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Just Care: Political Reality and Change

Fr Frank Brennan SJ AO

Opening Plenary
2004 National Conference Catholic Health Australia
6 September 2004

Though a stranger to Catholic Health Care Conferences in Hilton Hotels, I could tell this was a Catholic show with all men up here on the platform and a sea of women’s faces down there in the audience.  No doubt it will be different next year.  Being a Jesuit, I was delighted to hear that the lucky door prize at the trade exhibits will be a dozen bottles of Sevenhill wine – when only the best will do!

Over breakfast with my sister Madeline this morning, I was perusing the delegates list to get some I idea of who I would be talking to.  I think my family tops the poll with three siblings listed as delegates.  Though I noted that none of the doctors, nor the music therapist, physiotherapist or nurses from the extended family were in attendance – only lawyers.  So who is Catholic Health Australia?

I am hugely indebted to Francis Sullivan for having the foresight to invite me to speak at this opening plenary of the National Conference of Catholic Health Australia on the topic “Political Reality and Change” during a federal election campaign and six days before I leave the country. I will not be led into the temptation of making too many predictions about political reality and change.  Many pundits are suggesting the political reality of no change, no matter what changes there have been to the political landscape and political morality in this country.  I will have the luxury of noting the result among the autumnal leaves of Boston.

Sharing the platform with Bishop Eugene Hurley and Mr. Dale West here in Adelaide in 2004 under the rubric “Just Care”, I am conscious that the Catholic Church and its agencies in this state, here in the capital and out in the far flung parts of the Diocese of Port Pirie, have done much just to care for the hapless asylum seekers who were incarcerated behind our razor wire in the desert for long periods following the last federal election, it later being proved that 90% of them were refugees.  To just care for the one who is other and marginalised takes great courage, conviction and resources in our contemporary society.  To care justly for them requires a commitment to political action and a willingness to condemn that which is immoral even if it be popular and even if it be implemented by a government claiming a mandate.  And be careful, you might lose your funding!

How can you as Catholic health administrators be both prophetic, principled and political and also considered, responsible and worldly wise?  Back in 1982 I was appointed the adviser on Aboriginal affairs to the Queensland Catholic Bishops.  It was the year of the Commonwealth Games in Brisbane.  The colourful Sir Joh Bjelke Petersen had met with the ecumenical grouping of church leaders to discuss Aboriginal issues in July 1981.  Suffice to say that his later press conference did not square with the church leaders’ recollection of their discussion.  Archbishop Francis Rush, my mentor amongst the bishops, approached my provincial and asked that I be available as their adviser.

After my first meeting with the Queensland Bishops, Archbishop Rush pointed out that the late Bishop Eddie Kelly was absent so it would be advisable for me to go to Toowoomba to brief him.  At the end of that briefing, Eddie Kelly expressed his very practical concern to me.  St Vincent’s Hospital in Toowoomba needed more accommodation for their nurses.  A special request for funding had been made to the Queensland government.  A ministerial decision was expected in the near future.  Bishop Kelly advised caution in public criticism of the government for its Aboriginal policies which then included a denial of land rights and self-determination. 

I have no doubt that the changes to politics and to church-state relations in the last two decades have compounded even more the concern expressed by Bishop Kelly.  It is all very well for the likes of Frank Brennan who doesn’t have to fund anything, let alone a hospital system which cannot survive without government support.

I dare say if Australia’s most senior leaders of the Catholic Church were as strident as Pope John Paul II in the condemnation of the recent Iraq War without UN endorsement and without just cause, there would not have been fresh incentives offered by government for new church initiatives in Catholic tertiary education and health care.  If we are to operate in the real world, we know there are trade-offs with modern governments when it comes to prophetic stands and considered silence.

How do we espouse principle while living the compromises that might deliver better outcomes?  On Friday night, my paper for the Australian Catholic Social Justice Council The Timor Sea’s Oil and Gas: What’s Fair? was launched by Richard Woolcott AC.  He had been our ambassador in Jakarta when Indonesia invaded East Timor in 1975.  At the launch, amidst some heckling of “Principle not pragmatism”, he said, “There will be some in this audience tonight who are critical of the attitude of the Australian Government at that time towards Indonesia and East Timor. Some may even see me as in some way complicit in Indonesian policy”.  He had earlier jested that in the presence of so many church people, “I am conscious of the fact that I may not be in a state of grace.”

