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Most Catholic hospitals are no longer different
from voluntary or even
for-profit hospitals in the United States.
Catholic healthcare: We are
losing the identity battle
By Patrick Guinan
n The three major agents of Catholic evangelization in the United States prior to
Vatican II—higher education, social services, and healthcare—have developed a
Catholic identity crisis since that Council.1 We will single out one, Catholic healthcare,
for 1) a background review; 2) a definition of the problems and their etiology, and 3)
possible solutions.
1. Background
Catholic healthcare is unique in human history in its contribution to
the alleviation of human suffering, both physical and mental. No culture has put a higher
priority on healing than has the Catholic Church. This is so because Christ was defined as
a healer and even a physician.2 Of Christ’s thirty described miracles no less than
twenty or 66% were acts of curing physical illnesses. Christ’s message of love was
primarily to heal the spiritual, moral and emotional effects of sin, but also, where
possible, to alleviate physical pain and suffering.
This command was transferred to his disciples at Pentecost and
healthcare was a ministry of his Church from apostolic times. Deacons in the early Church
had the responsibility of looking after the physically ill members of the community. They
were responsible for the tradition of “hospitalitas” which later resulted in
what we know as hospitals.3 There was an organized care of the sick with a system of
hospitals at the time of Constantine the First. The Council of Nicea (325 AD) mandated
(Canon 75) facilities for the care of the sick.
With the recognition of Christianity as a religion in the Roman Empire,
by the Edict of Milan (313 AD), Catholic healthcare, particularly hospitals, expanded
greatly, usually in conjunction with monasteries. There was a big increase in hospitals in
the 11th and 12th centuries, most run by religious orders. The Knights of Malta were
founded 1108 to nurse the sick, only secondarily becoming a military power. In England
there were 980 hospitals in 1300.
This commitment to healthcare was taken when there was no industry and
little capital. It was unique to Christianity and was a result of the mission of the
Church. There was a preferential option for the poor and outcasts, as reflected in the
institutions for the care of lepers. This concern for healing was not reflected to the
same extent in other cultures such as the Buddhist or Hindu.
The rise of Protestantism resulted in a reduction of hospitals. In
England, with Henry VIII’s seizure of Church property most hospitals ceased to exist
with the result that the poor were without organized healthcare.
One of the outstanding aspects of the Catholic Church in America was
its commitment to healthcare. Begun initially by the Spanish, in part to care for Indians,
the first American hospital was organized in 1503 in Santo Domingo. Religious orders,
predominantly women, founded and staffed in excess of 1,000 hospitals in the United States
between 1840 and 1960. Most were founded to minister to Catholic immigrants who were
usually poor and without medical resources.
While medicine can be traced to prehistoric times, with a remarkable
development by the Greeks, it has traditionally been practiced by individuals. However the
healthcare ministry as a community mandate began with Christianity and was
institutionalized by the Catholic Church. It has been characterized by inpatient care
provided without financial profit by religious orders, principally women who lived in a
religious community life and who wore distinctly religious garb.
Their mission was the spiritual, as well as the physical health of
patients. Since 1965, or after the completion of the Second Vatican Council, there have
been significant changes. A review of these events follows.
2. Problems in Catholic healthcare
Catholic healthcare, certainly in the United States, has changed more,
and probably for the worst, in the past thirty years, than it had in the prior nineteen
centuries. The changes have occurred in its financial orientation, but also, and more
importantly, in its sense of evangelical mission. The latter, which is related to the
former, seems to reflect changes taking place in the American Church.
We will review financial orientation first. Catholic hospitals
traditionally had been clearly not-for-profit. These hospitals were run predominantly by
religious orders of women, who worked for little or no salaries. Their lives were the
Catholic mission of their orders. This tireless devotion and long hours enabled their
hospitals to care for the poor sick and immigrants who presented themselves at their door.
Since 1965 there has been a fundamental change: the non-profit
mentality has changed to one of the “bottom-line.” Granted that much of this is
because the mindset of contemporary American medicine is predominantly financial and only
secondarily health oriented. Unfortunately healthcare costs have risen so dramatically,
for a variety of reasons, with the resultant effect that, driven in part by the fear of a
government take-over, health maintenance organizations (HMO) have been formed. HMO care,
as a form of rationing, brings costs down, and in the process can result in a not
insignificant profit. Unfortunately, Catholic hospitals, instead of rejecting this
mindset, have only too eagerly conformed.
Catholic healthcare, for better or worse, coexists in a secular
economic system which is marginalizing hospitals.4 Ambulatory care is the name of the
game, and while hospitals are downsizing, they are frantically combining surgicenters,
nursing homes, hospices and neighboring hospitals (oftentimes non-Catholic) in healthcare
“systems.” In this setting the issues of direct and indirect cooperation in
unethical practices becomes complex.5
Paradoxically, some Catholic hospitals seem to have enthusiastically
adjusted by adapting to the HMO mentality and profit orientation. Catholic Healthcare West
(CHW) is an example.6 Thirty years ago numerous Catholic hospitals, run by several
different orders, began merging to remain financially competitive. Now CHW is one of the
nation’s larger healthcare delivery systems, with assets of $3.2 billion and revenues
of $2.3 billion in 1996.7 CHW’s chief executive officer receives $700,000 annually in
compensation.8 Another publicized example is the planned takeover of the St. Louis
University Hospital by the for-profit corporation, Tenet.9 While these Catholic hospital
systems claim to provide free care for the poor, it is doubtful that they provide
proportionately any more free care than secular healthcare systems.
