The Ethical and Religious Directives have been a popular topic of conversation in health care circles for the past year. But what if we stopped viewing them simply as a list of do's and don'ts, but as a living document articulating the mission and identity of Catholic health care?
The Ethical and Religious Directives have been a popular topic of conversation in health care circles for the past year. But what if we stopped viewing them simply as a list of do's and dont's, but as a living document articulating the mission and identity of Catholic health care?
Betsy Taylor, editor of Health Progress, and Fr. Myles Sheehan, SJ, MD, director of the Edmund D. Pellegrino Center for Clinical Bioethics and the David Lauler chair of Catholic Health Care Ethics at Georgetown University Medical Center, join the show to discuss the ongoing conversation around the ERDs and how they can fortify the identity of Catholic health care. Fr. Sheehan also speaks directly to several specific parts of the ERDs, giving a comprehensive view of the directives and guiding principles beneath them.
Brian Reardon:
Hi, Betsy. Good to see you.
Betsy Taylor:
Hey, Brian. Good to see you.
Brian Reardon:
Here we are again in the studio for another podcast. This time we're going to talk about one of the articles from the latest issue of Health Progress and the topic for this issue is Opening Doors: Access to Care. And I'm excited about our guest that we have. And so, you ready to get going?
Betsy Taylor:
That sounds good to me.
Brian Reardon:
Let's do it.
This is Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon. Joining me is Betsy Taylor, she is Editor of Health Progress for the Catholic Health Association. Again, welcome Betsy.
Betsy Taylor:
Thanks, Brian. Good to be here.
Brian Reardon:
And in just a couple of minutes, we're going to welcome Father Myles Sheehan. He's a physician and Director and he's a Professor of Medicine at Edmund Pellegrino Center for Clinical Bioethics and the David Lawler Chair of Catholic Healthcare Ethics at Georgetown University Medical Center in Washington, DC. We look forward to having him join us to talk about an article that he wrote for this issue of Health Progress. It's How the ERDs Can Deepen our Catholic Identity. So Betsy, before we bring in Father Sheehan, I want to just set a little context. The Ethical and Religious Directives obviously have been in the news quite a bit post-Dobbs and now of course the latest decision by the USCCB to begin discernment around updating the ERDs related to care for transgender persons. So I think my question to you is Health Progress, this is an issue that we've covered in the journal. I guess give us a little perspective on how you and the team have sought to address the ongoing narrative around ERDs from a Catholic health perspective?
Betsy Taylor:
Sure. So we often do pick topics because of their timeliness. I would say with this one though, this strikes me more as one of the foundational issues we cover in Health Progress. So we find a really good response if we're writing about things like a contextual explanation of the ERDs. I would put topics like sponsorship and formation into this same category. That sometimes if something isn't well known to the general public, it just really helps if we can revisit it and talk about the specialized or unique aspects of Catholic Healthcare in the publication.
Brian Reardon:
And what about this article? I really enjoyed reading it and I'm excited to talk to Father Sheehan here in a moment. But what stood out to you about the article?
Betsy Taylor:
Father Sheehan's written for Health Progress multiple times and he's really the kind of author you hope for. Obviously a doctor, a Jesuit, he explains things beautifully. So I'm just happy when he writes. I think what struck me about this was the holistic approach to the content he provided related to the ERDs and also just really a gift for explaining things clearly and in a way that people can follow pretty easily.
Brian Reardon:
No, and I would agree. And as both of us, we are in the profession of communicating and in my 20 years of Catholic Healthcare, I've always personally struggled with how do you articulate the positives of the ERDs? It just seems that the media coverage tends to be on the, "You shall not," aspect. And so I think the way he framed this up is going to be really helpful for our members and for those who work in Catholic Healthcare.
Betsy Taylor:
Yeah, I think anytime we can explain things more clearly to Catholic providers in Catholic Healthcare, that's helpful. And yeah, again, I think the all encompassing approach or wider approach he took to the ERDs is really helpful for readers.
Brian Reardon:
Well, with that, let's bring in Father Sheehan. He's joining us from Zoom. Again, Father Myles Sheehan with Georgetown University in Washington. Welcome Father Sheehan. It's great to have you with us.
