BY FRED FAKHARZADEH, M.D.

The social doctrine of the Church provides fundamental principles that serve to form our conscience and provide criteria for prudential judgment in evaluating the framework of society. Based on these criteria, we can implement policies and action to address the structures of society and make them more just with the aim of achieving the common good. According to the Catechism of the Catholic Church, the common good is defined as the “sum total of social conditions which allow people, either as groups or individuals, to reach their fulfillment more fully and more easily” (CCC 1906).

Healthcare certainly is one of the elements necessary to achieve the common good, which is why it is important to see how the prime principles of Catholic social teaching (CST) can be applied to healthcare.

Human Dignity

Human dignity is the prime principle, teaching that all people are created in the image and likeness of God. Hence, we respect all human life, from conception to natural death. Furthermore, as Pope Leo XIII states in Rerum Novarum, “the State is bound to protect natural rights, not to destroy them.” And as St. John Paul II noted in Centesimus Annus, “No one can take away this human right,” not even the majority of a democratic political body, because this dignity does not arise from the state or the will of the governed.

Contemporary society often overlooks this fundamental principle, for example when enabling and promoting abortion. It is a paradox that despite in utero imaging that provides such clear pictures of the developing baby — often the first picture people put in a baby album is their baby’s ultrasound picture — society denies that this baby is a human being. Thus, it can be aborted and deprived of life. At the other end of life’s course is the hastening of death by assisted suicide, euphemistically termed euthanasia or “death with dignity,” again abusing the sanctity of life.

The principle of human dignity also affirms the inherent value of all human life: people of all races, and with any and all impairments and variations. Furthermore, with its emphasis on the dignity inherent in all people, Catholic social teaching insists that the evaluation of a society rests on how it treats its most vulnerable members. As Pope Francis points out in Laudato Si, it “demands before all else an appreciation of the immense dignity of the poor.”

Solidarity

Solidarity reminds us of the obligation we have to love each other, to be responsible for and care for each other. This commitment is not only to our friends and family, but to all people. As Pope Benedict reminds us in Deus Caritas Est, “Love of neighbor…consists in the very fact that, in God and with God, I love even persons whom I do not like or even know. This can only take place on the basis of an intimate encounter with God.” Furthermore, St. John Paul II spurs us to action when he notes in Sollicitudo Rei Socialis that solidarity is not “a feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far. On the contrary, it is a firm and persevering determination to commit oneself to the common good; that is to say to the good of all and of each individual, because we are all really responsible for all.”

In its call for us to care for each other, solidarity invokes the primacy of the human person, to recognize and appreciate the inherent dignity of all people, dignity that is a grace born of our creation in the image of God. Solidarity establishes that we care for the human person, and that people come first, not systems or businesses or governments. Businesses, governments, and the like are there to serve people, not the other way around. In medicine, we need to care for the patient first; the patient is the priority. The healthcare delivery system should be a tool to help us care for our patients, not a driver of that care.

Subsidiarity

The principle of subsidiarity asserts that problems should be addressed by the most local entity that is capable of doing so. As Pius XI writes in Quadragesimo Anno, “It is a fundamental principle of social philosophy, fixed and unchangeable, that one should not withdraw from individuals and commit to the community what they can accomplish by their own enterprise and industry. So, too, it is an injustice and at the same time a grave evil and a disturbance of right order to transfer to the larger and higher collectivity functions which can be performed and provided for by the lesser and subordinate bodies.”

St. John Paul II predicted what happens when subsidiarity is overlooked when he stated that “by intervening directly and depriving society of its responsibility, the Social Assistance State leads to a loss of human energies and an inordinate increase in public agencies which are dominated more by bureaucratic ways of thinking than by concern for serving their clients, and which are accompanied by an enormous increase in spending. In fact, it would appear that needs are best understood and satisfied by people who are closest to them and who act as neighbors to those in need.”

This sounds eerily like a description of the current state of affairs in healthcare. Pope Benedict XVI adds that “the State which would provide everything, absorbing everything into itself, would ultimately become a mere bureaucracy incapable of guaranteeing the very thing which the suffering person — every person — needs: namely, loving personal concern.” 

In healthcare, it is the doctors, the nurses, and other healthcare professionals who are in the position to provide this loving, personal concern. They are the ones closest to the patient and in the best position to understand the patient’s needs and situation. Personal relationship is fundamental to healthcare.

Yet there are circumstances that may not be able to be handled adequately at a local level and thus necessitate a higher level of intervention. Public health emergencies, for example, may warrant a higher-level agency of oversight, but as the Compendium of the Social Doctrine of the Church states, “In light of the principle of subsidiarity, however, this institutional substitution must not continue any longer than is absolutely necessary, since justification for such intervention is found only in the exceptional nature of the situation.”

Application

When considering the application of Catholic social teaching, it is important to consider all three principles together. First, and foremost, is protecting the dignity of the human person as the foundation of all structures, policies and procedures aimed at providing for the common good through healthcare. Then solidarity and subsidiarity must be considered as equal points. Focusing on subsidiarity without consideration of solidarity, or vice versa, results in an instrumental use of the Church’s social teaching. The proper application of CST requires that all three principles be incorporated in order to provide truly equitable healthcare.

Further, it is possible to have multiple answers to a given problem that are all consistent with the principles of CST. Church teaching provides a framework for evaluation and prudential judgment to arrive at a solution, but it does not prescribe a single solution.

Catholic Social Teaching indeed offers us a framework to evaluate healthcare, guiding us in our approach to the care of our patients and to just and fair healthcare delivery systems, and to formulate ethical treatment and healthcare policy.

Frederick F. Fakharzadeh is the chair of the Catholic Social Teaching on Justice in Medicine Committee and is a hand surgeon in full-time private practice in Paramus, NJ. He has been a CMA member since 2013.SHARE