[Editor’s Note: M. Therese Lysaught is a tenured Professor at the Neiswanger Institute for Bioethics and Health Care Leadership and the Institute of Pastoral Studies at Loyola University Chicago. She is also the Graduate Program Director of the online master’s and certificate programs in Health Care Mission Leadership. Dr. Lysaught’s scholarly work brings into conversation the fields of theology, medicine, ethics, and bioethics. She is the co-editor of Catholic Bioethics and Social Justice: The Praxis of US Health Care in a Globalized World. Her other work can be found here. She spoke to Charles Camosy about bioethics and medical care in the world today.]
Camosy: We often don’t think of bioethics and social justice as connected, though with the help of thinkers like Lisa Cahill, you, me, and some other Catholic moral theologians that has changed over the last few years. Your book marks an important moment in this movement. But the field is now consumed by social justice concerns. So much so that some believe a “bioethics” specialization doesn’t or shouldn’t really be a thing. Instead, it should be considered just another interconnected concern of “social ethics.” Do you think Catholic bioethics can and/or should be its own discipline?
Lysaught: Exactly right—Michael McCarthy and I were certainly not the first to connect bioethics and social justice or Catholic bioethics and Catholic social thought (CST). A couple of years ago, Michael and I were asked to teach a course entitled “Catholic Bioethics and Social Justice,” so I went to look for a book to use for the class. But apart from Lisa Cahill’s Theological Bioethics and books on specific issues (primarily access to healthcare, HIV/AIDS), there wasn’t really “a” book. A handful of articles were scattered throughout the literature.
These dealt primarily, again, with certain topics (HIV/AIDS, access to healthcare), or like you and Cahill, they brought the lens of Catholic social thought to bear on traditional issues in Catholic bioethics (abortion, end of life, reproductive technologies). Relatively few articles used CST to address new issues. We sought, in this book, to bring these latter voices together in one place to give this emerging conversation greater visibility.
Is Catholic bioethics its own field or just a subset of social ethics? Very interesting question! We have to remember that terminology matters. The terminology has been very fluid over the past 50 years. Catholic bioethics was, more recently, Catholic healthcare ethics, and before that Catholic medical ethics, and before that simply Medical Morals (from that great Jesuit, Gerald Kelly). Somewhere in there we’d have to toss Catholic clinical ethics. These phrases reflect shifts in ecclesiology, institutional locations, and conversation partners.
So two things: First, the post-Vatican II identity of Catholic moral theology is still emerging. Pope Francis has been quoted as saying that it takes 100 years to fully implement a Council. That sounds about right. It’s going to take another 50 years before we know what a Vatican II moral theology looks like. I am hopeful that this Vatican II moral theology will have moved past the siloes that have hobbled Catholic theology and Catholic moral theology for the past few centuries. Much of my own work has aimed at breaking down boundaries between these siloes—systematics, moral theology, liturgical theology, scripture. I would hope the same thing for the boundaries between Catholic bioethics and Catholic social ethics.
Second, it will also depend on important reconfigurations underway in the Church and Catholic healthcare. These institutions have critically shaped Catholic bioethics. We are on the cusp of seismic—and necessary—transformations in how the Church is embodied in the world, in part because of the continued unfolding of the ecclesiology of Vatican II but also because of the sex abuse crisis and external pressures. The structure of Catholic healthcare changes about every six months. It continues to morph due to developments around population health, social determinants, and more. So whatever “Catholic bioethics” is in the future, it will necessarily be shaped by these new institutional contexts.
One of the most important aspects of your book is its global context. When U.S. American Catholics think about bioethics and health care, we often focus on U.S. law and policy. But an authentically Catholic context rightly takes a global view. What changes when we take a global view?
So many things change! We only scratched the surface of global issues in this book. Given our audience, we asked: What global issues do people in Catholic healthcare wrestle with? At the top of that list, of course, would be medical missions, relationships with international outposts started by their founding religious orders, as well as humanitarian responses to disaster relief, so we focused on those.
