Catholic moral wisdom in the time of COVID-19

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Joshua Evans, Ph.D, is an Assistant Professor of Health Care Ethics at Regis University in Denver.

In the recent weeks we have seen a beautiful flowering of support for the caregivers in our health care institutions.  They are suffering, walking with Jesus on the way to Calvary every day at the bedside.  They stand in a long line of saintly examples like Fr. Pedro Arrupe, SJ.  He was in Hiroshima when the atomic bomb was dropped in 1945.  He miraculously survived.  As a priest with medical training, he spent countless hours attending to the sick and comforting and blessing the dying.  Through courage and the grace of God he was able to be a witness to Christ’s love even in the midst of immense tragedy.

Saintly examples are crucial at this moment.  So, too, is the moral teaching of the Church. A number of ethical issues have arisen in the recent weeks. I am a Catholic theologian and ethicist, and below I offer some thoughts on how Catholic thinking can help us maintain our moral bearings in this crisis.

The most prominent ethical question has been this: how should we allocate scarce resources such as ventilators and Intensive Care Unit (ICU) beds?  Too many states and countries were tragically unprepared for the onslaught of patients in such a short amount of time, and we exacerbated the issue when too many people refused to take the crisis seriously.

When it comes to scarce resources, we should turn to the concept of distributive justice.  As St. Thomas Aquinas teaches, this form of justice “distributes common goods proportionately.”  In the case of limited health care resources, “proportionately” means according to how the “goods” – ventilators, organs for transplant, etc. – relate to the persons who need them. Those who stand to benefit the most from the good in question take the highest priority. This is not a question of one life being more valuable than another.  Rather, it is about responsibly using our resources.  Determining need and benefit is complex, and the teams who would make these decisions bear quite an unenviable burden.  Yet there is no way around the problem. Imprudent use of scarce resources would itself be a moral failure.     

Some outside of Colorado have advocated policies that seem to categorically exclude patients from treatment based fundamentally on age or the perceived value of a patient’s life. This is both simplistic and morally bankrupt.  Age in the health care setting is primarily relevant when it stands in as an imperfect shorthand for health. Furthermore, every patient’s life has immense value.  The federal government recently reminded the states that there shall be no unjust discrimination even in a crisis situation. Catholics should applaud this, because unjust discrimination in any situation displeases God and conflicts with the natural moral law that points us to happiness.

Colorado’s guidance document, on the other hand, seems to avoid this pernicious discrimination.  Called the “Crisis Standards of Care,” it will only be implemented in what it terms “an extreme situation.”  Learning from some of the errors of other states and countries, it explicitly prohibits unjust discrimination.  The guidance does not categorically exclude anyone from treatment based on age or disability.  It does, however, use age as one of a number of factors in a complex scoring system used to predict the likely benefit of aggressive treatment, such as a ventilator, for patients who have complicating health factors (“comorbidities”).  It also uses age – under the heading of “Life Years Saved” – as a potential factor in “tie-breaker” situations.    

People will disagree about whether the uses of age in the Colorado guidance are morally appropriate. Most importantly, we should remember that moral principles are not suspended in a crisis situation. Difficult ethical moments are when we need moral wisdom the most.  God-willing – and with fervent prayers – we will not see anything near this “extreme situation” in Colorado.   

There is a related moral issue in this crisis that would benefit from Catholic wisdom.  The media has cruelly and needlessly framed triage decision-making as  “choosing who lives and who dies.”  These decisions are traumatic enough for our caregivers, and we should not compound the suffering by falsely suggesting that anyone is making choices in favor of death.

Two important concepts from the Catholic tradition can help us avoid this misleading way of framing these difficult decisions. First, the Catholic tradition demands that we be accurate and precise when specifying moral actions.  Generalizations and euphemisms are never sufficient when using our consciences.  In allocating scarce resources, no one is “choosing who lives and who dies.”  They are, rather, choosing how to best use the limited resources available to them.  Death is never a goal or choice of good health care, even in a crisis. 

Second, the Catholic tradition has given us the essential concept of double effect. This concept relies on the crucial distinction between two kinds of effects of our actions: on the one hand, foreseen-but-unintended effects, and, on the other hand, effects for which we are responsible.  We often do good things that bring with them unavoidable negative side-effects.  This is morally acceptable and even praiseworthy as long as the act itself is not always wrong, we do not desire the negative effect, the negative effect is not essential to achieving the good effect, and the good effect outweighs the negative effect.  The concept of double effect can help us be sure that, when done appropriately, the allocation of scarce resources such as ventilators can be done in a morally upright way, even when we foresee that some patients will not survive.           