I happened to be in Dili two weeks ago when Dick Woolcott phoned me agreeing to launch the publication.  Every Timorese to whom I spoke was genuinely delighted that Woolcott had agreed to do the launch.  I know there would be some of the Australian church social justice network upset that I would ask Woolcott to perform such a task.  For them such an invitation would speak too much of compromise and too little of moral purity.  One journalist had phoned me joking about the Jesuits extending such an invitation.  I simply observed that we Jesuits are experts in reconciliation and redemption!  How much better that the following declaration come from Richard Woolcott rather than me:

Four tragedies have befallen the people of East Timor.  First, they endured centuries of Portuguese neglect and colonial rule.  Second, they lived through an often brutal Japanese occupation during world war II.  Thirdly, they were subjected to an often corrupt and insensitive Indonesian maladministration following the invasion in 1975.  The fourth tragedy was the death and destruction in September 1999 after the United Nations vote on autonomy or for independence. I believe that it is very important to avoid a fifth tragedy befalling the East Timorese people in the form of a breakdown in governance which would lead to East Timor becoming a failing, or a failed, state within its first decade of independence. Independence in a small state with limited resources is usually fragile and can be threatened, as we have seen in some African countries and in the South West Pacific, most recently in the Solomon Islands. 

We must cooperate therefore with East Timor and Indonesia to consolidate Timor - Leste’s independence and nurture its fragile institutions.

In the paper, I have made a strong plea for a better deal for the Timorese distinguishing the financial settlement of the Greater Sunrise deal from the negotiation of a permanent maritime boundary.  That plea must now have more chance of being heard in Canberra with Woolcott having said that my paper is “well argued and balanced” and that “In this case it may well be possible to resolve revenue sharing arguments well in advance of finalising the seabed boundary”. Woolcott agrees that “a fair outcome should not be clouded by politics in the coming federal election or by an artificial time limit to strike a deal”.

Nothing ventured, nothing gained.  Politics is all about compromises, fragile alliances, and strategic assessments.  I respect Richard Woolcott as an accomplished diplomat who would now advocate the most honourable and equitable dealing with Timor Leste so as to maximise the prospect of both a free and sustainable Timor Leste and a good neighbourly relationship between Australian and Timor Leste.

As health administrators, you are well aware of the need for commercial viability as a precondition for the delivery of charitable service.  You have always been able to do extra at the margins.  But the big question for you nowadays is:  Who gets access to the core business?  With the public and private hospital system, you probably have greater scope for enacting the complete Catholic life ethic in the private system while having a greater opportunity to exercise the preferential option for the poor through the public system.  Ironically, our Church is now more middle class than it has ever been in this country, precisely at the time when the church’s mission has been most strongly articulated as a church for the poor, a church of the poor. 

In your dealings with government, you have first to discern whether you want additional resources for service to the poor and marginalised or for comprehensive services to the middle class assured health care with a Catholic ethic from womb to tomb.  Some Catholic institutions might be emblematic, providing the leaven for the health system extending health care to the most marginalised, and offering health care with a Catholic ethic.  But symbols must match reality.  There is no point in Mark Latham having access to a public bed in St Vincent’s unless his unknown neighbour has the same access.

