This is the final installment of the roundtable on Cory D. Mitchell and M. Therese Lysaught’s “Equally Strange Fruit: Catholic Health Care and the Appropriation of Residential Segregation”.  In this post, Cory D. Mitchell and M. Therese Lysaught reply. See the bottom of this post for their full bios.

We thank Drs. Cuddeback-Gedeon, Camosy and Kelly for their insightful commentary and probing questions in response to our article “Equally Strange Fruit: Catholic Health Care and the Appropriation of Residential Segregation.” We applaud Jason King and the CMT for launching this monthly symposium with the Journal of Moral Theology and are so grateful that our article was chosen for engagement.

In ESF, we had two interrelated aims. The first was to spotlight the potential relationship between US residential segregation and Catholic healthcare in order to theologically and ethically deepen the discussion of racial health inequity in America while, secondly, furthering our larger project of engaging/challenging/reimagining Catholic bioethics. Per the latter, one could simply use a different framework—a strategy we pursued (as co-editor and contributor) in Catholic Bioethics and Social Justice (Liturgical Press, 2019).

Alternatively, however, one could and should directly engage Catholic bioethic’s traditional framework that continues to dominate the scholarly literature, magisterial commentary, and hospital practice. ESF takes this approach. As Michael McCarthy and I (MTL) have documented, this framework largely focuses on a narrow spectrum of “intrinsically evil acts” and their near-variants (e,g., “prohibited procedures”) committed by individual agents and/or moral cooperation therewith at the institutional level. Therefore, in ESF, we wanted specifically to complicate these two categories. We did so by forwarding M. Cathleen Kaveny’s concept of appropriation to complicate the narrow focus on cooperation; and by drawing on Gaudium et Spes (no. 27) and Veritatis Splendor (no. 80) to problematize the usual configurations of “intrinsic evil.”

This, per Conor Kelly’s question, is simply how we intended the category to function: as a subversive point of entry designed to crack open the monolithic traditional framework. Charles Camosy’s own analysis effectively covers our own rebuttal—we are grateful for his rousing and on-point defense of our use of the category! In drafting the article, we discussed whether we needed to establish (for a largely white readership) that residential segregation is, both, intrinsically evil and morally grave. We intended our lengthy section on residential segregation to do just that. More specifically, we wanted to demonstrate that residential segregation—or more specifically, concentrated poverty based on race shaped by decades of US policy—is a fundamental cause of excess morbidity and mortality in communities of color. Living conditions in these communities are rightly described, per GS and VS, as “subhuman.”  [Note: this differs from the ethnic/linguistic affinity communities Camosy describes].

Thus, as long as the term remains operative in Catholic bioethics, we maintain that residential segregation is a morally grave instance of intrinsic evil. Segregation is an abhorrent social system designed to dehumanize and ultimately harm the “other.” It is always evil, and people of good will cannot shy away from naming it as such, regardless of how uncomfortable it may be to do so. Per Kaveney’s article that Kelly helpfully cites, making this claim also deploys the term’s traditional function, mounting a prophetic critique of something that deeply opposes human flourishing.

This brings us to Lorraine Cuddeback-Gedeon’s well-argued and excellent analysis.  Overall, we appreciate and agree with her critiques and constructive moves. Channeling improv, we respond “yes…and…” to both her theoretical and practical observations.

First, theory. At the heart of Dr. Cuddeback-Gedeon’s response she asks whether and how Catholic moral theologians can use categories originally developed for assessing acts of individual agents to analyze and critique social structures and structural sin. The principle of moral cooperation within Catholic bioethics is a prime example. Pulled from near extinction by the 1994 Ethical and Religious Directives for Catholic Health Care, this principle—developed to determine, e.g., whether servants who ferried love notes about trysts between their duke and a neighboring damsel were sinning—was applied to relationships between Catholic hospitals, and it roared to new life. While a few attempts have been made to smooth over conceptual challenges this move presented, much more theoretical and theological work remains to be done.

