"Caring for Health: Our Shared Endeavor"
(hereafter CFH) is a proposed social statement of the Evangelical
Lutheran Church in America (ELCA). It will be considered for
adoption by the 2003 Churchwide Assembly (Milwaukee, August 8-11).
The statement, a response to current circumstances in health care,
is an elaboration of its succinct opening paragraph:
Health is central to our
well-being, vital to relationships, and helps us live out our
vocations in family, work, and community. Caring for one's own
health is a matter of common sense and good stewardship. Caring for
the health of others expresses both love for our neighbors and
responsibility for a just society. As a personal and social
responsibility, health care is a shared endeavor
A timely document addressing extremely complicated and immensely
important issues, CFH merits serious attention from all Lutherans.
Limited by space, this brief review will highlight salient aspects
of CFH, and then, with the hope of stimulating further reflection
and discussion, raise several questions. In this way I hope to
capture the power, and further the potential promise, of the
 CFH argues that there is a multi-faceted crisis in health care,
dimensions of which include: "a culture that often denies death and
suffering and places its faith in technology to overcome them,"
which leads to "increasing reliance upon expensive curative
medicine" that neither significantly extends lives nor improves
their quality (20-25); "rising health care costs [that] leave a
growing number of people without adequate health care"; "health
care resources [that are often rationed] based on ability to pay
rather than need"; serious problems of "access to quality health
care resources" for many persons; the "growing number of elderly
people" that increase "stress on health care resources"; and "fear
and self-interest [that] defeat social justice in the political
processes of health care reform" (28-38). The "breadth and
complexity of the challenges," CFH continues, require "serious
conversations and bold strategies to establish the shared personal
and social responsibilities that make good health possible"
 In this crisis the Christian Church is called to be "an active
participant in fashioning a just and effective health care system"
(49-51). God calls "the church-its institution and believers-to
work in society for individual and collective actions that promote
health and ensure care for those who suffer" (86-91). Our response
to this calling is one of gratitude for "God's saving love in Jesus
Christ that frees us to love and seek the well being of our
neighbor" (61-3). This response is "shaped by the witness of
Scripture-including the ministry of Jesus-and the Lutheran
Confessions," the historical and contemporary health care ministry
of the Christian Church (63-67), and biblical and theological
perspectives on health, illness, healing, and health care.
 For example, "God creates human beings as whole persons-each
one a dynamic unity of body, mind, and spirit." Health "concerns
the proper functioning and well-being of the whole person," is
"good for its own sake," and is also "good for living abundantly in
relationship with God and in loving service to our neighbor in the
vocations to which God has called us" (94-108). Illness is a "loss
of well-being or wholeness" that "disrupts lives, limits
activities, disturbs relationships, and brings suffering"
(135-148). Healing is a "restoration of wholeness and unity of
body, mind, and spirit," "addresses the suffering caused by the
disruption of relationships with God, with our neighbors, and with
ourselves," and "embraces more than cure"; that is, if "we limit
illness to disease and health care to cure, we miss the deeper
dimensions of healing through restoration to God" (150-157).
 Healing is grounded in the actions of the "triune God," who
"heals within and through the works of creating, redeeming, and
sustaining humankind." God heals through the "natural processes of
the body and is active in the work of healers everywhere"; we "give
thanks for God's healing work in and through creation and human
vocation" (178-196). God's redemptive work also heals; Jesus, "the
incarnate presence of God," is "Savior and healer of all," and has
irrevocably won our "final healing, salvation from sin and death"
(197-210). Healing is also sustained through the work of the Holy
Spirit, "who heals, sanctifies, and transforms through a variety of
gifts," including the ministry of Word and Sacrament, prayer, and
pastoral care (211-220).
 Health care encompasses "the wide range of services used to
treat symptoms or diseases or to maintain health." Further,
"[p]atients and caregivers are more than consumers or providers;
they are whole persons working together that depend on and preserve
community." Health care is, "above all," "an activity of caring
that grows out of relationships of mutual responsibility, concern,
and trust" and "cannot be reduced to a commodity" (231-244).
Indeed, we are to "guard against the ways in which motivation to
maximize profit and to market health care like a commodity
jeopardizes health and the quality of health care for all"
 Arguing that "piecemeal efforts to reform health care without a
clear goal will be inadequate" (271-2), CFH articulates what is
intended to be a guiding vision of "health care and healing as a
Health care as a shared
endeavor entails a comprehensive and coherent set of services of
good quality care throughout one's life span. At a minimum, each
person should have ready access to basic health care services that
include preventive, acute, and chronic physical and mental health
at an affordable cost (539-45).
