Adventist Healthcare Ethics – Myths and Dilemmas

We welcome new Spectrum columnist Mark F. Carr. Mark will be writing 6 columns per year, on the third Thursday of the month, alternating with Loren Seibold, who is reducing his workload to provide the other 6 columns during the calendar year – Spectrum Columns Editor

Greetings. I am Mark Carr, a fifty-five year old convert to Adventism with an Army brat background. A privileged white male whose father fought for the United States in three wars while Mom took care of us kids. In my conversion, God did an Ezekiel, dry bones sort of thing – he gave me a heart of flesh, changing me from the inside out. I really wanted to be like Christ. After I fell in love with academic life at Walla Walla College and Andrews Seminary I became a pastor in the Alaska Conference. Although I was ordained, I later left congregational ministry (but not my calling) and returned to school. I joyfully labored through a PhD in religious ethics at the University of Virginia.

After completing that program, many of my friends and family wondered why I would be so excited to find work as a professor at Loma Linda University. It was, they opined, a place where good Adventists lose their faith to liberal, secular, anti-biblical forces of evil. Seriously, people said that to me. On the contrary, words cannot properly express my appreciation for seventeen years of the richest theological, cultural, and congregational life I found within Adventism there in the Loma Linda environs.

But life kept happening and it moved me like everyone else so, after a short time at Kettering College in Ohio, I landed an excellent job back home in Anchorage, Alaska for Providence Health & Services. Providence is a large healthcare corporation built by the Sisters of Providence, an order of Roman Catholic Nuns dedicated to caring for the “poor and vulnerable” among us. They came to Alaska in 1902 and I find their commitment to this mission authentic and thoroughgoing. I am the Alaska Region Director of Ethics, which means I care for clinical consultation, ethics education, and ethics oriented policy management in Anchorage, Kodiak, Seward, and Valdez.

I hope, with this column, to focus on issues surrounding Adventist ethics and healthcare, though I take a broad approach which will wander at times. Feel free, via your comments and/or email, to help me tell that story in an uplifting manner. Help me be as historically accurate as possible but also as open to God's leading in order to allow our past to inform our future. I'll dig into some thorny issues because that's what theological ethicists do. And I'll encourage us not to fight about the issues in an "us" versus "them" demeanor. We live in a world that does plenty of that anyway, we don't need to bring it through the doors of the Church. We have a Christ who calls us to be persons of virtue, who invites us to let him mold our inner life and character. Let's do our best to follow his lead.

Now to begin. Consider 5 myths (so I claim) about Adventism, ethics and healthcare:

1) That there actually is a Seventh-day Adventist ethic, although I hope to encourage one and I certainly am a Seventh-day Adventist ethicist.

2) That there is no need for ethics, per se, in a Christian’s life, since offering ourselves to Christ removes all moral quandaries.

3) That healthcare is the “entering wedge” of the Church.

4) That the Church offers Seventh-day Adventist healthcare to our society.

5) (expanding on the fourth) that Adventist healthcare corporations have lost their way and given themselves over to the world.

Let’s next unpack them. I’ll begin from the end and work backward. Frankly, I am inspired by the commitment I see among leadership in Providence Health & Services to connect with their story. Of course, Catholic social teachings and ethics are essential to that effort, but the specific mission of the Sisters is recounted in lessons for every one of their ~ 75,000 employees. Millions of dollars are spent every year making sure the core values and mission of Catholic healthcare is upheld. Every Providence employee learns the reason we are in the service of caring for others. Chosen leadership undergoes further education in the hope that consistent decisions are made across clinical and business offices throughout the corporation and clinical sites. As a non-profit healthcare corporation they offered $848 million to benefit local communities in 2014.[i] And Providence is only one of a handful of large Catholic healthcare corporations in the United States. They encourage my optimism for Adventist healthcare. We have such a rich and vibrant story within our Church of an authentic desire to care for others out of the love of Christ and for his honor. I hope to encourage us to continue telling our story – starting in Battle Creek with visionary leaders bent on taking the three angels message and the love of Christ to their communities. There is plenty of money in healthcare and the Church to make it happen, but we need consistent and supportive encouragement from every level of the Church. From within two of our Church's healthcare systems (Loma Linda and Kettering) I have witnessed an authentic and thoroughgoing commitment to such mission.

