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Seek Justice: Come to the Edge

Keynote address for Catholic Health Australia
2005 National Conference
Perth 29 August 2005

Mark Raper SJ


The 'preferential option for the poor' means that:
the needs of the poor take priority over the wants of the rich;
the freedom of the dominated takes priority over the liberty of the powerful;
the participation of the marginalised groups in society takes priority over the preservation of an order which excludes the marginalised.
David Hollenbach SJ, Claims In Conflict, 1979

"At the end of our lives we will be judged by love."
St. John of the Cross


Looking around this hall this morning I see the many faces of Catholic Health care in Australia, nurses and doctors, administrators and pathologists, mission leaders and pastoral carers. Let us try to visualise too the faces of some of the tens of thousands of people whom daily you nurse to life, or help to die with dignity. Your mission is to serve people when they are pushed to the edges, often to their limits. A moment ago we called to mind the faces of the indigenous owners of this place, the Noongar people. Indigenous Australians are surely at the edge with regard to health care. They die 20 years prematurely; their diabetes rate is double that of other Australians; mental illness among them leads to twice as many deaths; their mortality from heart disease is six times that of the general population of Australians. As you network these days, you will share your concerns about the people whom you accompany and serve, and please God, you will get new ideas and energy to defend their rights.

"Come to the edge". We speak of a cutting edge, a clean edge, a sharp, straight or leading edge, a hard, blunt or plain edge, a ragged edge, a tracking edge. One can live on the edge, one can be at the edge, which sometimes means at sanity's edge. Many of you do assist our brothers and sisters who find themselves at reason's limits:

O the mind, the mind has mountains, cliffs of fall
Frightful, sheer, no man fathomed
Hold them cheap may who ne'er hang there. (G.M.Hopkins)

You go to assist and serve people in these limit situations, at the edges of human experience, because it is your mission to do so. Thank you for what you do for all of us.

"Seek Justice - Come to the Edge" is a poetic and perhaps provocative way to describe your mission in Catholic Health. It asserts a fundamental aspect of Christian spirituality that underpins our ethical behaviour: that people who are not normally at the centre of society do matter, that "the last shall be first". In a gospel story, the Good Samaritan, in a spontaneous, neighbourly gesture, rescued a person beyond the edge of his own social group, and set up a reliable way for the wounded man to be healed. Through this story, Jesus explained the fundamental law of love. "At the end of our lives", said St. John of the Cross, "we will be judged by love."

Society itself will only be in harmony if those at its edges, or margins, are valued and included in society's arrangements. "If you want peace, work for justice," said Paul VI. John Paul II called the work for justice "solidarity" with others, especially with those at the edges of society.

Solidarity is not just a vague feeling of compassion,…it is a firm and persevering determination to commit oneself to the common good… because we are all really responsible for all.

John Paul II used the terms "preferential option for the poor" and "love of the poor", insisting that the gospel demands this. Quite some years ago, David Hollenbach gave us a useful formula for how we might apply this gospel ethic in practice:

The 'preferential option for the poor' means, he said, that:

the needs of the poor take priority over the wants of the rich;
the freedom of the dominated takes priority over the liberty of the powerful;
the participation of the marginalised groups in society takes priority over the preservation of an order which excludes the marginalised.

I have no background in health. I speak to you out of two sets of experience. First I worked for twenty years outside Australia with refugees. Refugees, you might say, are defined by being on the edge, beyond borders. Second, I am now the Australian leader of a religious congregation which is looking for ways to build its ministries in sustainable ways, in partnership with lay people, in order to fulfil our mission which is to serve where the needs are greatest.

In the Jesuit Refugee Service, which when I left it was at work in 60 countries, we learned that the three aspects of our mission are intimately linked: accompaniment, service and the defence of the rights of refugees. The service we offer flows from our way of being present. Even though refugees are human rights abuse made manifest, we could not just 'add on' some advocacy. Their empowerment flows from our relationship with them. Knowing and serving them led to all manner of steps to defend, with them, their rights. I carry with me what I learned then, that organisations like yours and ours will be integrated in our mission if there is an intimate link between our way of being present, our style of service, and the actions for justice that we undertake. If only sections of our organisation have a concern for those on the edge, that is not good enough.

Now as a Provincial, I see that religious orders have a choice either to wind down slowly, or to pursue our mission vigorously. We are apostolic, we are on a mission, so we have chosen the latter. Choosing thus, we find many competent and faith filled lay people willing and able to join in this mission and to assume leadership in mission. The leadership of the Church in the 21st Century lies with them. The Vatican Council spoke about this 40 years ago in Lumen Gentium (No. 30 – 38). Yet this leadership by lay people cannot be taken for granted and requires preparation and a spirituality suited to it. One important role of religious today is to support lay people as they assume their role. The transition requires an adjustment for us religious. We are inviting lay people to roles in running our core business. It is not a matter of getting a CEO to do the administration, while we Jesuits still animate the mission. The CEO of an institution must be its mission leader and will be held accountable precisely on the implementation of mission.

Most of the 65 Catholic hospitals in Australia, and the hundreds of Catholic nursing and convalescent homes and homes for the elderly and for children, were founded by religious orders. They were founded as ministries to all in society, not just to serve Catholics. The followers of Catherine McAuley and of Mary Aikenhead went into health care because of the needs and the poverty at the edges of the society of their day. The Australian Grey Sisters, for example were founded to go to the homes of women who could not afford to go to the doctor or to travel to surgeries and hospitals. They went against the conventional wisdom of the centre at hat time. They went to the poor, to women, and they went with few resources.

The leadership of many of the organisations that the religious began has now transferred to lay hands, and as businesses, they are doing very well, thank you. The business magazine, BRW, in its August 11 edition, reports:

Many of the country's largest, best and fastest-growing medical enterprises are private operations run by church and charity groups. The not-for-profit hospitals provide nearly 40% of Australia's private hospital beds.

