A consideration of social justice

I am very pleased to have been asked to write an introduction to this special issue of The Linacre Quarterly dealing with a Catholic vision of social justice as it touches health care. There can be a perception that the provision of health care by Catholics is consistent with the Gospel demand to love one's neighbor precisely because health is a good which is consistent with the Gospel. Thus, it is easy to conclude that the primary reason that the Church is involved in health care is in order to assure better physical health on the part of the residents of a particular area. While there is no doubt that this is a good and that such an outcome is desirable, the deeper question which must be asked relative to any Catholic venture is whether it sufficiently fulfills the Gospel mandate. That mandate is to “go out to all the world and proclaim the good news” (Mk 16:15). The mandate is not limited to going out and working to actualize the message of good health. This is a good but it is not the entire good mandated by the Lord. The Church's mission is intimately tied to the essential message of supernatural health and eternal salvation. Further, even the message of good health needs to be proclaimed in a manner fully consistent with the Gospel from which all Catholic activity must flow. Maintaining this essential Gospel connection is crucial to the identity of Catholic health care.

Pope Francis, in his very memorable homily 1 day after his election as supreme pontiff commenting on what it means “to walk,” to “build up,” and “to confess,” said: “Third, to confess. We can walk as much as we wish, we can build many things, but if we do not confess Jesus Christ, it is no good. We will become a humanitarian NGO, but not the Church, bride of the Lord.” He continued: “When one does not walk, one halts. When one does not build on stone what happens? That happens which happens to children on the beach when they make sand castles, it all comes down, it is without substance. When one does not confess Jesus Christ, I am reminded of the expression of Léon Bloy: ‘He who does not pray to the Lord prays to the devil.’ When one does not confess Jesus Christ, one confesses the worldliness of the devil, the worldliness of the demon” (Francis 2013).

This is bold language, which is not unusual for Pope Francis; and it is language which, in the context of Catholic action, is entirely consistent with many related statements and pronouncements which the Church has made over the decades and centuries. One could almost be as bold as Pope Francis and declare that any Catholic who works for justice separate from God works for the “worldliness of the devil.” This is a real danger.

Statements such as this make it clear that what the Church does under the title of social justice, or under the title of Catholic health care or Catholic education, must be something substantially different than mere social justice or education or health care. Something very similar is intimated by Jean-Charles Nault, OSB, in his book The Noonday Devil. He writes: “Contemplatives witness to the primacy of the ‘vertical’ relationship. Given a certain current of thought that tries to reduce charity to mere social service, and the Gospel to a mere message of human fraternity, the monk must remind the world that it is necessary to lift our eyes to the heights” (Nault 2015).

It seems that both Pope Francis and Father Nault make it clear that charity is much more than “mere social service” and that social justice needs a much more stable foundation than some vague notion of “doing good” and serving the poor. Pope Emeritus Benedict, too, makes a similar point. In his beautiful encyclical Deus Caritas Est, he wrote:

Interior openness to the Catholic dimension of the Church cannot fail to dispose charity workers to work in harmony with other organizations in serving various forms of need, but in a way that respects what is distinctive about the service which Christ requested of his disciples. Saint Paul, in his hymn to charity (cf. 1 Cor 13), teaches us that it is always more than activity alone: “If I give away all I have, and if I deliver my body to be burned, but do not have love, I gain nothing” (v. 3). (Benedict XVI 2005, no. 34)

He continues, “Practical activity will always be insufficient, unless it visibly expresses a love for man, a love nourished by an encounter with Christ” (Benedict XVI 2005, no. 34). This central clause is essential. What is required for followers of Christ is not only a genuine humanitarian love for one's brothers and sisters but “a love nourished by an encounter with Christ.” This affects not only how one provides charity, but it also deeply touches how that charity is received.

