Friday, December 10, 2004

Healthcare without Charity

As Christians, it is our duty to see the face of Christ in the sick and poor. Jesus performed many miracles in healing the sick, and He commanded the Apostles to do the same. Early Christians, mindful of their duty to the least among them, cared for the sick and unwanted with great charity, since when caring for the sick and poor, they did that for Christ Himself.

During the reign of Emperor Constantine, after the legalization of Christianity, many hospitals were founded under the bishops and in monasteries to care for the sick among pilgrims and the poor. The charity of the Christians gave comfort and hope to their patients, as well as medicine, clean bed linens, good food, and warm lodging. This is in great contrast to savage tribes or even civilized pagans who would fatally neglect the unwanted or even directly kill the infirm. Hospitals continued to be supported in the West by Christians even after the collapse of the Roman Empire. The flourishing of Universities during the High Middle Ages led to great advances in medical knowledge and also to better hospitals. These Medieval hospitals would continue to care for the poor free of charge and also continue the tradition of caring for anyone regardless of creed; Christian hospitals in the Holy Land cared for Christian and Muslim alike. Hospitals were often under the patronage of nobility, but also owned property to pay for services, received donations, and often were in agreement with local municipalities to receive tax revenue.

These hospitals were run as charities. The paid staff (usually limited to lay physicians) was quite limited. Unpaid members of religious orders were nurses, cooks, and janitors, and performed nearly all of the services in the hospital. These Religious, being under vows to serve God and their neighbor out of Charity, did their duties not because of personal ambition, or for money, or for career enhancement, but for love. The horrors and dangers of hospital service were persevered due to the dedication of those who vowed their whole being to that service.

Since hospitals were a thoroughly Christian institution, the spiritual aspects of healing and death were not only recognized as being important, but were absolutely central to the institution. Christian patients were to go to Confession upon entry to predispose their souls to healing, attended the Mass daily, and were to pray for the hospital benefactors; they also received the Sacrament of Extreme Unction.

The Reformation led to a decay of the hospital system in many parts of Europe, with income-producing hospital properties being seized in England and elsewhere, and with an attitude among some Protestants that illness and poverty were signs of God's displeasure, and so those were not deserving of charitable healthcare. However, this was also the period of the formation of vast hospital communities of Women Religious, some of which still exist and own some of the largest hospital systems today. 19th Century revolution and forced secularization of hospitals, combined with vast migrations of workers to the cities often lead to hospitals that were poorly funded, overcrowded, and severely lacking in the original Christian charity that made them houses of hospitality.

Hospitals in the United States were still overwhelmingly religious charities until the 1970s. With the social revolutions of that era, the emphasis changed from charity to profit and social justice. Religious vocations also dried up during that time, with Brothers and Sisters being replaced by paid staff. Many hospitals were sold to private companies, with the religious affiliation greatly attenuated or even eliminated. Another trend during that time was the change from fee-for-service to medical insurance and government payments.

So we end up with several systemic changes:

- Costs rose dramatically. Vowed Religious, receiving only room and board and perhaps a small stipend, were replaced with paid, and often unionized, staff. Staffing costs are now the major cost of healthcare, even more than technology and pharmaceuticals.

- Insurance companies want increased control over healthcare costs, and will often dictate the type of care received; this is particularly true with 'managed care' where the management is from the insurance company. Often these insurers will insist on short hospital stays, eliminating the close, long-term care that hospitals traditionally offered.

- Private corporations insist on increasing revenue and will often use a large percent of that revenue for acquisitions instead of for patient care. Under this system however, excellent care is available for those who can afford it.

- National governments, increasingly paying for, or even monopolizing healthcare, are more interested in rewarding political interest groups than in their healthcare mission. Access to health care is now often framed in terms of so-called social justice theory, with favored groups getting better care than those out of favor.

What we get is a high-cost, low care hospital system, with interference based on the unpredictable desires of political power blocs. And charity is completely missing. Very few people in the health care field are doing their work out of love of their neighbor; hospitals are not operated out of the love for the sick and the poor. Instead, hospitals are run for money and power. This is the new synthesis between Capitalism and Socialism, neither of which philosophies are known for their love of either God or Man.