 Such a system would promote and improve the health of all
people, reduce the impact and burden of illness, and promote
healing even when cure is not possible (522-26). Important
dimensions of this vision include deepened individual
responsibilities (as a steward of one's own health, in helping
others, and advocating for those in need), an enhanced recognition
that the "ministry of healing is integral to the life and mission
of the Church" (this ministry is to include advocacy for those in
need), improved public health care services, a commitment to "whole
patient care," and increased support of lay caregivers
 CFH recognizes that a "major challenge" to this vision is
"achieving equitable access to basic health care for all people,"
and states "[w]e of the ELCA commit ourselves to work with others
to attain this goal" (754-757). This commitment (which CFH backs
biblically and theologically) is "a matter of love and justice."
"At the center of Lutheran ethics is the love (agape) shown us by
God through Jesus Christ." Citing 1 John 3:17-"How does God's love
abide in anyone who has the world's goods and sees a brother or
sister in need and yet refuses to help?"-CFH concludes "[i]n
response to God's love, therefore, we work to promote the health
and healing of all people" (758-766). Further, "Jesus called
justice one of the 'weightier matters of the law' (Mathew 23:23)";
and "our search for justice is a call from God, a concern
especially for the 'rights of the needy' (Jeremiah 5:28)."
Lutherans, then, are a people "compelled by justice"; hence "our
common effort to provide access to health care for all"
 CFH defines justice as giving each person his or her due based
on need (777-779), and states "[t]he chronic failure of our society
to provide it members access to basic health care is a moral
tragedy that should not be tolerated" (877-880). Achieving the
"obligations of love and justice" (865) will require giving
"priority" to "people and groups who are not benefiting from access
to health care services and research" (811-813), as well as
"sacrifice, goodwill, fairness" and an "abiding commitment to place
personal and social responsibilities of love and justice above
narrower individual, institutional, and political self-interests"
(865-869). These obligations can "be met through any number of
personal, market, and governmental means" (828-830); hence CFH
urges "all people to advocate for access to basic health care for
all and to participate vigorously in the public discussion on how
best to fulfill this obligation" (873-877).
 There is a great deal to be admired in CFH. It is a serious
and, if read carefully and reflectively, a thought-provoking
attempt to grapple meaningfully with some of our most important
problems. No document of its length can completely address the
numerous issues that are at stake. CFH does, however, address some
of the most fundamental: it identifies important dimensions of the
health care crisis; it correctly, in my judgment, indicates that
progress will require "serious conversation and bold strategies";
it considers, and defines, key concepts too often neglected in
secular debates-that is, health, illness, healing, and health care;
it consistently articulates biblical and theological backing for
the positions it holds; it correctly, in my judgment, points out
that without serious discussion of the goals of our health care
system meaningful reform is unlikely; finally, it articulates a
guiding vision for health care reform based on two fundamental
precepts of Christianity, love and justice.
 I will not quibble with things that might be improved in the
document: the arguments within it could be tightened and made more
forceful; the biblical and theological backings deepened; and
distinctions made more clear. In the spirit of continuing the
conversation, however, I would like to advance three areas for
reflection. First, is the content of this document clearly
identifiable as "Lutheran?" If so, how? If not, why? If not, should
it be? Reflection on such questions, I think, ask us to consider
the rich Lutheran theological heritage, and how Lutheran theology
and piety might inform our "post-modern" world. Second, I find the
use of "calling" and "vocation" in the document tantalizing, but
incomplete. I suspect that many Lutherans who read this document
will resonate, at least in part, with a sense of "calling" or
"vocation." Further clarity on and development of "calling" and
"vocation," traditionally great strengths of Lutheran theology,
would be helpful here. Third, one wonders to what degree Lutherans
will feel themselves bound by the "obligations of love and
justice," that is, the "commitment" to "equitable access for basic
health care for all people." The biblical and theological warrants
for this commitment could be more strongly developed, but the
substance and direction of the argument is clear. So, too, are its
implications: broadening access will (almost certainly) mean less
for those who currently have more. Such reflections force us to
consider, in a personal and powerful way, the implications of
self-sacrificial love, a central tenant of our faith.
 As one who, daily, confronts the many dimensions of the health
care crisis, in an "economically challenged" region of the country,
there is solace in CFH. The daily, shattering, hammer blows of
health care delivery-be they terminal illness, devastating
financial implications, layoffs of valued colleagues, and so
forth-threaten morale, happiness, dehumanization of self and other,
and one's sense of vocation. That the ELCA has seen fit to address
such concerns provides hope; to what degree the conversation
envisioned here will become a reality is far from clear. CFH is,
however, a start. It is my sincere hope that "serious conversation"
around these issues will continue, in service to each other and to