Catholic health care in the United States finds itself at a startling point of convergence with non-Catholic health care. On the one hand, after the Supreme Court overturned Roe v. Wade, other health-care systems across the country have suddenly had to become more like Catholic health care in restricting abortion. (As of January 2023, thirteen states ban abortion with next to no exceptions; similar bans are pending in several other states.) On the other hand, in the context of fierce competition and dwindling margins, some Catholic health-care systems appear nearly indistinguishable from their most ruthless, for-profit counterparts. The economists Anne Case and Angus Deaton, famous for their research on the rise of midlife morbidity and mortality in the United States over the past twenty-plus years, have claimed that “[t]he American healthcare industry is not good at promoting health, but it excels at taking money from all of us for its benefit. It is an engine of inequality.” The New York Times recently published two shocking stories about the Providence health-care system and about Bon Secours Mercy Health—both officially Catholic—showing that they have taken money from the poor and vulnerable to benefit themselves. In an inversion of Catholic social teaching, the poor received special attention not to be served, but to be shaken down.
It would be both ungenerous and inaccurate to suggest that those cases are the rule rather than egregious exceptions to it. At bottom, the mission of Catholic health care remains to tend the sick and proclaim the Kingdom of God. Nonetheless, these examples remind us that Catholic health care in the United States—comprising more than six hundred hospitals that employ more than half a million people and see one out of every six patients—is a very big business and therefore subject to the same market forces and trends characteristic of U.S. capitalism at large. Catholic health care also has to contend with the pitfalls of U.S. politics, as it did a decade ago in the uproar over the Affordable Care Act’s contraception-coverage mandate, and as it will likely have to do in the coming backlash against abortion restrictions. A Catholic hospital’s refusal to perform an abortion for a woman who is miscarrying, but whose nonviable fetus still has heart tones, means one thing when a non-Catholic hospital is willing to step into the breach. It will mean something else when a non-Catholic hospital declines transfer so that it won’t have to negotiate a poorly written state abortion law, and a woman dies of hemorrhage and sepsis in a Catholic hospital’s care.
Enter Todd Salzman and Michael Lawler’s Pope Francis and the Transformation of Health Care Ethics. Salzman and Lawler are moral theologians at Creighton University who have often collaborated. They present their book as a “critical commentary” on the sixth and most recent edition of the “Ethical and Religious Directives for Catholic Health Care Services” (ERDs), issued by the United States Conference of Catholic Bishops (USCCB) in 2018. In fact, their book is an extended polemic against the USCCB. A representative sentence begins, “Unfortunately, most bishops in the United States and the USCCB as a body….” Exhortation and excoriation follow. According to Salzman and Lawler, the 2018 ERDs, as they’re typically called, are “problematic anthropologically, methodologically, ecclesiologically, and pastorally.” Their book’s second thesis is that “Francis’s…contributions and shift in emphases invite a substantial revision of the ERD and the formulation of new directives.”
There is much that is just about Salzman and Lawler’s polemic, but there is also much that is misguided. They inveigh against authoritarianism in the Church with a righteous passion that sometimes sounds a little too, well, authoritative. Their book prompts the question of whether Catholic health care can find a viable middle way—a center that can hold, so to speak, against strident voices on both the Right and Left.