Catholic Church and health care



The Roman Catholic Church is the largest non-government provider of health care services in the world. In ancient times, the early Christians were noted for tending the sick and infirm, and priests were often also physicians. Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals. As Catholicism became a global religion, the Catholic religious orders, religious and lay people established health care centres around the world. In 2010, the Church's Pontifical Council for Pastoral Assistance to Health Care Workers said that the Church manages 26% of the world's health care facilities. It has around 18,000 clinics, 16,000 homes for the elderly and those with special needs, and 5,500 hospitals, with 65 per cent of them located in developing countries.

Catholic involvement in the field of health care is born of the teachings of Jesus Christ and of Catholic social teaching. Jesus, whom the church holds as its founder, placed a particular emphasis on care for the sick and outcast - such as lepers - and his Apostles reportedly went about curing and anointing the sick. Jesus identified so strongly with the sick and afflicted, that he equated serving them with serving him. The Benedictine rule of later centuries holds that "the care of the sick is to be placed above and before every other duty, as if indeed Christ were being directly served by waiting on them". In 2013, Pope Francis likened the mission of his church to "a field hospital after battle".

During the Middle Ages, monasteries were the key medical centres of Europe. The historian Geoffrey Blainey describes the Church in this period as an early version of a welfare state. For centuries, Catholic health care was scientifically primitive. Different saints were invoked for every body part in the hope of miraculous cures. Cathedral schools began in the Early Middle Ages as centers of advanced education which evolved into a well integrated network of medieval universities. Catholic scientists (many of them clergymen) made a number of important discoveries which aided the development of modern science and medicine. Saint Albert the Great (1206-1280) was a pioneer of biological field research. In Renaissance Italy, the popes were often patrons of the study of anatomy and Catholic artists such as Michelangelo advanced knowledge of the field through sketching cadavers. The Jesuit Athanasius Kircher (1602 – 1680) first proposed that living beings enter and exist in the blood (a precursor of germ theory). The Augustinian Gregor Mendel (1822-1884) developed theories on genetics for the first time. Women's religious institutes such as the Sisters of Charity, Sisters of Mercy and Sisters of St Francis opened and operated some of the first modern general hospitals.

The moral stance of the Church against contraception and abortion has been a source of controversy in modern times. The Church, while being a major provider of health care to HIV AIDS sufferers, and of orphanages for unwanted children, has been criticised for opposing condom use. Moral issues relating to IVF, surrogacy and stem-cell research are among other areas of potential controversy for the Church in the provision of health care.

Theological basis: euntes docete et curate infirmos


Catholic social teaching urges concern for the sick. Jesus Christ, whom the church holds as its founder, placed a particular emphasis on care for the sick and outcast, such as lepers. According to the New Testament, he and his Apostles went about curing the sick and anointing of the sick. According to the Gospel of Matthew 25:35-46, Jesus identified so strongly with the sick and afflicted that he equated serving them with serving him:



In a 2013 presentation to its twenty-seventh international conference in 2013, the President of the Pontifical Council for Health Care Workers, Zygmunt Zimowski, said that "The Church, adhering to the mandate of Jesus, ‘Euntes docete et curate infirmos’ (Mt 10:6-8, Go, preach and heal the sick), during the course of her history, which by now has lasted two millennia, has always attended to the sick and the suffering."

In orations such as his Sermon on the Mount and stories such as The Good Samaritan, Jesus called on followers to worship God, act without violence or prejudice and care for the sick, hungry and poor. Such teachings formed the foundation of Catholic Church involvement in hospitals and health care.

According to the Catholic Encyclopedia:

Philosophy of Catholic health care
The Benedictine rule, which led the profusion of medieval hospitals founded by the Church, requires that "the care of the sick is to be placed above and before every other duty, as if indeed Christ were being directly served by waiting on them".

