannot feel that it is enough simply to apply moral laws to those living in "irregular" situations, as if they were stones to throw at people's lives. This would bespeak the closed heart of one used to hiding behind the church's teachings, "sitting on the chair of Moses and judging at times with superiority and superficiality difficult cases and wounded families" (par. 304-305).
This background leads us now to examine some of the points Pope Francis has been raising in relation to health care.
D. POPE FRANCIS AND CATHOLIC HEALTH CARE
Because he has captured the mind and imagination of so many people around the world because of his concern for the poor, the sick, and the abandoned, it is only natural that we take a few moments to review some of Pope Francis’ teachings in relation to the sick and to those who, in various ways, care for them.
Among so many possibilities, I have selected eight texts from Pope Francis in relation to the delivery of healthcare, as an integral part of the Church’s mission. We will notice in them a number of common themes, which will help us orient our ministry of Catholic healthcare.
1. TO THE PONTIFICAL COUNCIL FOR HEALTHCARE WORKERS (March 24, 2014)
In his 2014 address, the Pope gives us three indications to mark our service to others. -18-
The first is to “do good to those who suffer”, showing them that they are never alone, because Christ is present with them, even if his image is blurred or disfigured.
The second is to remind ourselves that the experience of fraternal sharing with those who suffer opens us to the true beauty of human life which includes its fragility.
The third is a call to keep ever present the flesh of Christ present in six categories of persons: (1) the poor, (2) those who are suffering, (3) in children, especially the unwanted, (4) those with physical or (5) mental disabilities, and (6) the elderly.
2. WORLD DAY OF THE SICK 2014
In the second document which I selected, the message for World Day of the Sick 2014, once again the Pope gives us three indications.
The first is that he reminds us that Christ did not remove illness and suffering from human experience, but, by taking them upon himself, he gave them new meaning, because they no longer have the last word. They can become positive factors, because the illness and suffering of others enables us to love them in the same way as Christ loved us. As he says, “The proof of authentic faith in Christ is self-giving and the spreading of our love for our neighbours, especially for those who do not merit it, for the suffering and for the marginalized.” (We can readily think here of those who take no steps to protect their health).
The second point is that we are to recognize in Christ the “Good Samaritan” for all who suffer. The sign of love is to lay down one’s life for another. When generous devotion to others becomes the hallmark of our actions, we give way to the Heart of Christ and bask in its warmth.
The third is that, if we are to grow in tender love, and a respectful and sensitive charity, we have a sure Christian model to contemplate: Mary, who is always attentive to the voice of God and the needs and troubles of her children. She shows us how to look with mercy and tenderness on those who suffer, who are in need of help.
3. WORLD DAY OF THE SICK 2015
The 2015 message for the World Day of the Sick is addressed particularly to those who are volunteers and professionals in the field of health care. The Pope takes the words of Job, “I was eyes to the blind, and feet to the lame” (29:15) as the basis for his thoughts, which he focusses on wisdom of the heart. -19-
This time, though, he has five points to make, rather than the traditional three!
1. Wisdom is a way of seeing things infused by the Holy Spirit, and is found in the minds and hearts of those who are sensitive to the sufferings of others.
2. Wisdom of the heart means serving our brothers and sisters. The service of healthcare workers is difficult. As the Pope says, “They are close to the sick in need of constant care and help in washing, dressing and eating. This service, especially when it is protracted, can become trying and burdensome. It is relatively easy, he says, to help someone for a few days, but it is difficult to look after a person for months or even years, in some cases when he or she is no longer capable of expressing gratitude. And yet what a great path of sanctification this is.”
3. Wisdom of the heart means being with our brothers and sisters. We should pray for the grace to appreciate the value of our often unspoken willingness to send time with others who thus feel more loved and comforted.
4. This also means going forth from ourselves towards others. This implies an effective charity and a compassion which understands, assists and promotes.
5. Wisdom means showing solidarity with our brothers and sisters while not judging them. Charity takes time. True charity is a sharing that does not judge, which does not demand the conversion of others. It is free of false humility which, deep down, seeks praise.
4. TO THE PONTIFICAL ACADEMY FOR LIFE, March 5, 2015
Another most important dimension of Pope Francis’ concern for the sick and elderly concerns the care of the elderly, and, more particularly, palliative care.
Since this is such an important dimension of our ministry, it would be essential to note a couple of the Pope’s statements in this regard.
On March 5, 2015, for instance, he spoke to the Pontifical Academy for life, and laid out a number of principles. On that occasion, he said:
The elderly, first of all, need the care of family members – whose affection cannot be replaced by more efficient structures or more competent and charitable healthcare workers. When this is not sufficient, or in the case of advanced or terminal illness, the elderly can be benefited by truly human assistance, and receive adequate responses to their -20- needs thanks to palliative care offered in such a way that it supplements and supports the care provided by family members.
In particular, many elderly people feel abandoned.
Palliative care has to objective of alleviating suffering in the last stages of illness and at the same time of assuring the patient of adequate human accompaniment (cf. Evang. Vitae, 65). It deals with the important support for the elderly, who, for reasons of age, often receive less attention from curative medicine, and are often abandoned.
Probably his most poignant words are as follows:
Abandonment is the most serious “illness” of the elderly, and also the greatest injustice they can suffer: those who helped us to grow must not be abandoned when they need our help, our love, and our tenderness.
Therefore, we are encouraged to pursue this ministry, recognizing the value of the human person.
I encourage professionals and students to specialize in this type of assistance, which has no less value on account of the fact that it “does not save lives.” Palliative care recognizes something equally important: recognizing the value of the person. I urge all those who, under whatever title, are involved in the field of palliative care, to practice this duty of conserving the spirit of service in its fullness and recalling that all medical knowledge is truly science, in its most noble sense, only if it finds its place as a help in view of the good of man, a good that is never achieved by going “against” his life and dignity.
