The Benedict Medicine Consortium is pleased to be represented at the Catholic Medical Association’s Annual Educational Conference, which is being held at the Caribe Royal Resort in Orlando, Florida, starting today and running through September 8th. The CMA annual conference is a great way for Catholic medical professionals to grow in fellowship, as well as learn about aspects of medical practice informed by our Catholic faith.
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On Thursday, September 5th at 2:30pm (Caribbean Ballroom) I will be speaking about “Threats to a Catholic Anthropology in Primary Care Practice: A Call to Action”.  In the talk I’ll address four key principles of Catholic Social Teaching and how they can be applied to an authentically Catholic primary care response to the assaults on Christian principles that are present in contemporary medical culture. Moreover, I will discuss some ways we can formulate a systematic approach—a “call to action”, if you will—to these threats, and in so doing conform our practices and ourselves more fully to the light of truth, in imitation of the Divine Physician. 

Today the Church commemorates the descent of the Holy Spirit on the apostles, and thus the fulfillment of Our Lord’s promise to his disciples that He would send the Paraclete to “teach you all things, and bring to your remembrance all that I have said to you.” (John 14:26).

Upon their receiving the Holy Spirit, Who appeared as tongues of fire, the apostles were emboldened with a courage and conviction they had did not have before. They began to preach the word of God and to baptize in the name of the Father, the Son, and the Holy Spirit. They added great numbers to the Church as the result of the gifts of the Spirit which they had received.

As I consider the ways the Lord calls me to act in the world, I often reflect on the ways I might better reflect my baptismal commission to preach the Good News in all dimensions of my life. In addition to my vocation as a husband and father, I ask that the Lord enliven my healing vocation as a physician. For all of us who are physicians driven by the Faith, I pray that we may be the hands and feet of the Divine Physician, and that our work may always be animated by the same Holy Spirit Who descended on the apostles, Who comes upon each of us in the Sacrament of Confirmation, and Whom Our Lord promises will guide us in all He instructed.

To this end, the Feast of Pentecost is an ideal time for us to renew our conviction to the Faith in the way we practice medicine. For primary care physicians who are motivated by their desire for a seamless witness to Our Lord in our professional practice and personal vocations, may the Holy Spirit unite us all in voluntary association with other faithful Christian physicians who share this calling through the Benedict Medicine Consortium!
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--James O. Breen, M.D.

The Society of Gilbert Keith Chesterton recently opened registration for its 43rd Annual Chesterton Conference, to be held from July 25-27th, 2024 in Philadelphia. A prolific writer, Chesterton’s boisterous spirit and bounding joy come through across his innumerable works written in a wide array of genres. His playful use of language and succinct forms of expression are highly quotable.
G.K. Chesterton, along with Hilaire Belloc and other early 20th Century thinkers, was a vigorous proponent of the economic theory of distributism. Based on the principles of Catholic social teaching, distributism advocates for a wider distribution of private property and the ownership of families over their means of sustenance. It is a rebuke of both socialism (in which property is controlled by the state) and laissez-faire capitalism (in which property tends toward concentration in monopolies).
Considering the state of the healthcare system in the United States today, those who believe that the average working-class American ought to be able to access primary care without relying on the insurance company cartels or a government program would do well to reflect on what medicine might look like if G.K. Chesterton were a doctor today. 

--James O. Breen, M.D.

As the stridency of the secular medical culture becomes louder, it becomes increasingly difficult for Catholic physicians and nurses to maintain fidelity to the truth and remain in the common space of the public square. This piece, published today in Crisis magazine, is an example of the challenges we face while attempting to dialogue with an ideology that is not interested in dialogue. It has become apparent that our esteemed medical journals are not attempting to build consensus, nor are they particularly interested in representing the diverse views of their constituency. This is why it is so important to build communities of like-minded people, such as the Benedict Medicine Consortium!
The article from Crisis is linked here:  
Please leave a comment and let me know your thoughts!

​The Benedict Medicine Consortium is pleased to be a part of the Converging Roads regional conference on medicine and ethics on Saturday, February 17th. A ministry of the St. John Paul II Foundation, this conference series offers medical professionals continuing education that informs the ethical practice of their profession; it is also open to all who wish to learn more about Catholic medical ethics.
 This will be the first time the conference is being held in southwest Florida, at St. Leo the Great Catholic Church in beautiful Bonita Springs. The theme for this year’s conference is “Catholic Medicine in a Secular Society.” More information about this conference, and about Converging Roads generally, can be found here.
If you happen to be at the conference, please stop by our booth in the exhibition hall—we’d love to make your acquaintance! 
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--James Breen, M.D.

