Charity, Act Not Emotion

At times looking at an example of someone getting an idea wrong is actually the most helpful thing in formulating a better understanding of the topic. That's how I felt, some while back, when I ran into this post descriptively entitled, "Love Never Ends, So How Could A Just Society Bring An End To Charity?" which argues:

I have heard it said by many people that if the government provides for the needs of society through its social services, there will no longer be any need for charity. Yet, we are called to charity, and therefore, we must not allow governments to interfere in our acts of charity. There is something very mixed up with this notion. It is perverting the very nature of charity, twisting it in a way to make sure there will be people who are suffering, so that they can be the objects of our good will. We are being told we cannot wish for a more just society because if such a society exists, charity will vanish.

But this cannot be the case, can it?

What exactly is the aim of charity but love? Love can be manifest in many ways; when someone is in dire straights, love seeks to help them out of it. But that is not all love seeks for them. Indeed, does a husband or wife love their family less after they have provided for their family’s needs? Certainly not! If we would not look at our family relationship in this way, why do we look at the world in this fashion?

...

Charity is caritas, love; to act in charity is to follow the dictates of love. Charity seeks for the betterment of others; in doing so, it recognizes that the most immediate need should be taken care of first (food, shelter, clothing, health, quality of life, etc). If these are taken care of, this does not diminish the need for charity: it provides room for greater forms of charity, for greater forms of love.

Now, I don't think that, "Where will that leave charity," is a universally good answer to suggestions of instituting social services. In a society which is already weak and uncohesive, there's clearly a need for some minimal level of social services. The legitimate question to be argued between political factions is what the appropriate extent and form of social services should be -- not whether there should be any at all. (If you're unsure of this, ask yourself if you'd really support closing government homeless shelters and food assistance, abolishing unemployment, or eliminating the federal deposit insurance that assures that if your bank runs into problems your saving account doesn't vanish over night. The sight of people literally dying in the street was not uncommon 150 years ago in many parts of what is now the developed world, and the fact that we've largely eliminated that -- though social programs as well as through charity -- is certainly not a bad thing.)

However, I think the above blockquote shows a fairly common progressive misunderstanding of human nature and the nature of moral action, which it's important to recognize and counter if we're to come to a proper understanding of social and moral relationships.

It is suggested that since charity is love, it clearly goes far beyond providing people with physical necessities. And so, even if we are not responsible for providing people with physical necessities, we need not worry about charity losing its place in our social relationships. What I think this misses is that we are, as humans, incarnational beings. We are not pure minds or pure souls, but mind and soul bound intimately to physical body. And as such, our physical actions are not only one way to express our love and relationship with others, but one of the primary things that forms our relationship with others.

Picture an extreme example of this: Imagine that at some future point it become a pressing political issue that nearly 10% of children are unparented and a shocking 30-50% are under-parented. Children are our future, and we cannot stand by while people neglect our future! No loving parent would want to see their children disadvantaged as a result of his or her not having time or training for proper parenting! A national parenting agency is established, and properly trained government workers will make sure that all children receive minimum levels of food, affection, personal interaction and age level appropriate conversation in intellectually stimulating and hygenic surroundings. Parents will, of course, not be sidelined. So long as they obey proper child rearing regulations, they are welcome to provide above-and-beyond care and gifts to their children, and they can even engage in primary care opportunities such as nightly read-alouds and tucking into bed, so long as they have suitable training to provide as rich and nurturing an experience as parenting agency workers would.

I think virtually everyone would see such a system as clearly dystopian, because it would disrupt a relationship which we see as fundamental to human society. People would talk about the state "seeking to replace parents" -- and in a practical sense this would be true to a certain degree. But more insidiously, such a program would strike at the very root of relationship between parent and child. This is because it is through the act of caring for our children that we as parents learn to love them. It is the knowledge that this small life is dependent upon us for all things which first awakes love in us. And it is the slow training in putting other before self which parenting involves -- the nights spent awake when one would rather sleep, the diapers changed, the games played, the knees bandaged, the stories told, the awkward performances watched, the living earned, the necessities and small luxuries bought -- that we tern that inclination to affection into a deep and active love. And if the necessity of that care was removed, I think it takes little imagination to see that this fundamental relationship would be blighted at its root. Indeed, we have a rather good test case of this looking at those times when it was common for rich parents to put the day-to-day raising of their children almost entirely in the care of a nurse maid -- which if the literature written by such societies is to be at all believed often left the relationship between the nurse and the children incredibly intimate, while the relationship between parents and children became distant.