It is all too easy for those of us not in government and not in public administration to suggest that decision makers are amoral or insensitive to particular cases.  There are many refugee advocates in Australia today who are convinced of the complete amorality or immorality of the Howard government’s treatment of asylum seekers.  I have been a strong critic of the government’s over-reaction to boat people and its exploitation of the public’s fear of boat people for its own political advantage.  But I have never believed in demonising Phillip Ruddock any more than I would want to demonise an asylum seeker.  Often government does make its moral decision in the privacy of the Cabinet room discussion.  Government considers the options well before the public commentators are apprised the policy and its implementation.  Once Cabinet signs off on the policy, the matter is left in the hands of the responsible minister and all other ministers close the file, returning to the administration of their own portfolios.  When public controversy later erupts, those ministers are perceived to be uncaring and inattentive.  As far as they are concerned they have completed the moral argument and moved on.  There is a right time and a right forum for the making of moral decisions.  There are other times and forums where other persons may be able to provide additional moral insights.  There are the big decisions of resource allocation and the everyday decisions such as when to turn off the patient’s life support system.  You need to tailor the right forum for the decision making and the right forum for regular review of such decision making.  Those involved in the second forum should involve a sample of all those groups affected by the decisions. 

Who is the voice of the marginalised when the church is silenced? We live in a difficult political and media environment with the demonising of dissent by the church.  There is also much demonising of dissent within the church.  We need to get much better at respectful dialogue.  Much of what those with power label as dissent is simply an alternative perspective of those without power.

As administrators and policy makers, you need to have the capacity to consider a decision from all perspectives.  Here is a photo of three women – Amanda, Marilyn and Nasrin. 

Amanda, Marilyn and Nasrin
Amanda, Marilyn and Nasrin

You all know Amanda.  She is the new minister for immigration.  At first glance, you would think that she is the centre of the photo.  On closer inspection, Nasrin is the centre of the photo.  I first met Nasrin after the Easter riot in the Woomera detention centre at Easter time 2002.  I had been conducting a Good Friday service when the riot and breakout occurred.  The following Tuesday, the ACM manager told me that it was a pity that the wind had been blowing the wrong way resulting in some children being hit by tear gas.  I then met Nasrin for the first time.  She showed me the bruises on the legs of her seven year old son consistent with her claim that he had been hit with a baton as well as tear gas.  A single mother, she was in detention for almost three years with her son, until the old minister was convinced by advocates such as Marilyn (who stands between Amanda and Nasrin) to drop his appeal to the High Court.  She was then able to return to the Refugee Review Tribunal and to be issued with her refugee visa. 

Nasrin then single-handedly pursued a complaint before the Human Rights Commission.  Just before Christmas last year (when the journalists were at Christmas parties), Nasrin received an official written apology from the Australian government for the assault on her son.  As decision makers and social critics, we need to be able to stand in the shoes of all three women – Minister Amanda who has to make policies applicable to a vast array of cases, Nasrin who wants justice for herself and her son, Marilyn (wearing her SIEV X shirt) who agitates for policies more sensitive to the particular cases.

Only by stepping into all three pairs of shoes can we appreciate how utilitarian we have become in our approach to policy and service delivery in modern Australia.  If it works, we assume it must be right.  It doesn’t matter how efficient and popular the policy is for Amanda.  If it works an injustice on Nasrin, we must take remedial action. 

There are many Australians who think the Iraq war will have been right if the post-Hussein regime is even only marginally better than the Hussein regime.  Many Australians accept with regret the trauma to a few thousand children held in detention camps because they buy the government line that this will permit government to maximise outcomes serving the interests of off-shore refugees who would never have the chance of employing a people smuggler to bring them to Australia.  If a policy maximises the outcomes for the group, it is presumed to be right no matter what the impact on an individual.

What can bring us back from the precipice of wanton utilitarianism (and economic rationalism) to the font of a coherent political morality in our planning decisions and to a coherent health ethic?  I think there is no option but to rely on the formed and informed consciences of our health professionals and administrators who are confronted with the daily decisions.  I welcome this opportunity to clarify my public position on this vexed issue of conscience.  While in East Timor recently, I received a phone call also from a Murdoch journalist at The Australian seeking my view on the latest church controversy which happened to be the Vatican’s new declaration on the style of bread authorised for use in the Eucharist.  I pleaded ignorance of the Vatican declaration, disinterest in the domestic controversy, and a desire to get back to things that matter.  The journalist then sought my views on conscience which had been invoked by some clergy opposed to the Vatican declaration.  I referred him to my two recent addresses on conscience which were available on the Uniya website.  They were entitled “A Catholic Social Conscience: Can it be Reclaimed in Our Time?”, delivered at Australian Catholic University on 10 June 2004, and “What Do Our Students Rightly Ask of Us, the Church who are Many Parts, One Body?”, delivered to the Sandhurst Diocese Catholic Secondary Education Conference on 12 August 2004. 