It’s difficult for me to believe that more than a week has gone by since the 51st annual March for Life. I’m proud to say that I was present, in the company of my family. I’m ashamed to say that it was my first time ever attending the March. After years growing up in the DC suburbs, it was only after moving to Florida that I came to find myself walking determinedly down Constitution Avenue in my new Wolverine boots on the third Friday in January, bundled to the hilt.
Aside from it being my first-ever March, there were other notables about the event. For one, it snowed the entire day. By the time we awoke that Friday morning, there were already a few inches of accumulation on the streets and covering the grass. For the group of Florida high school students with whom we were traveling—many of whom had never seen snow--it was as if Christmas fell on the 4th of July. Who can contain themselves from throwing snowballs at one another on the National Mall during a snowstorm?
Not only did it snow, but it was cold. Really. Doggone. Cold. Again, growing up in the outskirts of DC, I was used to feeling the cold, but this time it felt more biting than I had ever remembered it. Even residents near our hotel in Arlington were commenting on the noteworthiness of the piercing wind. Perhaps south Florida is thinning my blood a bit too much…
My first impressions of the events surrounding the March were that the entire program was imbued with an air of infectious optimism. Of course, the cause behind the March is anything but joyful—the destruction of over 800,000 lives annually—but the unifying sense of solidarity among the marchers buoyed spirits and served as a reminder of the larger purpose that brought us to this place, at this time. The animated presence of so many young people from all across the country—in addition to the many cassocked and habited priests and religious sisters—emphasized the spiritual and existential dimension of our march for the inviolability of life. Championing the Pro-Life cause is not a political calculation or strategic gamesmanship; it is a response to a call to affirm that life is a gift from God which humankind cannot rightfully spurn or destroy.
On the Thursday evening before the March, our group attended the Vigil Mass at the Basilica of the National Shrine of the Immaculate Conception. The throngs of attendees, many of them high school or college-age kids, brought an air of anticipation to the event. The basilica was overflowing with people who had come for Mass several hours before its scheduled start of 5pm, dispensing with the conventional clap-trap that the Pro-Life movement represents an enfeebled and withering fraction of Americans’ opinions on abortion.
On the day of the March, our troupe piled into the bus in front of the hotel at half-past-six in order to make it to the Sisters of Life Life Fest at the DC Armory. In the shadow of the old RFK Stadium, where the Washington Redskins used to play in my youth, thousands of young people and religious gathered to share fellowship, hear testimony, and participate in Eucharistic adoration and the sacrifice of the Mass before descending on the National Mall. Again, the pervasive ebullience of the crowd stood in stark contrast to the angry, scowling masses attending other protest rallies for various causes that we’ve all grown accustomed to seeing on television.
Throughout the host of events surrounding (and including) the March, I kept wondering if we would be confronted by members of an angry mob that wished to disrupt the entirely peaceful protest that is the March for Life. But for a handful (like, three) of wise-guys along the March route, we didn’t really see any signs of opposition to the March. Later, in the warmth (and wifi) of the hotel, I was amused to read that some prominent pro-abortion counterprotests were called off because of the weather. It seems the pro-abortion organizers labeled the March for Life as irresponsible because it “put children in danger” by encouraging attendees of families to participate in the March in the cold. Oh, the irony…
During the entirety of our time in Washington, my heart was trying to make sense of the tremendous dissonance between the realities of the violent tragedy of abortion on women and children on one hand, and the exuberant joy that emanated from those who gathered in the Nation’s Capital on the other. The legal victory of the Dobbs decision has moved the legal struggle to hand-to-hand combat in state capitols across the country. The mantra of many of prominent speakers at the March is true; there is still so much work to be done to effect a large-scale change with regard to abortion. While the legal efforts to make abortion illegal wage on, the daily personal struggle for hearts and minds is the surest way to save lives and souls from the ravaging effects of abortion.
My heart’s restlessness was momentarily assuaged by the words of the priest who delivered the homily at St. Patrick’s Church in NW Washington on the Saturday evening before our return home. The homilist’s message spoke to my heart where it hurt the most. He said that surrendering ourselves to Christ means walking to the Cross, which is where we meet Jesus. We may be tempted to despair when we consider how things in our homes and work aren’t going our way; when affairs in the country aren’t going as we’d like; when division in the Church seeks to disrupt our peace. It is at those times of trial when we are called to place all that’s wrong with the world at the foot of the Cross and ask God to unite us with His Victorious Son in His due time. As we prepared to depart Washington and return home, the priest’s reminder of our assured spiritual victory caused me to consider the indelible inward effects of this annual event, the March for Life, on the hearts of every man, woman and child who braves the cold in DC every third Friday of January.