In this perspective, assisted suicide – by whatever name it is called – takes on an opposite meaning. We are not being attentive to the needs of others, but, rather, taking steps to resolve our own “problems”. Pope Francis returned to this subject again in an address of January 26, 2018, to the Congregation for the Doctrine of the Faith. He said that public opinion today, “by rendering absolute the concepts of self-determination and autonomy,” has given rise to the unhealthy notion that a “civilized” society would hasten the death of those who are facing terminal illness. -21-
5. WORLD DAY OF THE SICK, 2016
In the 2016 message for World Day of the Sick (February 11, 2016), we find a number of points that could easily be used as we try to reflect on our mission of delivering healthcare in a Catholic setting.
Pope Francis places the entire message in the context of entrusting ourselves to the merciful Lord, just as Mary did throughout her life, and, more particularly at the wedding feast of Cana, when she told the servants; “Do whatever he tells you” (Jn 2:5).
Listening to Mary’s words implies faith. And, as the message tells us:
... Not because faith makes illness, pain, or the questions which they raise, disappear, but because it offers a key by which we can discover the deepest meaning of what we are experiencing; a key that helps us to see how illness can be the way to draw nearer to Jesus who walks at our side, weighed down by the Cross...
He then goes on to speak more directly of our mission to the sick, following the example of Mary:
In Mary’s concern we see reflected the tenderness of God. This same tenderness is present in the lives of all those persons who attend the sick and understand their needs, even the most imperceptible ones, because they look upon them with eyes full of love.
This takes expression in a number of attitudes:
We too can be hands, arms and hearts which help God to perform his miracles, so often hidden. We too, whether healthy or sick, can offer up our toil and sufferings like the water which filled the jars at the wedding feast of Cana and was turned into the finest wine. By quietly helping those who suffer, as in illness itself, we take our daily cross upon our shoulders and follow the Master. Even though the experience of suffering will always remain a mystery, Jesus helps to reveal its meaning.
This is what characterizes Catholic healthcare in its various dimensions. It is not something that we should hold onto jealously for ourselves, but the Pope invites us to share this attitude with those of other religious traditions:
May it open us to even more fervent dialogue so that we might know and understand one another better; may it eliminate every form of -22- closed-mindedness and disrespect, and drive out every form of violence and discrimination. Every hospital and nursing home can be a visible sign and setting in which to promote the culture of encounter and peace, where the experience of illness and suffering, along with professional and fraternal assistance, helps to overcome every limitation and division.
6. WORLD DAY OF THE SICK, 2017
In his message of December 8, 2016, in preparation for the 2017 World Day of the Sick, Pope Francis related his message to the apparitions at Lourdes. Among many other valuable points, he noted the following:
Let us ask Mary Immaculate for the grace always to relate to the sick as persons who certainly need assistance, at times even for the simplest of things, but who have a gift of their own to share with others.
The gaze of Mary, Comfort of the Afflicted, brightens the face of the Church in her daily commitment to the suffering and those in need. The precious fruits of this solicitude for the world of suffering and sickness are a reason for gratitude to the Lord Jesus, who out of obedience to the will of the Father became one of us, even enduring death on the cross for the redemption of humanity. The solidarity shown by Christ, the Son of God born of Mary, is the expression of God’s merciful omnipotence, which is made manifest in our life – above all when that life is frail, pain-filled, humbled, marginalized and suffering – and fills it with the power of hope that can sustain us and enable us to get up again.
This great wealth of humanity and faith must not be dissipated. Instead, it should inspire us to speak openly of our human weaknesses and to address the challenges of present-day healthcare and technology. On this World Day of the Sick, may we find new incentive to work for the growth of a culture of respect for life, health and the environment. May this Day also inspire renewed efforts to defend the integrity and dignity of persons, not least through a correct approach to bioethical issues, the protection of the vulnerable and the protection of the environment.
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7. ADDRESS TO HUNTINGTON’S DISEASE PATIENTS AND THEIR FAMILIES, May 18, 2017
Another address chosen for this review is one that Pope Francis gave to patients with Huntington’s disease, and those who care for them. Because of the degenerative effects of this disease, long-term issues come to light.
I speak to you, physicians, health care workers, volunteers of the associations that are involved with Huntington’s Disease and with those who suffer from it. ... The service that you all provide is valuable, because it is surely your dedication and your initiative that give tangible shape to the hope and motivation of the families who trust in you. The disease poses many challenges related to diagnostics, therapy and assistance. May the Lord bless your work: may you be a point of reference for patients and their families who, in various circumstances, find themselves having to face the already difficult trials that the disease entails, in a social-health care context which often is not oriented to the dignity of the human person. In this way, however, difficulties multiply. ... You are like hands that God uses to sow hope. You are the voices that these people have so as to claim their rights!
8. WORLD DAY OF THE SICK 2018
The 2018 message (for February 11, 2018) from Pope Francis stresses the fact that healthcare is not a business.
This legacy of the past helps us to build a better future, for example, by shielding Catholic hospitals from the business mentality that is seeking worldwide to turn health care into a profit-making enterprise, which ends up discarding the poor.
Health care ministry will always be a necessary and fundamental task, to be carried out with renewed enthusiasm by all, from parish communities to the largest healthcare institutions. We cannot forget the tender love and perseverance of many families in caring for their chronically sick or severely disabled children, parents and relatives.
What a program he traces for us in these various addresses and messages!!!
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It would be relatively easy for staff in a Catholic institution to say: let the sponsors look after this, and we’ll continue going about our work. But, if we listen carefully to what the Pope is saying, we see that this change in attitude has to permeate all levels of an institution, and not only those who are in direct positions of responsibility.
So, where does this lead us?
E. SOME PASTORAL APPLICATIONS FOR OUR HEALTHCARE MINISTRY – TO BE A COMMUNITY OF HEALING
From all of these papal statements, what kind of summary could we make, to draw up, as it were, a check-list of attitudes that should mark any person caring for the sick in a Catholic healthcare institution? I am sure that you could come up with many others, but here are ten points that Pope Francis calls us to consider at this time and which will help us build up a community of health and healing, even though not all those we serve will be able to regain physical health.
1. Develop a strong sense of compassion, especially towards the marginalized.
2. Show mercy without fear of what others might think of us.
3. Show creative charity, not just performing routine actions.
4. Show the sick that they are never alone. This is particularly true when palliative care is offered to the dying.
5. Develop an understanding of the dignity of life which includes recognition of its fragility.
6. Recognize that generous devotion to others helps us, in turn, be Good Samaritans.
7. Be sensitive to the needs of others, looking on them with love and affection. They need our help, our love, our tenderness.