Concurrent with the financial shakeout of Catholic hospitals, there has
been, more importantly, an erosion of their Catholic mission. This occurred simultaneously
with the disappearance of the Catholic sisters whose presence was the hallmark of Catholic
hospitals. Now there are few if any sisters roaming the corridors, or in the board rooms,
as they once were, because there are few if any vocations. But also, and more importantly,
those who remain have consciously given up their visible Catholic identity—their
religious habits.
With the loss of these dedicated sisters the Catholic mission of their
hospitals has declined. The chapel, daily Mass, and more significantly, routine Holy
Communion for the patients have become less important. Priest chaplains have been replaced
by lay, usually women, ministers. And Catholic ethical standards are being compromised.
Abortion is but one example: there is no question but that abortion is forbidden in
Catholic hospitals, but with the recent mergers non-Catholic hospitals within Catholic
healthcare systems are performing them. Significant problems loom in the areas of
reproductive technologies and genetic engineering.
In short, Catholic hospitals are now less Catholic. The former mission
of spiritual as well as corporal healthcare to poor Catholic immigrants has been replaced
by financial competition in an HMO dominated industry with profit as the bottom line. Most
Catholic hospitals are no longer different from voluntary or even for-profit hospitals in
the United States.
3. Solutions
The solutions to this Catholic healthcare crisis lie in three areas: 1)
governance; 2) spiritual sustenance; and 3) ethical commitment. Governance will first
require the active involvement of the local bishops who by Canon Law are responsible for
the Catholic mission of institutions within their jurisdiction. Given the loss of will by
Catholic religious orders and the inability of Catholic doctors to effect change, only the
bishops, if even they, can return Catholic hospitals to their mission. The local bishop
will probably have to have one or more of his representatives on the hospital boards of
hospitals in his diocese.
Secondly, the spiritual needs of the patients and staff must be
attended to. The beginning of life, and especially the end of life, are crises requiring
close spiritual support. Too little attention is now given to the transition to eternity,
which all too often takes place in hospitals. The presence of a priest chaplain, Mass and
Holy Communion for patients and staff, should be required. It used to be that daily Holy
Communion for patients was readily available: the practice should be restored.
Thirdly, the Catholic ethical presence has to be safeguarded. Not only
must the NCCB Ethical and Religious Directives be adhered to but they should be
distributed to new staff members, be they medical or lay. An active Ethics Committee must
implement these Directives, including an articulated rape protocol, to protect not only
the rights of the woman but also any new life that may have been conceived.
In summary, given the irregularities in American healthcare, and the
fact that over 10% of the population has no insurance coverage, Catholic hospitals must
look less toward a positive bottom line, and more toward their evangelical mission of
caring for the physical and spiritual needs of the sick, and especially the sick poor.
This may require that some Catholic hospitals that minister in areas of affluence share
their largess with those hospitals serving a preponderance of poor patients.
Only by returning to the Gospel principles begun in the early
Church—of physical as well as spiritual healing—can we renew the Catholic
healthcare ministry. This historic legacy is too important to be displaced by contemporary
trends toward secularization, both spiritual as well as financial. n
1 Curran, C., “The Catholic Identity of Catholic
Institutions,” Theological Studies, V. 58, 90-109, 1997.
2 Luke 4:23.
3 New Catholic Encyclopedia, 1965, V. 5, pp. 185-186.
4 McCormick, R., “The Catholic Hospital Today: Mission
Impossible,” Origins, 24: 648-653, 1998.
5 Keenan, T., “Institutional Cooperation and the Ethical and
Religious Directives,” Linacre 64: 53-75, 1997.
6 Rundle, C., “Catholic Hospitals in Big Merger Drive Battle
Industry Giants,” the Wall Street Journal, p. 1, Mar. 12, 1997.
7 “Profile in Catholic Healthcare,” The Catholic Health
Annual of the United States, 1996.
8 Jones, Arthur, “Special Catholic Healthcare Report,”
National Catholic Reporter, pp. 11-15, June 16, 1998.
9 Schaeffer, P., “Cardinals Claim Rights in Hospital
Dispute,” National Catholic Reporter, p. 3, Oct. 24, 1997.
Dr. Patrick Guinan is president of the Catholic Physicians’ Guild of Chicago. He received his M.D. degree from Marquette University Medical School in 1962 and was chairman of the Division of Urology of the University of Illinois. He is currently on the Executive Board of the Hektoen Institute for Medical Research and holds the office of secretary, and is also on the Board of Archbishop Quigley Seminary in Chicago, Ill. His last article in HPR appeared in July 1998.
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