First, do no harm. Undoubtedly, every Catholic physician is well acquainted with this first promise and is well aware of its applicability in our present circumstances. Yet, for a Catholic physician the rule needs further differentiation. The Code of Canon Law concludes with canon 1752 which, while referring to the rules to be followed in the transfer of pastors, adds a general admonition about the purpose of all law. “In the cases of transfer the prescripts of Canon 1747 are to be applied, canonical equity is to be observed, and the salvation of souls, which must always be the supreme law in the Church, is to be kept before one's eyes” (Code of Canon Law 1983, emphasis added). In a world filled with the promise of salvation by science it is easy to forget that the purpose of Catholic institutions, especially institutions of health care and education, have a higher purpose than the promotion of physical health or intellectual excellence. There is nothing in these goals themselves which is contrary to the Gospel, but they are goals which are desirable even without any knowledge of the Gospel. The Church is involved in these apostolates precisely because She knows that they touch the salvation of souls. A Catholic physician then knows that the first promise must be applicable to the salvation of souls. Perhaps we could say, “First, do no harm; do nothing to endanger your own or your patient's spiritual welfare.” This could stand as the primary rule to be followed in any evaluation of the applicability of the Church's teaching regarding social justice in the realm of health care.

The Catechism of the Catholic Church, “a sure norm for teaching the faith,” offers the beginnings of a deeper appreciation for the richness of the Church's teaching. The Catholic notion of social justice far transcends the secular notion. It can even happen that many in the Church operate out of a limited or misguided understanding. In a key paragraph in the Catechism we find, under the bold heading of “Respect for the Human Person,” this paragraph:

Social justice can be obtained only in respecting the transcendent dignity of man. The person represents the ultimate end of society, which is ordered to him:

What is at stake is the dignity of the human person, whose defense and promotion have been entrusted to us by the Creator, and to whom the men and women at every moment of history are strictly and responsibly in debt. (CCC 1997, no. 1929, quoting John Paul II, Sollicitudo re socialis, no. 47)

This paragraph is critical in arriving at a proper understanding of the Church's investment in the promotion and pursuit of social justice. This “justice” must be intimately linked to respect for “the transcendent dignity of man.” A view of social justice which rejects the transcendent dignity of the human person bears some resemblance to the Church's understanding of social justice but is substantially defective. If such a defective, secular view is adopted by the Church or Her institutions then Her apostolates quickly devolve into just another form of materialistic humanism, a humanitarian NGO. Dietrich von Hildebrand refers to this as a desire to be “as little as possible distinguishable from a humanitarian philanthropist” (von Hildebrand 1993, 60). There is a danger to the faith in pursuing and promoting a concept of social justice divorced from this essential, God-related, aspect. It is precisely because man is created in the image and likeness of God and for his own sake that he is worthy of special attention and care. As noted in the Catechism, all other creatures are worthy of respect in light of the fact that they are created by God but only man has been willed for his own sake “Every human life, from the moment of conception until death, is sacred because the human person has been willed for its own sake in the image and likeness of the living and holy God” (CCC 1997, no. 2319).

Number 1930 in the Catechism reiterates the connection between the dignity of the person and the inalienable rights which flow from that dignity. “Respect for the human person entails respect for the rights that flow from his dignity as a creature” (CCC 1997, no. 1930). Our society, which is very quick to declare as a “right” an innumerable variety of preferences and choices, at the same time, fails to recognize some of the authentic rights which flow from the dignity of the person. In the Catholic world some of the “rights” established by law or by judicial decree have no authentic claim to the designation. Since the dignity of the human being or human person is the foundation of rights, it is impossible, for instance, to justify as rights such things as sterilization which violates the integrity of the human person or physician-assisted suicide which destroys the life of the human person whose dignity must be protected.

The commitment of the Church to various forms of Catholic action has a strong scriptural foundation. I do not intend a full scriptural analysis but simply wish to reflect upon one episode in the life of Jesus. It is His answer to the question of John the Baptist about whether Jesus was the “one who is to come.” Jesus’ answer is very instructive:

When John heard in prison of the works of the Messiah, he sent his disciples to him with this question, “Are you the one who is to come, or should we look for another?” Jesus said to them in reply, “Go and tell John what you hear and see: the blind regain their sight, the lame walk, lepers are cleansed, the deaf hear, the dead are raised, and the poor have the good news proclaimed to them^—and happy is the man who does not find me a stumbling block. (Matt 11:2–6)