8. Be willing to spend time with others, even with those who cannot express gratitude.
9. Learn how to work together with others, sharing Christ’s love, and not seeing ourselves simply in a competitive position with others.
10. Remember that Mary is a model for us in being attentive to the needs of others.
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We can notice a few things that strike us when we consider these points:
1. The Pope is not overly concerned with what we “don’t do” in our institutions, but more with how we approach what we do indeed do.
2. He does not use the business model as a basis for his thoughts, but, rather, brings them back to a model based on respect for each person.
3. He does not judge those whose values and activities do not correspond to those which an institution as a whole possesses.
How do these points translate into the direction of your institution today? This is a point for discussion, at all levels of management and delivery of healthcare services.
III. THE CATHOLIC IDENTITY OF INSTITUTIONS AND CHARITABLE WORKS
A. INTRODUCTORY NOTE
It must be said right from the beginning that we are dealing with a process, not with a cut and dry situation. As life evolves, so too do the medical techniques and the business practices applied to our everyday situations. We should not be surprised, then, to see that the law of the Church also evolves. As with other areas of church life and practice, we do not pretend to have all the answers; indeed, if we did, there would be no need to study the questions further. Some of the answers that are proposed today might eventually be found to be wrong, or not complete; some might even produce negative effects rather than the hoped-for ones that humanity is desperately seeking. The approval of the drug thalidomide some fifty or so years ago is an excellent example of this: while the immediate effects were considered to be quite beneficial, the long-term ones were disastrous. For these reasons, it is not surprising to note that the Church has to update continually not only its law, but also its teachings to respond to new and often unforseen situations. The example of the teaching on the death penalty found in the 1992 edition of the Catechism of the Catholic Church (Art. 2207) and the revised teaching put forward by Pope John Paul II some three years later in the encyclical Evangelium vitae (No. 25) is an excellent example of this type of development.
We have to keep in mind that the Catholic Church is the largest provider of health care in the world. To give an idea of the number of “Catholic” healthcare institutions, for 2017 (Mission Sunday 2017 Statistics), they are listed as 117,906, of which 5,391 are hospitals. In addition, among others, there are 16,610 dispensaries or ambulatory clinics, 604 care homes for people with leprosy; 16,270 homes for the elderly or -26- chronically ill; 9.924 orphanages; 38,484 social rehabilitation centres. Because of this, we should not be surprised to see that the Church wishes to protect and enhance this identity.
B. THE CATHOLIC IDENTITY AND MISSION OF ANY INSTITUTION
The Code of Canon Law does not specifically and directly outline the criteria for catholic identity. So, we must proceed by analogy (Code of Canon Law, canon 19). But, in addition, we must recognize that there are many ways of approaching the issue of Catholic identity: we can take (1) a purely legal or "institutional" approach, using verifiable criteria and principles to determine what we could call "catholicity"; or we could use a more (2) doctrinal approach, building on the examples and criteria derived from the Apostolic Constitution Ex corde Ecclesiae and the accompanying Norms, that helped identify Catholic educational institutions. There is also a third possible way, (3) by identifying values that we wish to promote and by observing them.
The key point to keep in mind is that there are many ways of being “Catholic”, and no one approach can claim to be exclusive of the others. “In my Father’s house there are many dwelling places” (Jo. 14, 2).
1. INSTITUTIONAL OR LEGAL CRITERIA
Obviously, canonists and other lawyers prefer the legal or "catholicity" approach because it is clear and precise. Some also like the hierarchical dimension found in it because it establishes clear lines of responsibility. However, we must keep in mind that there is more to the life of the Church than simply law and institutions. Law presupposes faith and commitment. Otherwise, it is of little avail.
Approaching the issue indirectly, we note that four canons tell us that no institution, school, undertaking or association may call itself "catholic" without the authorization of the competent ecclesiastical authorities (see canons 216, 300, 803, §3, and 808). But, beyond that, the Code does not tell us much. Nevertheless, the canons on catholic schools provide us with many elements that can be used.
I believe that, as a result of an analysis of these norms, there are a number of juridical criteria that could be applied to determine catholicity. I will mention these, without placing them in any particular order:
1) Internal Catholic values (such as a Christian inspiration, contribution by research to the understanding of the truth, fidelity to the Christian message as it comes to -27- us through the Church; an institutional commitment to service of the people of God);
2) Some reference to Church authorities (particularly to the diocesan bishop);
3) Canonically established (set up by Church authorities; having recognized statutes; or being an apostolate of an established religious house);
4) Bound by canon law requirements relating to the organization of pastoral care and the administration of property;
5) Subject as an institution to visitation by the diocesan bishop;
6) Sound stewardship of temporal goods and observance of intentions of donors.
2. CRITERIA DERIVED FROM AN INSTITUTIONAL COMMITMENT
A second approach could also be considered. It arises from principles operative in models of Church which are not "institutional" in their thrust, and where there is less direct involvement of church authorities as such, but where there has been a concerted effort to retain catholicity.
Various possible criteria could be noted were this approach to be adopted. They are not as precise as the former ones, but can be more demanding:
1) There is a general apostolic purpose — "to help others". This purpose is based on the personal commitment of those involved in the work.
2) The results are appropriate and proportionate to the activity. Thus, they are cost-effective as regards persons, time, and financial resources.
3) The faithful perceive the work as "catholic", that is, as operating under the auspices of a bishop or a catholic group, etc., and consequently as being trustworthy.
4) There is a form of "catholicity" permeating the establishment, although such is not legislated or contractual (for instance, a general relation to "Rome", Catholic traditions, religious signs, the name of the institution, and so forth).
5) The work corresponds to a need that is perceived as being in harmony with the purposes of the Church.
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6) Government authorities have granted the work certain exemptions that are usually reserved to religious organizations.
