A Review of "Caring for Health: Our Shared Endeavor"


[1] "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 (1-9).

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 document.

[2] 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" (39-47).

[3] 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.

[4] 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).

[5] 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).

[6] 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" (248-252).

[7] 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 shared endeavor":

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).

[8] 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 (278-748).

[9] 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" (767-776).

[10] 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).

[11] 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.

[12] 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.

[13] 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 God.



© August 2003
Journal of Lutheran Ethics
Volume 3, Issue 8