Most Rev. Charles J. Chaput, O.F.M. Cap., the Catholic Archbishop of
Denver, presented the annual "Archbishop Michael Miller Lecture" [2
March 2010] to Catholic health-care professionals at the University of
St. Thomas in Houston, Texas.
Thank you all for being here, and I especially want to thank Sister
Miller, Clarke Gormley and George Strake, and of course my friend John
Hittinger, for making our time together today possible. Texan
hospitality has lived up to the size of its reputation. I’m very
We should start with the obvious. I’m not a doctor, nurse, hospital
administrator, or insurance executive. I’m a pastor. So my thoughts on
health care come from that mission. My task
the task of a bishop
is to preach Jesus Christ, teach the Catholic faith, and guide the
people God puts into my care.
When Jesus proclaimed the Gospel, he did it with words. But then he
backed it up with deeds. Those deeds were often acts of healing.
Scripture shows Jesus healing the blind, the mute, the disabled, and the
sick. He cured a woman who was hemorrhaging. He brought a little girl
back to life.
Scattered through the Gospels are brief summaries of how Jesus and his
disciples understood his mission. Here’s one of them from the Gospel of
Matthew: “And Jesus went about all the cities and villages … preaching
the gospel of the Kingdom and healing every disease and every infirmity”
(Mt 9:35). Jesus redeemed the whole human person
mind, body and spirit.
Jesus gave this same mission to his Church. He told his apostles:
“Whenever you enter a town … heal the sick in it and say to them, ‘The
Kingdom of God has come near you’” (Lk 10:9). Thus, wherever a local
Church was founded, Christians started ministries to the sick,
especially to the weak and most vulnerable. They didn’t ask permission
from the civil authorities. They didn’t do these things to show good
citizenship, or because it was lucrative business. They cared for the
sick because that’s what Jesus did. And that’s what he commanded his
disciples to do.
Each of you here today belongs to that long tradition of Catholic
witness in health care. What you do continues Christ’s work in the
world. Your care for the sick is a sign of God’s Kingdom, a sign that
God is still with us.
That’s the backdrop for our discussion today. It’s important because the
current national debate over health-care reform has brought us to a
crossroads. We face big economic and philosophical questions about the
viability of the Catholic health-care ministry. But I want to talk about
the one question that undergirds all the others. That’s the question of
your Catholic identity and your mission: Who are you? And what does it
really mean to be a Catholic health-care professional?
To get our bearings, I want to borrow from the thought of the late
Herbert Ratner. Ratner was a Catholic and a family practice doctor who
devoted his life to questions of medical ethics. In the mid-1930s, he
was picked by Robert Maynard Hutchins to teach in the pioneering “great
books” curriculum at the University of Chicago. Ratner also taught on a
medical school faculty and served as a local public health official.
Until his death in 1997, he also edited a small but influential medical
journal called Child & Family.
Dr. Ratner knew the pressures of medical work firsthand. He also
believed in the nobility of the medical profession. He came of age
during the Second World War, when a generation of medical professionals
in Germany allowed themselves to become servants of Nazi genocide,
eugenics and human experimentation.1 Ratner actively promoted
the World Medical Association’s restatement of the Hippocratic Oath in
the wake of the Nuremberg trials. He did it for a reason. He felt as
early as the mid-1960s that American medicine
at its own friendly pace and in its own very different way
was on a similar path.
Ratner believed that the ancient Hippocratic Oath sworn by physicians
for 2,500 years offered another path. It could serve as a cornerstone
for the identity of persons working in health care. It could be a shield
from what he called bullying by the state, “the dehumanization of
society and the brutalization of medicine.”2 Unfortunately,
the original oath is rarely used these days. Louis Lasagna rewrote and
arguably softened it in 1964. We should also remember that while the
original oath barred physicians from helping with abortions
in fact, the oath specifically rejects medical aid for abortions and
some sources suggest that Hippocrates himself may have invented surgical
tools to perform abortions. Abortion, of course, was common in the
But that doesn’t change the importance of Dr. Ratner’s passion for the
oath. The original Hippocratic Oath is still deeply compelling. It
defines health care as a field where practitioners admit the higher
authority of God, and strive for purity and holiness of life. It defines
your health-care mission in this way: to help the sick to the best of
your ability and judgment, and to never intentionally do harm to a
That’s your mandate, whether you’re a doctor, nurse, pastoral care
worker, or administrator. Your purpose is to serve the life and health
of the human person; to help and protect; to do no harm. The common
ground that links Christian revelation with the founding philosophy of
medicine is exactly this: the sanctity of the human person.