If traditional individual-act-centered concepts can be applied to social and institutional contexts, we must ask further: where are the points of contact, of disconnect?  Kelly’s question—whether the individually-act centered concept of intrinsic evil can be used to describe a structure of sin—merits further analysis, although we would point again to GS and VS (cited in ESF and Kaveny’s America essay) where this shift has already begun. Cuddeback-Gedeon points to yet another candidate for analysis: intention.  We appreciate the nuance she brings here. Were we rendering it too monolithically in ESF?  Point taken. We welcome further study of continuities and discontinuities inherent in speaking of “institutional intention.”

Equally, Cuddeback-Gedeon raises incisive critiques at the level of practice. We share her commitment to local staffing as a key practice. [Robert Gordon’s chapter, “Inviting the Neighborhood Into the Hospital: Diversifying Our Health Care Organizations” in CBSJ highlights St. Bernard’s in Chicago’s Englewood neighborhood and addresses this very point.]. Indeed, CNAs are precisely the type of nursing extenders who benefit most when healthcare institutions provide education benefits so that CNAs can become LPNs, and LPNs can become RNs, and RNs can become BSNs, and BSNs can become MSNs and Advanced Practitioners. Thus, healthcare can be one of the most effective ladders from the depths of poverty for low-income workers. 

Yet, in ESF, we aim our complaint at healthcare executives for many reasons. Health systems are typically the largest employers in low-income black communities; they normally have relatively large resources (human and financial capital) to catalyze community development work; and religious health systems have an explicit mission to ensure the dignity of every man, woman, and child, regardless of race. And, it is healthcare executives who set parameters for workforce size and compensation, usually rewarding themselves disproportionately.

While we do not support “white saviorhood” as an adequate response to injustice, we do believe that white people have to be part of the solution. I (CDM), as an African American male, cannot lift the burdens placed on me by white society without assistance. Racism and residential segregation are systems built by policies opposed to my human dignity. I need white society’s help to combat such systems and policies. Let us speak truth to power; using narrowly construed white male moral concepts to critique white systems of injustice is what many black Christians have done since slavery, and we invite white moral theologians and people of good will to join us in continuing that work. 

Cuddeback-Gedeon rightly notes our focus on the importance of control in appropriation.  This is another reason we focus on healthcare executives. However, we agree that subsidiarity and solidary are always crucial for sound community development—thus, we highlight organizations like Purpose Built Communities as potential collaborators with health systems.  Readers are referred to Mitchell, Andreoni, and Hatchett in CBSJ who concretely demonstrate how equity can be built into community change processes from the bottom up. 

Lastly, we are ever mindful that Catholic healthcare is both a business and a ministry. We want to push our institutions from being narrowly focused on margins like for-profit corporations to becoming full-fledged stakeholder-oriented institutions. If we can achieve this goal, more communities (black, white, and other) will be served more effectively, advancing the common good. 


Cory D. Mitchell, D.Bioethics, MA is incoming Director of Mission Integration for Mercy Health Muskegon. Cory is a graduate of the Master of Arts in Health Care Mission Leadership program as well as the doctoral program in Bioethics and Health Policy at the Loyola University Chicago Neiswanger Institute for Bioethics and Health Policy. He is also currently a Master of Business Administration candidate at Syracuse University. Having served in the U.S. Navy, as a research intern at Johns Hopkins University’s Bloomberg School of Public Health, and a Program Specialist Intern at the National Institutes of Health Institute on Aging, Cory has significant experience working with vulnerable populations, including veterans and the homeless. As a black Catholic, his research interests are Catholic health care, health disparities, and theological ethics.

M. Therese Lysaught, PhD, is Professor at the Neiswanger Institute for Bioethics and Health Care Leadership at Loyola University Chicago, Stritch School of Medicine and the Institute of Pastoral Studies.  Frequent consultant with Catholic health systems, her books include Catholic Bioethics and Social Justice (Liturgical Press, 2019) with Michael McCarthy, Caritas in Communion: The Theological Foundations of Catholic Health Care (Catholic Health Association, 2014), On Moral Medicine: Theological Perspectives on Medical Ethics, 3rd edition (Eerdmans, 2012) with Joseph Kotva, Gathered for the Journey: Moral Theology in Catholic Perspective (Eerdmans, 2007) with David Matzko McCarthy, and the forthcoming Chasing After Virtue: Neuroscience, Economics, and the Biopolitics of Morality, with Jeffrey P. Bishop and Andrew A. Michel (University of Notre Dame Press, 2021).