Medicine is a pursuit that lends itself to the adoption of allegiances to false gods. While right-ordered medicine has as its ultimate goal the restoration and preservation of health and the promotion of human flourishing, the messy side of medicine gets tangled up in human pride and vanity, and often leads its practitioners astray. Sometimes, it’s marketing departments at pharma R&D that channel our Masters-of-the-Universe vibe.  Other times, it’s the marvels of technology and the supposed power over illness that they promise.
What do we mean by ‘false gods’? First, these self-appointed “gods” seek to place themselves as paramount in directing our thoughts and actions. They demand our undivided attention and obedience, and they expect that we become subservient to them. Second, we acknowledge them as “false” because they seek to take the place of the One True God, the Divine Author of the First Commandment: “I AM THE LORD THY GOD: THOU SHALT NOT HAVE STRANGE GODS BEFORE ME.”
Some false gods are deeply embedded in our way of thinking—so deep in fact, that we scarcely notice them. The lies of the modern ‘arc of progress’ that have captured the profession are at the root of many of these. The heady concept that we, as a medical profession, have a duty and obligation to remake society in our own conceited image, is one such lie that we are presented with regularly. Medical societies declare a unipolar stance on issues such as climate alarmism and the unqualified virtue of diversity, all while refusing to defend the ancient Hippocratic concept protecting all human life through its proscription of abortion and physician-assisted suicide. It would seem the irony is lost on them that similar concepts of social progress made movements such as Eugenics quite fashionable among some medical scientists in the last century. The more things change…
While progressive thinking is prominent among the false gods, the particular one that I wish to focus on in this essay is the god of technology in documentation.  It is one of the false gods that is most ubiquitous in modern practice and which many people treat as a panacea on the journey toward the utopian dream of a Highly-Functioning Health Care System. The compulsory promotion of the Electronic Medical Record (who remembers the HITECH Act?) is emblematic of our culture’s broader worship of technology. Seemingly innocuous, the computer has been thrust so forcefully into the practice of medicine that it cannot be ignored nor extirpated from the exam room. Under the effects of our collective retrograde amnesia, one wonders whether Sir William Osler preferred a Mac or PC when he set up his “dot phrases” and “smart sets” in the hallowed halls of Johns Hopkins hospital.
I don’t consider myself to be old, but I do recall a time (very early in my practice life) when computers were not a mainstay of medical practice. One day early in my career I came into the clinic and noticed workmen on ladders, threading cables above the drop-down tile ceilings of the exam rooms. When I asked what was going on, the workmen responded rather casually that they were running wiring for the computers that were to be installed in every exam room in the practice. I was incredulous.  I asked myself silently, “Do they propose there will be a computer in EVERY exam room? What if I want to see a patient in the overflow room down the hall; or what if the connection goes out?”
Since then the computer has taken center stage in physicians’ daily struggles with disease. It is a vain practice companion, as evidenced by the amount of time and attention it commands every time there is a software update, workflow change, or order-set development. Like all false gods, it is self-serving and inwardly focused in its orientation. The EMR preens in email messages about scheduled software updates, displaying its technological plumage to attract our attention to its time-saving novel workflows. It seeks to reassure us that it alone can protect us from human error; can prevent dangerous drug-drug interactions and overdoses; can enhance cost-effectiveness of our therapeutic decisions; and can streamline all aspects of doctor-patient interactions through secure messaging and instant results release to patient portals without the unnecessary drag of physician-mediated interpretation. In a sense, the computer promises to save us from ourselves.
In reality, EMRs distract us from the patient in front of us, while instead promising to increase physician productivity through the application of templated office notes; capturing data and text that enhance the billable value of our patient visits; and include valuable tools to facilitate the inclusion of detailed Reviews of Systems and physical exams.  While these enhancements seem like unqualified goods, the demands of rapid documentation compel doctors to adopt the reflex of heading to the keyboard and screen while in front of patients. As an additional slight to physicians’ professional integrity, often these electronic shortcuts compel us to prioritize “enhanced insurance coding” over truth in patient care. A brief example will illustrate what I mean by this.
One morning as I prepared to assume coverage of our group’s hospital service, I reviewed the chart of one of our patients, an elderly man with advanced lung cancer who had been admitted to the Intensive Care Unit. The unfortunate patient had presented with respiratory failure requiring emergency intubation, and his condition was guarded.  As I read through the notes of one of the consultants who had seen the patient the day prior, I scrolled through the automated text blocks that were generated to maintain compliance with some billing or documentation regulation.  The tiresome compliance-speak that comprised more than 50% of the note caused me to scroll even faster to the portion of the note containing the consultant’s assessment and recommendations. However, what I read at the bottom of the note sent chills up my spine. The final piece of boilerplate text read as follows: “Internal Medicine Quality Measure: Patient is counseled on smoking cessation and routine lung cancer screening recommendations with annual low-dose CT scan.” Based upon the patient’s poor clinical condition and his already advanced disease, one can only hope that the admonishments attested to in this final act of documentation did not accurately represent the events of the doctor’s visit to the bedside.
I mention this example to highlight a point. The clamoring of the Electronic Medical Record threatens to remake our thought processes. It compels physicians to become distracted by concerns about billing, regulatory compliance, and legal concerns at the expense of the interests of the patient. Inasmuch as it demands our obeisance and distracts from the first principles of our professional vocation, the EMR is a false god which offers solutions to worldly concerns at the risk of turning us into liars and cheats. As physicians, it is incumbent upon us to keep technology at bay as we go about the daily human work of caring for the people who entrust themselves to our care. 

