On October 26, the Notre Dame Law School’s Religious Liberty Initiative and the de Nicola Center for Ethics and Culture hosted the “Religious Liberty Issues in Healthcare” panel discussion in McCartan Courtroom. The discussion featured a panel of distinguished speakers from across various fields, including nonprofit and religious organizations, higher education and health care. The panelists provided their unique insights and personal experiences on various issues, ranging from the legal challenges facing religious health care systems, current issues in medical licensing and regulation, cultural challenges facing medical students and physicians, and the protection of religious rights of minority religions, especially of Orthodox Jews.
The panelists included Peter D. Banko, president and CEO of Centura Health; Dr. Lydia Dugdale, director of the Columbia Center for Clinical Medical Ethics; Rabbi Shmuel Lefkowitz, president of Chayim Aruchim; and Louis Brown, executive director of Christ Medicus Foundation. O. Carter Snead, professor of law at Notre Dame Law School and director of the de Nicola Center for Ethics and Culture, moderated the discussion.
Lefkowitz kicked off the panel discussion by addressing how his Orthodox Jewish faith strongly influences his work at Chayim Aruchim, also known as the Center for Culturally Sensitive Health Advocacy and Counseling. “For me, my actions are guided by the Torah, the Jewish Bible,” he said. “The Bible teaches us that the sanctity of human life outweighs all our earthly possessions. This applies even to a severely neurologically disabled person or a person who is destined to die due to a fatal illness or accident. The guiding principle is that life is of supreme value—every life.”
Chayim Aruchim, which translates to “long life,” seeks to help members of the Jewish community make end-of-life health care decisions according to their religious beliefs. Through his work, Lefkowitz has provided families with halachic guidance for various health matters, such as brain death and palliative care, two issues he addressed during his speech. He spoke in great depth about the importance of values in health care: “One must look for a doctor who shares the patient’s values. The United States of America has the most outstanding medical institutions in the world. However, when it is determined that a patient cannot be cured, this is where the religious values and the new progressive liberal values clash.”
Lefkowitz also recognized the diversity of perspectives and belief traditions that shape approaches to health care and thus the patient experience. He noted that medical schools have a role to play in instilling intercultural competence among health professionals. “It seems to me that the most important educational lessons a medical professional can learn is that there are many values out there and that the most important thing is to respect and treat the patient according to the patient’s values. I understand that in medical school they teach ethics. I don’t understand whose ethics they are teaching,” he said, eliciting a few laughs from the audience. “If they really want to [students] to learn about ethics, they need to bring in people from different backgrounds to teach them what their values are. That way, they will be sensitive to the need for medical care to be given in a culturally sensitive manner,” Lefkowitz continued. “Every faith must have their own Chayim Aruchim.”
Echoing some of Lefkowitz’s points, Banko reiterated that life is of the highest value and that faith has the power to play an integral role in how health care institutions approach their overarching services. “Judeo-Christian love is a living principle of health care, and it guides our principles of suffering and death,” he said. “Every person deserves a good birth and a good death. All life is sacred. All people are children of God.”
Banko serves as the president and CEO of Centura Health, a Christian organization in which CommonSpirit Health, the largest national Catholic health care system in the United States, is one of its two sponsors. “We asked our co-workers why they work there. One, mission; two, to work with incredible people; three, influencing their neighbors; and four, mind-body-spirit care, or ‘whole person’ care, which I think is different from other organizations. Spiritual care providers are part of the care team. ‘Whole person’ cares [means] to meet a person’s whole needs, not just what they are there for physically. It’s more person-centred care than just providing regular care,” he said.
In keeping with its mission to deliver inclusive and equitable care, Centura Health has begun doing significant work around unconscious bias training for physician and staff leadership. Like Lefkowitz, Banko also recognized the importance of ethics committees in health care settings as a way to ensure that health professionals and systems provide culturally competent patient care. “We need more faith in our work—faith in business, faith in law, faith in engineering. We need to speak in an inclusive way,” Banko said.
Toward the end of his speech, Banko gave the Religious Liberty Clinic a call for filing an amicus brief with the Colorado Court of Appeals on behalf of the Catholic Medical Association and Coptic Medical Association of North America. The amicus brief sought to protect the fundamental right of health care workers and religiously affiliated health systems to conduct their ministries in accordance with their religious beliefs.