A less outlandish example of the replacement of familial relationships with statist ones can be seen in our relationships with our parents. Working with a large number of recent immigrants from India, one of the biggest social differences that stands out when family interactions are discussed at work is that in Indian families it is expected that unless they are very rich, when parents retire they will go to live with one of their married children, or circulate from one filial household to another, staying at each for several months out of the year. This is practically unheard of in the US at this time, and it is frequent for US-born people around the office to say, when hearing about this, "I couldn't stand to have my parents visit for more than a week." However, such arrangements were far more common both in the US and in Europe before social programs to assure an independent income for the retired rendered such arrangements unnecessary. One can argue that longer distances make for closer families, and certainly, human nature being what it is, enforced closeness can lead to resentment instead of love, but I don't think it takes a great deal of imagination to see that this is a case where removing the need to care for each other in a practical and financial sense has allowed the erosion of social relationships.

Going beyond the family, and as I began my annual re-reading of Dickens' A Christmas Carol the other evening, I'm reminded of the famous exchange between Scrooge and the charitable gentlemen in Stave One:

"At this festive season of the year, Mr. Scrooge," said the gentleman, taking up a pen, "it is more than usually desirable that we should make some slight provision for the Poor and Destitute, who suffer greatly at the present time. Many thousands are in want of common necessaries; hundreds of thousands are in want of common comforts, sir."

"Are there no prisons?" asked Scrooge.

"Plenty of prisons," said the gentleman, laying down the pen again.

"And the Union workhouses?" demanded Scrooge. "Are they still in operation?"

"They are. Still," returned the gentleman, "I wish I could say they were not."

"The Treadmill and the Poor Law are in full vigour, then?" said Scrooge.

"Both very busy, sir."

"Oh! I was afraid, from what you said at first, that something had occurred to stop them in their useful course," said Scrooge. "I'm very glad to hear it."

"Under the impression that they scarcely furnish Christian cheer of mind or body to the multitude," returned the gentleman, "a few of us are endeavouring to raise a fund to buy the Poor some meat and drink and means of warmth. We choose this time, because it is a time, of all others, when Want is keenly felt, and Abundance rejoices. What shall I put you down for?"

"Nothing!" Scrooge replied.

"You wish to be anonymous?"

"I wish to be left alone," said Scrooge. "Since you ask me what I wish, gentlemen, that is my answer. I don't make merry myself at Christmas and I can't afford to make idle people merry. I help to support the establishments I have mentioned -- they cost enough; and those who are badly off must go there."

Quite the progressive in his own day, Dickens' view of social solidarity is the opposite the modern progressive outlook, in that he sees Scrooge's failure as being that of refusing to involve himself directly in supporting charitable work. Perhaps in an updated version, Scrooge would instead be asked to commit himself to gathering signatures to raise awareness of the necessity of opening a new and improved union workhouse funded via a tax on those in the top five percent of annual incomes. In the modern progressive pantheon, much greater virtue would be assigned to such advocacy for the many than for the more personal virtues of contributing to a fund for Christmas jollity for the poor, buying a prize turkey for a poor family, doubling Bob Cratchet's salary, or securing better care for Tiny Tim.

The danger of such an approach is that whereas we shall always have some contact with our families, even if we are not responsible for providing care in old age, unemployment, and distress for them. In the wider society, if we are absolved of any direct responsibility for helping to provide for those suffering in our neighborhoods or parishes, we are more likely than not simply never to encounter them at all. Expanding social services fund a contracting of our social sphere to only those whom we wish to see, since we are told that, like so many Scrooges, we should pay our taxes and rely upon the workhouses and the poor law to do their work. When real actions are no longer required, our relationships, which are formed by our actions, will soon shrivel quietly away.