Pope Benedict XVI discussed the philosophy of Catholic health and social services in the following terms:

Antiquity
The Church has, since ancient times, been heavily involved in health care. Early Christians were noted for tending the sick and infirm, and priests were often also physicians. According to the historian Geoffrey Blainey, while pagan religions seldom offered help to the sick, the early Christians were willing to nurse the sick and take food to them - notably during the smallpox epidemic of AD 165–180 and the measles outbreak of around AD 250 and that "In nursing the sick and dying, regardless of religion, the Christians won friends and sympathisers".

Among the early saints remembered for this role are the twins Cosmas and Damian. Historian of medicine Roy Porter wrote that these brothers from Cilicia in Asia Minor supplanted the pagan Asclepius as the patron saints of medicine and were celebrated for their healing powers. The pair reputedly won many converts by charitably working for no fee. Said to have lived in the late Third Century AD and to have performed a miraculous first leg transplant on a patient, and later martyred under the Emperor Diocletian, Cosmos and Damian appear in the heraldry of barber-surgeon companies.

Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals after the end of the persecution of the early church. Hospitality was considered an obligation of Christian charity and bishops' houses and the valetudinaria of wealthier Christians were used to tend the sick. It is believed that the first church hospitals were constructed in the East. An early hospital may have been built at Constaninople during the age of Constantine by St. Zoticus. St. Basil built a famous hospital at Cæsarea in Cappadocia which "had the dimensions of a city". In the West, Saint Fabiola founded a hospital at Rome around 400.



St Luke the Evangelist, one of the earliest and certainly most influential Christian converts of all time, was a Greek Physician who probably travelled as a ship's doctor. Notable contributors to the medical sciences of those early centuries include Tertullian (born A.D. 160), Clement of Alexandria, Lactantius and the learned St. Isidore of Seville (d. 636). St. Benedict of Nursia (480) emphasised medicine as an aid to the provision of hospitality. The martyr Saint Pantaleon was said to be physician to the Emperor Maximinianus, who sentenced him to death for his Christianity. Since the Middle Ages, Pantaleon has been considered a patron saint of physicians and midwives.

Middle Ages
Geoffrey Blainey likened the Catholic Church in its activities during the Middle Ages to an early version of a welfare state: "It conducted hospitals for the old and orphanages for the young; hospices for the sick of all ages; places for the lepers; and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates. It was common for monks and clerics to practice medicine and medical students in northern European universities often took minor Holy orders. Mediaeval hospitals had a strongly Christian ethos, and were, in the words of historian of medicine Roy Porter, "religious foundations through and through", and Ecclesiastical regulations were passed to govern medicine, partly to prevent clergymen profiting from medicine.



After a period of decline, the Holy Roman Emperor Charlamagne had decreed that a hospital should be attached to each cathedral and monastery. Following his death, the hospitals again declined, but by the tenth century, monasteries were the leading providers of hospital work - among them the Benedictine Abbey of Cluny. Charlemagne's decree required each monastery and Cathedral chapter to establish a school and in these schools, medicine was commonly taught. Gerbert of Aurillac (c. 946 – 12 May 1003), known to history as Pope Sylvester II, taught medicine at one such school. Petrus of Spain (1210-1277) was a physician who wrote the popular Treasury of the Poor medical text and became Pope John XXI in 1276.

Other famous physicians and medical researchers of the Middle Ages include the Abbot of Monte Cassino Bertharius, the Abbot of Reichenau Walafrid Strabo, the Abbess st Hildegarde of Bingen and the Bishop of Rennes Marbodus of Angers. Monasteries of this era were diligent in the study of medicine, and often too were convents. Hildergard of Bingen, a doctor of the church, is among the most distinguished of Medieval Catholic women scientists. Other than theological works, Hildegard also wrote Physica, a text on the natural sciences, as well as Causae et Curae. Hildegard was well known for her healing powers involving practical application of tinctures, herbs, and precious stones.

