Pastoral Reflections on Catholic
Health Care
October 18, 2000
Anthony Cardinal Bevilacqua
Healing the sick and caring for the weak have long been concrete ways Christians have lived out the gospel.
People desiring to heal and care have organized hospitals, nursing homes, even large health care systems to accomplish
this work. I write to the people of the Archdiocese of Philadelphia and all in the community regarding the Catholic
health care apostolate at a time when this ministry of care faces serious challenges threatening its existence.
My hope is that the following reflections on the state of Catholic health care in the Archdiocese will:
--raise awareness of the current situation of crisis in all sectors of the industry;
--encourage those who work in this needed apostolate;
--explain why the Church is involved in this ministry; and
--rally support for reforms ensuring that Catholic health care remains vigorous.
Our community has sacrificed too much to allow a two-century tradition of continuing Christ's healing ministry
to be lost.A History of Caring
The story of the founding of Misericordia Hospital exemplifies the spirit of sacrifice and hard work manifested in the early days of one health care ministry in the Delaware Valley. One hundred years ago, the population of the Catholic Church in the City of Philadelphia was shifting westward. Large numbers of people were moving to parishes in West Philadelphia. At the time, just three Catholic hospitals served the sick in the entire City, all located in areas which had been settled during the nineteenth century - Saint Joseph in North Philadelphia, Saint Agnes in South Philadelphia, and Saint Mary in Fishtown. By 1910, there was a great need for a Catholic hospital to care for the sick in the newly settled areas.
The development of such a facility was a goal of Mother Mary Patricia Waldron, R.S.M., Superior General of the Sisters of Mercy in Merion, Pennsylvania. In 1914 she mortgaged the property of her congregation to buy farmland along Cedar Avenue in West Philadelphia as a potential site for a new hospital. The following spring, my predecessor, Archbishop Edmond F. Prendergast, initiated a campaign across the Archdiocese to raise $200,000 for a hospital construction loan. Mother Waldron had only $2,000 at her disposal when the Archbishop authorized the Sisters of Mercy to assume responsibility for the hospital's operations. Prominent Catholic physicians met to assemble a competent medical staff. Working together, Archbishop Prendergast, the Sisters, the physicians and the faithful of the Archdiocese, the empty tract of land was transformed into Misericordia Hospital, known today as Mercy Hospital of Philadelphia. (1)
Led by visionaries like Mother Mary Patricia Waldron, Catholic health care has responded to the needs of the sick, suffering and chronically impaired. In particular, the Church's health care apostolate in the Archdiocese of Philadelphia, (2) indeed throughout the world, has been shaped and advanced largely by religious congregations that have tangibly lived out Christ's command to be merciful, compassionate, and mindful of our neighbor in need. Dedicated members of these religious communities, inspired by the charisms of their founders, developed ministries of healing and service for the vulnerable, sick, orphaned, widowed, poor and the disenfranchised in society. Their legacy continues to be a living expression of God's love and mercy in our world.
All of the apostolic works of the Church, including health care, are spiritually rooted in the Paschal Mystery of Jesus Christ; that is, they draw from His passion, death and resurrection. Catholics believe that by reflecting on the suffering of Jesus we can find meaning for our own suffering. Consciously uniting our pain and discomforts to Christ unites us in a real way with the person of Jesus who suffered as we do. This faith-centered understanding of the meaning of suffering inspires Catholics to find a value in their trials which transcends the "here and now." It sets us apart from those in our culture who deny the inherent dignity of sick persons who are judged less human because of their suffering, illness or disability. This same dismissive attitude extends to the unborn, the terminally ill, those with disabilities and others who live with life-threatening sickness or chronic ill health.
Through her health care ministry, the Church challenges the views of modern culture and proclaims the inestimable, God-given worth of every human being. In the face of the one who suffers, we see the face of Jesus Christ. We proclaim in our works of healing that the person who is sick is immersed in the healing waters of the passion, death and resurrection of Christ; that he or she is one with Jesus in the Paschal Mystery.
The Church advances her ecumenical and inter-faith initiatives for the common good of all through the health care apostolate. We reach out in service to people of all faiths. We welcome the contributions of so many non-Catholic individuals who embrace our mission and values. Catholic health care also provides the challenge of integrating the principles of business management with the work of the Gospel. It is a complex enterprise, employing tens of thousands of people in our country and providing care for millions. Because it is motivated by the Gospel, explicitly committed to the ethical values of Jesus, and integrated with the mission of the Church, Catholic health care is different from the care offered by other providers.