​--James Breen, M.D.

To all who read this post, Merry Christmas! Today we celebrate the entrance of our Lord and Savior into the world, taking the form of a babe born to a Virgin in a manger. As Venerable Archbishop Fulton Sheen put it so eloquently, “Bethlehem became a link between heaven and earth; God and man met here and looked each other in the face. In the taking of human flesh, the Father prepared it, the Spirit formed it, and the Son assumed it.”
On this first day of the Christmas Season, we wish you a Merry and Holy Christmas!

​--James Breen, M.D.

​The Catholic Social Teaching principle of Stewardship reminds us that we human beings have a duty to safeguard God’s creation. While this principle is often applied to our relationship to the natural environment, the same principles can be applied to all resources bestowed by God for human flourishing. Just like natural resources such as air, water and land, other gifts such as human talents, material and financial resources are God-given and ought to be employed in a way that respects their provenance from the Most High, as well as their natural end to further the common good—not only for those living today, but also keeping in mind the welfare of future generations.
Extrapolating this line of thinking to our use of resources in the development and delivery of medical care, we see that several types of resources are required in order to provide such care. Financial investment, material resources and human ingenuity and intelligence go into the development of diagnostic tests, treatments and techniques that are used to further human health and healing. We should all be profoundly grateful for the bountiful gifts that produce such innovations for the purpose of restoring and preserving health.
However, it should be obvious to anyone who has had an interaction with the healthcare system that the delivery of healthcare is permeated with a vast amount of wastefulness. The medical field is consumed by an overgrowth of regulation resulting in byzantine payment models and delivery mechanisms that inevitably lead to a great amount of waste—waste of money and diversion of human talents in the service of bureaucratic and managerial functions that perpetuate many of the wasteful systems and practices that do nothing to advance the ostensible aim of the healthcare system (ie, treating and curing illness and furthering health).
The natural end result of the addition of a vast workforce of functionaries who are removed from actual patient contact by orders of magnitude is an inflation in the cost of care. This increased cost is baked into the price of goods and services produced by the healthcare apparatus. Governmental payors (namely, Medicare and Medicaid) place caps on what they will pay for services; commercial insurers negotiate rates with service providers (doctors, hospitals and the like). Only the uninsured patient is made to bear the list price of the medical care provided to him—in other words, the very person who is least able to pay the full ‘rack rate’ of his medical care is the one who must negotiate on his own behalf with the healthcare provider (hospital, clinic) for a resolution to the inflated prices for which he is held responsible.
Returning to the concept of Catholic Social Teaching, the scenario described above is a tremendous affront to the principle of stewardship on many levels. First, it is not a prudent or judicial use of the economic or material resources given by God for the promotion of health. A recent study found that up to 30 percent of US healthcare spending was spent on administration, and that at least half of administrative spending was wasteful.
Aside from wasteful spending, there is a large contingent of people whose positions serve primarily to maintain the existing system’s bureaucratic infrastructure without directly benefitting patient care. One could argue this represents a misapplication of human resources that could better serve the care of patients in some other way (or be directed toward some other pursuit outside of healthcare—think of retraining large numbers of billing auditors and referral coordinators).
Another way that the current healthcare system works against the principle of stewardship has to do with the way financial resources are applied within the system. In order to capture revenue from governmental payors and commercial insurances, providers must ensure adherence to measurable “metrics” and protocols. Administrative functions designed to comply with these directives result in a higher price for medical care—and they skew the aim of the care from being solely focused on the patient to being directed toward fulfilling regulatory and financial mandates. This works against the common good by diverting resources away from real care, inflating the cost of care, and increasing the dependence of individuals and families on third party payors for all their healthcare needs. In CST parlance, the current system undermines subsidiarity (ie, local control in decision-making) and solidarity (joining of justice and charity), by working in detriment to the common good.
How can we reverse some of the erosion of poor stewardship that is inherent in the prevailing healthcare system? For one, it is important to bear in mind that the material and personnel needs of different specialties and care settings are markedly different—think of the differences between the needs of a primary care office and those of a liver transplant service. For the purposes of this article, I will focus exclusively on stewardship in the primary care setting.
Unfortunately, the prevailing insurance-dependent economic model which is used to finance nearly all healthcare expenses (see my previous blog on “subsidiarity”) has plundered economic and organizational resources in primary care. The reason for this is manyfold—first, primary care is not an ‘insurable’ event in the same way as trauma or emergency room care are. This is because, unlike emergency room care, the majority of primary care is predictable and foreseeable. Most people expect to see their primary care physician at least a handful of times a year for preventive care or a random episode of relatively mild illness, or to monitor chronic conditions such as diabetes and hypertension. By contrast, people generally do not anticipate having a major medical event such as a heart attack or stroke that leads to an ER visit or hospitalization.
The second way in which the insurance-payment model has hurt primary care is by treating the primary care practice as a “loss leader.” This means that large healthcare systems prefer to treat primary care practices under their umbrella as a financial liability, for the purposes of driving patients toward more lucrative services and specialties. The enormous overhead saddled on primary care practices—who are responsible for such tasks as requesting insurance authorization for subspecialty referrals, imaging studies and the like—makes primary care practices appear to operate at a loss. For primary care practices that are owned by larger healthcare systems, referrals for ancillary services such as labs and imaging are routed to the larger system without regard for cost of the service.
A reorientation of focus on stewardship in primary care is best achieved by decoupling primary care from large multispecialty health system care, and even from the insurance/government-payment mechanism entirely. Because of its relatively predictable and low-cost nature, primary care ought to be accessible to the average American without resorting to the pre-paid money laundering scheme that is the insurance industry operating in tandem with monopolistic healthcare systems. In the end, the goals of primary care are at odds with those of the hospital system—at its best, primary care obviates the need for higher-level medical care, while hospital-based care tends to incentivize more costly care. Even newer schemes such as ‘value-based care’—the newest iteration of the failed managed care policies of the 1990s—face a large burden of regulatory costs and metric-driven protocols that work at cross-purposes.
In summary, the CST principle of stewardship is intimately related to the principles of human dignity, solidarity and subsidiarity. When applied to primary care, stewardship promotes human flourishing through a judicious use of economic and human resources in the promotion of the common good—relying on local autonomous control over the delivery of care in response to the demands of justice and charity. 