The article lists two reasons for this success: "government policies promoting greater private sector involvement (including the 30% rebate on health insurance premiums)", and the "steady real growth in medical spending". Clearly you have handled the transition superbly from the operational and financial standpoint. Our question today is whether you can bridge the gap between corporate success and marginal people.

An edge is identified in tension with a centre. What are the preoccupations at the centre that distract us from considering the edges? Is it conventional managerial and economic wisdom, which says we should stay in the mainstream and help more people for the same cost, so that at least the middle class have high level services even if it means that some poor people miss out? Is it the belief that our institutions must survive on free market business principles? Or that we can only afford to assist the people under private insurance, and therefore, regrettably, we let the insurance companies tell us which ailments we may treat? Are we really only talking about a marketing edge, a trendy slogan setting Catholic health apart from our competitors, while in reality we market a product indistinguishable from the other players?

The Catholic Church is institutional. Through institutions the Church has purchase in society. But if the Church's service is indistinguishable from other services in the market, what is the point? Our discussion about the edge is valid so that the Church can remain true to its gospel mission. The Church has credibility when humbly we acknowledge our mistakes, our compromises, and we do instead what the gospel asks of us.

Every major religion tries to make sense of suffering. The cross, that piece of wood hung on the wall in many Catholic hospitals and homes, speaks of a suffering that gives hope. "If it were not for hope, our hearts would break,"the proverb says. The image of the cross fixes in time and space an event that occurred at the edge of Jerusalem, an event that transcends our comprehension. But the care and service you offer in your institutions gives it meaning. Yours is a ministry offered because you believe that human suffering can have meaning. The horizontal arms of the cross represent the wide arms of Catholic health which, being "no respecter of persons", reaches out to embrace all who suffer. The vertical line of the cross represents the way your presence, and your service and your action for justice make a living link between God and our world. In such a way, because you come with compassion to these edges of human life, the piece of wood on the wall symbolises the spirituality that drives you to so much more.

Maha Gosananda, a patriarch of the Buddhist church in Cambodia, gives from his tradition, another, but very compatible view of suffering and of the path to peace:

The suffering of Cambodia has been great.
This suffering gives rise to a great compassion.
A great compassion creates a generous heart.
From a generous heart is born an honourable person.
An honourable person builds a united family.
A united family generates a gentle community.
A gentle community creates a peaceful nation.

Walking with people on the edge, gives a new perspective on our world. Solidarity brings sea changes. I speak of my own experience with refugees, where so many encounters made me stop and look again at my life and my world. I could see through the eyes of another, a fresh view, a fresh perspective that gives joy, and makes new sense of life, of suffering, of who we can be for one another. Such relationships ground our service. Catholic health care means solidarity, means walking with people who need it, and adjusting what is on offer to their reality. That solidarity will inform our stance towards governments and insurance companies who fund health care.

Regarding your service and the defence of rights, how much freedom do you retain when you offer services under contract with government or agreement with insurance companies? There must be times when you are under pressure to become like a government agency on the one hand and like commercial businesses on the other. Whereas your role should be to protect the individual against the power of the State and also of the economy, you nonetheless run the risk of being precisely the agent of those forces. You have various accountabilities to balance: your contractual obligations to the government, your moral obligations to your clients, and your faithfulness to your mission. Moreover, we the public need you as our intermediaries in order to hold government accountable for the proper administration of public policy.

Accompaniment and service in humility give credibility. Catholic Health could come up with the creative Medicare Gold, and you have to be listened to when you speak of the rights of the over 75s, precisely because you are there with them in so many parts of the country.

Is the edge of your service at Australia's borders? John of God Health is giving East Timor's only hospital a pathology unit. Just by being there, you can learn what will be the next, more effective service that you can offer. You will meet and understand the people and their need for justice. Everyone in the business knows the international aspect of health care. A mishandled outbreak of SARS in China will have repercussions for you within 24 hours.

Are you just another service provider or are you in a ministry? When the squeeze comes, when the federal government begins to tax the not-for-profits, what will happen to your service? Hospitals like yours are the only places that asylum seekers and those on Temporary Protection Visas who are denied access to health services can go. It is deeply important that you begin early to include these activities at the centre of normal business, so that when the squeeze comes, these services are not dropped as non essential extravagances. It could be a regular exercise to ask, to which needy communities are we not reaching out, and which needy communities are we pushing the government to attend to? The homeless? Rural communities? The mentally ill?

Let me conclude. If your mission is clearly focussed, and owned by all your caregivers, you will have a happy team. With a happy team you will offer better service, and you will have happy clients, you will meet the bottom line more efficiently, you will address risk management more smoothly.

You will network among yourselves - within your organisations, looking for how to fulfil this mission - and among your partners. If Mercy Care feels it cannot sustain an important service at the edge of the Sandy Desert, then you'll be free to approach St John of God or another Catholic body to see if together something can be done.

If your service is to be both a sustainable business and give priority to the poor, then your institutional leaders will need to be imbued with that mission. The job descriptions and key performance indicators, and bonuses of your CEOs and of your directors will be designed to reflect how well they implement that mission. Your policies will combine realism with compassion, and will be reinforced by research, by experience, and by formation of co-workers.

Your organisational language and position descriptions will be written in terms of mission. I notice in your newsletter that all employees at Berwick Hospital are called caregivers, because everyone, from clinical to admin to catering, works to ensure patient needs are met.

You will know the people whom you serve. You'll walk with them at the edges of their lives, at the edges of our society, and you will bring justice.


* Mark Raper SJ is the Provincial of the Australian Jesuits and former Director of Uniya.

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