Preachers of the ERD

Deacons must be comfortable with proclaiming the Ethical and Religious Directives for Catholic Health Care Services.

The wisdom of the ERD is not commonly shared with Catholics in the pews.

The United States Conference of Catholic Bishops issued the Ethical and Religious Directives for Catholic Health Care Services (ERD)¹ as a way for medical professionals and institutions to serve in a manner consistent with the Catholic faith. The Ethical Directives began a committee of theologians and health care professionals having a goal of unifying the regulations concerning ethical medical practices in Catholic doctrine and theology. The result of this endeavor was the “Ethical and Religious Directives for Catholic Hospitals” published by the l.inaere Quarterly in 1948. How the Ethical Directives evolved was nicely summarized by Fr. Kevin D. O’Rourke et. al. in the November-December of Health Progress in 2001.²

Currently, the Ethical Directives is in its sixth edition, which was approved by the United States Conference of Catholic Bishops (USCCB) at its June 2018 Plenary Assembly. The current edition is available for download on the USCCB.org website. The bishops are working on updating the Ethical Directives to address issues in medical treatments for gender.³ Until the updates are approved, the bishops’ guidance in Doctrinal Note on the Moral Limits to Technological Manipulation of the Human Body should be consulted.⁴

Every Catholic hospital and medical institution is subject to the guidelines presented in the Ethical Directives. As such, this also entails the Catholic faithful going through their lives being impacted by the Ethical Directives either directly or indirectly. Examples of this may be situations regarding:

• Families struggling to make end-of-life decisions.
• Clerics advising people asking about beginning-of-life issues and assisted reproductive technology.
• Chaplains who are asked if organ harvesting and transplantation are morally acceptable.

Diaconal candidates only have time in their formation programs for a few short sessions on the topic of medical ethics. Meanwhile, society continually challenges many of the Catholic positions taken in the Ethical Directives. Deacons need not only to be familiar with the ERD but to help our faithful become aware of it as well.

The Ethical Directives plays a major role in the lives of Catholics everywhere. It is a beautiful document respecting God’s creation while too few even know the directives themselves exist. The Ethical Directives is meant to be a stabilizing force for Catholics in a world where differing views surround them.

Ethical and Religious Directives for Catholic Health Care Services

In a talk to the National Association of Catholic Chaplains, Fr. Tom Nairn notes that the Ethical Directives guide health care delivery and offer a “limited attempt to answer two questions.”⁵ The first question focuses on our Catholic identity by asking, “Who are we?” or “Who should we be?” The second question highlights our integrity by asking, “What should we do in light of this?” The Preamble states that the Ethical Directives is guidance from the bishops to set norms for making health care decisions by professionals, patients, and families. Compliance is expected from Catholic medical institutions through their corporate officers, administrators, medical professionals, and spiritual caregivers, as well as by the recipients of their services such as the patients, their families, and decision-making surrogate(s). The guidance provides the application of Catholic moral teaching to issues we face in health care ethics. Ultimately, they call upon us to “walk our talk” in faith.

After the preamble, the Ethical Directives consists of six parts that cover the major areas of concern in Catholic healthcare. Each of these six parts is divided into two sections: (1) an introduction that provides biblical and theological context to the section and (2) individually numbered directives addressing specific issues.⁶

Part One: Social Responsibility

The first section of the Ethical Directives reminds us of the social responsibility we have to each other. Catholic healthcare distinguishes itself through its focus on the human dignity of all God’s people and our common hope of eternal destiny in Christ. Respect for human dignity demands that we care for the poor and promote the common good while providing responsible stewardship that respects both the individual and the institutional conscience of the provider.

Part Two: Pastoral and Spiritual Care Patient/Professional Relationship

Catholic healthcare must treat all in a manner that respects human dignity and our mutual eternity in Christ. This entails a holistic approach that addresses the total physical, psychological, social, and spiritual dimensions of the person. Such an approach strengthens the promotion of health and relief of suffering when possible. It requires pastoral care, in addition to medical care, through the combined efforts of the institution with parish clergy and ministers of care.

Part Three: Patient/Professional Relationship Service to Liturgy

Catholic healthcare is grounded in respect for human dignity, which entails the rights of mutual respect, trust, honesty, and appropriate confidentiality. This collaborative approach addresses the moral responsibilities of all involved, including the institution itself.

Part Four: Care for the Beginning of Life

Catholic healthcare ministry must witness the sanctity of human life “from the moment of conception until natural death.” This witness includes avoiding practices that undermine the biological, psychological, and moral bonds of marriage and family. The purpose of the care provided must not circumvent the direct purpose of rendering procreation or separate procreation from intercourse. Applied relevant technology must not substitute for the marital act. Specific medical interventions, such as direct abortion or direct sterilization, are expressly forbidden within the Ethical Directives. In addition, the institution’s commitment to life begins with care for the woman and child during pregnancy and must continue after birth. We must work to ensure that adequate care for the woman and child continues to progress.

