Tag Archives: health care

Palliative care: intensive caring when cure isn’t likely

The word “palliative” may seem an odd word to use in medicine, as the dictionary defines palliate as “to relieve or lessen without curing.” Yet, isn’t it the purpose of a physician to fix and to cure? Modern medical technology often excels at providing diagnoses and treatment possibilities, but of itself, it doesn’t provide the necessary conversations when ailments prove incurable or refractory to treatment. Palliative care provides ways to care even when cure is not possible.

The Center to Advance Palliative Care defines palliative care and the medical sub-specialty of palliative medicine as “specialized medical care for people living with serious illness…to improve quality of life for both the patient and the family.” Palliative care can be helpful and appropriate at any age, in any serious illness stage, and works to provide relief from stress, in whatever form it takes. It is team-based, often with representation from medicine, nursing, social work, and chaplaincy, because serious illness affects one physically, emotionally, mentally and spiritually. Palliative care teams can be found in hospitals, clinics, or embedded in other subspecialty practices, like oncology. There is palliative care for adults, for children, even perinatally, helping parents cope when their pre-born baby is found with serious diagnosis during pregnancy.

Many people possess misconceptions regarding palliative care. Some think palliative care means “giving up” when it actually adds an additional layer of support. Patients can continue with all their other medical care, like dialysis, chemotherapy, and hospital visits. Others believe palliative care is synonymous with hospice care, but hospice is a small subset within palliative care. Both focus on comfort and living the best life possible despite serious illness. Hospice is most appropriate when care and hospitalization directed at the disease are more burdensome than beneficial. With hospice, the focus is patient comfort, most often in the familiarity of the home, surrounded by loved ones. Patients can continue medications providing symptom-management and comfort. Hospice care, when consistent with patient goals, can be a very peaceful experience for patients and families.

It is also important to emphasize that hospice and palliative care should never do anything to prematurely hasten death. The field is created as the antidote to the suffering that may cause one to seek physician-assisted suicide. As Dame Cicely Saunders, the founder of the hospice movement, said to patients: “You matter because you are, and you matter to the last moment of your life. We will do all we can, not only to help you die peacefully, but also to live until you die.”

The word “palliative” derives from the Latin pallium, meaning “to cloak.” Cloaking patients and families with support and symptom management encourages living the best life possible despite chronic or incurable illness. Studies show that people live longer – and better – with palliative care than without. Palliative care physicians witness a beautiful awe caring for patients in intense and intimate times. They are like leaves in autumn, which are most lovely before they fall, because the autumn in physical life can be a true springtime for the soul.

NATALIE RODDEN runs the palliative medicine consultation service at St. Anthony North Health Campus in the Denver area. She also serves as co-chair of her hospital’s ethics committee and travels nationally providing education and advocacy for authentically Catholic end-of-life care and against physician-assisted suicide.

Latest bishops’ health care directives stress Catholic witness

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.

Seeing stealth euthanasia for what it is

Most of us are aware of the horror of abortion, of parents paying a doctor to kill their child, even if it goes by a sugar-coated name such as “choice” or “planned parenthood.” Too few are aware that at the other end of life, children, in an ironic turnabout, can pay a doctor to legally kill their own parents; the sugar-coated names for this are “hospice” or “palliative care.”

I learned this from the case of my own mother, who recently fell victim to “palliative care” and was killed at the hands of doctors and nurses, on the orders of one of her own children. She had imprudently chosen the wrong child to be her “health care proxy,” who then immediately had her physician sign a bland, one-sentence statement that she was legally incompetent. It is true that my mother was somewhat confused, particularly about time, but she recognized and cared about people, ran her own life, and knew what she wanted. Although she should not have made a major financial decision at that point, she certainly knew whether she wanted to live or die.

Unfortunately, a few months later she fell and fractured her pelvis, requiring a move to a nursing home while the bone healed. The nurses attending her were charmed by her kindness and her stories, and said that with physical therapy she should soon be able to walk again. However, her proxy decided instead that it was time for her to die. My mother was removed from medical care, and placed in hospice, or palliative care. As much as I and my mother fought for medical care, there was nothing we could do. No medical aid, including nutritional supplements or physical therapy, were to be provided – just morphine, ostensibly to relieve pain, but as later made clear, actually to hasten death.

