: Just Care
Just Care: Political Reality and Change
Fr Frank Brennan SJ AO
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
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
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
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
We must cooperate therefore with East Timor and Indonesia to
consolidate Timor - Leste’s independence and nurture its fragile
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
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.
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
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
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:.
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,
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.
 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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