Part Five: Care for the Dying

Catholic moral teaching reminds us that we are stewards over the life created by God. While we work to preserve and respect life, our actions reflect our confidence of faith in eternal life with Christ. Such faith is the basis for our hope. The Catholic institution is called to care even when there is no prognosis of a cure. The process of dying is never a loss of dignity. Our faith requires us to avoid the extremes of (1) “useless and burdensome” technology and (2) withdrawing care with the intention of causing death.

Part Six: Forming New Partnerships

The last section of the Ethical Directives provides guidance for Catholic institutions that are merging with non-Catholic institutions. These partnerships should be seen as a way of providing a witness to our faith and evangelizing on our social teaching. The partnership must not mask the Catholic identity of the institutions nor provide services contrary to Catholic teaching. Such mergers are ripe opportunities to cooperate with evil and Catholic integrity must be safeguarded.

Secular Challenges

Unfortunately, not everyone sees the Ethical Directives as a Catholic love letter to human dignity. For some, the secular notion of personal gratification and freedom from any responsibility distorts this view. Rather than being seen as nurturing, faith is seen as an ideology used to dictate health care. As such, the Ethical Directives puts “patients at risk” through its challenge to the “anything goes” programs that advocate for reproductive and end-of-life care. Along with these claims, the Ethical Directives is proclaimed as being discriminatory against LGBT “families.” Thus, these groups fight against government healthcare funding to subsidize religious hospitals.

One of the worst offenders in this regard is the American Civil Liberties Union (ACLU). This organization routinely supports attacks on the Ethical Directives, even going so far as to claim that “increasing control of health care facilities” in the state of Washington is in violation of public policy and law.⁷ They continue to look for ways to bring legal action against Catholic healthcare providers and institutions.

People in the Pews

In all this complexity, the Church and the Ethical Directives are missing a vital element — the Church faithful who are in our pews each Sunday. Too often our clergy have the notion that “they know our Church teachings” in this regard. Yet most do not. It has been poorly catechized to my generation and to the generations that follow.⁸,⁹ Instead, our faithful are bombarded by secular teachings found in newspapers, television, social media, and public-school curricula.

There has not been an aggressive return to catechizing our faithful on Catholic healthcare teachings. In fact, the “New Evangelization” does not even mention this as an issue. We must ask ourselves, “Why wait for them to arrive at the hospital, unprepared for the pending medical crisis, to have these discussions?” Discussions in the emergency room or at the patient’s bedside are too late. The focus and energy of the family should be targeted at the crisis at hand, not on moral theology and eternal salvation. In this regard, Ethical Directives is a great failure. A generation that has been raised to fight institutional control is not going to listen to the teachings of the institutional Church at this time.

How Can Deacons Help?

As deacons, not only must we become familiar with the Ethical Directives, but part of our ministry is to help our faithful become aware of these guidelines. We must promote them not with “hammers” but with conversations. We need to look for opportunities to include mentioning them in homilies and hold parish sessions on the Ethical Directives and Catholic advanced directives. If we are not versed in medical ethics, we need to take the initiative to access the resources available in our dioceses. We can also speak at the plethora of men’s conferences that have formed around the country. As in all regards to our faith, let’s not “wait for Father to do it.” Let us lead in service as our ordination requires. The diaconate has the resources to move the needle on this, but only if we are willing to put in the effort and our pastors and bishops are supportive.

Be the Solution

It occurred to me that, perhaps, I was not seeing others step up because God wanted me to. Upon this reflection and in light of Mark 6, we need to leave our “second tunic behind” to journey and preach the wisdom of the Ethical Directives. Being authentic to Church teaching, we will face some opposition and must embrace such disagreement with love. Pray for us, that we may plant the seed of faith in the collective medical toils that we all will face at some point. We won’t be preaching “rules,” but highlighting human dignity. We will preach the love that God has for each of us as we prepare to travel our ultimate road home and, all the side trips we take along the way.

Conclusion

Are we not ordained to uphold and instruct the faith? Comfort the afflicted and afflict the comforted! If we wait for conversations to take place while a loved one is in the ER, we have lost the battle. Let’s take back our lost ground and proclaim our faith boldly in this regard. We are challenged to be “Preachers of the ERD”!

DEACON GREGORY WEBSTER is a deacon for the Archdiocese of Chicago and holds a D.Bioethics degree in Catholic and research bioethics from Loyola University of Chicago.