The doctor ordered large doses of morphine at six-hour intervals, whether my mother was in pain or not. Morphine is known to depress appetite; it is used, illegally, by runway models to lose weight. When she weighed little more than 70 pounds and was losing about a pound a day, I asked that she be given a nutritional supplement, such as “Ensure.” I was told it was forbidden, under doctor’s orders. When I asked that the morphine be given only when in pain, I was told it had to be given by the clock. When I confronted the director of nursing, saying “You are allowed to give morphine to relieve pain, but not to hasten death” her reply was, point blank, “Not true – it depends on the quality of  life.” When I asked what the terminal condition was that justified her being put in hospice, the answer was “she is 96 years old and has a broken pelvis.” A broken bone is not a terminal condition. What they were saying is it was time for her to die.

Although her weight dropped to about 60 pounds, she ended up dying not of starvation, but of thirst. When she became too weak to lift a glass to her lips, the nurses were forbidden to syringe any water into her mouth – under doctor’s orders, at the behest of the proxy. My mother’s will to live kept her alive far longer than the “authorities” wished, but she eventually died after an excruciating last few weeks.

The irony is that as a young Jewish woman in Germany in the 1930s, she was slated to be exterminated at Auschwitz, but miraculously escaped from the train en route. Ironically, 75 years later she died a 60-pound skeleton, looking for all the world like an Auschwitz victim, killed not by that Holocaust but by our own Holocaust, that of our “culture of Death.”

 

ROY SCHOEMAN  is a Jewish entrant into the Catholic Church, best known for his writing and speaking on the Jewish roots of the Church, particularly in his bestseller, Salvation Is from the Jews. He has taught theology at Ave Maria University and Holy Apostles Seminary, and currently hosts a weekly radio show on Radio Maria.

Taking heartfelt action for God’s littlest citizens

Everyday in America abortionists legally end the lives of 3,000 innocent children. They’re children with beating hearts, moving arms and legs, and newly formed faces and toes. They are precious in God’s eyes and have the right to our love and care. Yet instead of being welcomed into this world, they are destroyed.

This isn’t health care. This isn’t female empowerment. And certainly, this isn’t a “right.” In fact, it’s the greatest human rights abuse of our time. Yet many have embraced abortion as all these things.

Since founding Live Action — one of the nation’s leading pro-life organizations — when I was 15, I’ve seen countless times that when we expose the truth about abortion, we break apart these lies. When we shine a light into the darkness, we can change hearts and minds.

Through compelling educational media, human interest stories, and investigative reporting, Live Action exposes the abortion industry’s lies and its exploitation of women and children for profit. We also reveal the unquestionable humanity of the preborn child and the brutal reality of abortion, and we tell uplifting stories about people who choose life even in the toughest of circumstances.

In our most recent investigative report, “Aiding Abusers,” we collected court documents, police reports, and the testimonies of former employees who reveal that Planned Parenthood — a celebrated “Me Too” movement supporter and self-proclaimed advocate for women — has for decades refused to report men who sexually abuse 12- and 13-year-old girls, then bring them to Planned Parenthood for abortions to cover up their crimes.

The report led Congress in June to call for a federal investigation, which could help build the case for ending the abortion chain’s taxpayer funding. Since Planned Parenthood gets nearly half of its budget from taxpayers, defunding would be a huge step in crippling its abortion business — a business that kills over 320,000 preborn children every year.

Another tool in the abortion fight has been our “Abortion Procedures” online video series. The short four-minute videos feature a former abortionist using medical animations to show what happens to a baby and mother during the four most common abortion procedures.

To test their effectiveness, we showed the videos to 500 “pro-choice” millennial women and asked them their attitudes about abortion before and after watching. The results were astonishing. Almost a third viewed abortion less favorably afterwards. And nearly half said the videos were so eye-opening that they should be shown in high school sex education classes.

“Abortion Procedures” has become the most-watched pro-life series in history, reaching nearly 100 million views online with translations in Romanian, Spanish, German, Chinese, and several other languages. Because of their success, Live Action is working to put these videos in front of every American.

“Aiding Abusers” and “Abortion Procedures” are just two ways we are trying to change hearts and minds. While laws need to change, attitudes must change first to create a culture that respects life. Then the laws will follow.