It can happen that the strong proponents of social justice, who readily and properly find firm foundation for activity in Jesus’ answer to the question of John the Baptist, forget that the final phrase is preceded by that very important word, “and”: “… and the poor have the good news proclaimed to them.” The answer does not identify Jesus exclusively with the physical healing of sight and hearing and leprosy and limb, or even with the restoration of life itself, but rather these things and the proclamation of the good news, that is, the salvation of souls. It is hard to imagine how any of the material blessings which Jesus brings could become the “stumbling block” which He mentions. Certainly the world would have no difficulty with the Church if all She would do was to help the blind regain their sight, heal the lame, cleanse lepers, restore hearing to the deaf, or raise the dead. The “stumbling block” must be the preaching of the good news, the call to holiness, the call to conversion and salvation. There is the good news. The other things are all significant but, in our day, any agency or NGO can do most, if not all, of them. What they cannot do, do not do, and may even be forbidden to do is to proclaim the good news.

I believe it is essential in our human encounters, as witnesses to the Gospel, to extend charity and certainly justice to our brothers and sisters, but in the course of doing that it is essential, not optional, to lift them up in a way that restores them to authentic dignity. In effect, we need to say to them, “Do you not know that, in the entirety of the material universe, you, as a human person, are the only creature, created for your own sake?” (see ^{CCC 1997}, no. 2319). This speaks volumes about the nature and quality of God's preferential love for each of us. As ministers of charity, justice, health care, or education we become the messengers of this life-giving message provided we are in contact with the God whose love we are called to manifest. All of the practical and even necessary measures taken by Catholic institutions to improve health and education are good but, from a Catholic perspective they are insufficient. “Practical activity will always be insufficient, unless it visibly expresses a love for man, a love nourished by an encounter with Christ” (Benedict XVI 2005, no. 34).

Pope Pius XI made this same point when he wrote an encyclical to the Mexican bishops in 1937: “He [Jesus] healed the infirmities of the body and came to the assistance of temporal needs, He had the supreme end of His mission always in view, that is, the glory of His Father and the eternal salvation of souls.” He continued:

Then, too, by encouraging the spiritual formation and the interior life of those who are to collaborate with you, you put them on guard against dangers and mistakes that are always possible. Having always in mind the purpose of Catholic Action, which is the sanctification of souls, according to the Gospel precept Quaerite primum regnum Dei (Seek first the Kingdom of God) (Lk 12:31), you will not run the risk of sacrificing principles for ends that may be immediate or secondary, nor will you forget that to that ultimate end are to be subordinated every social and economic work and charitable undertaking. (Pius 1937, no. 12)

One cannot help but comment on the emphatic nature of the Holy Father's words that “to that ultimate end are to be subordinated every social and economic work and charitable undertaking.” The ultimate end is, of course, the promotion of the kingdom of God and the salvation of souls.

Pius XI is not alone among the pontiffs to make this point. Pope Pius XII in a radio message to the Barcelona Congress of Sodalities of Our Lady, December 7, 1947, made the same point in even stronger language:

For in this magnificent movement of lay apostolate, so dear to Our heart, two errors must be avoided, which can creep into the souls even of men of good will.

The first is the danger of excessive preoccupation either with the exterior element, with superficial and natural activity which We have called on another occasion: “the heresy of action,” or else with the interior element, with an excessive and timid concentration on pious practices, scarcely in harmony with the words of our Lord: “I am come to cast fire on the earth. And what will I, but that it be kindled?” (Lk 12:49). (Pius 1947)

In our day the danger of an excess of the interior element hardly seems possible. The other danger, however, seems to have been very well established, that is, “the heresy of action” or the heresy of good works.

Calling any form of Catholic action or Catholic institutional work “heretical” seems inconceivable. Yet, Saint Francis de Sales, using similar language, sheds some light on the meaning of the Holy Father.

In fine, I say to you this word, worthy of note. Heretics are heretics and bear the name, because out of the articles of faith they choose at their taste and pleasure those which it seems good to them to believe, rejecting and denying the others. And Catholics are Catholics, because without any choice or election they embrace, with an equal assurance and without exception, all the faith of the Church. Now it is the same in the articles of charity. It is a heresy in sacred love to make choices among God's commandments, which to observe, and which to violate: He who said: “Thou shalt not kill,” said also: “Thou shalt not commit adultery.” If then, thou kill not, but commit adultery, it is not for love for God that thou killest not, but it is from some other motive, which makes thee rather choose this commandment than the other; a choice which makes heresy in matter of charity. If a man told me that he would not cut off my arm on account of his love for me, and yet proceeded to pluck out my eye, to break my head, to run me through:—Ah! Should I cry, how do you say it is for love you do not cut off my arm, since you pluck out my eye which is no less precious to me, or run me through with your sword, which is still more dangerous to me? It is a maxim that good comes from an entirely sound cause, evil from some defect. To make an act of true charity, it must proceed from an entire, general, and universal love, which extends to all the divine commandments, and if we fail in any one commandment, love ceases to be entire and universal, and the heart wherein it is cannot be called truly loving, nor, consequently, truly good. (de Sales 1884, book 11, chap. 10)