In keeping with the Benedictine rule that the care of the sick be placed above all other duties, monasteries were the key medical care providers prior to 1300. Most monasteries offered shelter for pilgrims and an infirmary for sick monks, while separate hospitals were founded for the public. The Benedictine order was noted for setting up hospitals and infirmaries in their monasteries, growing medical herbs and becoming the chief medical care givers of their districts. The Capuchin monks sought a revival of the ideals of Francis of Assisi, offering care after plague struck at Camerino in 1523.

Healing shrines were established and different saints came to be invoked for every body part in the hope of miraculous cures. Some of the shrines remain to the present day, and were in the Middle Ages great centres for pilgrims, complete with relics and souvenirs. St Luke or St Michael were invoked for various ailments, and a host of saints for individuals conditions, including St Roch as a protector against Plague. St Roch is venerated as one who provided care to plague suffers, only to fall sick himself and be "healed by an angel". Through the devastating Bubonic Plague, the Franciscans were notable for tending the sick. The apparent impotence of medical knowledge against the disease prompted critical examination. Medical scientists came to divide among anti-Galenists, anti-Arabists and positive Hippocratics.

Crusader orders established several new traditions of Catholic medical care. The famous Knights Hospitaller arose as a group of individuals associated with an Amalfitan hospital in  Jerusalem, which was built to provide care for poor, sick or injured pilgrims to the Holy Land. Following the capture of the city by Crusaders, the order became a military as well as infirmarian order. The Knights of St John of Jerusalem were later known as the Knights of Malta. The Knights Templar and Teutonic Knights established hospitals around the Mediterranean and through Germanic lands.

Non military orders of brothers also took up the service of the infirmed. By the 15th century, the brothers of the Order of the Holy Spirit were providing care across Europe, and by the sixteenth century the Spanish founded Order of St John of God had set up about 200 hospitals in the Americas. In Catholic Spain amidst the early Reconquista, Archbishop Raimund founded an institution for translations, which employed a number of Jewish translators to communicate the works of Arabian medicine. Influenced by the rediscovery of Aristotelean thought, churchmen like the Dominican Albert Magnus and the Franciscan Roger Bacon made significant advances in the observation of nature.

Small hospitals for pilgrims sprung up in the West during the early Middle Ages, but by the latter section of the period had grown more substantial, with hospitals founded for lepers, pilgrims, the sick, aged and poor. Milan, Siena, Paris and Florence had numerous and large hospitals. "Within hospitals walls", wrote Porter, "the Christian ethos was all pervasive". From just 12 beds in 1288, the Sta Maria Nuova in Florence "gradually expanded by 1500 to a medical staff of ten doctors, a pharmacist, and several assistants, including female surgeons", and was boasted of as the "first hospital among Christians".

Clergy were active at the School of Salerno, the oldest medical school in Western Europe - among the important churchmen to teach there were Alpuhans, later (1058–85) Archbishop of Salerno and the influential Constantine of Carthage, a monk who produced superior translations of Hippocrates and investigated Arab literature. Cathedral schools began in the Early Middle Ages as centers of advanced education, some of them ultimately evolving into medieval universities. The medieval universities of Western Christendom were well-integrated across all of Western Europe, encouraged freedom of enquiry and produced a great variety of fine scholars and natural philosophers, including Robert Grosseteste of the University of Oxford, an early expositor of a systematic method of scientific experimentation; and Saint Albert the Great, a pioneer of biological field research Porter wrote that, "The great age of hospital building from around 1200 coincided with the flourishing of universities in Italy, Spain, France and England, sustained by the new wealth of the High Middle Ages ... The Universities extended the work of Salerno in medical education".

Renaissance
In Renaissance Italy, the Popes were often patrons of the study of anatomy and Catholic artists such as Michelangelo advanced knowledge of the field through such studies as sketching cadavers to improve his portraits of the crucifixion. It is often wrongly asserted that the papacy banned dissection during the period, though in fact the directive of Pope Sixtus IV of 1482 to the University of Tübingen said that the Church had no objection to anatomy studies, provided the bodies belonged to an executed criminal, and was given a religious burial once examinations were completed.