Among the main principles of Catholic Social Teaching is the principle of Subsidiarity. Similar to the principles we’ve already discussed (dignity of the human person, solidarity), the principle of subsidiarity is intricately connected to the other CST principles. That is to say, it is incomplete to discuss subsidiarity without a clear understanding of its relationship to solidarity and the dignity of the human person.  We’ll get into that in a bit.
For starters, let’s define what we mean by subsidiarity. The Catechism of the Catholic Church (CCC 1883) presents subsidiarity in the following way:
“The teaching of the Church has elaborated the principle of subsidiarity, according to which ‘a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co- ordinate its activity with the activities of the rest of society, always with a view to the common good’.”
In other words, subsidiarity states that it is fitting and proper for responsibilities and decision-making to encourage participation and take place at the lowest level of community life possible—without interference from elements of higher order than is necessary to fulfill a function. Contrary to the assertions of some, this does not make subsidiarity an anti-government principle. For example, there are functions that are best fulfilled by higher levels of governmental order (ie, national defense, law enforcement) which would be disastrous if left to lower-level aspects of the community. In sum—and similar to the principles of solidarity and dignity of the human person--the proper application of subsidiarity is directed toward the advancement of the common good.
With regard to medical care, the concept of local control has been largely abandoned in favor of health system consolidation, algorithmic practice protocols, medical documentation and payment infrastructure that has homogenized the way care is delivered. What’s more, the infiltration of the public health concept of “population health” into the lexicon of medical education for student-doctors has further eroded the most subsidiarity-based of all relationships in medicine—the doctor-patient relationship. The rationale for these forms of collectivism in medicine is based largely on the idea that healthcare is too expensive and complex to be successfully managed at a local level—in other words, that some form of economy of scale is needed to realize cost containment and efficiency needed to deliver care across a country as large as ours.
There is a category error in this assumption that cost and complexity mandate a higher order of management over the administration of medical care. This error is that “healthcare” is a monolithic entity that is best managed and financed with similar mechanisms across all aspects of medicine. In reality, the different disciplines of medicine are inherently distinct with regards to the resources and personnel each needs to perform its function, as well as in the volume and circumstances of the demand for each. As examples, primary care is, by definition, the entry point of most people into the medical system. The need for primary care is often predictable and routine, and the services it provides are relatively inexpensive when compared to other specialty care. On the other hand, services such as trauma care and intensive care are less frequently used by most people, are more unpredictable, and cost more to provide. Therefore, it would follow that the financing models for each of these disciplines ought to be different from that of primary care.
By making these three care domains—the primary care office, trauma bay and intensive care unit—reliant on the same insurance-based model, the system drastically inflates the cost of primary care and severely limits the ways that care can be provided. Rather than burden primary care practices with the hefty overhead and confining regulation inherent in insurance participation, a decoupling of primary care from insurance and governmental payors actually frees physicians (and patients) from encumbrances and limitations imposed by those third parties. It restores primary care decision-making to the level of the doctor and patient—the lowest (and most appropriate) level of management in this most intimate of human interactions. It works hand-in-hand with solidarity by conferring the responsibility for the medical needs of people in the community to local agents, and it respects the dignity of the person by making primary care more accessible to all people, irrespective of whether they carry an insurance card or not. (In cases where a social safety net is necessary, patients—rather than state bureaucracies—ought to be the main decision-makers over the way resources are allocated.)