The Present Crisis in Catholic Health Care
There is a concern in our community and in the country that health care is in crisis. All of the industry providers have experienced dramatic changes in recent years which have contributed to a climate of uncertainty and upheaval. Recent trends in health care have given rise to particular concerns for the future of faith-based care givers. Catholic providers are affected by this crisis as well. This current situation is having an adverse impact on the ongoing existence of the longstanding, Christ-centered healing which has characterized Catholic health care nationwide and in the Archdiocese of Philadelphia. This great work of the Church is at risk in the face of the current ethical, economic and social challenges facing Catholic health care.
The Ethical Challenges
The fundamental values on which the medical profession and our nation's health care system were founded are under siege. Respect for human life is seriously undermined by medical practices like euthanasia, voluntary sterilization and abortion on demand. Human life is also threatened by other manifestations of what Pope John Paul II calls a "culture of death:" (3) certain reproductive technologies, genetic engineering, fetal experimentation, organ harvesting and a trivialization of non-material values by evaluating everything based on standards of usefulness, beauty or worldly power. Life becomes a mere consumer good and health care a commodity, when considerations of what is valuable are evaluated in this manner.
Present generations have witnessed phenomenal advances in the ability of human beings to alleviate suffering and improve the quality and duration of life.Unfortunately, these technological breakthroughs have not always been accompanied by appropriate considerations of their effects on the inviolable dignity of the human person. A Catholic voice is essential in the discussion guiding clinical ethics and in the scope and limits of human medical intervention. The successful mapping of the human genome, for example, has enormous implications for health care and disease prevention. The use of this information must be guided by moral principles which esteem the value of the human person made in the image of God the Creator.
Across the country, there are some who seek to pressure Catholic health care systems to compromise their commitment to respecting human life. This commitment is most clearly articulated in the Ethical and Religious Directives for Catholic Health Care Services which provide essential direction to the Catholic health care apostolate. No faith-based health care provider should be prevented from operating because of the need to be faithful to its ethical principles. All health care providers, including Catholic sponsored ones, must be allowed to practice without compromise in accord with their ethical and religious beliefs. Economic Challenges
In the past, health care delivery was typically supplied by non-profit organizations, often faith-based institutions. Such organizations were founded on charitable motive to assist people in times of sickness and need. Those who could not pay nevertheless received care. Government subsidies or insurance later helped to cover costs. More recently, the provision of health care has become increasingly expensive due largely to technological and other capital costs. Restriction and government controls on health care services, competition for compensated care, changes in the ways that services are reimbursed by insurers and a decline in private philanthropy have also placed financial pressures on not-for-profit health care systems. At the same time, spiraling costs make health care unaffordable for many who need it. A tangible indication of these economic pressures is the large number of health care mergers that have occurred as these pressures threaten the very existence of free-standing hospitals.
Social Challenges
The application of business, economic and management principles to health services as well as the emergence of new models of compensation and insurance have created a crisis in effectively reaching the poor who need care. Health facilities are no longer supported as they once were by private philanthropy and governmental subsidy. Providing for indigent care is financially draining in this era of high operating costs. Government and private insurers have attempted to improve the efficiency and coordination of health services using "managed care" models of medical insurance in place of the traditional "fee for service" approach. While the concept of "managed care" is a good one, in practice, the application of the concept has often forced health care providers to make decisions regarding the care of patients based solely on financial constraints.
Recent years have seen a widening of the gap between the health insurance "have's" and "have-nots." Those who are insured or have financial resources demand increasingly sophisticated and costly care, while those who are uninsured or under-insured grow steadily in numbers at a disturbing pace. Despite the fact that we live in a period of economic prosperity, some 44 million Americans are without health insurance. (4) Nearly 12 million of them are children of age 18 and under. (5) The elderly receive basic health care benefits, but lack adequate coverage for prescription drugs, home health care or other services requiring out-of-pocket expenses. The plight of the uninsured is further complicated by poverty, poor nutrition, inadequate shelter, lack of education and little family support. There is so much to be done to assure that those who need health care have access to it, especially the poor, people with disabilities, children and others most vulnerable.
In the Archdiocese of Philadelphia, Catholic hospitals and nursing homes serve large numbers of uninsured or under-insured people. These institutions simply cannot absorb the high costs of care without some assistance. If health care is a right, then it must be accessible and affordable to all in the community.
A desire to provide generous service to the indigent has set apart faith-based health care from other providers
in the United States. Our nation's health care system will suffer from the weakening or loss of a strong network
of faith-based providers. Taken by themselves, Catholic health services comprise a significant part of our nation's
health delivery system: 1 in 5 Americans, regardless of religion, race, age,
or ability to pay, receive health care from Catholic care givers. (6)Catholic
health care must be preserved for the sake of the poor, the vulnerable, the uninsured and the under-insured, for
elderly and children, for people with disabilities or life-threatening illness, for those near death and for those
not yet born.