Father Myles Sheehan:
Thanks. It's great to be with you both.
Brian Reardon:
So the Ethical and Religious Directives, obviously as we just mentioned, been in the news a lot, particularly post-Dobbs and then more recently. You argue that the ERDs play a critical role in establishing and enhancing the Catholic identity of CHA members or systems in our facilities. And I'd love for you to just to start with an overview of what you wrote for Health Progress.
Father Myles Sheehan:
Sure. I think one of the things that's important and particularly when you look at the diversity of our Catholic institutions with the charisms from their sponsors, usually Women Religious, you see a variety of different ways in which the Catholic Healthcare Ministry is incarnated, if you will, across the country. And so the stories of our founders are very important in the way in which their particular inspiration brought healthcare to life in so many different places. I think from a national perspective, the Ethical and Religious Directives provide a framework for that charism to grow and to be expressed.
As you said earlier, so many people are only familiar from news articles about some of the controversial or allegedly negative aspects of the ERDs with some of the prohibitions. And that it's been my experience working at Georgetown, particularly after Dobbs and trying to explain the Ethical and Religious Directives to the faculty that they are impressed by the breadth of the Ethical and Religious Directives. Although it's quite possible you'll have faculty who are thrilled about some individual directives, the broad scope and the holistic way that they look at healthcare from our Catholic tradition and relying on the example of Jesus is something that resonates with many people of goodwill, whether they're Catholic or Christian or not.
Brian Reardon:
And you talked to how it is a testament to the common good. Can you expound on that a little bit?
Father Myles Sheehan:
Well, the first part, after the introduction of the Ethical and Religious Directives talks about the social responsibility of Catholic Healthcare and emphasizes that this is a way in which we can really show the preferential option for the poor and for those people who can be overlooked in our American health system. So really to try and provide exemplary care for people in crisis. Not necessarily an acute health crisis, but someone with long-term chronic illness, someone with a difficult pregnancy, someone facing the end of life.
A way in which, as the CHA expresses, that the healing ministry of Jesus Christ can really be shown in concrete ways. And I think that that's an important part that actually frames the whole Ethical and Religious Directives. That this ministry is meant to be a way in which the church shows that the body of Christ, Jesus, continues to work to heal people who are on the margins, folks who are otherwise forgotten, people in difficult situations. And to do that in a way that takes care of folks who are poor or people who are otherwise not particularly well liked in society in the same way that Jesus did his ministry.
Brian Reardon:
Can you talk a little bit about how this document, and I think you even say in the article, it is an evolving, living, breathing document?
Father Myles Sheehan:
Yes. And I mean, it has been revised multiple times. There's discussion about possible revision going into the future. So that's part of the evolution as it looks to new challenges and new issues that come up in healthcare. I think that the other issue here is that it helps define, if you look at the different parts of the ERDs, ways in which we can be intentional about the professional patient relationship, issues at the beginning or the end of life, as well as emphasizing the pastoral and spiritual responsibility of Catholic Healthcare. I mean, we have a lot of wonderful hospitals in the United States and I'm not saying that necessarily you're going to have a better outcome if you go to a Catholic hospital than to a secular hospital. But I think that one of the things that really makes the difference is that we try to treat the person not just physically but also spiritually and attend to their needs, which can be more than simply medical when they're facing a serious illness.
Brian Reardon:
And speaking of spiritual care, you do focus in on that as being a positive aspect of the directives and really emphasizing the need to have strong pastoral care. And as we look at our ministry and look at healthcare overall, how important is that as a positive that we really need to focus on across our ministry?
Father Myles Sheehan:
I think that this pastoral and spiritual responsibility is really the part that makes things Catholic. And that, again, attending to the whole experience of the person when they come into one of our facilities is crucial. With all the big economic pressures, it can be easy to cut back on certain aspects of pastoral care, but I would argue that that is shortsighted and really can undercut the mission in serious ways. The second thing I would urge is for hospitals, health systems to see ways in which with their professional chaplain staff, I mean the chaplains are well-trained, they go through a residency program, they require accreditation, that these folks can interact a lot with the doctors and the nurses. Because as we saw during the COVID epidemic, there's a lot of moral distress, a lot of pain for our caregivers as they care for people, particularly with a fragmented health system, with a lot of pressures from just the patient population perhaps being poor or suffering from various problems related to social inequity in our country. There's a need for the caregivers as well to have someone to care for and listen to them.