Locally responsive practices that respond to local conditions and the needs of patients. An economic model that decentralizes care and allows for ownership of care by patients and doctors. A practice model that does not exclude anyone on the basis of insurance networks or employment status. In summary, this is what subsidiarity in primary care medicine looks like. 

​--James Breen, M.D.

One of the key elements of Catholic Social Teaching is the principle of Solidarity. What does this mean to us in practical terms? And how is this applicable to the way we consider healthcare? Does the principle of Solidarity have any relevance to how we, as Christians, seek out (and--for medical personnel--provide) medical care?
The concept of Solidarity in Christian teaching is based on the idea that we are all called to care for one another, as sisters and brothers living in society. Justice and charity demand that we all work together to secure the protection and well-being of other members of our community, with special attention for those who are vulnerable or marginalized. As Pope St. John Paul II defined it, Solidarity is “a firm and persevering determination to commit oneself to the common good; that is to say, to the good of all and of each individual, because we are all really responsible for all." (On Social Concern, No. 38)
‘Now that all sounds very good’, you might say, ‘but how does this concept apply to medical care in a society like the United States, where there exist public assistance and social welfare programs to care for the poor?’
It is true that our country has developed a sizeable social safety net to account for the healthcare needs of materially poor Americans. Over the decades, this safety net has expanded to include an ever-larger segment of the American populace. At their inception in 1965, the Medicare and Medicaid programs were intended to provide assistance to the elderly and to poor Americans in need of healthcare. Over the years, the number and percentage of the American populace enrolled in these programs has expanded; they are no longer reserved for a small segment of marginalized Americans. As of 2022, Medicare and Medicaid comprised 24% and 19% of all US healthcare expenditures—the second- and third highest-spending entities after private health insurance. The implementation of the Affordable Care Act (ACA) in 2010, and the relaxing of eligibility requirements and freeze on Medicaid disenrollments during the Covid-19 emergency, have served as inflection points that greatly expanded the numbers of Americans covered by these programs.
Returning to the concept of Solidarity, it is important to remember that in its most authentic form, Christian solidarity is a matter of personal—not governmental—responsibility. Elected officials and bureaucrats may craft public assistance programs, but these do not substitute for the demonstration of true solidarity to our fellow men and women. On the contrary, one could argue that the encroachment of public payors (and commercial insurance payors) over the whole US healthcare system is one of the leading contributors to the unaffordability of basic services for ordinary Americans. This occurs when these government programs dictate payment schemes (ie, how much service providers will be paid for a given service), as well as the regulatory mechanisms that determine the conditions of payment. Because these processes (payment controls and regulatory oversight) are decoupled from the costs of providing services—and from the true need of the services by patients—the cost of healthcare tends to be inflated when the government plays a larger role in healthcare financing.
Sadly, one of the factors that has led to US primary care being driven into the ground has been the very government programs that ostensibly provide “access” on the part of a larger segment of the American population. The increase in practice overhead needed to comply with the rules and regs—not to mention the payment amounts dictated by programs (in the case of many Medicaid plans, less than the cost of providing care)—has forced many independent primary care practices to sell out to larger health systems to survive. This in turn has worked to the detriment of working-class Americans who lack private insurance and do not qualify for public assistance. In essence, the position taken by advocates of an expansion of Medicaid and Medicare is one that forces more people to depend on government assistance for even the most basic medical services—such as primary care.
In summary, government public assistance differs from the Christian notion of solidarity in three fundamental ways:

