ANOTHER IDENTITY CRISIS - Catholic Hospitals Face Hard Choices
Cochran, Clarke E., Commonweal
Case One. James Michener reports a conversation in Spain some decades ago. He asks about public hospitals and discovers there are none. All hospitals are church-operated. The idea of public hospitals astounds his Spanish friend. "You mean the government taxes you for what the church gives us? Tell me, would sensible men trust politicians to run a hospital? The church you can trust." Of course, in many parts of the United States at that time, Catholic hospitals did serve as the primary health-care providers, offering free or low-cost medical care.
Times change. Catholic hospitals still supply significant services (about 15 percent of all community hospital beds), but at prices as high as-and in settings often indistinguishable from-their public and other private counterparts.
Case Two. In a 1995 statement on the "Rationale of Catholic Health Care," the bishops of New Jersey stress its sacramental character and centrality to the church's mission. They also call attention to "forces which imperil the identity and integrity" of the ministry, including "market forces that gauge the effectiveness of health-care delivery solely in terms of profitability."
Prophetic statements sometimes are ignored. In August 1999, Modern Healthcare, the health-care industry weekly, reported the departure of top executives from Catholic Healthcare West, the fifth largest Catholic hospital system, after an aggressive market-based expansion strategy brought losses of hundreds of millions of dollars.
Case Three. Imagine being admitted to a Catholic hospital for serious surgery; or imagine that you are taking your elderly mother to a Catholic nursing home. What might you see that reassures you, that quickens your spirit in the midst of anxiety? Crucifixes surely; statues of the Virgin or saints quite likely; a chapel. What you will not see are the women religious who formerly dominated the daily life of the institutions they founded and who incarnated its Catholic identity.
Now take away your sense of sight. What will you hear, taste, touch, or smell that identifies this hospital or nursing home as distinctively Catholic? Will the words spoken on admission differ from those in a secular institution? Will the employees handle your mother physically in any different way?
Arguably, the sacramental and incarnational aspects of Catholic life inform Catholicism's distinctive quality. Yet our imagined admission episodes above-and our actual daily experiences in Catholic health-care institutions-may lead us to wonder whether this quality persists in the corridors, patient rooms, admission offices, and surgery suites formerly suffused with Catholicity. We might ask: If the facilities are not clearly sacramental, might it not be time to transfer the resources invested in them to more distinctively Catholic healing missions?
None of this is news to Catholic health-care leaders, to bishops, to well-informed lay persons, or to patients. Catholic identity is as hot a topic in health care as in higher education, the arena where this issue is most prominently addressed in Commonweal and other journals of opinion. The health-care world parallels higher education in its debate over the 1990 apostolic constitution Ex corde ecclesiae, and the nation's bishops have been drawn into hospital identity questions as surely as college campus issues. Bishops in Saint Louis, Chicago, Austin, and other cities have wrestled with plans for mergers and affiliations between Catholic and non-Catholic institutions, and with controversies over contraception and sterilization services in newly created systems.
As with colleges and universities, local bishops seldom own the health- care institutions in their dioceses. Yet they are held accountable by Rome and in the public mind for these institutions' fidelity to the church's moral teachings and for the question of whether the values of the marketplace and the medical profession, rather than Catholic ideals, control the institutions. …