This is why the Amish, hardly a group known for lacking solidarity with those in their community who are in need, eschew both government programs such as social security and medicare and also private insurance, using instead a direct community fund from which they pay for medical care and other emergency expenses on a case by case basis.

In the wider world, our communities are already far more fractured than those of the Amish, so we would be foolish to immediately abandon all the mechanisms we have developed for securing basic necessities for those in need in a mobile and fragmented society. At the same time, however, we must not allow ourselves to imagine that, when we place ever more needs under the maintenance of massive programs paid for through taxes, that we diminish our social solidarity and our relationships with others.

Economics and Morality

I may have to turn in my Catholic Geek card for this admission, but I still haven't finished reading Caritas in Veritate, I'm only about ten pages in. Though I've tried the usual background reading, Benedict's prose (though more readable than some of his predecessor's) is not really the sort of thing one can read one paragraph at a time in between working. And while I do usually have 30-60min between 11pm and midnight in which to read before falling asleep, I must confess I've mostly been devoting that time to finishing a spy novel rather than turning tired eyes to Catholic social thought.

However, if I may nonetheless take the liberty of addressing some of the general discussion of economics and morality which has been stirred up by the encyclical, there is what seems to me a familiar dynamic coming into play as people discuss whether the Church can or should teach on matters of economics. The situation strikes me as somewhat similar to the argument about whether the Church can teach on matters of science.

On science, I would like to think, the terrain if fairly well understood. The Church does not and cannot teach with any particular authority on scientific theories themselves: Is the universe six billion years old, or only 6000? Is string theory a load of rubbish? Does the Earth revolve around the Sun? Will the expansion since the "big bang" end in a "big crunch" or in the heat death of the universe?

However, the Church can and must speak on issues of theology or morality which are brought up by scientific and technological progress: Do humans have immortal souls despite being descended from animals? Is in vitro fertilization acceptable? Should we clone or genetically engineer humans?

All these the Church can and should speak to, because while science provides us with powerful tools for explaining the physical world around us and developing new technologies, it does not provide us with any sort of guidance about what the world actually means or what we ought to do in it.

Now, with science, there are those on both sides who disagree with this assessment. On the one hand, creationists insist that the Church does have special insight into the physical workings of the world and that we should take the indications in revelation above the indications of our senses and empirical science. On the other hand, there are people who insist that the Church has no business talking about the morality of embryo destroying research or cloning because "that's mixing science and religion", or indeed deny that there is anything beyond the physical world that can be known at all.

With economics we again have a field of study (one with, arguably, roughly the same strength descriptive power yet inability to account for all factors that characterizes evolutionary biology as well) which different people take in different ways as regards its relation to religion. For convenience sake, I will attempt to name them:

Indifferentists basically hold that economics are deterministic and economic decisions are not moral decisions. As in the Greek myth in which the king casts his daughter and grandson into the sea in a basket and rationalizes, "I have not harmed them. If they drown, it is Poseidon's fault," these people consider, "That is what the market determined," to exculpate any moral responsibility for an action.

Structuralists hold that Catholicism requires a particular set of social and economic institutions, and are prepared to dismiss any evidence from economic science that these might not actually achieve the desired effect. This often involves denying some fairly basic economic insights, such as that supply and demand affect the price of wages in much the same way as any other good or service. The sentiment among this group seems to be that what look like basic economic laws are in fact just tendencies in our particular society, and if another set of institutions is adopted, economic laws an be safely ignored.

Economic-moralists, on the other hand, accept the findings of economics, and support economic and social institutions which they believe will be most conducive to economic development, but also hold that all economic actors retain a moral responsibility to behave justly towards others, and a civic responsibility to support social programs or structures which will mitigate against any short term suffering caused by allowing economic development to more forward freely.

Now, it seems to me that much of the sound and the fury surrounding Catholic discussions of economics centers around Structuralists holding Economic-moralists to really be Indifferentists, since the Economic-moralists do not support the Structuralists' call for radically changing economic institutions. Meanwhile, the Economic-moralists, perhaps add to the confusion at times by denying that there are any Indifferentists.

Spiritual Armor and Social Justice

Fr. Fox, the best blogging priest on the 'nets, posted his recent talks for a homeschooling conference. Go and read; perusing Fr. Fox's homilies and speeches is like taking a mini-retreat.

