[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.
Process
[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.
Content
[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