Unfortunately, we live in a time when both of those simple words
“human” and “person”
have disputed meanings, and the idea of the “sanctity” of human life is
sometimes seen as little more than romantic poetry. And this cultural
confusion, fueled by trends in our science and technology, is magnified
in the current debates over health-care reform.
Dr. Ratner had a special uneasiness about the growth of secularized
bioethics in the United States, guided not by universal moral norms but
by questions of procedure, utility, and vaguely drawn “values” of
compassion and patient autonomy. And he feared that American medicine
would lose its autonomy and become “no longer … the dedicated servant of
the individual patient, but the dutiful instrument of the state.”
In the years since his death, at least some of Ratner’s concerns have
proven true. Already in a number of states, the Church has faced
government attempts to press Catholic hospitals, clinics and other
social service institutions into violating their religious principles.
This is becoming a national pattern. In Colorado, to name just one
example, lawmakers recently tried to block the sale of two local
hospitals to a large Catholic hospital system unless the Catholic system
agreed to demands that it arrange for abortions, sterilizations, and
other so-called women’s services.
This was a fairly bald attempt at bullying, and it failed. The state
attorney general sided with the Catholic system. The sale finally went
through. But hostile lawmakers remain in the state Assembly. They
haven’t given up. And they continue to work on undermining the
conscience rights of religious believers, communities and institutions.
In a nation built largely by people of faith, with a long history of
religious liberty, this is a battle Catholics should never have been
forced to fight.
The question we should ask ourselves is this: What kind of a society
would need to coerce religious believers into doing things that
undermine their religious convictions
especially when those same believers provide vital services to the
We might find an answer to that question in a curious but telling moment
from the U.S. Senate race in Massachusetts earlier this year. Near the
end of her already strange campaign, Martha Coakley, the state attorney
general and a Catholic, began running ads accusing her opponent of
wanting to deny emergency contraception to rape victims.
Massachusetts law requires every hospital in the state to provide
emergency contraception drugs to the victims of sexual assault. Catholic
hospitals were among the first in the state to have excellent protocols
for rape victims, including the administration of anti-ovulant drugs
when tests determine that ovulation has not occurred. But that wasn’t
good enough for the state’s abortion lobby. So it pushed through a law
that requires Catholic hospitals to administer drugs even if they might
act to cause an abortion.
Clearly that’s bad law and bad medicine. And it sets a dangerous
precedent because it allows the government to directly interfere in the
doctor-patient relationship. In effect, it dictates the exact medical
procedure that doctors must follow in every case, no matter what their
professional judgment might be. It requires doctors and nurses to be the
enforcers of state abortion ideology.
Coakley’s opponent, Scott Brown
who is not Catholic and describes himself as “pro-choice”
had sponsored an unsuccessful amendment to the law in the state
legislature that would have respected the rights of Catholic hospitals.
It would have allowed health-care workers to decline administering
anti-ovulation drugs in cases where they might cause an abortion. This
became the basis of Coakley’s attack ads.
An interviewer then asked Coakley about the impact of the Massachusetts
law on the religious freedom of Catholics. She replied: “You can have
religious freedom, but you probably shouldn’t work in the emergency
Embedded in that remark is a bias worthy of a 19th-century Nativist
bigot. And it captures the situation many Catholics now face across the
country. In effect Catholics, because of their backward religious
beliefs, should exclude themselves
or should be excluded
from some of society’s important health-care positions.