He continues:

Indeed, if the pagans practiced some virtues, it was generally for the sake of worldly glory, and consequently they had nothing of virtue but the action, and not the motive and intention: now virtue is not true unless it has a right intention. “Human cupidity has produced the fortitude of the pagans,” says the Council of Orange, “and divine charity that of Christians.” “The virtues of pagans,” says S. Augustine, “were not true, but only resembled true ones, because they were not done for a proper end, but for transitory ends.” (de Sales 1884, book 11, chap. 10)

Time and again the Church is challenged, particularly in the healthcare arena, to abandon Her moral principles in order to be allowed to “serve” in the public arena. As the comments above manifest, it is not possible for the Church to do this. Once the Church compromises Herself in order to continue to do the good works to which She is committed, those works are no longer compatible with the essential mission given to Her by Christ. Catholic physicians, too, are challenged to assist in or condone immoral practices in order to be permitted to pursue their vocation of evangelizing in the science and practice of medicine. Yet, their very complicity in immoral practices necessarily strips away the essential, faith-reason for their desire to serve. The transitory ends of serving the needy, the poor, and the sick are certainly attractive and have a certain value but if the “cost” of participating in that arena is the compromise of the primary relationship with God then that cost is too high.

Treating patients, whether Catholic or not, in a manner which conflicts with the Church's moral principles is to do them an injustice. Treating a person, created in the image and likeness of God as something less than a person of inalienable dignity does an injustice to that person. The Church, and Her ministers, cannot set this authentic view of justice aside in the interest of some other transient, apparent good. We believe in the inherent dignity of each human person and are committed to upholding that dignity even when the culture or the person himself or Herself fails to recognize that dignity. This is the Church's commitment to justice. Not a justice in search of an immediate, transitory, apparent good but a justice in search of those things and the real good of the salvation of souls. These two goals are not contradictory to each other despite the fact that legislators and judges would have us believe that they are incompatible. Their desire or demand is that the Church do what they determine to be fitting and consistent with their view of the dignity or lack thereof of mankind. When this demand is made the very reason, the “soul” of the Church's apostolate, is eliminated. Pope Pius XII says it well: “The message entrusted by the Divine Master to this apostolate is so opposed in every way to the opinions, logic, and customs of the world that Christians cannot hope to exercise this apostolate effectively by mere external activity” (Pius 1952, 555).

Jesus did indicate that we are to render to Caesar that which is Caesar's, but he also taught that we are to render to God that which is God's. Only by paying our first duty to God can we authentically render a proper justice to mankind. Again we return to the Catechism: “As leaven in the dough, the newness of the kingdom should make the earth ‘rise’ by the Spirit of Christ. This must be shown by the establishment of justice in personal and social, economic and international relations, without ever forgetting that there are no just structures without people who want to be just” (CCC 1997, no. 2832).

The Church has no desire to abandon the healthcare field—the most literal “field hospital” referred to by Pope Francis—but just as a conscientious physician worthy of the name would not engage in deadly medical practices, so Catholic physicians and Catholic healthcare institutions in general cannot engage in practices which are opposed to the attainment of eternal salvation. The Prayer of the Catholic Physician attributed by the Catholic Medical Association to Pope John Paul II contains this short and simple line: “Let me reverence Christ in the person of each patient that You send me.” In the light of the pressures to which Catholic physicians are subjected to compromise their values and to adopt an interpretation of social justice contrary to the faith of the Church, this prayer with a slight modification becomes a plea to the nation and the state to be allowed to continue to engage in the science and practice of medicine without compromising his or her deeply held religious beliefs: “Let me reverence Christ in the person of each patient that God sends me.”