Development of modern medicine
In modern times, the Catholic Church is the largest non-government provider of health care in the world. Catholic religious have been responsible for founding and running networks of hospitals across the world where medical research continues to be advanced. In 2013, Robert Calderisi wrote that the Catholic Church has around 18,000 clinics, 16,000 homes for the elderly and those with special needs, and 5,500 hospitals - with 65 per cent of them located in developing countries.

Europe
Catholic scientists in Europe (many of them clergymen) made a number of important discoveries which aided the development of modern science and medicine. Catholic women were also among the first female professors of medicine, as with Trotula of Salerno the 11th century pysician and Dorotea Bucca who held a chair of medicine and philosophy at the University of Bologna. The Jesuit order, created during the Reformation, contributed a number of distinguished medical scientists. In the field of bacteriology it was the Jesuit Athanasius Kircher (1671) who first proposed that living beings enter and exist in the blood (a precursor of germ theory). In the development of ophthalmology, Christophe Scheiner made important advances in relation to  refraction of light and the retinal image.

Gregor Mendel, an Austrian scientist and Augustinian friar, began experimenting with peas around 1856. Mendel had joined the Brno Augustinian Monastery in 1843, but also trained as a scientist at the Olmutz Philosophical Institute and the University of Vienna. The Brno Monastery was a centre of scholarship, with an extensive library and tradition of scientific research. Observing the processes of pollination at his monastery in modern Czechoslovakia, Mendel studied and developed theories pertaining to the field of science now called genetics. Mendel published his results in 1866 in the Journal of the Brno Natural History Society, and is considered the father of modern genetics. Where Charles Darwin's theories suggested a mechanism for improvement of species over generations, Mendel's observations provided explanation for how a new species itself could emerge. Though Darwin and Mendel never collaborated, they were aware of each other's work (Darwin read a paper by Wilhelm Olbers Focke which extensively referenced Mendel). Bill Bryson wrote that "without realizing it, Darwin and Mendel laid the groundwork for all of life sciences in the twentieth century. Darwin saw that all living things are connected, that ultimately they trace their ancestry to a single, common source; Mendel's work provided the mechanism to explain how that could happen".

Catholic religious institutes, notably those for women, developed many hospitals throughout Europe and its empires. Ancient orders like the Dominicans and Carmelites have long lived in religious communities that work in ministries such as education and care of the sick. The Portuguese Saint John of God (d. 1550) founded the Brothers Hospitallers of St. John of God to care for the sick and afflicted. The order built hospitals across Europe and its growing Empires. In 1898, John was declared patron of the dying and all hospitals by Pope Leo XIII. in The Italian Saint Camillus de Lellis, considered a patron saint of nurses, was a reformed gambler and soldier who became a nurse and then director of Hospital for Incurables in Rome. In 1584 he founded the Camillians to tend to the plague-stricken. Irishwoman Catherine McAuley founded the Sisters of Mercy in Dublin in 1831. Her congregation went on to found schools and hospitals across the globe. Saint Jeanne Jugan founded the Little Sisters of the Poor on the Rule of Saint Augustine to assist the impoverished elderly of the streets of France in the mid-nineteenth century. It too spread around the world.

The Americas
The Spanish and Portuguese Empires were largely responsible for spreading the Catholic faith and its philosophy regarding health care to South and Central America, where the church established substantial hospital networks.

Catholic hospitals were established in the modern United States prior to the American War of Independence. The first was probably Charity Hospital, New Orleans, established around 1727. The Sisters of Saint Francis of Syracuse, New York, produced Saint Marianne Cope, who opened and operated some of the first general hospitals in the United States, instituting cleanliness standards which influenced the development of America's modern hospital system, and famously taking her nuns to Hawaii to work with Saint Damien of Molokai in the care of lepers. St Damien himself is considered a martyr of charity and model of Catholic humanitarianism for his mission to the lepers of Molokai.