An article then appeared in The Australian declaring that Cardinal Pell and I were at war.  This was news to me, and I think to him.  Last week, The Australian was then reporting on my consultations about the Timor Gap claiming that I was a confidant of Paul Keating who had previously labeled me the meddling priest during the Wik debate.  In last weekend’s Weekend Australian I wrote: “In recent days, the Oz has had me at war with Cardinal Pell and now a close confidant of Paul Keating.  If this keeps up, I will hardly recognise myself.”

Fortunately I had already organised a meeting with Cardinal Pell to take place after my return from Dili, in part, to discuss my two previous addresses on conscience.  Respectful, reasoned dialogue is essential for those of us seeking to apply to the Catholic tradition to the complexity of our modern situation.  Cardinal Pell makes no apology for saying that “the doctrine of the primacy of conscience should be publicly rejected”.  I make no apology for urging caution lest such a call include a rejection of the idea that the Catholic individual should form and inform their conscience and to that conscience be true.  The Cardinal rightly thinks I should clarify my distinction between the primacy of means and primacy of ends.  The end we seek is truth, love and the Kingdom of God.  I agree with Cardinal Pell that truth has primacy as the end we seek.  But what means enjoys primacy as we seek truth in our complex post-modern world? 

How do we know truth, discern truth and live truth?  How do we respect life, preserve life and enhance life?  How do we determine what is just care for all?  Sometimes we can answer these questions by a literal application of the declarations of senior members of our church hierarchy, living and dead.  In such cases the formed and informed conscience would be in complete harmony with the consistent, coherent declarations of the pope and bishops.   But in many instances their declarations will be incomplete, will not have covered the field, will not have been stated with sufficient specificity to cover the case at hand, or will not have contemplated the modern development.  At the edges of science, at the boundaries of life, in the complexities of politics, and in the mystery of relationships, all of us (whether we be a lay person or a cardinal) must be committed to forming and informing our consciences and to that conscience being true.  As Catholics, we can do this only by knowing, praying and reflecting on the scriptures and church teachings.

It is not war, it is not even a big deal, that I prefer the pastoral approach of church leaders like Cardinal Murphy O’Connor rather than my local Cardinal Pell.  Pell’s blunt style has the strength of identifying what is distinctively Catholic and authoritative in the mainstream media, but it does not so readily communicate pastoral respect for the experience and discernment of the lay professional who is not privileged to have a personal relationship with him.  In his highly readable book At the Heart of the World, Cardinal O’Connor says:

The starting point for an understanding of the Christian concept of the ‘law within the heart written by God’ is a consideration of human happiness.  What is the most likely to lead to human happiness and fulfillment?  In addressing this question the Christian believer is, of course, proceeding from a conviction that human life, the universe and all it contains are gifts from the hands of a Creator who brought them into being and sustains them.  The Christian also believes that the correct analogy for the relationship between this Creator and his creation is that of a loving Father and his children, and that the journey upon which these children are embarked is intended to lead them ultimately to a fuller life in God.  To enable them to reach that goal God has given them, not a set of prohibitions but a map; and with that map the compass which we call ‘conscience’.

I do not find O’Connor’s approach dangerous.  I think it is helpful, though it be in language very different from the language of Cardinal Pell.  If we provide our Catholic health professionals only with a rule book of “do’s” and “don’ts” issued by the bishops, we know that many of those health professionals will leave the book on their library shelf to gather dust.  But if we can provide them with the map and the compass for the delivery of health services informed by the Catholic ethic, there is a greater prospect that grace and the gifts of the Spirit will find fertile ground as these professional people try to enact a Catholic health ethic in a complex world which throws up moral predicaments which many find irresolvable by reference only to a set of prohibitions. 