From his talk on equipping your children with spiritual armor:

Paul tells us our Faith is a shield.

There are a lot of things to say about Faith, but let me highlight three aspects.

Faith is about knowledge—it matters that we know our Faith;
Faith is about obedience to what Christ teaches—it matters that we live our Faith;

And above all…

Faith is a choice of the will—which is why the habits of faith matter, because they’ll help us stand our ground and keep our choice strong when it’s not easy.

Notice Faith is a shield—not the sword. Our Faith is not mainly an offensive weapon, but a means of defense—against the attacks of the enemy.

"Flaming arrows" sound pretty scary, but St. Paul assures us our shield of Faith will do the job.

Remember, our Faith is not just ours—when we speak of our Faith, we mean our personal, individual choice of faith, but we also speak of the Faith of the Church. Remember that from the Ritual of Baptism?

Right before the child or the adult is baptized, the deacon or priest asks that person—or others to speak for her—to renounce the devil, and profess faith in the Father, Son, and Holy Spirit. Everyone joins in, and then the priest says, "This is our Faith. This is the Faith of the Church. We are proud to profess it in Christ Jesus our Lord. Amen!"

When we recall that people die for that profession, even at this hour, those words take on new meaning, don’t they?

My point is, we have as our shield not only our personal faith, but the Faith of the Church, the whole Church. But it has to be personal, too; we have to be used to holding it, with a familiar grip—or we’ll fumble and drop it at the first sign of trouble.

And from his talk to teenagers on social justice:

Now, that example raises a couple of issues associate with the Church’s social teaching, did you notice?

Unions…

What do you think the Church says about unions?

Ø People have a right to form or associate with unions—Rerum Novarum, Pope Leo XIII.
Ø Unions should be about advancing the good of working people but not at the expense of others’ legitimate rights and the common good
Ø Catholics should not affiliate with unions if they aren’t compatible with Catholic teaching in general.

What the Church does not say about unions:
Ø That working people must belong to them.
Ø That unions are always right or should always prevail.
Ø That unions should be about employee versus employer: Pope Leo suggested the possibility of unions including employers—what idea was he trying to cultivate there?

Solidarity: i.e., yes, I am my brother’s keeper.
Related to this is the "common good." The idea is that sometimes I have to ask, not just what’s good for me, but what’s good for…us.

Let’s go back to that example: you go buy food in the store. You pay for it. You eat it. But you decided to buy some extra food and drop it off at the food pantry on the way home: you remembered the poor man, Lazarus.

Now, are you finished thinking about "justice" in this case?

Ø What about the workers who produced the food or brought it to you?
Ø What about the way the food was produced—care for the natural environment?

The workers involved in bringing this food to you are entitled to a fair wage and just working conditions—did they have the ability to negotiate and bargain collectively if they wanted to?

A Case Study on Costs and "Basic Health Care"

One of the elements of discussion about health care from the perspective of Catholic Social Teaching that often bothers me is when someone states, "Basic health care is a human right" and then goes on to insist that this means we need a system by which the maximum range of health care paid for by the best insurance in the modern US is available to everyone via a government single payer system. (The which leaves aside the practical matter that virtually no single payer systems cover as much as cushier US private insurance plans do.)

Modern medicine has brought us incredible benefits, which we rightly want to make sure that everyone in society is able to share. But modern medicine has also make it possible to throw large amounts of money at a problem to achieve a return which is statistically pretty small. Should this be considered "basic healthcare"?

When we sit down to ask ourselves, "Why can some people not afford health care coverage in this country," it seems to me that one of the reasons is that we've raised our standard of "basic" so high that it becomes hard to afford.