A Catholic Response to the Crisis in Health Care
We have been closely monitoring certain issues impacting Catholic health care in the Archdiocese of Philadelphia. In articulating a response to the crisis, we must never lose hope in God's presence and providence in this ministry of the Church. We must reaffirm the fact that Catholic health care is not an end in itself, but a fundamental expression of the healing that comes through the passion, death, and resurrection of Jesus Christ. Jesus promised his disciples He would be with us until the end of time. Filled with hope then, we can renew our commitment to the Church's healing mission. Some aspects of Catholic health care as we have know it may change, but the healing ministry of Jesus will go on forever. Perhaps in the future, Catholic health care will take shape primarily in non-acute forms of care, such as long-term care or community-based services. We must be open to this evolution when recommitting ourselves and our resources to the health ministry.
Faith must be expressed in action. I propose that the crisis in the health care system in our country can be
addressed most effectively through advocacy, collaboration and a thorough rededication to the mission and values
on which Catholic health care was founded. In addition to direct service to the sick and impoverished, we must
work to transform social structures already in place that neither serve nor effectively meet human need. The Catholic
Health Association of the United States has articulated an agenda for legislative advocacy.
(7) I encourage you to join me in supporting initiatives which would achieve the following goals:1. Accessible
and affordable health care for all. It is shameful that so many are cut off from the health care delivery system
because of inability to pay. Efforts to provide quality health care at reasonable cost to everyone are a matter
of justice.
2. Preservation of Ethical integrity. The health care environment must support and encourage ethical integrity.
Catholic sponsored health care must be allowed to operate in a manner which is consistent with Catholic Christian
beliefs. Our nation needs legislation which would protect the religious liberty of faith-based institutions and
provide "conscience clause" protection.3. An equitable payment policy. Health care should respond to
the needs of individuals and their communities in a coordinated and cost-effective way. Medicare and Medicaid rules
and payment systems must be responsible and fair for providers and plans.
4. Quality Services. Americans must have confidence that their health care is appropriate, compassionate and of the highest quality. The rights of patients must be respected and articulated. Opportunities to integrate federal housing programs with health programs for the poor elderly should be developed.
5. Promotion of non-profit health care. There is a trend which views health care merely as a commodity which is exchanged for profit. Catholic health providers must exemplify that altruistic, faith centered values are still key motivators in the health care industry. Collaboration among Catholic health care providers which would unite Catholic health care in the Archdiocese has been and continues to be my vision. It is my earnest hope that such a unity may come about in the near future. Some important steps have already been taken to strengthen and to unite the local Church's health apostolate.
In January of 1999, I promulgated particular law for the Archdiocese to guide the establishment of collaborative relationships between Catholic and non-Catholic health care providers. The Protocol and Procedure for Evaluating Catholic Health Care Collaborative Relationships was developed in response to the growing need on the part of Catholic health providers to establish relationships with health care entities which are not Catholic.
The leadership of the major Catholic health systems in the Archdiocese of Philadelphia has been meeting regularly for several years as the Delaware Valley Catholic Health Care Alliance. Through the Alliance, the local Catholic health care providers seek ways to collaborate in ministry and to explore creative ways to unite their work as an expression of the Church's one mission. It is my hope that these pastoral reflections on health care will assist the Alliance in identifying clearly defined initiatives. In 1997, in a collaborative pilot project of the Archdiocese of Philadelphia, Holy Redeemer Health System and Catholic Health Initiatives, a parish nursing program was established in the Philadelphia-North and Bucks County Vicariates. Later this year we expect to expand this program to be a resource for the entire local Church. The Archdiocese is a sponsoring member of a national coalition of Catholic health systems called Supportive Care for the Dying: A Coalition for Compassionate Care. Recently, that coalition funded a community-based project in Northeast Philadelphia involving eight parishes in an effort to unite and expand our efforts to provide the best care for people living with life threatening illness in the community.
All who work in the health care profession have the opportunity to play an active role on behalf of the common good. For those whose professional lives are dedicated to service in Catholic health care, I remind you of the individual role you play in furthering the mission of the Church. I acknowledge the many sacrifices which you make in order to carry on your work. Your service to the sick and suffering is very close to the heart of Jesus and the heart of the Church's mission. I urge you in this year of Jubilee to rededicate yourself to this work. I invite all who work in Catholic health care to reflect on the Ethical and Religious Directives for Catholic Health Care Services, and to develop an understanding of the Directives as a means of fostering growth in Catholic identity.