Finally, this crisis should prompt us to ask bigger questions about the moral foundations of our society.  Our world has been dramatically confronted with questions of human dignity, which sadly become most poignant only in the face of tragedy.  We are also confronted with questions of justice and the common good.  While we believe that human beings are fundamentally good, we know all too well that we are fallen and that rationality goes astray much too easily. Sadly, our moral debates tend to highlight just how fallen we are from God’s hopes for humanity.

We would do well to revisit Saint Pope John Paul II’s encyclical Evangelium Vitae.  In that encyclical – and in its earlier companion, Veritatis Splendor – the great pope reminds us of the richness, beauty, and necessity of Catholic morality.  The Catholic tradition has a robust and comprehensive moral vision that helps us ground our moral claims in reason enlightened by faith.  Anyone who says we should keep our Catholic principles out of health care – or out of society altogether – is naive about the inherent limitations of a secularized and godless morality. For too long we have attempted to build a society with a fragile moral edifice.  This crisis might allow us to see more clearly that religious buttresses have long been holding up that otherwise perilous secular structure.  Now is the time to deepen our moral foundations.    

COMING UP: A man for strengthening others

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When the choirs of angels led Father Paul Mankowski, SJ, into the Father’s House on September 3, I hope the seraphic choirmaster chose music appropriate to the occasion.  Had I been asked, I would have suggested the Latin antiphon Ecce sacerdos magnus as arranged by Anton Bruckner. The all-stops-pulled moments in Bruckner’s composition, deploying organ, brass, and full choir, would have been a perfect match for Paul Mankowski’s rock-solid Catholic faith, his heroic ministry, and his robust literary and oratorical style; the a capella sections, softly sung, mirror the gentleness with which he healed souls. Above all, I would have suggested Bruckner’s motet because Father Mankowski truly was what the antiphon celebrates: “a great priest who in his days pleased  God.”

We were friends for some 30 years and I can say without reservation that I have never met anyone like Paul Mankowski. He was off-the-charts brilliant, an extraordinary linguist and scholar; but he wore his learning lightly and was a tremendous wit. He rarely expressed doubts about anything; but he displayed a great sensitivity to the doubts and confusions of those who had the humility to confess that they were at sea. He could be as fierce as Jeremiah in denouncing injustice and dishonesty; but the compassion he displayed to spiritually wounded fellow-priests and laity, who sought healing through the work of grace at his hands, was just as notable a feature of his personality.

His curriculum vitae was singular. The son of working-class parents, he put himself through the University of Chicago working summers in a steel mill. He did advanced degrees at Oxford and Harvard, becoming the sparring partner of a future Australian prime minister, Tony Abbott, at the former, and delving deeply into the mysteries of Semitic philology – unfathomable, to most of his friends – at the latter. He taught at the Pontifical Biblical Institute in Rome and was pastor of an English-speaking parish in Amman, Jordan. Wherever he was, he lived like a true ascetic; he was also the best company imaginable at a meal or a party.

He was a writer of genius, although his published bibliography is considerably slimmer than it might have been, thanks to the years when he was silenced or censored by his religious superiors. A good example of his ability to combine keen insight and droll humor is his 1992 dissection of the goings-on at the annual convention of the American Academy of Religion (available here). More recently, Father Mankowski drew on his extensive experience as a confessor and spiritual director to pen, with his superiors’ permission, a respectful but sharp critique of his fellow Jesuit James Martin’s book, Building a Bridge (available here). In the decades between those two pieces, and when permitted to do so, he published essays and reviews on a wide range of topics, including literature, politics, Church affairs, biblical translations and the priesthood, while sharing his private musings with friends in a seemingly endless series of pungent parodies, revised song lyrics, and imagined news stories.

Years ago, his friend Father Richard John Neuhaus dubbed Father Mankowski one of the “Papal Bulls:” Jesuits of a certain generation notable for their intellectually sophisticated and unwavering Catholic orthodoxy, which often got them into hot water of various temperatures (including boiling) with their Ignatian brothers and superiors. Paul Mankowski was no bull, papal or otherwise, in a china shop, though. He relished debate and was courteous in it; what he found off-putting was the unwillingness of Catholic progressives to fight their corner with a frank delineation of their position. This struck him as a form of hypocrisy. And while Father Mankowski, the good shepherd, often brought strays back to the Lord’s flock, he was unsparingly candid about what he perceived as intellectual dishonesty, or what he recently deplored as “ignoble timidity” in facing clerical corruption. Paul Mankowski was not a man of the subjunctive, and he paid the price for it.

He is beyond all that now, and I like to imagine St. Ignatius of Loyola welcoming him to the Father’s House with a hearty “Well done, my son.” In this valley of tears, freshly moistened by those who mourn his untimely death at age 66, Father Paul V. Mankowski, SJ, will be remembered by those of us who loved him as a man and a priest who, remaining faithful to his Jesuit and sacerdotal vocations, became a tower of strength for others. This was a man of God. This was a man, whose courageous manliness reflected his godliness.