3. CRITERIA BASED ON VALUES TO BE PROMOTED
The third way would entail identifying values that are to be promoted by those responsible for the work. Building on publications of the Catholic Health Association of the USA over the past twenty-some years, we could list seven of them, noting that they are not incompatible with the other criteria listed under the previous approaches. They call for institutional and personal commitment.
1) To make certain that we are dealing with a recognized apostolic activity (through the diocesan bishop).
2) To be publicly identified with the Catholic Church and guided by its teachings. Responsible stewardship of temporal goods, one of the pillars of the Church's social teachings, requires that we use natural and social resources prudently and in service to all.
3) A preferential option for the poor marks the corporate decisions and calls for particular commitment to those who would otherwise be deprived of quality care.
4) A holistic approach to the human person underlies all activities. Every person is the subject of human dignity, with intrinsic spiritual worth, at every stage of human development.
5) There is respect for the person's needs and right of self-determination. People are inherently social; their dignity is fully realized only in association with others. Our social nature calls for the common good to be served; the self-interest of a few must not compromise the well-being of all.
6) There is respect for human life, for suffering and for death, in the context of a fuller life.
7) We are offering a service, and not simply a commodity exchanged for profit.
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In all of these approaches, there is one common thread: a link with the diocesan bishop. In fact, we could state that if a work is not in communion with the diocesan bishop, there is no way that it can be considered “Catholic” (see canon 394, §1). The -29- bottom line, then, could be presented in the following terms: a work is catholic if the diocesan bishop says it is and is willing to recognize it as such.
C. THE CATHOLIC IDENTITY AND MISSION OF HEALTHCARE INSTITUTIONS
We could take the above-mentioned criteria and apply them literally to our healthcare institutions. Some would easily pass the "catholicity" test, while others might not. However, there is another approach, again first elaborated some years ago by the CHA, that could be taken in determining the catholic identity of healthcare institutions; this consists in grouping our data around four critical themes: mission, sponsorship, holistic care, and ethics. These themes, like ingredients in a cake, cannot really be separated one from the other once they have been placed together. Yet, catholicity, like the cake, is more than the sum of the four, although it presupposes them and is based on them.
1. MISSION
The mission of the Church is to demonstrate God's love and saving power present in the world. This power, incarnated in the person of Jesus, is clearly seen in the Gospel where we witness Jesus touching, healing, and restoring persons to physical life. The meaning of life becomes expanded to include one's relationship with God and others and hope for life to come.
The mission of a healthcare organization drives the entity to actualize its core values and philosophy. It is also a benchmark to evaluate authenticity and effectiveness. Mission should be the driving force by which decisions are made and by which structure and systems are developed.
In this regard, the criteria mentioned above, relating to apostolic purpose and to communion with the diocesan bishop, can be applied here.
A catholic healthcare institution should be able to determine the values which shape its corporate culture, using ones that are consistent with the Gospel. These must also become evident both in policies and in practice.
2. SPONSORSHIP
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Given the changing circumstances affecting healthcare delivery, it is most likely that sponsorship, as we presently know it — operating in the name of and under the authority of a given Church entity, such as a canonical “juridical person” — will change its focus from control to influence. There might even come the day when we will no longer be able to influence certain decisions directly. If such occurs, the sponsorship role might even be reduced to one of advocacy: a voice crying in the wilderness.
Criteria relating to accountability would be applicable under this heading.
Sponsors must be able to articulate the non-negotiables for the Catholic ministry, yet be flexible to choose between total control and having some presence with the power to influence. The process demands a commitment to collaboration with others in order to make the transition to new forms of healthcare delivery.
We will return to this point in the next section of this presentation, so as to enter into more details.
3. HOLISTIC CARE
Holistic care encompasses the relationship of emotional, intellectual, occupational, physical, and spiritual aspects of personhood through the entire process of healthcare delivery. Simply put, holistic care is sensitivity to the whole person, and not just to a disease or condition that requires medical intervention.
Humans are wonderfully whole in their creation and being. No aspect of the person can ever be considered apart from the totality of personhood.
Criteria relating to quality control would be considered under this heading.
A catholic institution would have to ask itself how it understands holistic care and how this is expressed in the organization's policies, procedures, and practices. Thus, it would have to ask itself also how the spiritual care of persons is integrated into the overall care program? How does this care meet the needs of persons of all denominations?
4. ETHICS
Ethics is the discipline that seeks to answer the question: what is good and right for persons as individuals and as members of the human community? Ethics helps us -31- understand how human beings should relate to self, others, and God in order to be fulfilled as human beings.
For Christians, ethical behaviour means living our lives in accord with Gospel values, so ethics is never added on to or separate from anything else we do. Continuing analysis and reflection are essential to be certain that who we claim to be is consistent with who we are in practice. Catholic identity demands on-going ethical analysis to ensure that the values at the heart of our catholic tradition are expressed in daily operations at all levels.
Criteria referring to doctrinal issues would fit under this category.
We must recognize that there are many types of ethics that affect the catholicity of an institution or system.
For instance, we have social ethics which governs the provision of healthcare services to individual members of the community, thus taking into account the common good. There are also forms of corporate ethics which are expressed in the policies and practices of the institution in regard to social justice. A third ethical area is what could be called clinical ethics whereby respect for the sacredness of life at all stages of development is demonstrated. These ethical issues are concerned with questions that originate in the clinical setting where healthcare is provided. This is a specialized field that includes (but is not limited to) issues related to human genetics and reproduction, treatment decisions at the beginning and end of life, and research involving human subjects.
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It is obvious that these four areas — mission, sponsorship, holistic care, ethics — cannot be separated. For, one without the other would lead to an incomplete catholic presence. Of course, it is most difficult to evaluate whether these criteria are operative to a required degree, but that does not mean that they can simply be overlooked.
No matter which criteria are used, the institutions or systems have to address a number of new issues that were not in the forefront a decade or two ago. These new questions pose a serious challenge to the future of catholic healthcare.