Through the years I have heard so many derisive comments about how lost those “liberal” people at LLU are. While we speak in public of the magnificent healthcare institutions we've built, privately I've heard so many deride those “crazy California” liberals whose Adventism has vanished. I reject such cynical and pessimistic perspectives. In fact, dedicated people from both healthcare and church leadership are doing their best to cast a vision for continuing a path of a cooperative commitment. One that respects our primary emphasis and blended history. Of necessity healthcare must be non-sectarian and purposefully prioritize the health of its local community. Similarly, of necessity, Church leadership must be sectarian with primary emphasis toward sharing the three angel's message around the world. The fact that these two subcultures within the Church have different initial priorities doesn’t necessitate conflict. All significant institutions have multiple, interactive priorities to balance. Recognition and appreciation of this reality is step one toward partnership renewal between our clerical, medical, and business subcultures. You will read much more of this in future columns, and likely will note my analysis of what I call "subcultures" within our Church.

I'll admit some confusion about the fourth myth, that the Church, per se, doesn’t own or offer healthcare to the public. As I understand it, in the late 80’s and early 90’s, the Church aligned legal ownership from the General Conference to the several corporations in order to avoid ascending liability.[ii] There remains, to be sure, a deep connection respected on both sides. The governing boards of Adventist Health, Adventist Health Systems, Kettering Health Network, Loma Linda University Health, and Adventist Healthcare may be chaired by Church leaders, but the corporate, and therefore legal, structures of these Church institutions is not traced back to the General Conference of Seventh-day Adventists. The one, notable exception to this rule is Loma Linda University Health. Ideologically, although these systems remain thoroughly committed and authentically Adventist, they are not owned by the General Conference similar to Division, Union and Conference corporations. The effect this corporate and legal reality has on our healthcare institutions is incredibly complex and I don't pretend to fully understand it – few people really do. As social institutions offering care to the public, we have an immense responsibility to the states and countries within which we work. And note that my comments are necessarily limited to the context of healthcare in the United States.

The "health message" of the Church was initially conceived to be the "entering wedge" for the three angels message. The goal wasn't just to help people be healthy it was to also have them join our faith community and commitment. A worthy goal to be sure. But this is no longer the case. I suspect if we were to poll younger generation Adventists about the "health message," most would not (or could not) give a coherent answer. I don't take this as some sort of failure – it's just the way it is. I suspect, however, that the vast majority of our younger people know that we offer them careers in healthcare. We used to focus a great deal of effort steering our young people toward healthcare professions (e.g. physicians, nurses) but today, we do an equally (if not better) job steering them toward the healthcare business. Whether we speak of the business or medical end of our public healthcare offerings, we must do more as a Church to help build into their personal and professional development the core values and mission orientation of our healthcare institutions. If we say our mission is to extend the healing ministry of Christ, we must tell our clinical and corporate leaders what exactly that means to us. It is impossible to offer our “brand” of healthcare with a 100% Adventist population at the clinical, managerial and executive levels. We, like every other faith-based healthcare corporation in America, must hire from outside our faith at almost every level. What are we doing to help non-Adventists working with us to fully understand what the "health message" means to us?

And scripture does not directly address many of the most vexing issues of our time. How, for instance, can we help the physicians, nurses, and managers on a labor and delivery unit decide which precious human life to save when a pregnancy has progressed to the point that both mother and baby cannot be saved? Of course there is nothing new about this and ethicists and medical professionals have been dealing with it for a very long time. But this is part of my point, we need scripture carefully interpreted and deeply imbued within our ethical frameworks to properly address this and other issues. There are newer medical technologies for which we need a more expansive method of hermeneutics. For me, the Wesleyan quadrilateral is helpful. How does medical science, church teaching, and reason work together with scripture to help us navigate present day issues? Artificial wombs, reproductive technologies, life extending medical equipment and research, social responsibility toward those who cannot afford healthcare, and assisting people to end their lives – names just a few of these issues.

Finally, I'll admit I'm a bit touchy about having no distinctive Seventh-day Adventist ethic, given the fact that I self-identify as one. Some of my own colleagues disagree with me here, suggesting that there is no need for a specific approach to ethics for Seventh-day Adventists given the broader field of Christian ethics, and I get their point. Similarly, we have argued for a very long time over the idea that some points of Adventist theology are very particular, unique to us, and not found elsewhere in Christianity. But I believe it is helpful to mine our story for elements of thought and approach to our present, complicated lives, particularly in our engagement with healthcare.

Well, this has been an extensive introduction to issues and concerns I plan to examine in coming months. I invite you to journey with me, interactively, to explore and rehearse our stories, problems and collective future.

