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The Great Works at the Acton Institute Open House

Thursday, November 4, 4pm - 8pm

Religion & Liberty: Volume 29, Number 4

The moral quandary of national healthcare

Almost all discussions about health policy focus on whether different systems of providing healthcare are more efficient, more equitable, or lead to better health outcomes. These are, of course, important issues. Just like food, shelter, or education, healthcare does possess value in and of itself. But as St. John Henry Newman reminds us in the last chapter of The Idea of a University, which focuses on medical education, we should have deeper considerations in mind when judging healthcare systems. 

To begin with, Christians should take a special interest in issues related to the provision of healthcare, because so many decisions taken in the medical arena involve ethical judgements. These things are too important to be left only to the state or to those commercial interests that take a purely utilitarian view. For this reason, Christians in the West should consider how they can develop institutions to help recover their traditional role as the major providers of healthcare. 

... ethical decisions are intrinsic to healthcare, and ethics should not be nationalised away.

Medical decisions often, if not normally, involve ethical aspects. In the UK, about 50 per cent of all medical care is provided in the last 18 months of life. A great deal of medical care also takes place at the beginning of life – that is, from conception until soon after birth. The socialisation and state monopolisation of medicine can require people to pay for things they find morally repugnant, such as abortion services, invasive fertility treatment, and possibly euthanasia. 

In systems such as that of the UK, where there is complete socialisation in a single-payer system and the nationalisation of healthcare providers, there is no possibility of creating a network of practitioners who put a particular ethical perspective at the centre of all they do. The government should not make it difficult for people to choose a healthcare provider that takes a Christian view of the protection of life from conception, or an appropriate view about palliative care near death. By taxing people to pay for healthcare in a state-provided system, all but the very richest are prevented from making ethical choices about their healthcare settings. These kinds of ethical decisions are intrinsic to healthcare, and ethics should not be nationalised away. 

In Britain, the one healthcare sector that the state has not taken over is the hospice sector. This is a Christian-inspired movement that cares for people as they approach death. Hospices are widely admired, as they allow people to die with dignity in a way which is consistent with a Christian ethic. This is something that should be the responsibility of Christian institutions and not state bureaucracies. In the UK, the hospice sector is a beacon of Christian hope. But, interestingly, it is also a beacon of independence from the National Health Service (NHS). 

The U.S. Conference of Catholic Bishops has reflected some of this thinking in its own reflections on Obamacare. In a letter to Congress in 2017, the bishops wrote: 

The Catholic bishops of the United States have consistently advocated for access to decent health care that safeguards and affirms human life and dignity from conception until natural death. … While we supported the general goal of the law to expand medical coverage for many poor and vulnerable people, the USCCB ultimately opposed the Affordable Care Act because it expanded the role of the federal government in funding and facilitating abortion and plans that cover abortion, and it failed to provide essential conscience protections.

The important questions, though, are not limited to overtly ethical considerations, such as matters to do with abortion or euthanasia. We should also recognise the intrinsic relationship between medical practitioners and their patients. Relationships involved in the provision of healthcare should be one of total devotion from medical practitioners towards their patients. Of course, there are many non-religious medical practitioners who are devoted to their patients and many religious medical practitioners who are not. However, the concepts of vocation, love, and sacrifice are intrinsic to the Christian calling and can, arguably, best be practised in a pluralistic healthcare sector of which Christian institutions are an integral part – even if the state is helping finance the healthcare of the poor. 

Healthcare should be about the whole person and not just about the provision of a technical service.

Interestingly, Newman raised the question of medical education in a talk that comprises the last chapter of The Idea of a University. Just as Christians should play a significant role in the provision of healthcare, they should be at the forefront of the provision of medical education, too. Newman’s case for Christian medical education was based on the important Christian principle of the unity of knowledge. If medical education is done in a technical and secular context, biology will be the apex of the discipline. As Newman put it, we will treat man as an animal with only physical needs. If medical education is undertaken in a Christian context, then medical science will be – or ought to be – understood in the context of a Christian understanding of the human person. Bodily health is not the ultimate end of man: There is a higher law and spiritual needs beyond the finite. Christian medical practitioners, invoking God’s law and the spiritual aspect of life, may come to different conclusions about how to provide healthcare in particular situations than when purely utilitarian considerations are paramount. These should be reflected both in medical practice and medical education. Public policy should allow this but will not do so if medicine is provided as a state monopoly. 

Christian social thought calls attention to the person in his or her totality: physical, emotional, social, intellectual, and spiritual. In this context, it is interesting to note that the word “health” has its roots in the Old English word “hoelth,” meaning wholeness. Healthcare should be about the whole person and not just about the provision of a technical service. 

It is impossible for a health system that is dominated by a state bureaucracy to properly recognise this. At the same time, just as Christians should point out that the state should not monopolise healthcare, it is the responsibility of Christians – individually and institutionally – to ensure that (just as with education) we are not leaving a vacuum that it is too easy for the state to have an excuse to fill. 

Christians have something special to offer in the provision of healthcare. Whilst in countries such as the U.S. and Germany, this is widely understood and accepted in practice, in the UK things are very different. In the UK, Roman Catholics (and many, though not all Christians) tend to accept that parents should be able to educate their children in religious schools. Furthermore, it is also widely assumed that Catholic institutions ought to be paramount in the education of maths teachers, history teachers, and so on (including my own university, St. Mary’s). Should similar reasoning not apply to the practice of medicine and medical education? The practice of medicine and medical education can never be morally neutral. 

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Philip Booth is Professor of Finance, Public Policy and Ethics, St. Mary’s University, Twickenham, which is the UK's largest Catholic university. He is also a senior academic fellow at the Institute of Economic Affairs (IEA).