IV. THE “SPONSORSHIP” OF CHARITABLE WORKS IN THE CATHOLIC CHURCH
A. CERTAIN CANONICAL NOTIONS RELATING TO SPONSORSHIP -32-
It has generally been held that, for a work to be able to be identified as “Catholic”, it must, in one way or another, be related to a Church entity, such as a diocese, a religious institute, one of its provinces, or even one of its established houses (canon 634). While, in general, this statement is obviously true, we must keep in mind that, indeed, there could be exceptional situations in which no formal canonical entity is involved and yet the work is considered by the diocesan bishop to be “Catholic”. In spite of this possible and very rare exception, we can nevertheless proceed today under the general presumption that, indeed, there is to be a canonical sponsor in order for a work to be considered as fully within the ambit of the Church’s mission.
In general, religious institutes or their component parts, such as provinces, regions, sectors, etc., have been identified among the principal sponsors of apostolic works. At times, though, the work did not have an existence distinct from that of the local community to which it was related, or at least distinct from that of the province or the institute itself. It did not have separate canonical recognition, even though it might have been incorporated civilly, distinct from the sponsoring institute. On many occasions, it has been very difficult to determine which came first: the work, or the community which operated it. While, generally speaking, this is not of the greatest importance, it takes on significance when it comes to distributing the assets of a work when a religious institute wishes to withdraw from it.
Lately, new canonical entities established specifically for sponsorship purposes have been recognized either by Bishops or by the Holy See. These entities, usually known as “public juridic persons” (but sometimes also called “ministerial juridic persons”, or “foundations”) assume the sponsorship responsibilities previously carried out by a religious institute (or one of its parts) or by a diocese. In some instances, these new entities also assume all the ownership and property rights previously held by the original institute or diocese. In others, actual ownership is not transferred, but the goods are administered by the new entity. The documents of foundation should determine clearly whether such is indeed the case.
The term “sponsorship” is relatively new in Church circles. It was originally given wide circulation as part of a threefold approach to health care works: ownership, sponsorship, control. “Ownership” referred to holding title to the property; “sponsorship” usually referred to the body under whose name it operated; and “control” referred to the internal governance.
With time, the distinctions among these three dimensions have come more and more blurred. For instance, we can have sponsorship with or without ownership; ownership with or without control, or with very little control; and degrees of control with various forms of sponsorship.
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The term “sponsorship” is not used in the Code of Canon Law. In a sense, this is very advantageous because we are not bound by any special parameters. Through the course of time, however, various forms of sponsorship in the Church have been tried and tested. No one form has proven to be the only correct one, with the others being inferior, or even bad. The forms are different, and nothing more. Some of these forms referred, for instance, to a single identity between the work and the sponsoring institute, or to various forms of separate civil incorporation, the use of reserved powers, joint sponsorship with other Church entities, and so forth.
Therefore, it is not possible to quote directly canons that would give us an answer to the questions we are considering on sponsorship. Rather, we have to find the answers in the life of the Church itself and in the responses given to new situations being faced by Church leaders on a daily basis.
It is generally accepted that, today, “sponsorship” entails the use of one’s name and the exercise of certain ecclesial and internal responsibilities that arise from this use. It often entails elements of “quality control”. To a certain extent, it could be considered somewhat parallel to a franchise. If there is no accountability, then there is a serious risk of fraud and deception. A person’s good name – whether that “person” be an individual, a group, or a work – is of primary importance today, and sponsorship responsibilities are exercised in relation to what the name stands for. In our case, we are referring to works undertaken in the name of Christ, on behalf of the Catholic Church (c. 116.1).
Traditionally, sponsorship had emphasized a position of corporate strength and independence through ownership and control via reserved powers. Today, as new relations are established with other providers (who are not necessarily Catholic), a presence is required that relies more on the ability to influence. Questions of ownership are becoming more and more blurred, particularly as Governments, at times, provide or direct various forms of funding to support the works or some of their activities.
Sponsorship in canon law has little if any meaning if it is not related more particularly to the mission and ministry of the Church. The Church’s mission is threefold: to teach, to sanctify, and to serve God’s people. Undoubtedly, healthcare fits in among the elements of ecclesial service; education is part of the mission to teach; pastoral and social services would also come under the service dimension.
B. QUALITIES TO BE FOUND IN A SPONSORED WORK
A clear distinction is to be made between “Catholic works” and the “works of Catholics”. The former are undertaken “in the name of the Church” (canon 116.1), with all the -34- guarantees of the Church behind them. On the other hand, works of Catholics are those undertakings of Catholics which might have an ecclesial relationship, or might be totally secular in their nature. A number of very “Catholic” activities are, indeed, works of Catholics and not “Catholic works” as such; I am thinking more particularly about the activities of the St. Vincent de Paul Society, or those of the Knights of Columbus, and so forth. Pushing things even more, and at the risk of sounding a bit ridiculous, if a group of Catholics founded an airline, and even named the planes after saints and had them blessed, this does not make the airline “Catholic”, even though it could be said to be a work of certain Catholics, but without any type of Church recognition.
For a work to be carried out in the name of the Church, a number of conditions must be met. I intend to refer to seven of them – a perfect biblical number! These are not spelled out, as such, in one place in the Code, but are derived from canonical principles interspersed throughout the Church’s legislation.
1. First of all, it must have a spiritual purpose (see canon 114). Such a purpose can be either a work of piety, a work of the apostolate, or a work of charity. Canon 676 speaks of lay religious institutes participating in the pastoral mission of the Church through the spiritual and corporal works of mercy. It is not difficult to see how the healthcare or educational ministries fit into a number of these categories of “mercy”.
The words of Jesus (Matthew, 25: 35-40) and those recorded in Matthew, Chapter 5, vv. 3-10 (“The Beatitudes”) have led to what have been traditionally considered in the Church to be “the corporal works of mercy”: (1) to feed the hungry; (2) to give drink to the thirsty; (3) to clothe the naked; (4) to shelter the homeless; (5) to visit and care for the sick; (6) to visit those in prison; and (7) to bury the dead.
2. Secondly, a work carried out in the name of the Church must answer a need. Canon 114 even speaks of a “genuinely useful purpose” (when dealing with juridic persons). It could have happened in the past that some Catholic institutions were established, not because there was a real apostolic need, but rather to “fly the flag” because other groups were carrying out a similar mission in the same geographic area. Fortunately, in many places, the time for such undue rivalry and competition has passed. Of course, what was, at one time, a particular need, might not be so today because of changing circumstances.