But Coakley’s gaffe also shows the larger problems in a certain kind of
“progressive” thinking. Tucked inside Coakley’s attitude is the notion
that government is the embodied will of the people. Therefore the agenda
of the government and its leaders trumps everything else. And following
that logic to its remote but real conclusion, human dignity and
religious freedom are not finally God-given and inalienable rights, but
benefits that government may distribute or withhold depending on its
Ironically, this is exactly what the Jesuit scholar John Courtney Murray
warned Catholics to resist more than 50 years ago.3 He saw a
growing secularist spirit in America’s leadership classes, even then,
that identified civil society exclusively with the state and thereby
spirit that recognized no human dignity higher than civil dignity, and
no law higher than civil law. And he judged that kind of thinking as
Murray put it this way: “Given this [secularized] political theory,
[churches] are inevitably englobed within the state, as private
associations organized for private purposes. They possess their title to
existence from positive law. Their right to freedom is a civil right,
and it is respected as long as it is not understood to include any claim
to independently sovereign authority . . . The notion that any church
should acquire status in public life as a society in its own right is
per se absurd; for there is only one society, civil society, which may
so exist.” Murray added that “In this view, the separation of church and
state, as ultimately implying the subordination of church to state,
follows from the very nature of the state and its law . . .”
What Father Murray feared, we now often see in the actions of our public
authorities. It’s precisely the opposite of what the American Founders
intended for our country. The Founders worked hard to create the
structures of a limited government subordinate to civil society. Civil
society is much larger and much more alive than the state. And to stay
that way, it depends for its survival on the autonomy and free
cooperation of its parts
families, communities, churches, synagogues, and fraternal and
charitable associations. All of these entities have rights completely
independent of government. Rights that precede the state.
Now how does all this relate to the very practical topic of our time
together today: health-care reform and the future of the Catholic
health-care ministry? I’ll answer with a few simple facts.
First, while access to decent health care may not seem like a “right” to
some people in the same sense as our rights to life, liberty and the
pursuit of happiness
reasonable people might reasonably disagree about that
the Church does see it as a right. At a minimum, it certainly is the
duty of a just society. If we see ourselves as a civilized people, then
we have an obligation to serve the basic medical needs of all people,
including the poor, the elderly and the disabled to the best of our
ability. This is why America’s bishops have pressed so hard for national
health-care reform for so many decades. And they continue to do so.
Second, a government role in ensuring basic health care for all citizens
and immigrants can be very legitimate and even required. Americans have
always had a prudent wariness toward government and expanding state
for good reasons, as we’ve just seen. But that doesn’t justify excluding
government from helping to solve chronic problems when no other
Third, the principle of subsidiarity reminds us that problems should be
solved as locally as possible.
Fourth, no national health-care plan can be morally legitimate if it
allows, even indirectly, for the killing of the unborn, or
discriminatory policies and pressures against the elderly, the infirm
and the disabled. Protecting the unborn child and serving the poor are
not unrelated issues. They flow from exactly the same Christian duty to
work for social justice.
Fifth, despite everything I’ve just said, the health-care reform
proposals with any hope of advancing now in Washington all remain
fatally flawed on the abortion issue, conscience protections and the
inclusion of immigrants. But the even harsher reality is this: Whether
we get good health-care reform or not, legislative and judicial attacks
on Catholic health care will not go away, and could easily get worse.
If our nation’s abortion lobby and “family planning” interests have
their way, ultimately hospitals and other health-care providers will be
mandated by law to provide abortions, sterilizations, and a range of
other so-called “reproductive services” the Catholic community sees as
deeply wrong. And many other pressing issues like physician-assisted
suicide and new developments in biotechnology will raise very difficult
moral questions in the years ahead.
So what do you need to do as Catholic health-care professionals in the
face of these challenges?
