The ethical and religious Directives for Health Care Services, authored by the U.S. Catholic bishops, is a valuable and unique document. First published in 1971 and now in its sixth edition, this 42-page pamphlet contains specific directions for Catholic patients, physicians, and health care facilities on a wide range of moral issues. The work is divided into six sections devoted to the topics of social responsibility, pastoral care, the professional-patient relationship, the beginning of life, the end of life, and collaborative arrangements between Catholic and non-Catholic health care providers.
The Vatican has published a similar document, though in a very different form, called Charter for Health Care Workers. This appeared in 1994 and was revised in 2016. Remarkably, the American document preceded it by more than 20 years and has been the subject of much more intensive revisions. The two works stand in agreement, of course, but that produced by the U.S. bishops is much more practical in character, with each directive dedicated to a single point of concern; for example, directive 49: “For a proportionate reason, labor may be induced after the fetus is viable.”
Catholic bioethicists must think about how to apply these directives in particular cases. The directives therefore are a subject of constant scholarly debate and sometimes receive different interpretations, but what is noteworthy is that such detailed moral guidance is available. No other religious tradition has such a resource. The existence of the directives reflects the long-standing concern within the Catholic Church for resolving medical-moral questions. Though designed for Catholic health care centers, every Catholic would be well advised to have some knowledge of this small but important booklet because all of us will likely face some serious medical question during our lifetime.
The most recent revision introduces changes only to the last section, “Collaborative Arrangements with Other Health Care Organizations and Providers.” As everyone knows, we live in a time of intense competition among health care centers. The pressure for consolidation and the need to find collaborative partners is common for Catholic institutions as well. These arrangements can be very complex and often pose significant moral challenges. The secular world does not see the human person in the same way as does the Catholic Church. Indeed, the writing of the directives first became necessary when mainstream medical practice diverged in significant ways from what was once the nation’s common moral code.
The most striking change in the sixth edition is its emphasis on “witness.” The new edition stresses that Catholic health care institutions must be able to maintain their witness to Christ and His saving mission in any collaborative venture with a non-Catholic partner. This may seem an obvious point, but health care delivery is big business and the pressure to conform to a secular worldview is enormous. When millions of dollars are at stake — not to mention hundreds, if not thousands of employees’ jobs — tremendous courage is needed to negotiate agreements that are not only financially attractive for the Catholic party but that also preserve the Christian mission to act as a witness to the faith.
Caring for the sick is one of the mandates of Christ, but this aim can also be achieved incidentally by secular institutions whose primary aim is often the mammon of corporate profit rather than the mercy of corporal works. There are many who labor in health care who are not Christians and some who have no faith at all. They do not witness, despite the fact that they share in our mission of healing. We work alongside them, but as Christians we know that all things in this life are ordered to the next. The call to witness makes the presence of Christ known to the world so that this message of salvation can be heard.
EDWARD J. FURTON, PH.D., is director of publications for the National Catholic Bioethics Center (Philadelphia), and among its team of seven ethicists. He’s editor-in-chief of NCBC’s award-winning National Catholic Bioethics Quarterly and Ethics & Medics.