And I think also that the pastoral care of the patients and the families is much improved when our chaplain staff is brought into contact with the doctors and nurses and have a better sense of what's going on in a really collaborative relationship. Sometimes it's helpful that a chaplain can raise a question or an ethical question. The other part in which ethics consult services are not necessarily a pastoral part, but they're a professional part. And then they can help, not serving as the ethics police, but helping to resolve controversies, to elucidate different issues, to bring different voices to bear so that especially in a complicated case, you can be sure that people have looked at the issues from a variety of different angles and have tried to find, well, what Dr. Pellegrino would've said is the right and good healing action for that person in front of us.
Brian Reardon:
And I know you went through really three parts of the ERDs. And the ones that, as we talked about earlier, that tend to get the most media attention. Part three around the patient and physician or caregiver relationship. Part four, the care at the beginning of life and part five, care for those who are seriously ill. So I do want to spend a minute maybe on each to get your thoughts. I think part three, at the end of your article, you asked the question, is the healthcare professional and patient relationship respected? And do demands for productivity and increased price, patient volumes not threaten the development and maintenance of meaningful caring relationships? And that's a question you asked again to the readers, to those in Catholic Healthcare. Can you talk a little bit about how part three of the ERDs really looks to address that and make sure there is that emphasis or respect for that really sacred relationship between a physician and his patient or her patient?
Father Myles Sheehan:
Well, I think that in that clinical encounter is really where Catholic Healthcare happens. And that if it is rushed and if the clinician, whether it's a doctor, a nurse, nurse practitioner, doesn't have the ability to actually begin to understand what it is that the patient is feeling, thinking, what's the patient's own sense of the good, we really are not able to establish a healing relationship where we can find the right course forward. The pressures are really hard, I understand that. And we are moving to healthcare teams a variety of different ways in which we provide primary care and other care services. But the idea that we should prioritize relationships within them is I think an important part of part two of the ERDs. And I think it's something that as we look to new models of healthcare, we should be careful that supposed ways to bring efficiency and increase revenue and productivity did not diminish the quality of the interaction.
Brian Reardon:
I think the way you describe it really is very beautiful and that it really speaks to our commitment to human dignity at all stages of life. So could you maybe share a little strategy for those listening, for those working in Catholic Healthcare? How do we better articulate part four of the ERDs and the care for the beginning of life?
Father Myles Sheehan:
Well, our care for women who are pregnant rests on our belief, not simply that they're carrying a child, but they're a unique human being who has their own dignity that has to be respected. And so that as we care for the unborn child and with a prohibition against abortion, it doesn't mean that we don't care for the difficult circumstances in which some women might feel compelled to terminate a pregnancy. And I think part of the onus on Catholic Healthcare is to provide a variety of services that can support women who otherwise might find that they face an impossible burden with their pregnancy, so their dignity is respected fully and that they're allowed to have the real opportunity to continue to have a good life for themselves and a good life for the child that they're carrying.
Too many times I think that in the current debate, everything is presented as a competition between the woman and the unborn. I would argue that we have a special responsibility at Catholic Healthcare to care for both with great compassion and to assist women to allow the child who is growing within them to come to life and to help that woman post the time the child is born. Sometimes people will say that people who are pro-life are only pro-life until the baby's born. We have to really make clear that that's not the case and look to innovative ways in which women in difficult situations are supported through their pregnancy and beyond as well as their children.
Brian Reardon:
And in your article, you articulate, you asked members what their institution does to promote family health, women's ability to access resources to continue pregnancy despite pressures and the support for women and children going forward. You also, and really I like the part on part five, the care for those who are seriously ill and dying, really speaks to our work at CHA around promoting palliative care.