3. A third condition mentioned in the Code is that the undertaking have sufficient means to achieve its purposes (see canons 114, §3 and 610). We all know that, in many circumstances, some works were simply unable to prosper because of lack of funding. On the other hand, we are all well aware that there are many instances of Foundresses of religious institutes who made do with almost nothing and, through faith, enabled the works to flourish. The necessary means are not limited to financial assets; a spirit of faith and a willingness to work diligently are also part of the necessary means. Likewise, sufficient qualified personnel is a prerequisite.
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4. Fourthly, works carried out in the name of the Church are expected to have a certain perpetuity or stability. We are not involved in fly-by-night operations. It takes a long time to nurture a bud so that it becomes a tree in full bloom. Of course, if the need to which the Church has been responding no longer exists, then the principle of sound administration would call for the closure of the work.
5. Fifthly, canon 116 refers to tasks or missions that have been “entrusted” to those who are to carry out a work. Those who have been so “entrusted” are to carry out their tasks as good stewards, caring for the work and its assets (see canon 1284, §1). So, the responsible stewardship of the temporal goods entrusted to a work of the Church, and the resulting need for appropriate accountability, are major components of good sponsorship.
6. There is a sixth and most important characteristic that we find mentioned in canon 806. While this canon does not apply directly to healthcare institutions – indeed, there is no mention of these in the Code – it applies directly to educational activities in the Church, and, by analogy (in accordance with canon 19) could – and perhaps should – be applied to our various hospitals and related healthcare institutions, as well as to our social services. With appropriate adjustments, we could say then that the canon notes that those in charge of a Catholic work are to ensure, under the supervision of the local Ordinary, that the care given in it, or the works carried out are in their standards, at least as outstanding as those in other similar institutions in the region. In other words, if the name of the Church is to be attached to a specific undertaking, this work must be one of quality.
Indeed, if an activity is not of the highest quality, serious questions ought to be asked about whether or not it should continue. There is no place for second-rate activities. This does not mean that activities have to have the latest technological instruments and facilities, but what it does mean is that the apostolate carried out there be of fine quality.
7. In many areas, providing a work of quality calls for special preparation. Canon 227.1 refers indirectly to this. Just as we would not let a physician practice who has not been prepared, duly licenced, and who remains up to date, so too those in charge of mission and related areas must also be duly prepared and remain well-informed. It is difficult to improvise in such situations. Possibly, today, the one area that is going to call for even great quality and preparation is the area of ethics, with its various dimensions. As issues become more and more complex, and the pressure to regard simply the financial implications of decisions rises, it is not always easy to have quality ethical decisions in the workplace. A good ethical decision does not necessarily mean the strictest one possible. Rather, it is one that takes into account all of the factors that are operative in the situation. it is interesting to note that Pope Benedict XVI, in his Encyclical, Caritas in Veritate, speaks of “intergenerational justice” as one of the facts of ethics to be kept in mind today when making decisions (No. 48) – what impact will our decisions have on future generations? -36-
These principles, found here and there throughout the Code, can serve as a guideline for those who are carrying out their mission in the name of the Church. This mission is not just a personal activity; rather, it is part of a much larger plan, one that will eventually lead those sharing in it to the fullness of life in faith and in joy.
V. MODELS OF SPONSORSHIP
To understand a number of the present situations, it would be worth our while to go back a bit in history to study the recent evolution in the delivery of healthcare by Catholic religious institutes.
However, we must keep in mind that not all institutions went through the same restructuring process, or in the same order. However, a number of common traits enable us to see better where we might be moving in the future.
- Form 1: the most common form of sponsorship in the past derived from direct ownership of the property and the active presence of many persons identified with the sponsor (for instance, religious sisters or brothers on staff). The name of the sponsoring institute was often found in the name of the sponsored institution.
- Form 2: after the Vatican II period, more emphasis began to be placed in Church circles on the dignity of the baptismal vocation, moving away from an almost exclusive reliance on the vocations of priesthood or religious consecration. More and more lay persons became directly involved in the decision-making processes. At the same time, the number of available religious began to diminish.
- Form 3: with time, and also because of these factors, the duties of sponsorship became somewhat identified with those of a board of directors and the establishment of policy, rather than with actual delivery of various services.
- Form 4: later, certain works acquired a civil recognition distinct from that of the sponsoring religious institute. This lead to the establishment of separate boards of directors, with membership sometimes overlapping with the sponsoring institute.
- Form 5: then, there came about a further separation as a two-tiered structure was put in place: a distinction was made between the “members” of the corporation, and the board of directors. In such instances, the sponsorship responsibilities were generally identified with the “members”, rather than with the “board”, although, by no means was this universal.
- Form 6: relations between the “members” and the “board” were directed by the use of reserved powers. Although the Code of Canon Law makes little reference to what -37- are now known as “reserved powers”, when reserved powers were first being considered as an acceptable mode of operation, there were some fourteen or so powers that were considered to be essential, since institutes did not wish to let go of their institutions too easily. Among such powers we found:
1. To establish or change the mission and philosophy of the corporation 2. To amend the corporate charter 3. To amend the bylaws 4. To appoint the board of directors (trustees) of the corporation or of intermediate boards and to remove them from office 5. To appoint the chief executive officer (CEO) and to him/her from office 6. To lease corporate real estate 7. To sell corporate real estate 8. To encumber corporate real estate (by, for instance, contracting debts) 9. To merge, dissolve the corporation, distribute corporate assets 10. To establish subsidiary corporations 11. To approve capital budgets 12. To approve operating budgets 13. To require a certified audit 14. To appoint the certified public accountant
- Form 7: again, with time, the number of essential reserved powers was diminished, as sponsors become more comfortable with the idea of having others directly involved, and these powers (identified as three “p”s), now focused on:
1. “paper” - - mission and documents (corporate documents and by-laws, mission statements) 2. “persons” (CEO and Board) 3. “property” (alienation, mortgages, bond issues).