Referring to the filing Banko addressed, Brown said, “I am concerned that more and more states will seek to investigate, harass and shut down religious health care providers and professionals in our country. This is not only an issue of the violation of basic civil rights essential to human dignity, but it is also an issue of access to health care in the United States.
Through his speech, Brown highlighted the importance of religious freedom in relation to health care and highlighted the potential concerns and negative impacts that could arise for the health and well-being of patients if health care institutions in the United States choose to curtail religious freedom. “It is my contention that the collective action to undermine medical conscience and religious freedom at the federal level and some states, if successful, would delegitimize Catholic health care in the United States and over time deprive millions of patients who are some of the most vulnerable and most need for quality care,” Brown asserted.
Brown consistently defined religious freedom as the “freedom to love,” which led him to encourage the participants to consider contrasting motivations for helping people; these motivations have a strong correlation with approaches to health care. “If we strip religious freedom and medical conscience from health care, we strip caritas (charity) from the healthcare system and replace it with a financial motive, [but] the patient is not simply a financial opportunity. The patient is someone I have an obligation to love, to care for — for their life and their dignity,” he said.
Brown leads Christ Medicus Foundation (CMF), a Christ-centered Catholic health ministry where Catholic teachings are central to its mission and core values. Through its CURO Catholic healthcare community, the ministry offers Catholic health coaching, online wellness courses, as well as spiritual guidance through its Spiritual Health Program, which launched earlier this year; these services are partly influenced by the work of dr. Bob Schuchts and the John Paul II Healing Center. “We see health care as an expression of the love of God for the sick and the suffering,” Brown said.
Like Banko, Brown drew attention to “whole person” care and how such care provides patients with healing benefits that go beyond physical health and well-being. “We need a massive expansion of faith-based and Catholic health care. Catholic health care is, I believe, the best health care in the United States because God designed the human body,” Brown said. “Catholic health care—rooted in biological, scientific, human truth—is the best health care and it generates the best health outcomes every time.”
Following Brown’s speech, Dugdale closed the panel discussion. She works as a practicing physician, primary care physician, clinical ethicist, and the director of the Columbia Center for Clinical Medical Ethics. As the only panelist not representing a religious organization, Dugdale was able to offer her perspectives on health care issues from a different vantage point.
“I’ve worked in several large academic health care centers that are all secular and not faith-based,” she said. “What drives us is not human dignity, it is not life, it is not love. It is to be at the forefront of medicine. The world I’m in is a world of power and technology and money-making and not a world characterized by love for the patient.”
Dugdale provided a bigger picture of how academic healthcare centers approach their work in patient care. She drew a stark contrast to the approaches her fellow panelists were talking about – care based on faith-based values. Academic health care centers, according to Dugdale, demonstrate compassionate care for patients by centering their work on “having the best technology, the crucial approaches and techniques.” Perfecting the latest medical treatments and cures is considered equivalent to the best patient care.
Dugdale shared two cases in which, from her point of view, religious freedom was threatened at prestigious secular institutions. In one example, an evangelical medical student was assigned to care for a dying patient whose religious beliefs matched the student’s; so the student, patient and patient’s family prayed, sang and read the scriptures together. When the dean of students found out about this, he dismissed the student’s actions and told her that participating in worship and religious practice was not the role of a medical professional. He ordered the student to stop the activity; otherwise she would be put on leave. In a second example, a pro-life student club at a secular institution faced significant backlash and was eventually closed.
Referring to the diversity of the panel, Dugdale said: “From the point of view of a practitioner at a non-religious institution, everything we’ve said represents the diversity of the American experience. There is no one size fits all approach to health care. There is no single approach to medical education. And certainly, what is permissible and acceptable in some places will not be at all in others.”
After reflecting on the panel discussion, Hadiah Mabry—a first-year student at Notre Dame Law School and one of the Program on Church, State, and Society’s first Murphy Fellows—shared her thoughts on the dynamic relationship between religious freedom and human dignity: “Religion. freedom creates a space for dialogue because it is built on respect and a willingness to see the innate dignity in another person by allowing them to choose for themselves, even on matters of existential importance. Without the ability to seeing goodness in another person makes it very difficult to work for justice or peace.”
You can see the full event recording on the Religious Liberty Initiative’s YouTube channel here: Religious Freedom Issues in Health Care.