The Catholic Church is the largest private provider of health care in the United States of America. During the 1990s, the church provided about one in six hospital beds in America, at around 566 hospitals, many established by nuns. The church has carried a disproportionate number of poor and uninsured patients at its facilities and the American bishops first called for universal health care in America in 1919. The church has been an active campaigner in that cause ever since. In the abortion debate in America, the church has sought to retain the right not to perform abortions in its health care facilities. In 2012, the church operated 12.6% of hospitals in the USA, accounting for 15.6% of all admissions, and around 14.5% of hospital expenses (c. 98.6 billion dollars). Compared to the public system, the church provided greater financial assistance or free care to poor patients, and was a leading provider of various low-profit health services such as breast cancer screenings, nutrition programs, trauma, and care of the elderly.

Asia


During the Middle Ages, Arab medicine was influential on Europe. During Europe's Age of Discovery, Catholic missionaries, notably the Jesuits, introduced the modern sciences to India, China and Japan. While persecutions continue to limit the spread of Catholic institutions to Middle Eastern Muslim nations, and such places as Communist China and North Korea, elsewhere in Asia the church is a major provider of health care services - especially in Catholic Nations like the Philippines.

The famous Mother Teresa of Calcutta established the Missionaries of Charity in the slums of Calcutta in 1948 to work among "the poorest of the poor". Initially founding a school, she then gathered other sisters who "rescued new-born babies abandoned on rubbish heaps; they sought out the sick; they took in lepers, the unemployed, and the mentally ill". Teresa achieved fame in the 1960s and began to establish convents around the world. By the time of her death in 1997, the religious institute she founded had more than 450 centres in over 100 countries.

Oceania


French, Portuguese, British and Irish missionaries brought Catholicism to Oceania and built hospitals and care centres across the region. The church remains not only a key provider of health care in predominantly Catholic nations like East Timor but also in predominantly Protestant and secular nations like Australia and New Zealand.

As restrictions were lifted by British authorities on the practice of Catholicism in colonial Australia, Catholic religious institutes founded many of Australia's hospitals. Irish Sisters of Charity arrived in Sydney in 1838 and established St Vincent's Hospital, Sydney in 1857 as a free hospital for the poor. The Sisters went on to found hospitals, hospices, research institutes and aged care facilities in Victoria, Queensland and Tasmania. At St Vincent's they trained leading surgeon Victor Chang and opened Australia's first AIDS clinic. In the 21st century, with more and more lay people involved in management, the sisters began callaborating with Sisters of Mercy Hospitals in Melbourne and Sydney. Jointly the group operates four public hospitals; seven private hospitals and 10 aged care facilities.

The Sisters of Mercy arrived in Auckland in 1850 and were the first order of religious sisters to come to New Zealand and began work in health care and education.

The Sisters of St Joseph, founded in Australia by Australia's first Saint, Mary MacKillop, and Fr Julian Tenison Woods in 1867. MacKillop travelled throughout Australasia and established schools, convents and charitable institutions. The English Sisters of the Little Company of Mary arrived in 1885 and have since established public and private hospitals, retirement living and residential aged care, community care and comprehensive palliative care in New South Wales, the ACT, Victoria, Tasmania, South Australia and the Northern Territory. The Little Sisters of the Poor, who follow the charism of Saint Jeanne Jugan to "offer hospitality to the needy aged" arrived in Melbourne in 1884 and now operate four aged care homes in Australia.

Catholic Health Australia is today the largest non-government provider grouping of health, community and aged care services in Australia. These do not operate for profit and range across the full spectrum of health services, representing about 10% of the health sector and employing 35,000 people. Catholic organisations in New Zealand remain heavily involved in community activities including education; health services; chaplaincy to prisons, rest homes, and hospitals; social justice and human rights advocacy.

Africa
Catholicism has grown rapidly in Africa over the last two centuries. As in all other continents, Catholic missionaries established health care centres across the continent - though limitations on Catholic institutions remain in place for much of Muslim North Africa. Caritas Internationalis is the Church's main international aid and development body and operates in over 200 countries and territories and co-operates closely with the United Nations.