- Form 8: then, to facilitate coordination and to reduce expenses, systems began to be established, grouping several works or institutions. This resulted in a further refinement of reserved powers, with some being operative at a lower level, rather than at the level of membership. St. Joseph’s Health System in Hamilton, ON, was one of the first of these systems in Canada.
- Form 9: more recently, a number of provinces or even institutes have come together to sponsor their works jointly. At times, the reserved powers were exercised separately for institutions originally owned by one institute, as distinct from another sponsor; then later, many of them were delegated jointly on a permanent basis to the new board governing the joint sponsors, with only the property issues being reserved to the original sponsors.
- Form 10: as institutes and dioceses came together to operate institutions and works jointly, it became appropriate to establish new diocesan church corporations – known -38- as “juridic persons” to assume sponsorship of the joint works. The works took on a life of their own, distinct from that of the original sponsoring institutes. Covenant in Alberta, and Providence in Vancouver are examples of this.
- Form 11: some diocesan bishops became somewhat uncomfortable with inter-diocesan systems, especially when decisions were being made outside their own diocese (especially relating to moral and ethical issues), but affecting their territory. There developed a need for cohesion with a system, but how to address the challenge? Because of this overlapping, it sometimes became necessary to have a higher authority grant canonical recognition. Thus, the more recent involvement of the Holy See in granting new types of recognition. In Canada, for healthcare, we have CHI, CHSO, CHSM.
- Form 12: at the same time as the last few developments were taking place, another set of factors began to make themselves felt. For instance, partnerships were no longer exclusively with Catholic providers. LIHNS in Ontario are an example of this.
- Form 13: as Catholics began to partner more and more with groups that were not Catholic, the issues revolving around moral theology and ethics began to take on more importance. Beforehand, these were simply taken for granted. Today, a positive commitment has to be made towards a number of values. While, in the case of hospitals and healthcare activities, it was relatively easy to enter agreements to cease all abortion activities, when such partnerships were considered, such has not been the case with sterilizations and other means of contraception. Yet, as practices are now becoming more and more harmonized from diocese to diocese, new moral issues are arising which have not yet been fully addressed, such as cloning, gene experimentation, end of life issues, and so forth. These too will have to considered delicately, yet clearly. The ethical focus is now centered on governance, management, and finances.
- Form 14: in addition to establishing alliances with providers who were not Catholic, there has also been the pressure in recent times of entering into agreements with providers who were operating on an investor-owned or a “for profit” basis, thus risking a change in the nature of the work from that of an “apostolate” to a “business”. Some of the private clinics in Alberta and Quebec exemplify this approach.
It is obvious that not every undertaking moved through all these steps. Nor is it necessary to do so. It is also obvious that some of these models are starting to show their age and will need thinking, to keep adapting to new situations. For instance, and merely as an example, at the present time, most of the pontifical public juridic persons (PJPs) relate to the Vatican Congregation for Institutes of Consecrated Life. However, as religious withdraw more and more from the sponsorship of these PJPs, the Vatican Congregation might no longer have the legal competence to oversee their ministry. So, it is important to remain aware of the changing elements involved and to take the necessary precautions to preserve Catholic identity. -39-
VI. THE SPECIAL CANONICAL DUTIES OF THOSE RESPONSIBLE FOR SPONSORED HEALTHCARE WORKS
The duties of those responsible for Catholic sponsored healthcare ministries can, for reasons of convenience, be considered under a number of particular headings. There is no particular order in these topics.
We should also keep in mind that, depending on the type of agreement entered into by various parties, what are responsibilities of the “members” in one case are not so in another, where some of these responsibilities are either shared with the “board of directors”, or entrusted totally to it.
A. IN RELATION TO THE GOVERNING CANONICAL “STATUTES”
1. From a canonical perspective, the primary duty of those in charge is to assure that the institutions under their supervision operate in accordance with the teaching, discipline and laws of the Roman Catholic Church. This is to be done, however, taking into account the mission, vision and values of the system they represent.
2. This implies six elements, three of which are somewhat on a philosophical or spiritual line, while the other three are on a more practical one:
- (1) mission, (2) vision and (3) values of the system
- (4) teaching, (5) discipline and (6) laws of the Catholic Church
In order to carry out these duties, the “members” usually exercise certain powers which relate directly to the philosophy and mission of the system or the institution. Sometimes, however, these powers are shared with the board, depending on the way in which the organization has been structured.
3. It can even happen that both members and the board are also exercising a sponsorship role; in the case of the members, this, obviously, does not imply operations. Rather, the responsibilities of the members, as canonical stewards, will be situated more at the level of ideas than of operations, which are the responsibility of the various officers of the system.
4. Of course, if the board is also functioning on the secular level (which is most often the case), then the obligations that arise from the applicable civil legislation and from the corporate documents have also to be observed. -40-
5. But, from the canonical perspective, in order to exercise the responsibilities relating to mission, vision and values, those in charge will have to keep abreast of the teaching, discipline and laws of the Roman Catholic Church and apply these to the best of their ability. For this, they can usually count on the assistance of the Mission Integration department of the system, by whatever name it is known. Nevertheless, they have ultimate responsibility for the decisions taken and will most likely have to arrange periodically for some form of on-going formation in these three areas, possibly using the expertise already found among themselves.
B. IN RELATION TO TEMPORAL GOODS
1. As was the case with the canonical documents and the mission of the system, so too is it with matters relating to temporal goods. The same persons could exercise both canonical and civil responsibilities, or be functioning exclusively on one level. I will focus here on the canonical obligations in this area.
2. The goods owned by a public juridic person (such as a religious institute, or one of the PJPs currently operating in various countries) are ecclesiastical goods. Thus, it will be important to determine precisely, in each case, whether the ownership of institutions or works is absolute, or whether we are dealing simply with goods that have been entrusted to the system for administrative purposes.
3. Since the presumption would be that we are dealing with ecclesiastical goods, when a work is accepted for sponsorship, a clear statement should be made as to the eventual canonical “ownership” of these goods. For instance, some goods (as in the case of a community hospital) are sometimes simply entrusted to the system, without transferring ownership rights and responsibilities.
4. If these goods are not ecclesiastical goods, then the norms governing administration and alienation do not apply in the same way as they do for ecclesiastical goods.