[ii] Duska, R. 1982. "Autumn council creates 7th largest health system," Spectrum13:69–70. See also, Greene, J. 1990. "Adventist Health/U.S. dismantles system, forms new association," Spectrum20:35–36. And Evans, R. A. 2000. "Adventist hospitals: An ailing system? Part I," Adventist Today8:12–22

Mark F. Carr is an ordained minister and theological ethicist with experience as a pastor, pilot, commercial fisherman, professor, and now clinical ethicist. He writes from his home town of Anchorage, Alaska.

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This is a companion discussion topic for the original entry at http://spectrummagazine.org/node/7327
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Helpful article! I’m not an ethicist, but have been in many discussions with a major Adventist system on the West Coast on this topic.

My impression is that the system (I’m now retired) was rather episodic and case-specific about its approach to health care ethics. “We’ve got LGBT employees? What do we do about that??” “Oh, we now own a hospital with an ‘Employee Association’ ??” “Well, thank God it’s NOT a Union. But what do we do about that??” “The vast majority of our employees are NOT SDA. So how can we continue saying we’re ‘Adventist’?” And so on.

But almost of more interest to me is the author’s paid position: An SDA ethicist working for a Catholic health care system – where I assume that a major part of the “health-care ethic” has to do with reproductive rights and services? How does THAT work!!!

A very pertinent question. In Catholic hospitals when the question arises when the mother and/or baby’s life is at stake. Who takes precedence? Also, if the baby doesn’t breathe, or only takes a few breaths and is declared dead, the attending physician is supposed to administer last rites (unless that has been changed).

In the Catholic hospital in the town where I live, and others, a woman and her physician plans on her delivery with a C-section there, expecting a tubal ligation which has previously been requested to be performed then, it is refused and she must schedule surgery at a later time in another hospital at great inconvenience.

Mark, how do you and your facility handle these situations?

Thanks for your thoughtful article. The challenges within the Adventist-managed institutions are not dissimilar to the challenges faced by the system in which you serve: a medical system that relies on models based on for-profit incentives in which equity of incentive is very disproportional between people working in the “trenches” and those sitting in “important offices”, a medical system vs. a health system, issues of poverty. In my mind there are only three main reasons behind Adventist health care: 1) Provide the best medical care feasible in an equity le fashion to all regardless of income, race, sexual orientation, income, religion, etc. 2) As platforms/workshops in which the All Mighty’s character of love and service can be shown 3) Give Adventists and thousands of others opportunity to serve and the income survive and thrive.

That may not be signally different than that which any hospital Catholic, Jewish, Protestant, or other community to tertiary hospital best do.

Caring for people and working for their longevity and quality of life, for healthier communities, is the calling, the vocation. I say this as an Adventist who’s people have been supportive of the Adventist call to be a healing force in the world for now five generations.

Our challenge, I think, is to continually expand our horizons to engage others along with us in the healing process of communities and individuals. Thank you for your witness, Mark.

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A breath of fresh air.
A friend of our [class mate of my daughters] took her MD training at LLU, and now is ER physician for a few years.
LLU has a great Children’s Hospital program.
LLU has a great program in Public Health degrees. Unfortunately, the SDA church does not make much use of the Public Health Dept. at the local conference levels.
LLU has a good relationship with the Jerry Pettus VA hospital that is there.
Recently LLU has been assisting with permanent hospital care in needy surrounding communities where good health care has been lacking for various reasons.
LLU has a huge over seas and over the borders program of training by LLU medical staff, and at times have taken Teams of Staff to places to do procedures that are needed for a person’s survival, but unavailable in that area where they live.

LLU assisted with the establishment of the Sir Run Run hospital in north east China near the North Korea border. Last I knew North Koreans could cross the border and be treated there.

In the Tennessee Nursing Home Industry for 25 years I was well acquainted with Surveyors of the Health Care Industry. Part of their Job Security is to discover a deficiency, however slight. It is with the Idea that no one is 100% Perfect.
However, I was Director of Nursing of one nursing facility-- both ICF and Skilled beds. And for the 3 years in a row we had No Deficiencies. So it is possible, but not easy. Takes the cooperation of not only Corporate, but also each individual employee to make that happen. ONE EMPLOYEE can create a deficiency.