The first thing all of us need to do
and I mean bishops, priests, deacons, religious, mothers and fathers,
mechanics, lawyers, shopkeepers, business executives and doctors
is to ask God for the gift of honesty. We need to examine our hearts
with real candor. And we need to ask ourselves how “Catholic” we really
want to be. If the answer is “pretty much” or “sort of” or “on my own
then we need to stop fooling ourselves, for our own sake and for the
sake of the people around us who really do believe. There’s no more room
in American life for easy or tepid faith.
This has consequences. If you’re a doctor or ethicist or hospital
administrator or system executive working in Catholic health care, and
in good conscience you cannot support Catholic teaching or cannot apply
it with an honest will
then you need to follow your conscience. The Church respects that.
Obedience to conscience is the road to integrity. But conscience, as
Newman once said, has rights because it has duties.4 One of
those duties is honesty. It may be time to ask whether a different place
to live your vocation, outside Catholic health care, is also the more
honest place for your personal convictions. What really can’t work is
staying within Catholic health care and not respecting its religious and
moral principles with all your skill, and all your heart.
If on the other hand, you’re one of the many in Catholic health care
too many to count, starting with the people in this room
who see the Church and her teachings as the ministry of Jesus himself,
and seek God in your vocation, and see the face of Christ in the
suffering persons you help; then you are what the soul of the Catholic
health-care vocation has always been about.
The recognition of human dignity, which you serve every day in your
work, is at the heart of the 2,000 year-old Catholic tradition of
medical ethics. It’s at the heart of the American bishops’ Ethical and
Religious Directives for Catholic Health Care Services, the ERDs.
They’re easy to find on the internet. Read them. Study them. Talk about
them with your colleagues. And then live by them. These directives offer
practical, real-world moral guidance for your daily work. But they’re
much more than a listing of ethical “dos” and “don’ts.” They provide you
with a spirituality and a wisdom based on the example of Jesus Christ,
the teachings of the natural law, and the truth of the human person as
created in the image and likeness of God.
The Holy See’s “Charter for Health Care Workers” tells us that “Health
care is a ministerial instrument of God’s outpouring love for the
suffering person; and, at the same time, it is an act of love of God,
shown in the loving care for the person.” In God’s plan, you have a
beautiful and demanding vocation. God asks you to be servants of life
and guardians of human dignity through your healing and care of others.
It’s a noble calling, and it’s threatened by trends in our society which
are magnified in the current debate over health-care reform.
Have courage. Trust in God. Speak up and defend your Catholic faith with
your medical colleagues. Commit yourself to good and moral medicine. Get
involved and fight hard for the conscience rights of your fellow
Catholics and their institutions. Remember the Hippocratic Oath.
Dedicate yourselves again to being truly Christian and deeply Catholic
You and I and all of us
we’re disciples first. That’s why you gave your heart and all your
talent to this extraordinary vocation in the first place. Remember that
as you go home today. Use up your lives for the glory of God and the
dignity of your patients. You walk in the footsteps of the Healer of
humanity and Redeemer of history. In healing the sick, proclaim his
Kingdom with the witness of your lives.
1 See Michael Burleigh, Death and Deliverance: Euthanasia in
Germany, 1900-1945, Cambridge University Press, New York, 1994. Burleigh
argues that many in the German medical profession had already abandoned
their traditional medical ethics for a more utilitarian model years
before the Third Reich came to power. This made their complicity with
Nazi eugenics much easier, and in a sense, logical. Burleigh also notes
how skillfully the regime manipulated Catholic and Protestant
institutions caring for the mentally and physically disabled. In their
attempts to save a few of their patients, keep their doors open and
maintain relations with the regime, religious institutions surrendered
thousands of other disabled and chronically ill patients to “mercy
2 See "The Physician's Obligation: Society vs. Person," 1978;
a talk collected in Nature, the Physician, and the Family: Selected
Writings of Herbert Ratner, M.D., 2nd. ed., Author House, 2007, pages
3 John Courtney Murray, S.J., “Civil Unity and Religious
Integrity,” 1954; available online from the Woodstock Theological Center
4 John Henry Cardinal Newman, “Letter to the Duke of
Norfolk,” 1875; available online
Used with permission from the Archdiocese of Denver