1. Government programs are incapable of expressing solidarity because they are, by definition, faceless and nameless bureaucratic institutions. They lack the capacity of building human relationships and compassion, which is the cornerstone of solidarity;
2. Public assistance programs are themselves a sort of political currency. Their expansion and funding are used as a lever of control to promote desired social outcomes, which is a far cry from solidarity’s foundation on justice and charity;
3. Rather than serve as a temporary assistance for needy individuals who are struggling to access medical care, governmental programs promote intergenerational dependence on government. An expansion of the numbers of people who depend on public assistance means that fewer people will be able to provide for their own needs without relying on government programs, which itself undermines the dignity derived from work and in meeting one’s own needs and the needs of the family.

A Christian approach to primary medical care is called upon to provide care for the vulnerable and marginalized in the local community. One of the ways it can respond to this need is by offering care that is economically accessible to working-class people, while also offering care to materially poor people who would not otherwise be able to access medical services. By viewing solidarity as a starting point, Christian primary care practices prioritize economic accessibility and welcome for the vulnerable as expressions of justice and charity. 

--James Breen, M.D.

We hear a lot of talk about ‘human dignity’ these days. Like many other terms that are often bantered about in the popular lexicon, the exact usage of the term may be different from what we have come to understand. (Think of the modern-day usage of the word “pride” as an example of an inversion of meaning.)
In some contexts, we hear the word “dignity” used to support the notion of a right to self-actualization. Recall that we are living in a time when a self-referential definition of values is deemed the highest good. By this standard, the highest protection of “human dignity” is expressed by creating ‘rights’ to such things as autonomy over choosing when one will die, whether one will continue a pregnancy (or not), and the expectation that others refer to us by how we define ourselves. By this criterion, the preservation of “human dignity” may even imply an obligation of others to affirm concepts that violate observable reality (think ‘preferred pronouns’), or to act in opposition to one’s own idea of dignity (such as the expectation of physicians’ participation in the legalization of physician-assisted suicide in the name of “death-with-dignity”).  It also implies that some people have a higher degree of ‘dignity’ than others, in keeping with a secular-humanist, utilitarian view of human worth (ie, qualifying human worth on conditions such as “consciousness”, or “quality of life”.)

So, what do we as Christians mean by ‘human dignity’?  And why is it so important in medicine?

One of the most radical propositions of the Judeo-Christian worldview is the idea that all human beings are made in the image and likeness of God--Imago Dei. Thus, the very essence of our nature as humans means that we have an irrevocable self-worth that cannot be erased. It is ours because we are creatures created by God, and as such we are all God’s children. Moreover, this concept of human dignity is present in all people, at all stages, irrespective of any other condition.