2/2216 EDIT-- ARE our hospitals and Health Care System itself erected for JUST Primary, short-stay care, ACUTE care. ARE our Medical Programs in our Universities JUST to crank out graduates who can ONLY provide primary, short-stay, acute care?
THEN WHY do we even pay persons to sit in an office that says, Health and Temperance Directors? A pastor could just as well read quotes from Ellen White from the Pulpit, or Just put a Quote in the weekly bulletin. Seems like a waste of money.
It seems like it would be MORE APPROPRIATE to have an Office of Public Health and REALLY mean it!
That we would be, As A Church, A GLOBAL Church interested in the Public Health of the Nations in which we have a church named. People are dying, literally by the millions, who with information and encouragement, could have an opportunity to live longer, and have a life more abundant.
One commenter on here said that NEWSTART [and I will add CREATION] is in Another SPHERE. I would like to say THESE are the HEART of the Sphere of the National Health Care that Seventh day Adventists can offer.
At this time we are no better than Catholic, Methodist, Baptist hospital corporations. We are providing the VERY SAME Services. I have worked in a Catholic hospital. Care is no different than the huge Medical Center in town own by the County, or say Hospital Corporation of America. At least Catholics have the Crucifix of Jesus everywhere to remind people to PRAY and give Thanks.

It is about time to END ALL Of The Myths about Adventist Health Care. Become REAL, and develop a GLOBAL National Health Care of Seventh day Adventists, and train Adults [16 and over] SDAs in how to promote health of those in their communities and invite them to presentations, or better yet, Be PROACTIVE and go to them where they live and worship. Use THEIR houses of worship as centers for renewed health.
Tell them as 3 John 2 says, Beloved, I wish above ALL THINGS that you prosper and Be In Health.
And then, help them to enjoy the realization of this Bible verse in their lives.

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Nice introduction, Mark. I will be looking forward to future installments. I knew you enjoyed fishing in Alaska, but I didn’t remember hearing about the permanent move there. Congratulations on that.

I wonder if you might address the financial mismanagement of our institutions. I’m aware of the recent $119 million penalty charged to Adventist Health System, and have recently read Doug Hackleman’s book on shameful mismanagement at other institutions in decades past. I’m concerned these ethical issues persist. As embarrassed as we should be by these detractions, we still have much to be proud of–including what transpires at Loma Linda University. BTW, I appreciated your defense of LLU and southern Calilfornia, where Adventists of all flavors coexist (usually amicably) in a healthy mix. I occasionally rely on LLU healthcare, and have usually sensed “mission” and have always appreciated my conversations with the care providers.


EDIT:

Thank you for clarifying this! (I really hope you are correct.)

Well stated, Mark.

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As an Adventist who taught for 32 years and was chairperson for 5 years of the Religious Studies Department of Saint Mary’s College, Notre Dame, IN, and as a former columnist of the Spectrum blog, I congratulate Mark Carr for his becoming a columnist at Spectrum and wish him many satisfactions in his work with the Sisters of Providence. I can happily testify that my time working with the Sisters of the Congregation of the Holy Cross gave me many satisfactions and taught me much about how to be a Christian. It is not until you participate in the life of the “other” that you can really know what your own life should be like.

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Actually the penalty for AHS wasn’t due to mismanagement or poor ethics. It was an honest mistake at several facilities. As part of the ACA Congress linked the new regs with the Stark Law for fraud… and it was not done well. In a nutshell it made some things technical violations of Stark that weren’t there before, and as soon as a hospital found that they may have missed something, a total internal audit was done and the System self-disclosed everything to the Government. The settlement was big, but the Government found nothing to indicate willful wrongdoing, so AHS wasn’t even put under a monitoring plan or other punitive actions.

So really, I would say AHS lived up to their Christian standards, paid what they owed, and the regulators recognized that.

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Hi Jeffrey,
As “BreakingBadventist” notes, the complex layers of Federal legislation and oversight in healthcare is staggering. In one conversation with an SDA healthcare administrator focused on the fact that a regulatory visit was coming up, he said that once they step on campus, one never knows where the visit will end or what they will find. They may come for a regular visit, or a particular follow-up on a citation previously, but they have a way of digging and finding issues that faithful people in the institution have done honest work caring for. I liken it to the tax code, it is so complex and so few people know it so completely that when the examination begins, one is hard pressed to guess where it will end and what may be found. Of course, there are times when very bright and decent people behave badly, which keeps me in a job. :slight_smile: But beyond that some of these (our) healthcare corporations are so big and so diverse that it may be wishful thinking on our part to imagine they will never run afoul of regulations. And let’s not forget that regulation does not equal ethics and ethics doesn’t equal regulations. And I have often inserted “law” for regulation in this mantra!
Mark

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Powerful introduction indeed. As a young adventist minister currently employed in an adventist hospital as chaplain, I will be following this with much interest. I am especially interested in the 3rd myth. I have at times met a challenge from both within and without the institution that I have an “ever present field to evangelize” and I might, however, hold a varying view from that because of some of the cases similar with those you cite in the article. This will be beneficial for me to follow.