Father Myles Sheehan:
I mean, one of the things, being involved with Catholic Healthcare since the 1990s that I'm really happy about is the tremendous improvement in palliative care services over the last 30 years. And so when this stuff was starting in the '90s, I would talk at Catholic hospitals, people were often hostile to anything other than aggressive care until the moment the person died. That's totally changed and that many Catholic hospitals do have palliative care services. There's not an overabundance of palliative care physicians, so there's a need for more training and more resources devoted to those individuals.
But at the same time, I think that, again, encouraging a culture where people are allowed to have a natural death, where that death can be as pain-free and symptom-free as possible. And where people are allowed to come to the end of their life with an understanding that it's opening on to an eternal life is really something that's a great way to look at it. I laughed when I used to be at Loyola University Medical Center, I would often say we should have as our slogan, "Loyola, a great place to die." Well, the people in public relations did not like that.
Brian Reardon:
No, I don't think we would. That would not be something we'd put on a billboard.
Father Myles Sheehan:
And Loyola is a great place to get healthcare as well. But the thing I would say is that really when so many people have so many fears about dying and recognizing we're all going to do it, there should be a way in which we can recognize that this is not going to be easy, but we can assist in variety of ways to make this meaningful transition something that can be well done and without suffering.
Brian Reardon:
Yep. So I'm going to bring Betsy in just a minute, but my last question, and I love this line, you describe the ERDs as, "Counterculture." Can you share a little bit more about that?
Father Myles Sheehan:
Well, we have a vision that every life counts and I don't think that that's the vision of the world around us. And so, again, the unborn counts, but so does a woman who maybe is pregnant because she's been raped and we have to care for that woman with special attention. And that the person at the end of life who maybe is extremely cognitively impaired, that person still deserves to be cherished and receive the best possible care. Recognizing that that might not mean aggressive life sustaining interventions, but still something devoted to respecting who that person is and that they are made in the image and likeness of God. That's something that's just very different than the society around us. I think a lot of the debates around abortion talk about dignity in ways that opposes it. And I think if we realize that every life counts no matter what and we present that in a way that is active, "Love is shown in deeds, not words." That's what St. Ignatius, the founder of the Jesuit said. We really can present a witness that has the capability to change minds and lives.
Brian Reardon:
Betsy, final thoughts?
Betsy Taylor:
I was really struck by what Father Sheehan said about the importance of turning words into deeds in the work that we do. Lots of times with these articles, we'll do questions for discussion at the end and we didn't hear just because Father Sheehan poses so many nice questions on his own within the article. So far be it from me to tell someone how to use Health Progress, but I could see this as a really good lunch and learn at a facility. I just think there's a lot here, it explains the ERDs well. And I think it is about ideally taking these articles, certainly reading them, spending some time with them, but then putting them into practice. It's about how we treat patients in our healthcare settings every day. And I think there's some really helpful ways of thinking about people's professions in here as part of the article
Brian Reardon:
No, this is a really valuable article and again, we appreciate you writing for Health Progress and for taking some time out to share your thoughts on the article and go a little bit deeper on that. So again, Father Myles Sheehan, he is a physician, he's a Professor of Medicine and Director of the Edmund D. Pellegrino Center for Clinical Bioethics and the David Lawler Chair of Catholic Healthcare Ethics at Georgetown University Medical Center in Washington, DC. It was great to have you with us. Thanks so much.
Betsy Taylor:
Thanks, Father Sheehan.
Father Myles Sheehan:
Thank you.
Brian Reardon:
And for Betsy Taylor, I'm Brian Reardon and this has been another episode of Health Calls, the podcast of the Catholic Health Association of the United States. If you're looking for more resources related to the ERDs, be on the lookout for CHA's annotated ERDs launching soon on our website. This resource features the original ERD text annotated by ethicists from across the Catholic Healthcare Ministry and in collaboration with the USCCB. These will be available in both print and digital editions, and again, can be found on our website. Health Calls is produced by Josh Matejka and engineered by Brian Hartmann at Clayton Studios in St. Louis. You can listen and download Health Calls on all of your favorite podcast apps. And of course, you can also access episodes at the CHA website, which is chausa.org. Thanks for listening.