Chaplain Keith Goheen on reassessing our covenants

Healthcare through a Theological Lens

While politics is generally not foremost in our day-to-day business as chaplains, it impacts the care we offer every patient in our facilities. However, periodic reflection on the composition of the political sea in which we swim informs and enriches my practice. Recently, I sampled the current political waters by attending Michael Moore’s latest movie, Sicko. Many of the poignant, first-person stories shared in this film proved remarkably similar to experiences that I have witnessed, either here in my hospital or in the wider community. I found resonance with Moore’s sense of social outrage, but beyond the political implications, the film raised an unexpected theological rumination for me. I was startled into thoughts and feelings about the two great understandings of salvation in our American religious culture: individual and communal.

The economics of our healthcare system echoes a theological emphasis on individual salvation, wherein persons are ultimately responsible for bearing their separate costs for healthcare. This practice is congruent with a social vision that places a premium on individual free will and views personal choice as an ontological necessity. Each of us must approach the system, singularly, with whatever resources we can privately muster, at a particular time as called by the onset of disease. Recognizing that few of us have adequate financial reserves to answer this demanding call, we fear being judged as financially inadequate, or sinful, in the eyes of the industry that would redeem our physical well-being in a time of trial or tribulation. How then are we to overcome this inherent deficiency, avoiding rejection and the suffering and decay that follow?

We could rely on institutional grace, but the healthcare industry is not infinite in its nature and must offer a grace heavily circumscribed with qualifying criteria. In the past and to some extent in the present, we have congregated into bodies of mutual support and security, but mutual responsibility also brings mutual accountability, soon moving us into conflict around free will’s compelling requirement for personal choice. More commonly and more congruently, we practice works of righteousness, earning through the economic purchase of insurance policies, a personal mediator who will intercede before the medical industry. Our fate then rests with the efficacy of our advocate.

Moore’s film can be used to throw the healthcare systems of other nations into sharp theological as well as political relief. His forays into the Canadian, British, French and Cuban systems spotlight the strong community-mindedness that defines these systems, a theological as well as political value. Here are systems offering economic redemption through direct participation in the political body. For them, the system is itself redemptive, because membership in the political body, in the form of citizenship, also means membership in the healthcare system. In a display of social unity, the community makes a collective economic sacrifice through taxation on behalf of its members for the benefit of the body as a whole. Their fate rests in the efficacy of the community’s bonds.

Many of our medical institutions were conceived as religious inspirations, and the generosity of the founders continues to live among the people who serve within them. But the systems operating these institutions are now largely divested of any overt religious affiliations. Today, they look to the public square for ethical guidance. Fortunately, even the most secular of industries is not immune to the religious forces in the communities where they do business. The visions of various religious models for society continue to subtly shape daily life. Does the United States’ healthcare system reflect the deepest values of our collective religious will? This is a profoundly troubling question for me.

As a hospital chaplain, I often sit with people who are plagued with financial anxieties that eclipse their medical worries. In the quiet of my office, I wonder why I must pray for economic deliverance with such frequency in a nation possessing so much of the world’s wealth. Is it possible that our free market healthcare system is usurping an economic grace that should be a natural part of a shared life, or is the Dante-like, financial pit to which the under-insured are consigned an eschatologically necessary state of forsakenness in a free market economy?

More than a century ago, Ralph Waldo Emerson cautioned his religion-conscious American audiences “to be careful what we worship, for what we worship we are becoming.” Michael Moore’s film invites me to reconsider who we in the healthcare field are becoming. If Moore were a prophet, instead of a pundit, he would be calling us as a people to reassess the emphases we give to our covenants with the God of our understanding and the people among whom we dwell. Beneath Moore’s message, I hear a desire for the life-giving rain of healthcare to fall equally on all our citizens. It is a desire that I believe lies close to the spiritual roots of American healthcare.

How might we as chaplains respond to such a call?

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.