Live Action has the largest and most engaged online following in the pro-life movement — with three million followers sharing our content with their friends to reach millions more. Live Action and its followers work together to educate, inspire, and activate others to make abortion as unthinkable as other human rights abuses like slavery, human trafficking, and genocide.

By shining the light of truth into the darkness using the power of storytelling, and by using the power of our followers to share this truth with others, we are spreading the pro-life message throughout the nation in an effort to end abortion in our lifetime.

 

LILA ROSE is a featured speaker at the upcoming Legatus 2019 Summit. She is the president and founder of the national pro-life organization Live Action. Follow her on Twitter, Facebook, and Instagram.

Alfie Evans Case — poster-child for health care ‘best interest’

Two months ago, the British court senselessly ordered two-year-old Alfie Evans to be taken off life support, despite his parents’ desperate pleas and a worldwide outcry. In the aftermath of Alfie’s government-mandated death, many of us are asking whether our government has the power to determine when life is simply too burdensome to justify saving. But with the federal government’s waning influence over individual health care as a result of the weakening of Obamacare regulations, another question arises: Whether the health care providers and insurance companies could trump the rights of families in cases like Alfie’s. After all, in many cases, providers and insurance companies do have the power to ration health care. The degree to which they do is up to us.

Currently, the federal government prohibits hospitals from withholding or withdrawing infant life support. There are, however, three exceptions. Life support may be withdrawn if: (1) the infant is chronically and irreversibly comatose; (2) life support would merely prolong dying or be futile in terms of the infant’s survival; or (3) the life support itself, under the circumstances, would be inhumane. These exceptions can give doctors too much power to make end-of-life decisions. Given the possibility of coercion or undue influence on parents, the current system is set up for an Alfie Evans-like tragedy here in America.

Moreover, many in the medical profession, including the American Academy of Pediatrics, are advocates for the “best interest standard,” which gives doctors the ability to make arbitrary decisions about what is in the best interest of infants. The standard does give parents a role in the decision making. However, parental rights can be seriously compromised by health care providers and insurance companies that may pressure parents to make the more “economical” choice under the guise of an infant’s “best interest” and against the backdrop of skyrocketing hospital bills.

Another source of pressure can come from hospital “ethics committees,” which many consider to act like “death panels.” For example, the Texas Advance Directives Act empowers hospital administrators to arbitrarily withdraw or withhold care, regardless of the reason and the patient’s condition. The danger of the Texas law is illustrated in the case of Christopher David Dunn. In that case, a “bioethics committee” ruled that a 46-year-old man’s life was not worth living, and it therefore withdrew his life support. His family vigorously pleaded for his life to no avail. While many have defended such committees as an appropriate way to strike a balance between the patient’s right to life and the medical professionals’ reasonable end-of- life treatment, the potential for abuse is enormous. Indeed, many ethics committees have little guidelines and accountability; and, with the pressure of insurance companies and other health care providers, the risk of exploitation is very real.

Most agree that prolonging a painful process of dying for a terminal patient is inhumane, and they argue that doctors should not be forced to provide such treatment. Moreover, there is no constitutional right to receiving medical care paid for by others. But, as advocates for life, we must be vigilant in ensuring that health care providers and insurance companies do not have the arbitrary power to decide if one life is worth more than that of another. Furthermore, the withholding of food and hydration to a patient in need of it can never be morally justified. This is in keeping with the mission of faithful Catholics, who started the hospital system long ago based on the belief that nothing is worth more than the life of a person created in the image and likeness of God.

ATTORNEY CHARLES S. LIMANDRI is a past member of the Legatus board of directors and a recipient of the Legatus “Ambassador of the Year” award. He is the president and chief counsel of the Freedom of Conscience Defense Fund (www.FCDFlegal.org).

Everything is bigger in Texas

DR. SUSAN LOCKE writes that Houston’s Texas Medical Center is a true wonder . . .

Susan Locke

Susan Locke

Houston’s Texas Medical Center (TMC) shines as one of the largest medical centers in the world.

With the highest density of clinical facilities for patient care, basic science and translational research, TMC includes 54 medically related institutions: 14 hospitals, two specialty institutions, three medical schools, six nursing schools, plus many other schools for virtually all health-related careers.

If you’re living nearby, how do you know where to go? If you don’t live nearby, how to do you avail yourself of the highly skilled physicians there? Fortunately for Legates, Healthnetwork Foundation partners with four of the best medical institutions within TMC. One phone call to Healthnetwork will help you identify the right experts and provide you with the best access to Houston’s leading physicians.