 * HIV AIDS

Pope Paul VI issued the Humanae Vitae Encyclical Letter on the Regulation of Birth in 1968, which outlined opposition to "artificial birth control" on the basis that it would open a "wide and easy a road ... towards conjugal infidelity and the general lowering of morality". In response to the subsequent AIDS epidemic which emerged from the 1980s onward, the United Nations Population Fund (UNFPA) has argued that "comprehensive condom programming is a key institutional priority ... because condoms ... are recognized as the only currently available and effective way to prevent HIV – and other sexually transmitted infections – among sexually active people". A 2014 report by the The U.N. Committee on the Rights of the Child called on the Church to "overcome all the barriers and taboos surrounding adolescent sexuality that hinder their access to sexual and reproductive information, including on family planning and contraceptives".

In Africa today, the church is heavily engaged in providing care to AIDS sufferers amidst the AIDS epidemic. Following the election of Pope Francis in 2013, UNAIDS wrote that the Church "provides support to millions of people living with HIV around the world" and that "Statistics from the Vatican in 2012 indicate that Catholic Church-related organizations provide approximately a quarter of all HIV treatment, care, and support throughout the world and run more than 5,000 hospitals, 18,000 dispensaries and 9,000 orphanages, many involved in AIDS-related activities." UNAIDS co-operates closely with the Church on critical issues such as the elimination of new HIV infections in children, and keeping their mothers alive, as well as increasing access to antiretroviral medication.

Religious orders dedicated to care giving
In keeping with the emphasis of Catholic social teaching, many religious institutes have devoted themselves to service of the sick, homeless, disabled, orphaned, aged or mentally ill. Women's religious institutes played a particularly prominent role in the development of the Catholic Church's health care networks.

Bioethics
Because the Catholic Church opposes abortion, euthanasia, and other health procedures, Catholic health facilities will not provide most or all such services. In public debates, particularly among Western nations like the United States, this has raised questions over insurance public/private financial co-operation and government interference and regulation of health facilities. Writing in 2012, the Australian human rights lawyer and Jesuit Frank Brennan, in response to calls for public funding to Catholic hospitals to be contingent on them offering the "full suites of services", said that:

The Catholic Church's opposition to abortion has also restricted its hospitals' treatment of miscarriages. In cases where evacuation of the miscarriage from the uterus is medically indicated, doctors have been prohibited from carrying it out while a fetal heartbeat is still present, "in effect delaying care until fetal heart tones cease, the pregnant woman becomes ill, or the patient is transported to a non–Catholic-owned facility for the procedure."

A number of controversies have arisen over the application of these treatments in Catholic hospitals, or the lack thereof; for instance, in the United States, a member of a hospital ethics committee was excommunicated when she approved a therapeutic abortion to save a patient's life, and in Germany, a case of two hospitals turning away and refusing to examine or treat a rape victim led to new guidelines from the country's bishops stating that hospitals could provide emergency contraception to victims of rape.

As regards IVF and surrogacy, the church is currently formulating responses to new technologies.

Physicians
There are a number of patron saints for physicians, the most important of whom are Saint Luke the Evangelist, the physician and disciple of Christ; Saints Cosmas and Damian, 3rd-century physicians from Syria; and Saint Pantaleon, a 4th-century physician from Nicomedia. Archangel Raphael is also considered a patron saint of physicians.

Surgeons
The patron saints for surgeons are Saint Luke the Evangelist, the physician and disciple of Christ, Saints Cosmas and Damian (3rd-century physicians from Syria), Saint Quentin (3rd-century saint from France), Saint Foillan (7th-century saint from Ireland), and Saint Roch (14th-century saint from France).

Nurses
Various Catholic Saints are considered patrons of nursing: Saint Agatha, Saint Alexius, Saint Camillus of Lellis, St Catherine of Alexandria, St Catherine of Siena, St John of God, St Margaret of Antioch, and Raphael the Archangel.