But a global view pushes us further. Most clinical ethicists in the U.S. will tell you that they spend 80 percent or more of their time dealing with end-of-life issues. A number of years ago, I attended a medical ethics conference in Mexico, and I mentioned this to a Latin-American clinical ethicist. He shook his head and said that 80 percent of the issues they dealt with concerned access to care. This experience has been confirmed for me repeatedly.
The issues that fill books and journals in secular or Catholic bioethics really are quite provincial, quite particular to the rarified and peculiar U.S. context. They mostly are, as Paul Farmer has aptly named them, “quandaries of the rich.” As a result, they render invisible the issues that most of the people in the world deal with most of the time. That is a problem. Or, to put it positively, a global view brings into focus an entirely new range of questions, issues, and resources for Catholic bioethics.
But it’s even bigger than that. Step outside of the U.S. and immediately everything is different! A global view — if taken seriously — challenges the philosophical (and theological) framing of bioethics. Faith isn’t marginalized. Persons aren’t conceived as autonomous decision makers. Families matter. Communities matter. Economics is front and center. We talk about our healthcare resources as…scarce? Let’s be serious! The problematic excesses of US healthcare are more readily seen from a global perspective.
A global perspective also reveals how thickly neoliberal economics has both negatively impacted health outcomes for people from ‘resource poor’ countries and shaped the structure of US healthcare delivery and US bioethics. Standing in a non-US space, one can more easily see how neoliberal bioethics has been exported — in global practices of medical research, outsourcing, bodily commodification, and more, that are largely invisible to US bioethics. That’s a longer conversation for another day.
I’ve been struck by the chapter in your book by Brian Volck in which he discusses the “scandal of borders.” If one doesn’t see borders as morally normative, I wonder if US American Catholics interested in social justice ought to rethink a focus paying taxes in support of US state programs. Perhaps our resources would more justly be used, say, supporting international Catholic health care institutions serving populations much more vulnerable than our own?
Amen, amen, I say to you — you are not far from the Kingdom. I have had good friends who have tried this sort of tax witness, mostly around protest of military spending, and let me tell you — the IRS makes it really hard to do this. (So much for the American myths of freedom and autonomy).
Brian’s argument — which is crucial for a Catholic bioethics — is basically a sacramental and ecclesiological argument (see, again, Vatican II). Catholics are part of that great transnational community, the Catholic Church, the Body of Christ. We should understand this as our primary identity. But how many Catholics do? How many Catholics view people in other countries as our kin, our fellow citizens — by both our common humanity and our common Baptism by which make us one in Christ?
We don’t have much choice about paying our taxes. But we do have choices about the rest of our resources. Communities more vulnerable than our own certainly could use our financial resources. But one theme resounds through our ‘global health’ chapters: What vulnerable populations and communities want most from US partners are sustained, long-term relationships where both parties relate as equals. What they need is our persons, our very selves.
This is the opposite of the “short term mission trip” mentality. It requires significant self-emptying on the part of US Catholics — particularly of our belief that our job is to parachute into places armed with “the answer,” to fix things, and to move on. This approach to ‘resource re-allocation’ requires taking the time to put our bodies into foreign places wracked by a variety of structural violences. In so doing, we get to know real people in local communities, to learn from them about their own realities, to elicit from them and engage with them in a shared process of creating solutions.
It entails real risks. It is not efficient. We also learn a lot about ourselves — including, many things we might not like. But it’s also the only way to craft real long-term solutions as well as to authentically live as the Body of Christ, even if the solutions only come at what seems to be an eschatological pace. This, for me, is the take-away of the chapters by Volck, Bruce Compton, Brian Medernach and Antoinette Lullo, Alexandre Martins, and Dónal O’Mathúna.
Robert Gordon had a very interesting chapter titled ‘Inviting the Neighborhood into the Hospital.’ Most health care professionals don’t understand that their training often doesn’t help (and sometimes hurts) their ability to think ethically. Having neighborhood community members on, say, the ethics committee, is absolutely invaluable for getting a wide range of perspectives. What are some other ways that hospitals can incorporate the perspective of neighborhood community members?