Fixing broken hearts. From the smallest premature babies to octogenarians, heart care experts are abundant in Houston. For more than 50 years, Texas Children’s Hospital has excelled in pediatric cardiac care. They treat thousands of children with heart conditions, combining cutting-edge technology with compassion and a family-centered focus.

Houston Methodist Hospital excels in work with aneurysms, bypass surgery, cholesterol drug research, and robotic heart surgery. CHI St. Luke’s/Texas Heart Institute has ranked in the top 10 cardiology and heart surgery centers in the nation by the US News & World Report.

Magnet designation. Great medical care extends beyond the expert physicians in Houston. The nursing staff within each of Healthnetwork’s partner hospitals in Houston has been awarded the Magnet designation: Texas Children’s Hospital, Houston Methodist Hospital, MD Anderson Cancer Center, and CHI St. Luke’s / Texas Heart Institute.

The Magnet Recognition Program® recognizes health care organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Developed by ANCC, Magnet is the leading source of successful nursing practices and strategies worldwide.

healthnetTransplants welcome. Houston has become a destination for complicated surgeries and transplants. Houston Methodist is recognized as the only institution in the area that transplants all solid organs. CHI St. Luke’s and Texas Heart perform more cardiovascular procedures than anywhere in the world. Additionally St. Luke’s gastroenterology and general surgeons are internationally recognized for their performance of complex procedures. Texas Children’s has the most active pediatric transplant center in the nation and one of the most active in the world.

Making cancer history. Cancer is a frightening diagnosis, and having a strong team on your side is vital. MD Anderson is one of the largest cancer centers in the world. Many innovative cancer therapies become available at MD Anderson before they become standard in the community. With the lofty goal of making cancer history, their research focuses on a greater understanding of how cancers begin, how they respond to treatment and how to improve the quality of life for survivors.

Whether you need a heart surgeon in Houston, a chronic back pain specialist at Cedars-Sinai, or a meniscus repair at Mayo Clinic, Healthnetwork Foundation provides Legates and their spouses, children, and parents the best access to the right physicians. Our contact information is below!

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

If you like your health care plan

John Hunt contends that the only way to comply with ObamaCare is to deny your faith . . .

John Hunt

John Hunt

Not a day goes by that I don’t thank Our Lord and his Blessed Mother for the gift of being a U.S. citizen. The freedoms we enjoy and the abundance we have been blessed with are gifts that cost our forebears much blood and treasure.

Most of our ancestors arrived on our shores in search of the freedoms we often take for granted — the freedom to worship as we choose, to pursue our dreams, to live where we choose, and to aspire to a life that provides the very best for our children and grandchildren. Those blessings include the availability of quality health care that is incomprehensible to those who have gone before us — and is unmatched in any other country on earth.

The beauty of the recently enacted Affordable Care Act (aka ObamaCare) is that — as President Obama has stated on numerous occasions — “if you like your health care plan, you can keep your health care plan.” The freedom inherent in the president’s promise is certainly consistent with the freedoms Americans have enjoyed since our country’s founding.

For Catholics, however, the President’s promise requires a bit more analysis. Consider this: “If you like your health care plan you can keep your health care plan as long as you would deny the truths of our faith, that all life is sacred and worthy of protection from conception to natural death.”

Or consider the Catholic physician who is obligated under the Affordable Care Act (ACA) to perform abortions and provide contraceptive and abortifacient services to his patients despite his/her Catholic beliefs. Or consider a Catholic hospital, forced by law to provide abortion-related services for its patients, contrary to Church teaching.

Or consider the position of the Catholic employer who, under the ACA’s Health and Human Services mandate, is required by force of law to provide contraceptive and abortifacient services in the company’s group health plan.

When one considers the unwarranted and unconstitutional intrusion into the lives of Catholics that the ACA imposes (the basis of Legatus’ current lawsuit against the U.S. government), when combined with governmental mandates imposed on Catholic adoption agencies to place children with gay “families,” it is clear that the Catholic Church is under attack in our country.

So, “if you like your health care plan, you can keep your health care plan” so long as you are willing to deny your Catholic faith in the process. Thank you, Mr. President!

