Listening to the Whispers: Re-thinking Ethics in Healthcare

3. Ethics of Articulation: Constituting Organizational Identity in a Catholic Hospital System

3 Ethics of Articulation Constituting Organizational Identity in a Catholic Hospital System simon j. craddock lee Introduction The religious morality underpinning Catholic healthcare informs the ethical motivation to provide care for the poor and the sick in the modern world. The challenge posed by the world is how to sustain an organizational identity that is at once the descendant of the formal Catholic Church and yet a distinctive response to the demands of the pluralistic environment of contemporary healthcare. This chapter documents and analyzes the pragmatic dimension of ethics at work in a Catholic hospital system through the daily work of women religious (sisters) and their lay colleagues.1 In describing the ethico-political constitution of Catholic Paci fic Healthsystem (CPH),2 this chapter demonstrates how the practice of ethics extends beyond sets of rules and guidelines to a way of thinking, of self-fashioning, not only of individuals but also of a new catholicity—a model that engages religious legacy and community values, navigating the increasing social pluralization of contemporary society, to reflect truly cultural dimensions of ethical praxis. First, I will define my terms and briefly describe the research methodology . Then, I will provide the context of anthropological research in Catholic healthcare ministry and preface my analysis of CPH with the particular historical setting of contemporary California that has helped shape American assumptions about, and expectations of, Catholic hospitals . My analysis will show the relation of faith and agency in the CPH 69 system and makes a case for the ethical effects of values articulation through a juxtaposition of the anthropology of organizations with a Catholic ethics of discourse. Explicit examples of exteriorizing processes, programmatic devices, and language intervention reinforce mission, creating an ethico-political culture to which business practices should conform. The implementation of an ethical decision-making process tracks this ethical culture in practice. My analysis concludes with the problem of translation that attends such organizational processes at the intersection of healthcare, religion, and modern pluralization. Terms and Methodology In Catholic terminology, “women religious” is the generic term for those who have taken vows of religious life; this story concerns “sisters,” who are active in public ministry, rather than “nuns” of contemplative orders (cloistered or not). For ease of analysis, I use the label “secular community hospitals” to describe facilities that are traditionally not-Catholic, to distinguish them from the traditionally Catholic-identified hospitals. But as my informants reminded me, Catholic facilities are arguably also community hospitals; CPH generally refers to their secular partners as simply “community hospitals.” A sponsoring congregation is the official group of sisters (e.g., Sisters of Charity of the Incarnate Word) who founded a hospital as one of their works. “Sister-sponsors” may be employed across the system according to their individual training as nurses, lab techs, or administrators, yet because they are both employees and sisters, they occupy a unique social role and are perceived as conduits to CPH leadership. “Mission” is a ubiquitous term in not-for-profit healthcare now, but in Catholic hospitals , it refers to the religious purpose of caring for the poor and the sick through the core values, especially of particular congregations. CPH core values are dignity, collaboration, justice, stewardship, and excellence. “Mission Integration” refers to the division charged with fostering that sense of purpose in every aspect of the organization’s daily operations, literally ensuring that mission is integral to each function. Fieldwork Methods and Analysis This chapter is drawn from a larger study based on 18 months of sustained ethnographic fieldwork capping a six-year critical engagement 70 lee with one of the largest hospital systems in the United States (Lee, 2003). In my fieldwork, I chose individual hospital sites that have a history of community and partnership interaction, focusing especially on secular facilities now operated by this Catholic system. I conducted daily participant observation at a charity clinic arm of a Catholic hospital, the system office, and two regional offices. I spent one month per facility among: three nonreligious community hospitals in southern, central, and northern California as well as a Catholic hospital sponsored by a different order (Saint Catherine-by-Sea) than the hospital where I had earlier conducted an additional six months of comparative fieldwork in chaplaincy and spiritual care (Incarnation Hospital). I attended administrative and executive meetings, including strategy, planning, operations, mission integration , and governance with management, medical staff...