With fewer priests in the Australian church, with rapid developments in medical technology, and with increasing complexity in the delivery of health services, it is no surprise that the answers to moral quandaries will now be more often provided by laity well trained in theology and science, following their formed and informed consciences.  Surely the mission of Catholic Health Australia must be to provide the map and the compass for those committed to this journey. 

Though I have had little interest to date in Vatican declarations on the style of wafer permitted at communion, on my return to Australia, I received the news from one of my family that a young niece of mine is unable to consume the hosts usually distributed in Australian parishes.  I am told by this well informed member of the laity that if we assume the bread at the last supper was made of wheat flour it would have been from a grain known today as spelt wheat.  Unlike modern wheat, spelt wheat retained its husk until full ripening - and was therefore hard to mill.  Breeding of wheat in the modern era has produced a grain which drops its husk - providing for easier milling.  Spelt wheat was (and is) very low in gluten content.  Most people intolerant of gluten can eat spelt wheat products - but they are much more expensive than modern wheat.  Those who would strictly insist on faithfulness to the type of bread used at the last supper would use only a flour very low in gluten content, thereby avoiding the problem for most people with gluten intolerance.  So where does this leave us with excessive legalism, theological fundamentalism and scientific development?  Persons with gluten intolerance are surely entitled to share in the table of the Eucharist.

I invite you once again to contemplate the photo of Nasrin, Amanda and Marilyn while you take in Noel Rowe’s Poem Visitation:[1].  You will recall the visitation meeting between Mary and Elizabeth whose husband Zechariah had become tongue tied prior to the birth of John the Baptist:

You, Elizabeth, at once understood the chance
we had to make God more companionable,
one who might again walk among our evenings,
past the swamp oak whose thin, long leaves, in the wind,
whisper where the wild orchid grows,
past the blue gums breaking out their bones
and the ancient pines hauling up their skirts,
all set to dance
 
where women speak of justice, folding sheets and their own
mothers’ memories, of babies, rain and love
(they are laughing now, their bodies wise,
blood and water beckoning), of having earth respected,
          making peace
possible, and how difficult it is
removing wine stains from the tablecloth,
 
here, where cyclamen and tulips, idling light, tell
in mauve and red and gold that life, the best of life,
is waiting, passion, dream. You understood, while  the priest,
your husband, counted up the truths and stars
as if they were his sons, his grief making him
desire high altars and even higher vocabularies,
until the sanctuaries he loved, jealous
of their power, locked away his tongue.
 
So let us, like the maidenhair and violet, be
within our senses scrupulous;  let us
speak words that are winged with fire,
fire that made the first waters undertake a world
but now makes a miracle all the mightier
for being small.

Our mission is to make God more companionable in our hospitals and health care facilities – to see Him walking again amongst our evenings.  Let’s with our senses be scrupulous.  Let’s speak words that are winged with fire.  Our miracle of just care is all the mightier for being small. 

Paul Keating once said that in any race you should always back self-interest because at least you know that it is trying.  But our mission for just care cannot be reduced to enlightened self-interest no matter how broad we might draw the strokes of enlightenment.  Our Catholic health ethic cannot be reduced to utilitarianism no matter what the demands of economic rationalism and of government dictating terms to health providers.  In being true to the Catholic ethos, we must encourage, educate and trust our health professionals in the informing and forming of their consciences.  Equipped with the appropriate compass and map, they will be able to venture faithfully into those realms which are still sufficiently novel not to have been susceptible of universal definition bearing the seal of approval or disapproval by the teaching authority of our church.

Just care in the Catholic tradition in the contemporary Australian social and church environment entails “being cunning as serpents and yet as harmless as doves” (Mt 10:16), setting the moral parameters for just process and just outcomes, trusting and helping our health professionals to form and inform their consciences, and to that conscience to be true.  Our dream is to provide health care informed by the Catholic ethic for all, especially the poor and the marginalised.  That dream is presently unachievable in Australia.  But with the right map and compass we can lead more of the sick and their healers along that road.


[1] N Rowe, Next to Nothing, Vagabond Press, 2004, p. 32

Fr Frank Brennan SJ AO is the Associate Director of Uniya Jesuit Social Justice Centre.

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