For thousands of years, physicians took a solemn vow to work for the good of the patient; sometime in the 20th century it was changed to working for the good of society, which is a very dangerous idea. Formerly, the relationship was between the persons of physician and patient; now, it is a relationship between a person and...what?...Society? What exactly is society? Is it the national government, an activist judge, a political party, a business manager, an insurance company, or perhaps an ethicist on the hospital staff? Certainly it is not a clear relationship between two distinct, identifiable persons.

Charity is out of our hospitals; so is -- for the most part -- religion. However, 'spirituality' is becoming recognized by our modern hospitals as an important component of healing, but certainly not Christianity as we have known it. Hospitals usually have a chapel, but often just a vague nondenominational-looking room; even Catholic hospitals will have a chapel of iconoclastic design. Instead, hospital counselors will just offer a New Age spirituality. A friend told me that when his Uncle Leroy was dying, he was visited by a spiritual counselor -- a female Protestant minister -- who wore clown pants, couldn't find Psalm 23 in the Bible, and didn't even offer a good prayer. Contrast this with traditional Catholic hospitals, where a dying patient would be ministered the Sacraments by a priest and be visited by a roomful of Sisters in full habit who would pray for him. Those were the days of spirituality led by charity.

In both the United States and in Britain, recent healthcare privacy rules have had the unintended consequence of denying the sacraments to hospital patients. Formerly, a patient's church would be notified upon admittance; now, the patient has to give specific consent to notification. Clearly, if a patient is unconscious, they are not able to give this consent. I've heard that thousands are dying every year without getting the sacraments because of these new laws. I hope that this was an unintended consequence of the law: let's see if the laws are amended to correct this problem.

Progressive philosophers talk about quality of life, where they make judgments on whether a life is worth living or not. These philosophies have been quickly absorbed by those regulating healthcare. Unwanted babies, of course, are aborted, and the very sick, elderly, and depressed are euthanized under such a system. Progressive countries originally allowed euthanasia with informed consent, but now those rules are being relaxed, with larger classes of persons subject to euthanasia without consent. It's been done before, and the results were disastrous and cruel. Where will this end? The most civilized, progressive, and educated country in the world, Germany, killed millions of these undesirables. Euthanasia and assisted suicide are now being framed as positive social justice issues. It's for the good of society.

Withholding care from certain patients is treading very close to direct euthanasia; the sick and elderly are now strongly encouraged to sign a so-called 'living will' which would be more accurately described as a "will to die". Clearly this is a difficult subject, for we all will eventually die, and sometimes it is just our time to go. Every Christian accepts that the Lord will call him when He Wills it. I just see the ethical trend is moving towards a looser definition of when that time will be, and more problematically, hospital staff, relatives, and now even the courts may make that decision for the patient, against his will. Good advice now is to carefully choose someone who will have the power of attorney for such decisions.

Hospitals were created by Christians as charities, to care for the sick and poor. Hospitals have now been taken over by secular powers and are no longer charities. Patients live if they are wanted or productive, or if they can pay for it. The unwanted and unproductive die. A shudder should run through the soul of every Christian who realizes this, for we are called to see Christ in the least among us. We Christians should attempt to regain the virtue of Charity to turn back this great evil.

Here are some things that we Christians can do:

- Encourage the founding of new Religious Hospital Orders. The Church is at a low point now, but changes are coming. We need to encourage heroic charity in ourselves and our children.

- Operate hospitals as charities again. Charge on a sliding scale. Be politically active to prevent government interference in the operation of these hospitals.

- Accept the poor and unwanted free of charge in the hospital. No patient ever should need to worry about the withholding of care or involuntary euthanasia.

- Aggressively promote Christian values in hospitals. Refuse to accept secular theories on life issues. Have plentiful access to Christian spiritual direction, prayer and the Sacraments. Fill the hospital with religious iconography.

We may be entering an age where our very life depends on the whim of others. We are Christians, we must fight this with love.

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