I just love Bob Gordon’s chapter. Bob tells the story of St. Bernard’s Hospital and Health Center, located in the Englewood neighborhood of Chicago, a neighborhood that is 97 percent African American and has one of the highest rates of poverty and violence in the city. St. Bernard’s is amazing. In the 1960s, the Sisters made an explicit commitment to diversifying its staff and to hire from the local neighborhood. Its staff is now approximately 60 percent diverse. That is unheard of in healthcare — even Catholic healthcare.
I first visited St. Bernard’s a few years ago and was astounded, because here it was in my backyard, and I had never heard of it. Nor had most of my colleagues in Catholic healthcare! So I am so glad that we can tell their story while also raising the ethical issues (clinical, organizational, and communal) that attend the lack of diversity in most Catholic healthcare institutions.
St. Bernard’s hires from their neighborhood. They also have a portfolio of initiatives — affordable housing, green initiatives, support of local artists — in which they work with the neighborhood to improve the local community health by attending to social determinants. Chapter 4, by Cory Mitchell, Lena Hatchett, and Armand Andreoni, also describes an important partnership between a hospital system (Loyola University Health System) and a local community through Proviso Partners for Health (PP4H).
But I think the main answer to your question comes from the liberation theologians and particularly Alexandre Martins, who wrote Ch. 19 on palliative care in global health. Liberation theologians don’t simply want community members to be invited to the table — to have to enter the power space that is comfortable for people like you and me and attempt to speak there. They recommend that the table needs to be moved from the hospital into the community.
That is an absolutely crucial insight. The main ways that hospitals — and bioethicists — can incorporate the perspective of neighborhood community members is to go into the community, spend time in the community, walk around the community — maybe even (gasp!) live in the community. How many hospital CEOs live within walking distance of their hospital? How many hospital associates have buy-in to local issues because they own a home in the local neighborhood, because their children attend local schools?
As Catholic healthcare incorporates into massive systems, system headquarters are located in far-away states healthcare administrators have no knowledge of and no investment in local communities. What happens in local communities doesn’t affect them personally — so does it factor into their decision-making?
I really do think that Catholic hospitals and health systems need to learn and implement community organizing—both internally and externally—and listen and learn from the people in their local communities. Launching that might be my next venture.
In the introduction you offer the now familiar critique that Catholic bioethics has been limited by a “pre-Vatican II” approach. Because it developed out of the concerns of confessors, it is focused too much on acts taken by individuals. This seems correct, but a century or two from now Catholic moral theologians will no doubt also have a critique of us based on history. “Oh, these early 21st Century thinkers were limited in their vision by the new problems of institutions and economies, especially as they were affected by globalization.” Perhaps these critics would even want to return to a focus on individual acts and responsibility. (I think we can already see the beginnings of this shift in the focus of many intersectional thinkers on individuals repenting of their privilege.) So, I wonder if we should try to incorporate both the important ethical insights coming from a focus on acts and repentance of individuals and the insights of social justice concerns?
That critique might be familiar to you and me but vast hordes have never heard it! I do not doubt that future generations will look back and wag their tongues at our unavoidable idiosyncrasies. I do hope, though, that they will not return to a narrow or exclusive focus on individual acts and responsibility. I hope we’ve unlearned that for good. But the new way forward has to be a both/and.
We aimed CBSJ at people working on the frontlines in Catholic healthcare as well as undergraduate and masters students, so we wanted it to be accessible and practical. We wanted to introduce a new range of analytical tools central to the Catholic tradition and to show how those tools put new issues on the map. And we wanted to show how Catholic bioethics isn’t simply about ‘decision-making’ but also about actually taking practical, corporate action as a ministry of the Church.
But that’s just the starting point. I hope that in doing so, we’ve also illuminated a range of theoretical and theological issues that require further study and clarification. For example: How do you bring the strengths of these two conversations together into a new, more cohesive framework? What is the dross best left to bygone historical contexts? How do we craft a moral framework that attends equally to the moral valence of individual acts and of social structures — and do so with real theological rigor? Both individual character and social dynamics are aspects of lived, human reality and part of the Catholic tradition.They cannot be mutually exclusive. But integrating them will take a lot of hard intellectual and theological work.
I think that’s an exciting intellectual program going forward. It gives me hope for the future of moral theology, Catholic healthcare, and the Church.