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it would be interesting to compare inside ethics with outside ethics. TZ

Ethical issues in healthcare are common. Nearly every decision that’s made has ethical implications–for patients, for providers and for healthcare leaders. I wish you well in your new job. I have a suggestion for you to consider being more tentative as you begin your duties. You said in this article “I find their (Providence Health & Services) commitment to this mission authentic and thoroughgoing.” Be careful about becoming the “corporate apologist” or “p.r. go to escape hatch”. All health systems, particularly church-related ones, are facing difficult challenges in having and implementing health care in an ethical, legal, and moral context…

There are some employees of Providence Health & Services, the state’s largest health care provider, who may disagree with your initial assesment. They are suing the Catholic health system in federal court alleging it is using a religious tax exemption to skirt federal pension law.(Providence lawsuit raises questions about Catholic health providers’ church pension plans -Puget Sound Business Journal Thursday, December 4, 2014)

See more about Providence-lawsuit: http://www.pensionrights.org/newsroom/items/providence-lawsuit-raises-questions-about-catholic-health-providers-church-pension-pl#sthash.hZGk5zrk.dpuf

One thing I am sure about, your input and expertise will be needed!

And really extracting a financial pound of flesh is what the government is most interested in anyway…

Thank you Pr. Carr!
A breath of fresh air indeed.
Thank you I needed to read this and will share with my husband.
Thank you for your thought provoking article. Very wide and deep, yet so needed in our church, as well as calling out the shenanigans of some who like to condemn with no basis for that.
And even if you had not elaborated anything on the ethics, your own life story has been a huge blessing for me right now.
My husband is a pastor in a Conference and we are considering leaving congregational ministry in the near future but not our calling either.
Praying for this a lot. And we are thankful for your story and article. Uplifting and encouraging for us! Thank you!!!

Plnameister : A tubar resection - even when for severe health difficulties with another pregnancy are to be expected -is an ethical decision. And the oher methods of birth control require ethical decisions. - They never were discusssed in a wider range, ( ironically : They are no matter ogf “Nutrition”) since they are neither tea nor coffee. And it is a pity that IVF is applauded with a “Huraah !” " by Adventist Review " since a number of eggs is ferilized, then the pre - implantaion selection they have to pass - one (“we want a healthy blonde boy” ist implanted and the other human individuals are away into the gully - or we use them as sources for stem cells. . It is quite odd to see a top SDA physician smile into the camera of ANN " Stem cells ? MyChurch has no stance on it".- - - - - - - My belief has a stance on everything ! (Romnas 14 : 17., 16. - I. Kor. 10 :31.)

Mar, I am retired now for ten years. And I have ancestors far back the Protestant - Konverticle - Group line, who then joined Erzberger and Andrews. We have a Church , belong to a Church - and elaborate our own ethics in long, earnest discussions. It is an ethical decision to applly an ECT (very risky !) when you only can suppose this is getting into malignant catatonia; it is an ethical decision to order a tubar resection for a yong patient, with a severe mental retardation -when the social worker says : well, it is her right to get pregnant, and, well, we now can conduct an abortion once the year ! _ and : How about signing the document that describes the symptoms of brain death - thre times, every one after another six hours, two signatures required - - for turning the switch to “off” for the machinery that supported an pseudo - life by supplying the body with respiration that sponatneouslyhad ceased hurs ago… (And having the whole family waiting and hoping outside on the corridor, since the big boss, just passing by, had given them hope with akie)
oith a lie)

But : “My Church has no stace on it !” - we, my colleagues and I, do not care what the Church says. we do our best , having in mind that we work with and on a special handmade creation of God, a creation Paul calls the temple of the Holy Spirit. - - we check our decisions with how understandng the Bible describes the dognity of mankindand not asking the BRI. Or some “evangelst”

And to widen our view we go to “Stift Heiligenreuz” for hearing others on Bioethics, Medical ethics - - and sharpen our views and decisionmaking.

NEWSART is in anozher sphrere…
.

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I enjoyed your article professor Carr. Looking forward to more in the future.