The Next Big Picture in Bioethics

What happens if, after about a decade or so, not much has changed in the fight for defending human dignity? (Or, God forbid, things get even worse?) If cultural change is not on the way, I propose that religious organizations and institutions mobilize for a massive, all-hands-on-deck response of our own. Speaking from my own perspective as a Catholic Christian, I can say that—while the task is daunting—not only does the Church have the international reach to mobilize for such a response, but this work would also be consistent with our history of responding to the signs of the times. Indeed, in some ways this is precisely the problem that a massive, transnational, multi-millennial religious institution is called to address.

After all, some scholars, like Rodney Stark, even believe that the Church’s response to health-care disasters helped it grow from a small and strange sect into a dominant cultural force. The first hospitals came from the Church and from the emphasis of certain religious orders on health care. The Benedictines insisted that care of the sick must be put before everything else. Sometimes whole new orders came into being specifically to deliver health care. The order of Knights Hospitaller was founded, at least at first, in association with an eleventh-century hospital in Jerusalem to provide health care for the sick, injured, and poor Christians on pilgrimage to the Holy Land (interestingly, this order evolved into the Order of Malta, which still continues its health-care work globally).

Sometimes the Church mobilized to meet local outbreaks of disease. To deal with people who had leprosy, for instance, the Church created hospitals specifically for lepers (called leprosariums) and whole congregations emerged devoted to those suffering from the outbreak. The National Library of Medicine at the National Institutes of Health has exhibits dedicated to remembering “The Saints of the Plague” who served people during health-care emergencies.

In the last three centuries, orders of women religious have taken the lead in setting up hospitals all over North America—including during key moments of health-care crises. It began with an Augustinian nun named Marie Guenet de Saint-Ignace, who immigrated to Quebec in the mid-seventeenth century with the goal of establishing a Catholic hospital. She founded Quebec’s Hôtel-Dieu, beginning the tradition of women’s religious orders providing free no-strings-attached medical care in North America. The Sisters of Mercy and Daughters of Charity are among a dozen religious orders who served the United States during the Civil War, and in the process built the foundation for what would become the infrastructure of US health care.

Catholic orders of women religious mobilized around health-care education as well, founding approximately 220 nursing schools by 1915. In doing so these sisters “stamped their distinct understanding of nursing onto secular society.” And that imprint has endured: for instance, I recently gave a talk at Mercy College of Health Sciences in Des Moines, Iowa, which was founded as a nursing school by the Sisters of Mercy in 1899.

In addition to administering hospitals and schools, contemporary women’s religious orders are still doing direct work in health-care fields for the most vulnerable. A feature story in The Atlantic, “Nuns vs. the Coronavirus,” detailed the selfless service many US religious women have given to the elderly and disabled in nursing homes during the 2020 pandemic. Beyond the pandemic, there are many different religious orders geared toward the very issues I raise in Losing Our Dignity. An obvious example that comes to mind is the Little Sisters of the Poor, founded to serve the impoverished elderly who are thrown away at the end of their lives. Another important contemporary example is the Sisters of Life. Conceived by Cardinal John O’Connor of New York in the 1980s during a major health catastrophe, the order is called “to protect and enhance the sacredness of human life.” O’Connor had abortion primarily in mind, and the sisters have done and continue to do amazing work counseling and housing pregnant women in vulnerable and difficult situations.

But there is yet another health catastrophe related to the sacredness of human life on the horizon in the United States and around the world. Again, especially as human beings live longer, the number of people with late-stage dementia will continue to grow—in fact, the numbers will double about every twenty years if a cure is not found—and there will be tremendous pressure within our consumerist throwaway culture to declare them human non-persons and make the problem go away. Assuming that efforts at dialogue over the next decade do not bear fruit, religious groups like the Catholic Church will have to mobilize to house, feed, and otherwise show hospitality to this extraordinarily vulnerable population.

Orders like the Sisters of Life and Little Sisters of the Poor no doubt will rise to meet the challenge in even greater numbers as the massive need becomes clear. But other religious orders will certainly need to retool their missions. We may need to resurrect orders from the Church’s past which did similar work, like the Order of Widows. Brand new orders will likely need to be created, as has happened throughout centuries past. And of course, we will need many more vocations to the religious life, including lay religious life, especially from larger religious families.

Hundreds and hundreds of new hospitals and clinics, along with thousands of nursing homes, will need to be built and maintained. And if the surrounding culture is hostile to our understanding of fundamental human equality, we must be prepared—again, as we have been in the past—to build institutions that resist its practices. Here I have in mind what I hope does not turn out to be an eerie comparison to how a significant number of German Catholics resisted the Nazis’ euthanasia program aimed at Lebensunwertes Leben, or “life unworthy of life.” It was this comparison which awoke Dr. Shewmon to the terrible reality of what was being done to human beings thought to be brain dead.

Indeed, given what I explore in Losing Our Dignity, it is worth wondering why nearly 50 percent of physicians (a much higher proportion than any other profession) joined the Nazi party and why they were seven times more likely than other employed German males to join the SS. Ashley K. Fernandes points these statistics out with a deep concern for our current moment in medicine—one in which he sees a new and ominous focus on “the state,” “public health,” and “quality of life” over the good and radical equality of all human beings. Nazi physicians, disturbingly, were eager to move from “doctor of the individual to doctor of the nation.” Fernandes has reason to worry that we are moving in this direction again.

Like the German resistance of that day, our hospitals and other health-care institutions must be ready to resist. Perhaps we can look to the example of Cardinal Clemens August von Galen, who inspired such public backlash that the Nazis ended up abandoning their program of euthanasia for disabled adults. According to the historian Richard J. Evans, nurses and orderlies, especially in Catholic institutions for the sick and the disabled, were able “seriously to obstruct the process of registration.”

