Virtual Mentor. May 2007, Volume 9, Number 5: 384-387.
Medicine and Society
Roman Catholic Ethics and the Preferential Option for the Poor
The Catholic health care system has a history of preferential option for the poor through its charity work and demanding justice for the poor.
Thomas A. Nairn, OFM, PhD
Roman Catholic health care facilities follow a set of guidelines that are compiled in a publication entitled The Ethical and Religious Directives for Catholic Health Care Services. Developed in 1949 by what was then known as the Catholic Hospital Association, these directives were published by the United States Conference of Catholic Bishops in 1971 and most recently updated in 2001. Whereas the early versions of the directives almost exclusively concerned specific procedures that were either allowed or not allowed in Catholic hospitals, especially those procedures that occur at the beginning or at the end of life, the 1994 and 2001 versions begin with a section entitled, "The social responsibility of Catholic health care" .
Each of the six sections of the ERD, as the document is known, begins with an introductory narrative. As part of the introduction to the chapter on social responsibility, the bishops state:
Preferential Option for the Poor
The bishops speak of the care for the poor—or the preferential option for the poor—as a biblical mandate. The gospel narratives often link this option to the early proclamation of Jesus in the synagogue where, quoting Isaiah, he notes that his mission is to "bring glad tidings to the poor, proclaim liberty to captives, recovery of sight to the blind, to let the oppressed go free, and to proclaim a year acceptable to the Lord" (Luke 18-19). Other pertinent texts refer either to the beatitudes, which declared the poor to be blessed (Matthew 5:3-12; Luke 6:20-23), or to Matthew's account of the last judgment scene, in which the poor are seen to represent Christ (Matthew 25:31-46).
The language of preferential option for the poor in the body of the ERD, however, is of more recent origin, coming from the Latin American Bishops' Conferences that met in Medellin, Colombia, in 1968 and in Puebla, Mexico, in 1979. The Medellin Conference called upon the Catholic Church in Latin America to become a church of the poor: "to be the evangelizer of the poor and one with them, a witness to the value of the riches of the Kingdom, and the humble servant of all our people" . During the Puebla Conference, the term "preferential option for the poor" was coined. In their description of the term, the bishops stated that "this option does not imply exclusion of anyone, but it does imply a preference for the poor and a drawing closer to them" .
In 1986, the United States Catholic bishops continued discussion of this theme. They explained, "As followers of Christ, we are challenged to make a fundamental 'option for the poor'—to speak for the voiceless, to defend the defenseless, to assess lifestyles, policies and social institutions in terms of their impact on the poor" . A year later, Pope John Paul II also addressed this theme in an encyclical:
Health Care and the Option for the Poor
To understand how the Catholic preferential option for the poor affects health care, one must explore the nature of health care itself. According to Catholic social teaching, health care is not a commodity best regulated by a free market economy. Rather it is a social good that is considered to be a basic right. If health care is a basic right, then the fact that tens of millions in this country and billions around the world lack access to it must be viewed as a grave injustice. The Catholic social tradition stresses that the antidote to this injustice is solidarity and dedication to the common good.
This notion of a preferential option for the poor involves a self-conscious move from a passive understanding that the work of Christians is to provide charity to the poor to an active position that demands justice for the poor. The latter stance raises questions regarding the causes of injustice, which are often linked to what Pope John Paul II called the social structures of sin. The preferential option demands solidarity with the poor, defined not as some "feeling of vague compassion" but "a firm and persevering determination to commit oneself to the common good" . What do such responsibilities encompass? The Jesuit theologian Thomas Massaro puts it succinctly, "The entire tradition of Catholic social teaching…can be interpreted as a unified effort on the part of church leaders to encourage a more humane society where the most vulnerable members are better protected from harm" .
Cardinal Joseph Bernardin, the late archbishop of Chicago, was a prelate who took the preferential option for the poor seriously. His book, Consistent Ethic of Life was an attempt, as he repeated in many of his talks dedicated to this topic, "to defend the right to life of the weakest among us and to be visible in the support of the quality of life of the powerless among us" . In a 1986 address at the Catholic Medical Center in Jamaica, New York, he articulated the contours of the sorts of challenges that must be faced by those in health care who take seriously the mandate of a preferential option for the poor. As one reads his words, one could simply substitute "preferential option for the poor" for "consistent ethic":
Cardinal Bernardin continued:
At the present time, the preferential option for the poor in health care is more of an ideal than reality. It calls for what Catholics describe as a conversion of heart. Yet, it also offers hope to more than just the poor. Thomas Massaro suggests:
To adopt the principles of Catholic social thought is to agree that we all need to work hard so that full participation is extended to all, without favoritism or discrimination. We all have something to contribute to the common good, and all may benefit from the gifts we bring to the common table of human community and solidarity .
Thomas A. Nairn, OFM, PhD, is a Franciscan priest and the Erica and Harry John Professor of Catholic Ethics at the Catholic Theological Union of Chicago, and director of its Health Care Mission Leadership Program.
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