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Comments on "Caring for Health"


[1] In a meeting I was recently asked what I thought about Wittenberg's statement of institutional values. All I could think to say was "Values are good. These seem fine." (It had been a long meeting.) I suspect that some readers may have a similar reaction to the proposed social statement "Caring for Health: Our Shared Endeavor." One is repeatedly told that health is good, health care contributes to health, the church promotes human flourishing, and the church is in favor of health care and all that enhances health and wellbeing. What can one say other than "Amen?" It would be wrong however to think that there is nothing noteworthy or controversial in the proposed statement. The text breaks new ground and addresses some exigent issues in health care today, not least of which is justice in access to health care. For that alone, the proposed statement is a welcome addition to the ELCA's growing body of social teaching.


[2] As one who has participated in the drafting and redrafting of predecessor church social statements, I have great appreciation for the challenge undertaken by the ELCA Task Force on Health and Health Care and the principal writer or writers. Not only are problems of our health care system complex and difficult in themselves, but one must address them in conversation with the five million-plus members of the ELCA. To be sure, most members do not care about social statements (if indeed they are aware of them at all) but some do and more than a few - particularly among clergy and lay leadership - care a lot. It is from this narrow yet engaged and articulate audience that the drafters tend to hear. The guidance offered reflects the speaker's age, gender, education, occupation, economic status and ethnicity as well as life experience. Along with all of this, consider the differing conceptions of the church, scripture and theology found among ELCA members and one begins to grasp the magnitude of the task.

[3] When I was in divinity school my homiletics professor used to say that a good sermon always verges on the heretical because it is a mistake to introduce all of the qualifications, nuances, presuppositions and implications necessary for a comprehensive presentation of orthodoxy. In short, one can't say everything simultaneously if one is to communicate effectively. It's much the same with social statements. Everyone wants his or her issue and values expressed in every context. Drafters of social statements may succumb to the temptation to try to say everything that might be said and to say it repeatedly so that no one will feel that his or her concerns are being neglected. At the same time, the drafters' burden of speaking for as well as to the whole church may weigh heavily, causing them to adopt a magisterial tone. While the former may represent the politically prudent course and the latter may be understandable, together they make for some tedious - even soporific - prose. To my ear, the proposed social statement seems occasionally to reflect these pressures.

[4] Perhaps it is to be expected since the process of preparing a social statement and pushing it through to approval by the Churchwide Assembly is, after all, a political process in the formal sense and politics is the art of compromise. A price must be paid to gain support. Language must be found that is sufficiently commodious to shelter persons of disparate conviction. If the text of a proposed social statement does not win the favor of the board of the Division for Church and Society and the ELCA Church Council, Churchwide Assembly delegates will never see, it much less vote on it. Sometimes it may be necessary to adopt the intentional imprecision of a diplomatic communiqué or to strike an expedient compromise. No one should be aghast at this because the "visible" church is a human institution and politics is simply a fact of (in this case, ecclesiastical) life. Moreover, as is often observed, the structural necessity of compromise contributes to the stability of democratic institutions and the church is no exception.


[5] Caring for Health: Our Shared Endeavor is admirably comprehensive in its diagnosis of what ails the American system of health care. The prescriptions it offers on matters such as preventive and palliative care, peaceful dying, mental health services, personal responsibility, caregiver support, and resource allocation are appropriate and timely. However, its greatest contribution, in my judgment, is its compelling argument for equitable access to health care. While some in the church will be nervous about such an urgent and explicit call for the reform of our national health care policy, it is hardly precipitant.

[6] The ELCA has long supported the goal of universal health care. Since 1978 a series of social statements on human rights, economic justice, and racism have called for legislation guaranteeing health care to all persons equally. Through the Lutheran Office for Governmental Affairs in Washington, D.C., the church has engaged in advocacy activities to make this goal a reality. The collapse of a health care initiative during the Clinton administration set back the prospects for fundamental reform but did nothing to deal with the problems.

[7] It's sometimes hard not to be cynical about the church's advocacy efforts. A cartoon in New Zealand's Evening Post (July 13, 1993) illustrated the problem. From a cathedral pulpit, a bishop declared to a handful of congregants scattered throughout an expanse of empty pews, "Political parties need to know that they ignore the church's statement on social justice at their own risk...." Actually, the situation in the United States might seem even bleaker, in that Americans do attend worship and identify with religious institutions to a far greater extent than in other developed countries. The fact that the ELCA and other churches that share its view have not made a greater impact on the political debate over the years is most regrettable but it is not reason to stop caring about justice or to give up on advocacy. It does, however, suggest that advocacy should begin at home. That is precisely why the reflection and discussion generated by the proposed statement within the ELCA community is important.

[8] The Lutheran churches of Scandinavia and Germany have for some time enjoyed the benefits of universal health care systems. In these countries religious conceptions of social solidarity and shared responsibility for caring for the basic needs of others are operative in public policy. Of course, this does not mean that these systems are without problems or that the churches need have no further concern about access to health care. A 1989 joint declaration the Council of the Protestant Church in Germany and the German Roman Catholic Bishop's Conference may be instructive. The churches observed that shared social responsibility for health care "has lead to ...a passive attitude to one's own health and so to too great an expectation of the help to be had from others." They called for increased personal responsibility in relation to preventive health care, diet, alcohol consumption, smoking, drugs, exercise, and lifestyle. In light of the aging of the population and rising costs, they called for self-restraint and renewed individual responsibility for the health service system as a whole.

[9] Anyone who makes use of services only because he pays his contributions calls into question the fundamental principle of health insurance as a fellowship in solidarity. But it is equally certain that basic changes in the structure of the health service are necessary. But they must not be at the expense of certain sick individuals or groups such as the handicapped.

[10] One of the strengths of the proposed social statement is the fact that it forthrightly addresses these concerns.

Two Additional Comments

[11] The present text of Caring for Health is replete with biblical quotations and references. Doubtless many will think this highly appropriate. Rumor has it that some with responsibility for reviewing previous drafts thought that they did not contain enough biblical citations. Thus the current text may represent overcompensation driven by political necessity. Obviously the theological differences within the church I noted earlier will lead some to say "too few" and others "too many" or "just right."

[12] But a comparison of LCA social statements prior to Peace and Politics (1984) with the ELCA statements that have followed shows a marked trend toward the inclusion of more and more biblical references. At some point are we not in danger of "prooftexting" or creating the impression that unless a biblical citation can be made, Lutheran ethics has nothing to say? Ours is a tradition of ethical reflection that respects the contributions of natural law, the Golden Rule, reason and vocation along with those of scripture. We would do well to remember that especially when we wish to address matters of public policy in a pluralistic public forum. 



© July 2003
Journal of Lutheran Ethics
Volume 3, Issue 7