C. IN RELATION TO THE DIOCESAN BISHOP
1. Since the members and the board accept responsibility for an apostolic activity, we must recall that all apostolic works are under the direction of the diocesan bishop (see canon 394, §1). The way this responsibility is implemented will vary from diocese to diocese.
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2. Whether the establishment of these forms of relationship is the prerogative of the canonical sponsors (i.e., the “members”), or of the board, will depend on the way the system operates. We can presume that, no matter which approach is taken, the board would be part of the process.
3. In particular, the diocesan bishop should be involved in matters relating to chaplaincy services (“care of souls” and the “liturgy”), and to the work itself (see canon 394, and, by analogy, canon 678).
4. Also, it is the diocesan bishop who applies in his diocese the Health Care Ethics Guide, or, in the USA, the Ethical and Religious Directives. We have to keep in mind that just because a given policy exists in one diocese where a system is exercising sponsorship, this does not necessarily mean that it applies in all the dioceses where it carries out its mission. It can thus follow that a diocesan bishop could remove “Catholic” identity from a hospital because he judges that its activities are not in conformity with Church teaching and practice.
5. As a public juridic person assumes the sponsorship of more and more works, it will have to develop good protocols for dealing with the bishops of the dioceses where they carry out this mission.
6. Possibly, it might also be necessary to establish some type of mediation procedures, since it must be remembered that in some areas, Church authorities or their representatives won’t look upon lay people as the “official” representatives of the Church which they often are, especially in the case of a public juridic person established specifically for the delivery of healthcare. It takes time to change mentalities.
7. It would be essential to keep the bishops of the dioceses where there are works sponsored by the system informed of the progress of the work, of difficulties encountered, and of challenges for the future. In a period of revision and restructuring, this is an excellent time to establish good strong relations with the bishops or their healthcare delegates.
VII THE FUTURE VIABILITY OF OUR HEALTHCARE MINISTRY
1. It is obvious that the Church’s healthcare ministry in North America is facing many challenges, both from without and even from within. These challenges can arise from financial pressures, from competition, from ethical positions, and so on.
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2. Those involved in sponsorship must be aware of these pressures, and not simply wake up some morning to find themselves face to face with something that could have been avoided.
3. In particular, and without hardening the point too much, I am concerned with maintaining the Catholic identity of our institutions, not just in name, but also in mission and philosophy.
4. We cannot expect the leaders to do tasks for which they are not suitably prepared, nor for which training is not made available.
5. In addition to the general duties mentioned above, a sound application of the Church’s canon law would call for those in charge of Catholic works to:
- remain aware of developments in moral and ethical teachings; - exercise responsible stewardship over the temporal goods entrusted to their care; - make certain that we are indeed dealing with a recognized apostolate (which calls for communion with the diocesan bishop); - make certain that new members and trustees are suitably informed of situations; - establish good rapport between their civil responsibilities and their canonical duties, particularly when these appear to be in conflict; - be particularly careful when considering proposed new mergers, amalgamations, joint ventures, closing down, and so forth.
6. Naturally, when a board brings together persons who represent different elements in a “system” or an “integrated relationship”, the responsibilities will be distributed according to the constituency represented by the board members. Thus, for instance, if a system comprises both Catholic and secular institutions, clear distinctions will have to be made as to the parts of the operation to which canon law applies.
But, if persons accept to be part of a board of directors or to assume specific leadership roles within the system or one of its institutions, it can be expected that they will espouse the values of the system as a whole, as well as the principles on which the system has been built.
VIII. PATHS FOR THE FUTURE
1. Recognizing the importance of mission over business. Because of the numerous pressures placed on boards to make ends meet financially, it often happens that the “mission” is the first area to suffer. Mission effectiveness and pastoral care -43- departments are often cut, because the boards do not place much value in their services.
2. Answering real needs. Although the Church has been actively involved for years in the delivery of healthcare, it might be necessary to examine carefully how its resources in personnel, time and finances are being used. Are they being put to the best possible advantage?
3. A commitment to Catholic Church teachings. If the basic philosophy of the board is simply to try and “get around” Catholic teachings, it is not of much use to put so much energy into what we are doing. It might be preferable in such instances for the Church not to be involved and to leave such tasks to others. Of course, this is not what we are doing here, but there is always a danger lurking in the background.
4. Integrated relationships. Although Catholic undertakings are committed to maintain Catholic identity and values, this does not mean that they must exclude other forms of relationships. The overview of the development of sponsorship forms shows this clearly. No two relationships are alike, and therefore one size does not fit all. We must build relationships, not legislate for them. The same applies to “catholicity” – we must live it, not legislate it!
When people are insecure, they have a tendency to legislate. Our ministry should be based on concern for the people we serve, not primarily on retaining what we had in the past.
5. What do we insist upon. If Catholics are involved in an undertaking, then we should not be surprised that they are going to insist on certain values that they wish to have promoted. These, in turn, will lead to better service of the community, because they offer consistency, and help make the vision a reality.
Today, in Catholic institutions, there is strong emphasis placed on:
- the value of human life in all its forms and at all stages; - no discrimination based on sex, race, religion, state of health, and so forth; - the responsible use of resources (persons, finances, time); - concern for the whole person (including the spiritual), and not just for a physical part of the person; - recognizing the place of suffering and even death in the plan of human existence; - a focus on wellness, rather than on healing; thus, preventative care; - a dimension of charity towards those who do not have the necessary financial means. -44-
CONCLUSION
Obviously, we are living in challenging times. We should not be afraid to recognize that we do not always have the answers.
What counts most is that those who have devoted their time and energy to the furthering of healthcare ministry be given the opportunity to update themselves and to know what are the underlying expectations attached to their position.
Therefore, it is essential that both members and boards focus on:
- mission (what are we about?) - persons involved (how are they chosen, selected or named; how are they formed for their duties?) - accountability, since they are not operating in their own name - the ethics involved (corporate ethics, medical and social ethics, etc.)
Francis G. MORRISEY, O.M.I., Professor Emeritus, Faculty of Canon Law, Saint Paul University, OTTAWA, ON, Canada K1S 1C4
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