We've been experiencing an applied study in this as we sort out our options in regards to BabyDarwin being breech. 3-4% of pregnancies are breech. BabyDarwin is in what is termed a Frank Breech position, which means his bottom is down, and his feet are up near his head. This is, according to most of the reading we've done, by far the safest form of breech positioning, and some medical authorities maintain that it's basically as safe to deliver a baby in a Frank Breech position as it is deliver a baby who's head down. Others maintain it's slightly more dangerous. The only actual numbers I was able to find were in the Wikipedia (with all appropriate provisos):

Umbilical cord prolapse may occur, particularly in the complete, footling, or kneeling breech. This is caused by the lowermost parts of the baby not completely filling the space of the dilated cervix. When the waters break the amniotic sac, it is possible for the umbilical cord to drop down and become compressed. This complication severely diminishes oxygen flow to the baby and the baby must be delivered immediately (usually by Caesarean section) so that he or she can breathe. If there is a delay in delivery, the brain can be damaged. Among full-term, head down babies, cord prolapse is quite rare, occurring in 0.4 percent. Among frank breech babies the incidence is 0.5 percent, among complete breeches 4-6 percent, and among footling breeches 15-18 percent.

There are also some other dangers that are more of an issue in other breech positions or with a premature baby -- in that if the legs and torso are delivered first and are much smaller than the head (which is usually only the case with premature babies -- at full growth the torso is large than the head) then the baby may be partly delivered while the mother is insufficiently dilated, and then the head gets stuck. This can cause damage to the head, loss of oxgen, and a range of injuries resulting from trying to pull the baby loose.

Because of the 0.4% versus 0.5% difference in risk between standard postion and Frank Breech, and because "breech" in general has a bad name as a result of the other issues (with premature babies and with other positions), the verdict we're getting is pretty much that if we can't get BabyDarwin to turn, we'll have to go the c-section root, because no doctor around here is willing to deliver a breech baby naturally. (And the home birth midwife is clearly not willing to touch it with the proverbial ten foot pole.)

We have solid insurance, so the c-section root will actually cost us less out-of-pocket than what the homebirth route (not covered by insurance, and unfortunately already paid for). But the overall health care cost issue is significant.

Googling around for costs on a c-section I'm seeing a "list price" in the ballpark of $20,000 (though I'm sure the insurance company manages to get it for less.) The prices I'm seeing for a normal vaginal delivery in a hospital are around $6,000. The home birth cost was $2,100 (though that was with an early payment discount -- and before they raised their prices, so apparently "list" is now $3,600.)

The difference in risk between normal delivery and c-section in our particular case is apparently around 0.1%. So comparing a c-section and hospital delivery, we as a society are spending just shy of $28 million on doing 1999 unnecessary c-sections in order to avoid one natural delivery that would have resulted in serious problems. Looking at the difference between a c-section and a home birth at list price, that difference grows to $33 million.

We're justly hesitant to put a dollar value on a human life, and obviously, if you're the 1 out of 1000 who sees your child die or severely injured as a result of the difference in risk between normal positioning and Frank Breech, knowing that the chances were low would do nothing to console you. However, aside from the question of how many lives could be saved if that $30 million were used in some other way than getting c-sections for all breech babies, there's another element to the incentives at play here.

This is primarily an academic discussion for us because we're middle class and well insured, and so we have no problem at all affording the c-section if we can't get the baby turned. (And no problem affording the multiple ultrasounds and consultations and such involved in trying to get the baby turned.) But imagine that we were poor an uninsured. Because the incentives and regulations for our medical system are built around the assumption that everyone worth thinking about has the deep pockets of an insurance company behind him, we'd still be faced with no doctor of midwife being willing to provide a normal delivery, so we'd be stuck going into $20k of debt that we had absolutely no way to pay off in order to get a c-section that we probably didn't need.

As it stands, our medical system is built around the assumption that cost is no object. And doctors are very heavily penalized based on any "avoidable" injuries or deaths that occur on their watch. The result is that instead of providing good, high quality "basic" health care, and using extreme (and expensive) measures only when necessary, we often require extreme measures "just in case". This makes it far, far more difficult to provide "basic" health care to all.

I don't know enough about health care to provide specific policy proposals, but just working through this example it seems clear to me that we are not discussing enough variables when it comes to making sure that "basic health care" is available to everyone. Instead, the only debate going on in our political arena is on how to provide everyone with the level of health care which is often provided under comprehensive insurance policies -- a level which we probably cannot afford to provide to everyone, and which is determined as much as a matter of tail-covering as medical need.