JOHN HUNT is Legatus’ executive director. He and his wife Kathie are charter members of Legatus’ Chicago Chapter.

Trust and ethics in health care

Jennifer Miller contends that underprivileged people are targeted for unsafe studies . . .

Jennifer E. Miller

Gaps in trust and ethics continue to challenge the bio-pharmaceutical industry, providing fodder for the media and provoking chagrin from consumers — including concerns about the quality and accessibility of medicine, essential life-saving therapies and human research subject protections.

Curiously, despite the number of publicized breaches of trust and ethics, we’re in an age that demands excellence in health care ethics in developed countries. We’re also concerned that the poor in developing countries aren’t used solely as means to an end. Yet the practicality of articulating, ensuring, monitoring and evaluating excellence in ethical standards remains both a challenge and an opportunity.

A surmountable challenge in crafting biomedical ethical standards includes marrying ethical theory with real life practice. Ethics scandals by U.S.-based clinical researchers in the mid-20th century have been particularly well documented, including cases like the Tuskegee, Guatemala syphilis and Willowbrook studies. These studies have been criticized for their unethical treatment of traditionally vulnerable populations.

During this era, it wasn’t uncommon for established experts to conduct their federally funded studies with disadvantaged people. For example, Dr. W. Paul Havens Jr., a WHO viral disease expert and pioneering hepatitis research scientist, furthered his studies by exposing patients in mental institutions to hepatitis. Similarly, the man who invented the polio vaccine, Dr. Jonas Salk, conducted his flu vaccine clinical trials on Michigan state insane asylum patients in 1942.

Unethical research practices have not necessarily been ameliorated over the past two decades. In the mid-1990s, Johns Hopkins Medical School’s Kennedy Krieger Institute recruited 108 poor black families to live in lead-painted houses in East Baltimore to study pediatric retardation resulting from lead paint ingestion.

Some researchers claimed the study was justified because it provided the benefit of otherwise unaffordable housing to the research subjects. Many of these families subsequently reported that they were deliberately recruited into a study with inadequately disclosed foreseeable harms. At least one family’s children suffered learning disabilities and cognitive impairments.

While in Thailand last month, a doctor from a public clinic shrugged when I asked about the use of placebos. He said that on one hand his patients have little access to cancer drugs without enrolling in a drug trial, and on the other hand only half of the participants he enrolls will receive care in a placebo-controlled trial. Compounding the situation, paternalism in many countries can be common, prompting patients to defer to doctors without reading consent forms.

New and emerging ethical issues still challenge the industry. A 2007 Harris poll found that only 11% of the U.S. population believes pharmaceutical companies are “generally honest and trustworthy,” ranking barely above tobacco and oil companies. In the area of research, some 50% of white and 73% of minority respondents reported that it’s “very likely” or “somewhat likely” that they might be used as guinea pigs without their consent. Moreover, the industry’s role is often not well understood: Surveys suggest that about 70% of Americans “believe that drug companies are too concerned with profits and not concerned enough about helping people.”

To address these and other emerging ethics and trust challenges, I founded Bioethics International (BEI) in 2005 — and its initiative, the BEI World Council for Ethical Standards (WCES). This council comprises key stakeholders in health care, including doctors, academics, ethicists, patient advocates, senior company executives and former regulators. WCES is committed to the delivery of ethically responsible and trustworthy decision making and innovation in biomedicine.

WCES has been working to map a comprehensive set of ethical standards and assessment methods for ethical biomedicine. The work is now poised to invite large and small bio-pharmaceutical companies to enlist in a pilot program that combines ethical principles and theory with the corporate day-to-day practice of implementing policy, complying with regulations and laws, and respecting industry codes of ethics. The process also aims at a comprehensive understanding of how to pursue excellence in ethics in the biotechnology and pharmaceutical industries — as well as to identify strengths and opportunities for improvement.

This initiative is both timely and representative of the cultural changes in the health care sector. A culture of trustworthy innovation mirrors the words of Aristotle that “we are what we repeatedly do. Excellence, then, is not an act but a habit.” BEI’s initiative is committed to providing a practical tool to attain excellence because in matters of health and life, just enough isn’t good enough.

Jennifer E. Miller is the founder and executive director of Bioethics International. She co-wrote this article with Marie Catherine-Letendre, Religious Studies Department Chair at Marymount International School.