This Imago Dei concept of human dignity is of utmost importance in medicine; it defines medicine’s role in promoting and protecting all human life, and supporting human flourishing at all stages of development. It’s why we say that a doctor who cares for a pregnant woman has two patients—the woman and her unborn child. It’s why the American Medical Association is right to condemn physicians’ participation in executions and wrong to promote the killing of the unborn.  It means that doctors may not ‘play God’ in selectively choosing whether to carry out their professional duty to preserve and restore human life. As Pope Francis reminds us, ““Promoting the dignity of the person means recognizing that he or she possesses inalienable rights which no one may take away arbitrarily.”

​--James Breen, M.D.

This week, the Chesterton Society's weekly podcast features a conversation about how making medicine local, affordable and Catholic.
The discussion goes deeper into the reasons why a Catholic response to our current healthcare system is needed. We also touched upon the reasons why primary care is the natural starting point for the project to reanimate an approach to medicine around the principles of Catholic Social Teaching. 
To view the podcast on YouTube (also available on Apple, Spotify, and other podcast platforms), click here:

Happy Thanksgiving!

​-James Breen, M.D.
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​Welcome to this inaugural blogpost of “In Not Of.” Through this medium I hope to publish reflections on the evening twilight where Christian physicians and patients find ourselves today—able to see just enough to make out the shapes of things, while still knowing the crepuscular lighting is a sign that we are on the verge of being consumed in darkness. By deriving strength from one another, we needn’t be afraid of the dark.

This blog is being written to further the mission of the Benedict Medicine Consortium—to renew the practice of medicine adherent to the principles of Catholic Social Teaching, restoring it as an expression of the corporal works of mercy and a means of evangelization through action. While this may sound novel to us today, it is not a new idea--for countless Christians dedicated to healing over the course of Church history, care for the sick led to the conversion of countless souls to the Faith.

In our tumultuous time, Catholic physicians are not only battling the ravages of human disease but also contending with societal decay and a Leviathan administrative state that casts orthodox Christian beliefs as inadmissible in the secular public square. Rather than recognize the existential therapeutic alliance between doctor and patient, our contemporary healthcare leaders believe that medicine should be a top-down, centralized institution ordered toward efficiency and uniformity of processes and outcomes. It must be devoid of any values except the preferences of the patient, as if the profession of medicine had nothing more substantive to offer than what is suggested by business experts in customer satisfaction. Tragically, this erroneous attitude leaves us with physicians who are considered interchangeable technicians, and patients with deep suspicions of the entire medical enterprise.

We are witnessing a time when the entire medical profession has adopted a way of thinking that rejects its Hippocratic calling to protect and preserve all human life, as evidenced by nearly all mainstream medical societies’ promotion of abortion as a right and a fundamental good, and the looming rise of physician-assisted suicide. Similarly, stating basic biological truths about the human person—things as heretofore incontrovertible as the immutability of the two sexes—is pilloried as contemptible speech. In fact, an entire field of ‘gender medicine’ has been fabricated in an attempt to pass off flagrantly ideological concepts as respected medical therapeutics.

For all the confusion present in the profession of medicine today, we must remember that its errors are not exclusive to medicine, but rather are reflective of errors in the broader culture. This is because medicine is a byproduct of societal norms and values. This proposition is even more unsettling because we have been led to believe that medicine is based on scientifically validated knowledge tempered by the wisdom of a longstanding tradition of medical ethics. In recent years, the confluence of pernicious ideologies in the fields of medicine and education has uprooted the healing profession from its Hippocratic (and later Judeo-Christian) foundations.

Despite the starkness of this message, it is not meant to be dourly pessimistic. On the contrary, I believe it represents an opportunity for Catholic physicians to partner with patients and revitalize the medical profession, refashioning it into something much better than it has been. Much like the classical Catholic education movement has arisen as a response to the depredations of the public school system, the Benedict Medicine Consortium seeks to give rise to a similar movement with primary care practiced in accord with Catholic Social Teaching, to offer a bold alternative based on scientifically sound medical care grounded in the truth of faith.

As Christians, we are called to relationship—within our families, our communities, and most importantly, with Our Lord Jesus Christ.  To this end, I believe that what is needed is a countervailing force in medicine, characterized by the collaboration of Catholic primary care physicians and people of faith who elevate the dignity of the human person, service of neighbor, grass-roots local control, and prudent stewardship of resources as essential principles. Staying focused on these ideas works to deepen our sense of Christian community while providing the world with a practical and bold witness. It’s up to us to stand watch for the first rays of the dawn.

In future posts we’ll delve into why the principles of Catholic Social Teaching are so fundamental to the practice of medicine.
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--James Breen, M.D.