I gratefully acknowledge the efforts of all the religious congregations operating health care facilities in the Archdiocese of Philadelphia and encourage them to remain steadfast in their fundamental mission of compassionate service and care to the sick and infirm. Together we must seek ways to assure that Catholic health care remains viable into the future for the greater good of society.
All who work in fields of medical technology, research and education: you have an important opportunity to shape the health care system of the future through the formation of leaders. Never lose sight of the need to care for all people and to respect the sanctity of all human life.
The example of leaders like Mother Mary Patricia Waldron continues to call the leaders and directors of Catholic health care to faithfulness to the mission of the Church in this period of crisis and uncertainty. I urge all who are Catholic health care leaders today to continue to look to the life and ministry of our redeeming Lord to find meaning and direction in your own work of healing. Find new energy by uniting your efforts to the broader mission of the Church. Look for ways to reaffirm and strengthen your Catholic identity and to form lay people and religious who will lead the Catholic health apostolate into the future.
May our loving God, the supreme healer, bless all who work in health care. May the Blessed Mother, together with Saint John Neumann and Saint Katharine Drexel intercede for this ministry of the Church. We can be confident and encouraged by the belief that, despite the present challenges, God will continue working powerfully through those committed to bring the healing and love of Jesus to all who are sick and suffering.Anthony Cardinal Bevilacqua
18 October 2000
Feast of St. Luke, Evangelist and Physician
Appendix: Catholic Health Care Providers in the Archdiocese of Philadelphia
Catholic Health Care Services, Archdiocese of Philadelphia:
Immaculate Mary Home, Philadelphia
Saint Francis Country House, Darby
Saint John Neumann Nursing Home, Philadelphia
Saint John Vianney Center, Downingtown
Saint Katherine Drexel Residence, Philadelphia
Saint Martha Manor, Downingtown
Saint Mary Manor, Lansdale
Catholic Health Initiatives;
Sisters of St. Francis of Philadelphia and
Sisters of the Holy Family of Nazareth
Saint Agnes Medical Center, Philadelphia
Nazareth Hospital, Philadelphia
Saint Mary Medical Center, Langhorne
D'Youville Manor, Yardley; Grey Nuns of the Sacred Heart
Holy Family Home for the Aged, Philadelphia; Little Sisters of the Poor
Holy Redeemer Health System; Sisters of the Holy Redeemer
Holy Redeemer Hospital and Medical Center, Meadowbrook
The Lafayette-Redeemer, Philadelphia
Saint Joseph's Manor and Redeemer Village, Meadowbrook
Little Flower Manor, Darby; Sisters of the Divine Redeemer
Sacred Heart Home, Philadelphia; Sisters of St. Dominic
Sacred Heart Manor, Philadelphia; Carmelite Sisters of the Aged and Infirm
Saint Ignatius Nursing Home, Philadelphia; Felician Sisters
Saint Joseph Villa, Flourtown; Sisters of St. Joseph
Saint Joseph at Villa Joseph Marie, Holland; Sisters of St. Casimir
Saint Mary of Providence Center, Elverson; Daughters of St. Mary of Providence
Catholic Health East - Mercy Health System;
Sisters of Mercy, Merion Regional Community:
Mercy Hospital of Philadelphia, Philadelphia
Mercy-Fitzgerald Hospital, Drexel Hill
Mercy Community Hospital, Havertown
Mercy Suburban Hospital, Norristown
Villa Saint Teresa, Darby; Sisters of the Divine Redeemer
ENDNOTES
1. For more on the efforts to establish Misericordia Hospital, see Sister Mary Consuela's "The Church in Philadelphia (1884-1918)," in The History of the Archdiocese of Philadelphia, ed. James F. Connelly (Wynnewood: The Archdiocese of Philadelphia, 1976), 330-331. See also "Selfless Contributions and the Kind Offerings of Others," The Mercy Connection, Summer, 1995: 17.
2. See Appendix for a listing of Catholic Health Care Providers operating in the Archdiocese of Philadelphia.
3. Pope John Paul II, Evangelium vitae, 21, Acta apostolicae sedis LXXXVII, no. 11 (1995): 921-982. English translation: On the Value and Inviolability of Human Life (Washington: United States Catholic Conference, 1995).
4. Catholic Health Association of the United States, Continuing the Commitment: A Pathway to Health care Reform(St. Louis: The Catholic Health Association, 2000), 1.
5. Based on Bureau of the Census figures provided in March, 1997 Current Population Survey available on the world wide web at http://www.childrensdefense.org/health_keyfacts.html#1.
6. Catholic Health Association of the United States, htttp://www.chausa.org.
7. Catholic Health Association of the United States, Agenda for Legislative Advocacy (Internet: http://www.chausa.org).