For Two Reasons, Catholic Universities Should Continue Sponsoring Such Schools

Catholic hospitals and Catholic medical schools have much in common, but they are also very different. The mission and purpose of Catholic hospitals was clear and purposeful from the outset in a way that has not been historically true of Catholic medical schools. By and large, American Catholic hospitals were founded by orders of religious women who were spiritually inspired to respond to God’s call in their lives by caring for the sick. Sociologically, these were generally poor women who found in nursing opportunities for educational advancement and professionalism. They came to the United States largely to escape poverty such as that in Ireland or oppression like that of the Kulturkampf in Germany. They responded to the emerging needs of a growing American nation for nurses and hospitals during the Civil War and then afterwards in recurring epidemics of cholera, typhoid, and tuberculosis, in the Western expansion, and in Eastern urban poverty. These Catholic women essentially shaped the American nursing profession and hospital care, and they grew and adapted as medical science grew. While there were struggles along the way, there was also, until recent years, a synergy between what nursing sisters offered and what America needed and wanted. Their care for the sick was their prayer and their preaching, and for 150 years it was resoundingly American, Catholic, and professional.1

American Catholic medical schools, by contrast, grew up rather accidentally. American Catholics originally founded colleges to train seminarians, eventually expanding their purposes to teach advanced catechesis and apologetics and to provide social opportunities for Catholic immigrants. In time, they added professional schools, providing a quick way for the college to become a university while serving the needs of Catholic students

Nine U.S. Catholic colleges have had medical schools, four of which have been closed or sold.3 One of these (Niagara) lasted only two years (1888-1900). Another (Fordham) closed in 1921. Seton Hall’s medical school opened in 1956 and was purchased by the state of New Jersey in 1965. Marquette’s medical school became the Medical College of Wisconsin in 1967. Four Jesuit institutions (Saint Louis, Georgetown, Creighton, and Loyola Chicago) still operate medical schools. The newest, New York Medical College, became affiliated with the Archdiocese of New York in 1978, making it the lone non-Jesuit U.S. Catholic medical school still in existence.

The students and faculty of the first eight of these medical schools were, by and large, culturally Catholic. The students came from Catholic undergraduate institutions where the work of catechesis was assumed to have been completed. The mission of these schools was never really so much to train doctors to be Catholic as it was to train Catholics to be doctors. There never really were any clergy on the faculty of Catholic medical schools. Canon law at the time prohibited priests from performing surgery.4 A token Jesuit taught the requisite brief course on medical morals. But there has never been any such thing as a distinctively Catholic approach to histology. So these schools just taught histology and concentrated on producing competent physicians.

Over the last few decades, however, the students and faculty at all of the five extant U.S. Catholic medical schools have become increasingly diverse and the cultures of these schools have become increasingly secularized. All of these schools are struggling financially-three have been forced to sell their university hospitals; one, which never owned its teaching hospital, simply employs strong teaching affiliation agreements. None of these is ranked among the top 25 U.S. medical schools. And, when compared with Catholic hospitals and nursing schools, these medical schools have been a sideshow in the history of U.S. Catholic health care.

So the question why the church should sponsor medical schools is genuine. With increased opportunities for Catholics at secular medical schools, one of the major historical reasons for their existence has become obsolete. And the historical basis of the Catholicity of these schools has also become a thing of the past: Large minorities or even majorities of the student bodies and faculties at Catholic medical schools are no longer even nominally Catholic. Keeping any medical school open these days is hard work. Keeping a medical school open and Catholic is even harder.

Perhaps the best thing to do for the sake of the church would be to empower lay Catholic men and women to go to secular schools and to live the Gospel. At least it seems that the burden of proof has shifted to those who would keep Catholic medical schools going.

Mark Sargent, the dean of Villanova Law School, has stated that the purpose of a Catholic law school is to be a vehicle by which the church “confronts in creative dialogue the world’s different truth claims.”5 Whether such a mission is strong enough to carry the Catholic identity of a law school can certainly be debated. However, there is no debating the fact that such a statement would seem senseless to the faculty of a Catholic medical school. What purposes can there be for having Catholic medical schools?

PROFESSIONALISM AND CATHOLIC IDENTITY

By and large, the demands for technical and professional excellence have caused Catholic medical schools to lose sight of their Catholic missions and religious sensibilities more completely than either Catholic undergraduate institutions or Catholic hospitals. This leads one to wonder whether the demands of professionalism are in essential tension with the demands of Catholic education, or whether the present situation has simply been an accident of history.

There are many definitions of professionalism. However, the criteria set forth by Abraham Flexner, the great reformer of American medical education, seem especially relevant since the five extant U.S. Catholic medical schools survived his careful scrutiny and initially flourished because of his famous report.6 Flexner set forth six criteria that distinguish professions from other human enterprises. He suggested that professions:

* Are intellectual operations with large individual responsibility

* Depend upon science and learning

* Put their learning to a practical and definite end

* Possess an educationally communicable technique

* Engage in self-organization and self-regulation

* Tend to become increasingly altruistic in motivation7

The first four of these criteria do not, it seems, raise any immediate issues for Catholic professional education that are not true of Catholic higher education in general. Science and the church have certainly had their struggles, especially over physics. But the church docs not claim the competence to declare the function of the pituitary gland. Gaudium et Spes (nos. 36 and 59) explicitly reserves such pronouncements for the proper sciences. Ex Corde Ecclesiae (no. 29) states that, “The Church, accepting ‘the legitimate autonomy of human culture and especially of the sciences,’ recognizes the academic freedom of scholars in each discipline in accordance with its own principles and proper methods, and within the confines of the truth and the common good.” So, at least in medicine, the issue does not seem to be one of competing claims about empirical truth.

However, Flexner’s last two criteria are very interesting. I think that the fifth, the mandate of professions to engage in self-organization and self-regulation, docs pose significant tensions for Catholic professional schools, while the sixth, altruism, points to what Catholicism can best give to our desperately needy professions. Out of the tensions involving the church and these two defining characteristics of genuine professions, I will suggest, arise the best reasons one can hope to give for having Catholic professional schools in the 21st century.

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