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Health Care Ethics USA Catholic Social Teaching: From Principles to Practice Catholic social teaching (CST) and the principles embodied within that teaching provide the broad framework for understanding how Catholic health care organizations should structure themselves and interact with their employees. Yet while the principles of CST are relatively clear, the implications of the principles are less transparent. In this essay, I will describe several principles within CST and highlight their implications for Catholic health care organizations, specifically focusing on how the principles shape and guide organizational structure and employee relations. Principles Four principles have been articulated within CST that have special relevance for the present study. The first principle is human dignity which holds that every human person is made in the image of God and thus is of inherent dignity and incalculable worth. This principle is the cornerstone of CST. The basic source of human dignity does not reside in a person's functional ability or social utility. Rather, God's love that encompasses all of humanity provides the basis for human worth and subsequently confers on every person an inalienable dignity. The second principle is participation which maintains that every human person has a right and a corresponding responsibility to participate in society to the extent they are able, promoting at once themselves, their families, and the common good. This principle pertains especially to human work because it is in and through work that persons: enhance their dignity and become more truly and fully human; promote and protect their families; and contribute to the building up of society and participate in the unfolding of God's own creative design for humanity and the world. The third principle is solidarity which claims that every human person is at once unique and historically/culturally conditioned but nevertheless part of one human family. This principle illuminates the deep connections among all persons, regardless of race, sex, age, national origin, religion, personal characteristics, and so on. It also points out that in a mysterious and profound way, individual persons are their sisters' and brothers' keepers in this interconnected and interdependent world. How a persons acts affects others and thus individual choices must promote the good of others and the common good. The fourth principle is subsidiarity which contends that decisions should always reside with individual persons or groups at the lowest, most appropriate level. This principle limits the extent to which governments and organizations can usurp proper decisional authority by insisting that no higher level of organization should perform any function or make any decision "that can be handled efficiently and effectively at a lower level of organization by human persons who, individually or in groups, are closer to the problems and closer to the ground."1 Discussion While the principles of human dignity, participation, solidarity, and subsidiarity have been considered separately, they are actually overlapping and intersecting. That is they work back-and-forth upon one another in shaping and guiding organizational structures and employee relations. The precise implications of these principles for Catholic health care organizations in terms of how they structure themselves and interact with their employees are widespread and can only be worked out in the context of the individual organization. This points to one of the strengths and limitations of principles, that is, they are normative guidelines that prompt action and generate response, but they must always be interpreted and applied in a particular setting involving unique circumstances. Notwithstanding the difficulty in formulating precise implications for Catholic health care organizations, some overarching implications can be delineated from these principles. In light of the principles of human dignity and participation, the following implications can be drawn. First, just wages and appropriate benefits such as affordable health insurance and vacation time are vital to the overall well-being of employees because they allow employees to increase their dignity, nurture and sustain their families, and participate in society. Catholic health care organizations are thus required to provide employees with just personal wages and appropriate benefits established in view of the contribution of the employee to the organization, the financial state of the organization, and the general and common good. Second, in addition to just wages and appropriate benefits, it is absolutely critical that employees are able to perform their daily tasks in healthy work environments free of unsafe conditions, abuse, and discrimination so they can increase their dignity and contribute to the building up of the organization through their own work. Catholic health care organizations are thus required to structure work environments in ways that enable employees to do their jobs safely and develop processes to respond to unjust behavior that contradicts the dignity of employees and impedes their active involvement in the organization. Third, education and training initiatives that help employees increase their skill sets are crucial in our technological world because they make it possible for employees to meet the demands of their jobs and respond to ever-changing work environments. Catholic health care organizations are thus required to provide educational and training opportunities to employees so they are well equipped to fulfill their job responsibilities and are able to realize their full work potential and participate effectively in the life of the organization. Moreover, given the volatility in the health care industry and the elimination of the implied "lifelong employment contract" in the general work setting, education and training designed to improve skill sets is a vital safety net for health care employees in the event of downsizing or closure. In truth, enhanced skill sets is one of the only promises Catholic health care organizations can make to employees in terms of continued employment. In light of the principles of solidarity and subsidiarity, the following implications can be drawn. First, involving employees in planning processes and decisions that directly affect their work is important so employees feel more connected to the organization as well as to other employees and recognize their legitimate decisional capacity in matters directly relating to their work. While top-down decision making is necessary to some extent in any organization, concrete decisions should be handled by knowledgeable employees who are closer to and more in tune with the actual issues. Catholic health care organizations are thus required to facilitate processes that allow employees to take part in decisions that have a direct impact on their work. Not only is this sound leadership, but it also encourages and empowers employees to take more ownership in the organization, unite with other employees, and cultivate their own gifts and talents. Second, adequate communication to employees regarding the cultural and strategic pathways of the organization and specific job requirements is an important element of the overall work relationship because it fosters commitment and accountability on the part of the employee. Catholic health care organizations are thus required to align employee activities with the mission and values as well as the performance initiatives of the organization. By doing this, employees will gain a better understanding of the nature of their own work and come to realize how their work combines with the work of others to fulfill the overall vision of the organization. Conclusion These are just some of the overarching implications that flow from the principles of human dignity, participation, solidarity, and subsidiarity. While this discussion of implications for organizational structure and employee relations may not be exhaustive, it does provide a framework for understanding some of the demands that these principles place on Catholic health care organizations. The principles of human dignity, participation, solidarity, and subsidiarity provide the backdrop against which Catholic organizations should be measured in terms of how they structure themselves and interact with their employees. If Catholic health care organizations are not able to meet the general and specific demands of these principles, then social justice requires that they change. This change, however, should always be effected with due consideration for all stakeholders (i.e., employees, management, the organization, patients/families, the community, and the common good), not just one set of stakeholders over the rest. 
Michael Panicola, PhD Suggested Readings Henriot, P., DeBerri, E., and Schultheis, M. Catholic Social Teaching: Our Best Kept Secret. Maryknoll, New York: Orbis, 1992. Naughton, M. "Distributors of Justice: A Case for a Wage." America 182 (May 2000): 13-15. Questions for Discussion
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