Sister Anna Bertha Königsegg, a member of the Congregation of the Sisters of Mercy of St. Vincent de Paul, was one of the most important leaders of the resistance against the forced sterilizations and euthanasia of the disabled. She was arrested by the Gestapo, and later the whole Congregation had their property confiscated throughout the Reich, but the general resistance they embodied was effective. Our own Christian health-care institutions must be prepared to resist in similar ways: nurses never registering the disabled for euthanasia, religious orders refusing to cooperate even if the government confiscates their property, and local bishops (along with other Church leaders) inspiring the people to rise up in defense of fundamental human equality.

Our institutions must also pay the professional staff who care for this population (including home care staff) a living wage—a commitment that will require substantial outlays. Catholics and Protestants must, therefore, put aside differences and pool many different kinds of resources to meet the challenge. Such support must come not only from the hierarchical leadership, but also from the bottom up: with local parishes and churches setting up programs by which parishioners will go to work in local facilities and visit with residents, take them on walks, help at meals, and treat them with the fundamental human equality they deserve. We will also need to cooperate with our fellow people of the book, Muslims and Jews, and with all those committed to being a countercultural light in the darkness of a society that disregards or even undermines fundamental human equality.

If you are thinking that such a gargantuan undertaking might require a new religious revival, especially in the secularized consumerist West, I suspect you are right. And perhaps it sounds like wishful thinking, but I do wonder if our looming catastrophe might actually motivate such a revival. Great people in our Church’s past, after all, began their lives caught in the trap of consumerism, but escaped to serve the most vulnerable during health-care emergencies.

During the first stages of the COVID-19 pandemic, the president of Fordham University, Fr. Joseph McShane, S.J., sent our entire university community weekly pastoral messages. On Sunday, May 29, for instance, he sent us a note about how he had wept before a stained-glass window in the campus church depicting St. Aloysius Gonzaga receiving his First Communion from St. Charles Borromeo, the Archbishop of Milan. The story he related of “St. Al” is worth quoting at some length:

Aloysius was the eldest son of the Marquis of Castiglione. Therefore, to say that he was a child of privilege would be an understatement. A vast understatement. A budding princeling, Aloysius spent his early life among the courtiers of the noble houses of Renaissance Italy (those hotbeds of ambition, corruption, intrigue and power), with a few side trips to the Hapsburg courts of Spain and Austria. Although he was destined to inherit his father’s title and live a life of privilege, his head was not turned by what he saw in those settings. Far from it. In fact, he was deeply troubled by the venality and corruption he encountered in them and decided at an early age to enter the newly-founded Society of Jesus. His father was furious. Aloysius stood his ground. He renounced his titles and his inheritance and left behind him the life his father wanted for him. After he entered the Jesuits, he pursued his studies at the Roman College, where St. Robert Bellarmine was his spiritual director. When a plague broke out in Rome, like many of his young Jesuit confreres, he worked in the city’s hospitals, ministering to its victims. When his superiors (for fear of incurring his father’s wrath) forbade him to continue his work, he pleaded with them to allow him to continue.

He continues:

They relented, but with a catch. They told him that he could only work in a hospital that did not serve contagious patients. He accepted the assignment on the spot. In the course of his service, however, he cared for a patient who had, in fact, been infected with the plague and was himself infected. He died shortly thereafter. His brethren recognized his holiness. They recognized his heroism. They recognized his goodness. They were also astounded by the magnitude of the sacrifices he had made: giving up the life of a courtier to live a life of simplicity, and giving up his life to serve the suffering. (His old spiritual director, Robert Bellarmine, a saint, a scholar, and a cardinal, was so impressed by Aloysius that he asked to be buried at his feet.) Throughout his life and in the manner of his death, then, Aloysius was a “sign of contradiction” (or a living oxymoron): he was a humble noble.

Millions and millions of people in the consumerist West are spiritually adrift, vocationally frustrated, addicted to empty practices of buying and selling, mortally lonely, and looking for meaning in their lives. Is it outrageous to think that dozens of millions of lukewarm or fallen-away Christians of various stripes will be deeply troubled by the “venality and corruption” of their daily lives and, amid a cultural emergency, come to grips with the importance of religious faith for the broader culture in which they live?

Would not the millions of human beings with late-stage dementia, at risk of being discarded as mere things, also tug at the spiritual heartstrings of traditional believers who are not active in living out their faith? And would not the massive mobilization efforts themselves—perhaps like the efforts of the early Church described in Losing Our Dignity—be similarly attractive to new converts? Some, no doubt, would decide to enter newly founded religious orders. What energy, what hope, such a movement could bring! How much it could build! How many it could serve! It would truly be the light of Christ shining in a terrible darkness.

But we have not yet reached the final stage of the terrible darkness. Over the coming decade the medium-term goal of dialogue across differences on these issues can and should be pursued with high energy. If we can rekindle a broad cultural fire in defense of fundamental human equality, that would obviously be the better option.  

EDITORIAL NOTE: This essay is an excerpt of the concluding chapter from Charles Camosy's forthcoming book, Losing Our Dignity. It is reprinted here by courtesy of the New City Press, ALL RIGHTS RESERVED.

Featured Image: Taken by AnnettevhHerman van Hoogdalem working on his faces of dementia paintings, date unknown; Source: Wikimedia Commons, CC BY-SA 2.0.


Charles C. Camosy


Charlie Camosy is Professor of Medical Humanities at the Creighton University School of Medicine and holds the Monsignor Curran Fellowship in Moral Theology at St. Joseph Seminary in New York. He is the author of seven books, most recently Bioethics for Nurses: a Christian Moral Vision.

Read more by Charles C. Camosy