Health care: a right or privilege?

A ‘right’ to health care completely skirts the issue of individual responsibility . . .

Deal W. Hudson

Deal W. Hudson

Our bishops want health care reform. They are advocating reform resulting in universal health coverage that respects “human life and dignity” and includes “freedom of conscience,” while restraining costs and applying “costs equitably among payers.”

The bills now before Congress give the federal government the commanding role in providing universal coverage; however, they also leave the door open to funding abortion and end-of-life care, which the bishops have loudly rejected.

The bishops do not consider a government-run program the only option for providing universal health coverage. “There may be different ways to accomplish this, but the bishops’ conference believes health care reform should be truly universal and genuinely affordable,” the bishops explain on their website.

“The Church does not teach that government should directly provide health care,” wrote Bishop R. Walter Nickless of Sioux City, Iowa. “The proper role of the government is to regulate the private sector in order to foster healthy competition and to curtail abuses. Therefore, any legislation that undermines the viability of the private sector is suspect. Private, religious hospitals and nursing homes, in particular, should be protected because these are the ones most vigorously offering actual health care to the poorest of the poor.”

Many Catholics are moved by the argument that health care is a “moral issue.” That claim, however, has to be rightly understood. Health care is not a moral issue per se. No one is obliged to pay for the sum total of all medical care either needed or desired by his “neighbor.” This is not the intent of Catholic social teaching regarding the “right” to health care.

As Bishop Robert W. Finn and Archbishop Joseph F. Naumann wrote recently: “The right of every individual to access health care does not necessarily suppose an obligation on the part of the government to provide it. Yet in our American culture, Catholic teaching about the ‘right’ to healthcare is sometimes confused with the structures of ‘entitlement.’ The teaching of the Universal Church has never been to suggest a government socialization of medical services.”

The problem with talking about “rights” to things like health care is that it completely skirts the issue of individual responsibility. Why am I responsible for paying for another person’s medical care when that person has squandered their resources, abused their physical well being, or simply chosen not to make a contribution to work-based health care coverage? The latter is why well over 10 million Americans are uninsured.

There’s also the issue of making distinctions within the category of health care itself. No Catholic wants to pay for another person’s abortion, contraception, in-vitro fertilization, euthanasia or embryonic stem-cell treatment. To give the federal government control over medical care in this country will eventually result in all of these services, including abortion, being paid for by Catholics. Even if abortion funding is stripped from the current legislation, it will undoubtedly be added later on. All it takes is one vote of the House and the Senate and one signature in the Oval Office.

Clearly, any sort of national or state health care program is not going to delve into issues of a person’s use of their financial resources which could have been spent on health coverage, or their employment history which could have provided health coverage, or even the treatment of their own well-being. That’s why a citizen’s moral obligation should be limited to essential services. This “safety net” approach to health care means that those without insurance, and in real need of medical care to treat serious health issues, should receive assistance. In point of fact, our nation’s hospital emergency rooms already provide this assistance. It is federal law that no hospital emergency room can fail to find treatment for someone presenting him or herself for medical care. The number of children being born in U.S. hospitals to illegal immigrants attests to this.

There are many moral issues, but none of us is morally — in a financial way — responsible for assisting people in obtaining the goods associated with that moral issue. After all, the goods associated with our moral choices most often cannot be possessed without our serious commitment to them. The best example is with regard to education. No one is educated by virtue of sitting in a classroom or, as St. Thomas Aquinas put it: “The student is the primary cause of his education.” The same dictum should be kept in mind with health care.

The Catholic Medical Association (CMA) understands that individuals must be held responsible for their own health. CMA supports an approach to health-care reform “achieved by legislation that empowers people to own their health insurance policies (as contrasted with government- or employer-controlled health care insurance) and using targeted measures to help people who cannot afford the entire cost of their insurance premium.”

CMA’s recommendation points the way to an alternative solution — one based on the principle of subsidiarity — to reach the goals advocated by the bishops. Universal coverage can be achieved without handing health care entirely over to the federal government. This alternative vision of reaching the bishops’ goals for health-care reform should be put before the Congress as soon as possible.

Deal Hudson is the president of the Morley Institute & the former publisher of CRISIS Magazine. The director of InsideCatholic.com, Hudson has published articles in The Wall Street Journal, New York Times, National Review and others.