Caritas deal gets support of leading theologians
Critics of a proposed joint venture between the local Catholic hospital chain and a secular insurance company say they are concerned about the arrangement because of one major issue: abortion.
But supporters say there is another issue at stake in the discussion of whether Caritas Christi Health Care should take part in providing insurance to low-income people in Massachusetts: poverty.
As the debate over the merits of the Caritas deal with Centene Corp. rages in the Catholic Archdiocese of Boston, the Globe asked moral theologians around the country to assess the deal, which would result in a 39-hospital joint insurance venture that would cover abortion services, but not at the six Catholic hospitals involved. A dozen scholars and clergy members agreed to offer their opinions, and, to a person, they supported the venture.
"Catholic social teaching is very clear that access to healthcare should be a basic human right," said Todd Salzman, chairman of the theology department at Creighton University in Omaha.
Salzman argued that Cardinal Sean P. O’Malley’s pledge that the hospitals would not be involved in performing or financing abortions should assuage critics.
"What could also cause scandal, however, is that Caritas would reject cooperating with Centene in a program that would provide healthcare for the most needy and vulnerable in society," Salzman said.
The proposal is also getting support from key leaders in Catholic healthcare.
"Nobody is more attentive to life issues than the cardinal-archbishop of Boston," said Sister Carol Keehan, president of the Catholic Health Association of the US. Keehan said that she had reviewed key provisions of the Caritas-Centene deal, and that "Caritas has done more than one would usually see" to avoid being involved with abortion and other services opposed by the Catholic Church.
"As I look at the way Caritas Christi has structured this arrangement, it allows them to be participants with the state in the care of the poor and the most vulnerable citizens of the state of Massachusetts in a way that brings the richness of their system and the caring nature of that system to the poor, without in any way violating any of the religious directives or the moral imperatives of our faith," Keehan said.
O’Malley has spoken out twice on the subject, first by issuing a statement to the news media and then by posting a comment on his blog.
"To be perfectly clear, Caritas Christi will never do anything to promote abortions, to direct any patients to providers of abortion, or in any way to participate in actions that are contrary to Catholic moral teaching, and anyone who suggests otherwise is doing a great disservice to the Catholic Church," the cardinal blogged. "We are committed to the Gospel of Life, and no arrangement will be entered into unless it is completely in accord with Church teaching."
O’Malley also said he would seek a second opinion about the proposed deal from the National Catholic Bioethics Center, a Philadelphia-based think tank with conservative credentials.
"One thing we have found about these collaborative arrangements is that when you have seen one collaborative arrangement, you have seen one collaborative arrangement," the center’s president, John M. Haas, said in an e-mail exchange. "They are generally quite complex and really have to be studied individually."
Caritas is proposing to join with Centene in a bid to offer insurance in a subsidized program called Commonwealth Care that covers 164,00 low-income adults in Massachusetts. The program is part of the state’s pioneering 2006 health initiative, which aims to extend health coverage to nearly everyone, including low-income adults who did not previously qualify for state-subsidized insurance.
State regulators are scheduled to vote tomorrow on whether to accept the Caritas-Centene bid, as well as four others submitted by companies already participating in Commonwealth Care.
The criticism of the deal, scholars say, is a reflection of an increasingly absolutist antiabortion movement in the United States. "For some of these prolife groups, no cooperation with evil is ever justified, but that’s more of a prophetic stand, a new way of applying the tradition," said Cathleen Kaveny, a professor of law and theology at the University of Notre Dame.
Caritas has repeatedly refused to answer questions from the Globe about the proposal. Yesterday, the hospital network declined to say what services are prohibited under Catholic teaching, how the Caritas hospitals currently respond to patients who seek such prohibited services, or how Caritas proposes to handle requests for such services under the Centene deal. The state contract requires that the venture provide coverage for abortion.
"Out of respect for the legal process of the Connector Authority, we will not comment further on additional questions," said Caritas spokeswoman Teresa Prego, referring to a state regulatory board. "We would be happy to respond to questions following the Connector board meeting."
The controversy over the Caritas bid surrounds one of the more complicated but important concepts of Catholic moral theology: cooperation. Catholic teaching forbids not only intentional cooperation with evil, but also certain kinds of indirect cooperation.
But the scholars consulted by the Globe each said they did not believe the proposed Caritas-Centene arrangement appeared to constitute cooperation.
"There is not here any intention of merging Catholic and other facilities or of abortion being done in any Catholic or partly Catholic institution," said David F. Kelly, founding director of the Health Care Ethics Center at Duquesne University in Pittsburgh.
"It is clear to me, at least from what I have read about this proposal, that there should be no objection based on the usual interpretation of Catholic moral principles."
Lisa Sowle Cahill, a theologian at Boston College, went further, saying, "It will be an appalling scandal if the Archdiocese of Boston obstructs or refuses to participate in Massachusetts’ cutting edge healthcare reform program. . . . Where is the Catholic debate about the best way to ensure healthcare for all?"
Kay Lazar of the Globe staff contributed to this report. Michael Paulson can be reached at mpaulson@globe.com. For the full text of the theologians’ responses, as well as questions Caritas declined to answer, visit www.boston.com/religion.
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