This is a guest post by Travis LaCouter (KU Leuven) for our series on the CTEWC/JMT edited volume Reproduction and the Common Good: Global Perspectives from the Catholic Tradition. The volume is available as a free download thanks to the partnership between Catholic Theological Ethics in the World Church and Journal of Moral Theology. Other contributions to the CMT series are linked at the end of this post.
Emily Reimer-Barry’s discussion of conflicting conscience claims in the context of Catholic healthcare raises a number of salient theological points. It is an admirably clear and irenic treatment of the relevant ethical factors that come into play when patients require, or desire, treatments that are perceived to be in conflict with established Catholic doctrine, such as tubal ligations or induced abortions. These and other hot-button issues in healthcare are often framed as debates around “conscience,” but Reimer-Barry helpfully distinguishes between the different moral agents who can be thought of as exercising conscience in such cases—namely, the institutional Church, the individual healthcare provider, and the patient—and draws meaningful conclusions about how to weigh their claims in the context of the complex system of power and advantage that is the American healthcare market. Reimer-Barry’s key point, that “the patient is, in comparison to the institution and the provider, the most vulnerable” one within this context, leads to her conclusion that the “patient’s medical needs” ought to be ranked “higher” than the others, especially in cases where there is an acute risk of harm.
I come to this discussion as a systematic theologian, with no special expertise in Catholic healthcare systems or the complicated ethical issues involved therein. But I am currently part of a research project at KU Leuven focused on dissent and the contestation of normative claims in the Roman Catholic Church. I am particularly interested in the effects doctrine can have on bodies and lives—marking out some but not others as ecclesially (il)legible or ontologically (im)possible. Dissent, which is frequently thought of as the logical counterpoint to doctrine, is one category that is used to theologically justify the priority of some bodies over others (for a concrete example of this, the question of women’s ordination provides a case in point). The effect upon the “dissenter” is one of alienation and dis-integration: her life (bios) becomes increasingly unintelligible to herself by nature of her participation in the theological discourse (logos) of the community to which she belongs. Graham Ward has argued that the purpose of doctrine should be to help one give an account of oneself as a creature loved by the all-loving God, and in this way prove to be a “therapeutic operation” aimed at “salus,” or health understood as flourishing (see How the Light Gets In: Ethical Life I [Oxford University Press, 2016], p. 26-27). But in light of the disjunctions introduced by a certain conception of “dissent,” doctrine becomes the opposite: a source of confusion and harm for those whose bodies and lives are excluded from consideration.
It struck me in reading Reimer-Barry’s chapter that a similar dynamic is at work in any number of ethical dilemmas associated with Catholic healthcare practices. When Catholic hospital staff refuse to perform, or are punished for performing, medical procedures that protect the health of the mother, so as to not be seen as dissenting from Church teaching, then doctrine ceases to function as a salutary mechanism. Indeed, doctrine in such cases can and does kill, as the tragic death of Savita Halappanavar in an Irish hospital in 2012 shows (Halappanavar was repeatedly denied her requests for an abortion in the midst of a prolonged miscarriage on the grounds that “Ireland is a Catholic country” and consequently died of sepsis several days later). Doctrinal logos can come at the expense of bios.
Reimer-Barry’s chapter thus alerts us to the real ways in which doctrine plays out on bodies. But then the question becomes: Whence this conception of doctrine that would see a woman in extremis die rather than live? Clearly, this is not the only way of interpreting existing doctrinal commitments, as the contributions to this volume demonstrate. Reimer-Barry suggests (borrowing a phrase from Anne E. Patrick) that “ecclesiastical fundamentalism” is at work when bishops elevate their own interpretation of doctrine above all others. Within the realm of medical ethics, this has meant ignoring the judgments of those who have direct experience of hospital administration, like the Sisters of Mercy, and “refus[ing] to acknowledge” how restrictive policies can “lead to the coercion of pregnant patients.” It has also meant construing conscience – which has a firm foundation in doctrinal documents and statements – as obedience to bishops’ directives. I thought Reimer-Barry’s chapter was particularly valuable for showing the “novel understanding of a collective [or institutional] conscience” advocated for by bishops, despite the fact that existing Catholic teaching has traditionally understood conscience as an “intimate” capacity within each person (Gaudium et Spes, 16), even if this is necessarily formed communally. Thus, beyond the serious bodily harm that may occur in any given instance, the prevailing approach to conscience claims in Catholic healthcare may also carry the risk of impoverishing a key moral faculty to the extent it outsources conscience-formation to institutional Church leaders.
Reimer-Barry hints at one possible source of all this when she observes how Catholic “communities are ill-equipped to navigate […] confusion and conflict.” This seems to me to be a truth that applies well beyond debates about Catholic healthcare practices. But it is in the context of healthcare issues that we see quite clearly the life-and-death costs of this aversion to conflict. If Reproduction and the Common Good does nothing else than challenge the notion that there is but one way of handling complex moral issues in Catholic healthcare, it will have rendered an invaluable service.
Travis LaCouter is a systematic theologian and postdoctoral research fellow at KU Leuven, where he is part of the Dissenting Church research project (FWO–Research Foundation Flanders). Previously, Travis was a Visiting Assistant Professor at the College of the Holy Cross, where he taught classes on political theology, Catholic spirituality, and theology and sexuality. He earned a doctorate in theology from the University of Oxford in 2020 and graduated from Holy Cross in 2013. His first book, Balthasar and Prayer, was published by T&T Clark in 2021. His co-authored article with Judith Gruber, Ryszard Bobrowciz, and Taylor Ott, “Contra Silentium Obsequiosum: On the Roman Catholic Approach to Dissent and Tradition,” is forthcoming with Theological Studies, and his non-academic writing has appeared in Commonweal, US Catholic Magazine, and The Revealer.
A sincere thank you to all of the contributors in this series! The introduction to the series by Simeiqi He can be found here. Taylor Ott’s response to the introduction of the book can be found here. Dr. Ann Mary Madavanakkad’s response to Virginia Saldanha’s chapter can be found here. Jacob Kohlhaas’s response to Hoon Choi’s chapter can be found here. Stay tuned next week for more posts to drop!
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