Catholic Health Care in the Public Square

Second Quarter 2003

By Clarke E. Cochran

The excerpts that follow are from an essay by Dr Cochran, expected to be published in 2004 in a book being edited by David Guinn. Cochran is Professor of Political Science at Texas Tech University—Ed.

Religious institutions have a unique place on the border of public and private life. They must attend both to their particular ecclesial traditions and to their public responsibilities. Thus, existence in civil society produces distinctive challenges to their public and private identity. They must defend that identity, but at the same time accept that others with political and social authority may patrol their boundaries.

Regarding Catholic health care specifically, we must inquire whether particular alliances and tensions with state and medical power help or hinder Catholic health care's creative articulation of its distinctive mission and identity in situations where these diverge from and indeed challenge state authority and political culture. In the case of Catholic health care the difficulties come primarily from: 1) ideological currents at odds with Catholic theology and culture; 2) medical technology's relentless pressure on Catholic ethics and mission; 3) capitalist market forces; and 4) politics and policy that impinge on Catholic identity.

How do Catholic institutions exist on this border?

Four Dynamics

For religious institutions in the public square, tension consists of four different dynamics occurring simultaneously and interactively. There is a dynamic of collaboration, where government and religious institutions cooperate to address an issue of mutual concern. This is the model for Catholic hospitals, which receive Medicare and Medicaid funds to do work paid for, in effect, by government.

Second is a dynamic of competition in situations where different institutions strive to determine who can better implement programs to address recognized social problems. For example, both government and churches sponsor schools.

Third, there is conflict or challenge, a dynamic of confrontation in which, in effect, the religious group says (not necessarily successfully) "thus far and no farther."

A fourth dynamic is transcendence, the struggle to define and live a mission not confined to the alternatives given by existing political, social, and economic structures. The transcendent dimension spurs Catholic institutions to create new forms of nursing homes, assisted living, or continuous care programs for the elderly that profoundly integrate sacraments, prayer, nursing care, companionship, and medical care.

The basis for understanding this tensional frontier we might call "normative pluralism" in which a wide variety of institutions and spheres of life have independent grounds of existence. From the Catholic tradition, we can build on the notion of subsidiarity for this normative pluralism. The Dutch Calvinist tradition of social thought speaks of sphere sovereignty as the basis of pluralism. A full theory of religion and civil society cannot stop with describing associations in themselves, however. And it cannot be satisfied with describing relationships between church and state. Religious institutions must interact with the economy and establish an orientation to the broader culture as well, for they have a variety of relationships beyond that with the state. Competition, cooperation, challenge, and transcendence will become manifest in a wide variety of relationships.

The Tension of Pluralism

For this reason tension is the most characteristic feature of religion in public life, yet the tension is difficult to live with. It is hard for a church to maintain, as it were, four faces to the state and to other associations in civil society. The stresses and conflicts within Catholicism in the United States and in other parts of the world are at least partly related to divergent views on whether the church should be in competition, cooperation, conflict, or transcendence vis-a-vis state, economy, or culture in particular contexts.

My argument, however, is that tension is healthy, necessary, and normative, at least for Christian churches. It simply is the case that Christian commitment sits uncomfortably with market power, political demands to reduce one's distinctive ethical commitments, and the drive to dominate nature through technology.

Catholic health care enriches the pluralist public square of American society and culture in the early 21st century, just as that square generates challenges that call for creative response from the tradition of Catholic moral reflection and institutional creativity.