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Month: August 2009
Health Care Reform
A few thoughts on the proposed reform of health care. American bishops' criticism of it has mostly focused on the unborn and on conscience. But though I have not myself studied the document at length, I have heard from reliable persons that the proposal is unsound, even rotten, from beginning to end.
A few articles have been written critiquing the proposal from the point of view of the Catholic principle of subsidiarity. See this article by Bosnich and this one by De Vous. The principle of subsidiarity means, basically, that decisions and actions should be made by the persons most directly concerned, unless this is impossible. The principle of subsidiarity does not of itself exclude the managing of the overall financing of health care at the highest level. However, it does require that decisions be left up to the individuals in need of health care and who provide it (doctors and hospitals). A couple of examples: (1) The possibility of choosing other means of financing, e.g., should be left open. If the health care system is on the broad level financed by taxes, people should be given the possibility of financing their health care by other means–e.g., through private insurance, or from their own income–and be proportionately freed from the taxes that finance health care. (2) Patients and the doctors who treat them should be able to make the decisions relevant to the health care. This is thoroughly violated by the proposal, which aims directly, or indirectly through monetary sanctions, at reducing the decision-making power of individuals, doctors, and hospitals, and increasing the power of the bureaucratic administration.
Many other criticisms (rationing of healthcare, the requirement for end-of-life counseling) build upon or follow from this basic problem of the government taking over too much responsibility for decisions that should be made at an individual level. If, e.g., co-payments are reduced to such an extent that patients have little financial reason to refrain from treatments that are not really necessary, and yet financial considerations must be taken into account, then they will have to be taken into account, and the decisions made by others. This is practically an unavoidable consequence of the top-down approach that is determined to provide health-care for all, but which does not in fact have unlimited resources. In principle a much better approach would be to have those who can finance their own health care do so, and to provide it for those who cannot by way of non-profit institutions, individual assistance, etc.
Moral Theology and Legalism
In my post on Aquinas on Sexual Sins I promised to return to the issue of the legalistic morality that became dominant in the Catholic church. For St. Thomas Aquinas, law is fundamentally an ordinance of practical reason perceiving the appropriateness of things to an end, and ordering concrete means to that end. A law which is unreasonable, which does not correspond to the exigencies of man's true end, is neither a true law, nor morally binding on man. The lawfulness of law does not arise simply from the will of the lawgiver, but presupposes knowledge of the subject of the law, and what is appropriate for him. This is true not only of human law, but of divine law as well. God's will and knowledge is not caused by created reality, but is the cause of it. Nonetheless God's knowledge of the orderliness in his plan is logically prior to his will to impose that order as natural or divine law.
Nominalism, which does not recognize an intelligible order in real things as the basis for law, attributes law to will alone. In St. Thomas's understanding, murder is forbidden by natural and divine law because murder is incompatible with, contradicts man's true good. In the nominalist understanding, murder is immoral only because God willed to forbid it. This same understanding is reflected today in the all-too-common statements that, e.g., contraception isn't bad, but it's a sin. Sin is seen as something extrinsic to the human action, rooted in God's positive will alone.
In following centuries this nominalistic, legalistic view of law came to dominate Catholic thought. One significant historical reason for this seems to have been the desire for a system that confessors could use to determine the gravity of sins and appropriate penances. The rule-based approach seemed well-adapted for this purpose. Over time, then, moral theology became separated from man's desire for happiness, practice of virtue, asceticism, prayer, etc., and was more or less restricted to obligations, precepts, and sins.
One dangerous consequence of this view is that, when men's extrinsic motivations for obeying God decrease–because, e.g., they don't believe in hell, or doubt whether God would differentiate men's final destinies on the basis of their actions–they have little motivation at all to obey laws in which they don't see much sense, e.g., the law for openness to procreation and against artificial contraception.
Conscience and relativism
This legalistic view of morality pops up in another way as relativism in the modern emphasis on conscience as a guide of one's action, even if the action is objectively bad. Thomas Aquinas explains that the binding force of conscience consists in the fact that it is the concrete judgment that an action is good or bad; thus the need to follow conscience derives from the need to act well, if one is to attain one's end and be truly happy. But when obligation is separated from goodness and happiness, then the binding force of conscience is no longer seen as based on the need to seek man's true good, but is absolutized. The moral value of man's action is seen as simply consisting in his following his conscience, regardless of whether or not what he does is truly good.
Due to illness, including my own, over the past three weeks, I've been posting more infrequently, and will be probably do the same for the next month. I'll usually post at least once over the weekend, however.