Todd A. SALZMAN & Michael G. LAWLER. Pope Francis and the Transformation of Health Care Ethics. Washington: Georgetown University Press, 2021, pp. 223. $34.95 pb. ISBN 978-1-64712-071-9. Reviewed by Dolores L. CHRISTIE, Cleveland, OH.

The authors arrange a rich buffet, sure to nourish bioethicists and others who cope with contemporary medical moral issues. Their primary focus is the newest version of the Catholic directives for health care (the ERDs), so the title is somewhat misleading. Francis’ writings are referenced, but more importantly the book outlines in careful detail why a better document is needed and what it should include. It reprises advances in bioethics in Catholic thinking over eighty years.

The earlier chapters offer a strong foundation for later conclusions. They lay out the distinction between relativism (bad ethics) and perspectivism (the authors’ term for thinking about moral issues from the place of the real). Moral rightness cannot be reached soley by applying church-constructed norms, what David Kelly calls “eccelsiastical positivism.” The ERDs demonstrate the dichotomy of the church’s rather relaxed treatment of social ethics and its heels-dug-in physicalist positions on things sexual. Moral tenets are not core doctrine, of course; so arguably they are open to development.

Chapters 1 through 4 explore in detail the tensions between the ERDs and various aspects of moral thinking. Historically, Catholic ethics has drawn not only from scripture and tradition but from science and human experience. The authors contend, rightly, that the ERDs do not use these sources to best advantage. They employ a narrow understanding of them, particularly in areas of sexuality; and give preeminence to hierarchical authority. Such methodology can result in flawed conclusions.

The current directives diminish the sovereign authority of conscience and the importance of the common good, central elements in the personalism of Gaudium et spes. They neglect the importance of experience and the realization of social justice. The authors conclude that Francis gets it right. He puts church teaching in its proper place: a strong aid to conscience formation, not its preemptor.

The ERDs need a more holistic moral method, one based in dignity, dialogue, what the authors   term “synodality,” an emphasis on the poor, and a more inductive methodology. The bishops must exit their ecclesiastical bubble and look with fresh eyes at today’s urgent issues. There is an urgent need for a much more contemporary and comprehensive view of today’s complex world.
Climate, race, technology, gender, waning Catholic influence—to mention a few—must be considered as they form teaching.

This is a carefully written book, a rich and generous banquet offering many innovative “dishes” of moral wisdom. Maybe because I am a recovering normative-stage-of-moral-development ethicist and now espouse their positions, I want to heap my buffet plate twice over with everything they say.

For some the fare may be just too rich, sometimes too detailed or too repetitive. If the reader thinks this is the case, he or she might choose the small-plate version: the final chapter. It summarizes the authors’ recommendations and highlights Francis’ approach to these things.

This book should be required reading for anyone sitting on an ethics committee at a health care facility. Bishops, whom the ERDs designate as the keepers of Catholicism in health care, must read it with openness and humility. Pastoral persons in hospitals, often called upon to weigh in on controversial decisions, should read it religiously. The questions it raises, the lacunae in the newly revised ERDs version it demonstrates, and the well-reasoned and well-supported arguments for change must not be ignored by anyone who espouses a “Catholic” stamp on health care.

The final words of the book quote Pope Francis. He notes that we “cannot insist only on issues related to abortion, gay marriage, and . . .contraceptive methods,” nor be obsessed with “a disjointed multitude of doctrines to be imposed insistently.” Strong words indeed!

Bravo, professors, for advancing this hope!