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by Joseph A. Califano Jr. ’52
 My Special Ethics textbook at Holy Cross (written
by my professor, Fr. Joseph Sullivan, S.J.) concluded with
this admonition for graduating seniors:
“The duty of every one is to improve the condition
of society to such an extent that material wrong-doing will
not be forced upon anyone by reason of the social co-operation
into which he must enter ... If God has given you talents,
He will require an account of them. Do not sit with idle
hands while there is so much to be done. Do not draw into
a narrow selfish circle ... join some worthwhile organizations;
throw yourself into life in its intensest point, and make
your impress upon it - the impress of a courageous, right-minded,
wise and thoroughly instructed man. Be a doer of the Word,
not a hearer only.”
As President Carter’s secretary of Health, Education
and Welfare (HEW), I experienced “life at its intensest
point.” On my watch, it was HEW’s responsibility
to determine whether saccharin was carcinogenic and Laetrile
efficacious for curing cancer; how dangerous marijuana was
(and if spraying it with paraquat posed a significant additional
health hazard). After the Three Mile Island nuclear accident,
we tested food and water for safety and assessed the health
effects of the radiation; in Philadelphia we did epidemiological
detective work to nail the cause of Legionnaire’s disease;
in Colorado, we assessed the health hazards of moving leaking
Weteye bombs. We taught English, history and social customs
to refugees from Southeast Asia and Soviet Jews. We worked
with the commercial television networks and PBS to caption
programs for the deaf. The Congress and the president vested
us with frontline responsibility to fight discrimination
on the basis of race, religion, ethnic origin, sex, age and
handicap. When I was secretary, the department had all the
functions now dispersed among three separate cabinet agencies:
Department of Health and Human Services, Department of Education
and Social Security Administration.
Looking back, I realize that as secretary of Health, Education
and Welfare, my Catholic faith and the philosophy courses
taught by the Jesuits at Holy Cross gave me more support - and
sometimes more angst - than at any other time of my
life, as we confronted issues like abortion, in-vitro fertilization,
and the use of extraordinary life-extending procedures. In
a secular, pluralistic democracy these issues of life and
death involve questions about the right of individual Americans
to decide and the obligation of the federal government to
finance their decisions. Such issues come freighted with
religious beliefs and moral convictions, often further complicated
by a lack of scientific certainty.
In philosophy courses at Holy Cross, I was taught that murder,
suicide and euthanasia were morally wrong. I learned that
each individual had an obligation to take ordinary means
to preserve one’s life, but as my ethics text stipulated, “one
is not obliged to take extraordinary means.” As HEW
secretary, I had to make the vexing distinction between suicide,
murder and natural death, between ordinary and extraordinary
means of maintaining life, as our scientists wrestled with
the will of God, and each day unveiled a new medical machine,
miracle pharmaceutical or surgical procedure.
In September 1978, between campaign stops with Connecticut
Gov. Ella Grasso during her run for re-election, we discussed
these issues, and the way our society treated its elderly.
She was appalled when I told her that a third of Medicare
funds were spent on medical treatment for patients during
their last year of life. “I want you to come back so
I can show you something,” she said as I left to fly
to Washington.
When I returned, Grasso introduced me to the hospice movement.
The movement began in England, she explained, to ease the
pain and fear of terminally ill patients, usually cancer
victims, during their last days or months of life. Rather
than tie people to machines and tubes, or subject them to
savage long-shot chemotherapies, they are given a “hospice
cocktail” of drugs to ease the pain sufficiently to
permit the patient to live at home.
Grasso took me to the New Haven hospice team headed by Dr.
Sylvia Lack in a small, three-room New Haven office. We then
visited a man who was terminally ill with cancer in his home.
Ella and I sat on the couch and talked with the couple. This
simple, unsophisticated man was more comfortable in the conversation
than I was. He had come to terms with dying; I had not. I
was 47 years old, my parents were alive, and I had never
come close to someone I knew who was dying.
I asked Ella what I could do.
“Medicare reimburses for all the expensive therapy,” she
said, “but it doesn’t cover hospice as health
care.”
I promised to look into it.
Then she added, “I want to build a free standing hospice
in New Haven, and I need a million dollars.”
“You’ve got it,” I said.
“We could also use a little encouragement from someone
in high places,” Lack interjected.
When I returned to HEW, I was told I had no authority to
make a grant of one million dollars for a hospice. “I’ll
go to jail for giving Ella Grasso the money,” I said,
and personally signed an order to make the grant. Ella Grasso
put up the first free-standing hospice in the United States,
outside New Haven. At the first annual meeting of the hospice
organizations from across the country, on Oct. 5, 1978, I
announced that HEW would begin funding hospice care.
As my professional and political life intensified over the
years, especially at HEW, the moral theology of the Catholic
Church became more interesting and important to me.
What haunted me more than any economic or political controversy
in my HEW years was how HEW’s deepening involvement
in health-care delivery and medical research had shoved the
department to the center of the most profound moral, ethical
and religious questions. I was struck by how little thought
we as a nation had given to this development.
Although the Jesuits recognized some uncertainty in ethical
issues, by and large, at Holy Cross, lines were drawn with
a measure of precision and certainty I did not find in my
HEW experience. Vatican II encouraged Catholics to rely more
on individual conscience; it gave more freedom to moral theologians
for debate. But not until I became HEW Secretary did I begin
to appreciate the significance - and limitations - of
my personal convictions in making public decisions in a pluralistic
democracy.
The problems I faced at HEW could not be resolved by a bend - or
jerk - of the knee. I found no automatic answers in
Christian theology and the teachings of my church, or in
the Democratic party position or the administration’s,
or in the science of medicine, to the perplexing and controversial
questions of public policy on abortion, sterilization, recombinant
DNA, aging, in vitro fertilization, fetal research,
extending the final days of terminally ill patients.
I was grateful for my entire life experience, from the streets
of Brooklyn and the Jesuit classrooms of Brooklyn Prep and
Holy Cross to the West Wing of the White House and newsroom
of the Washington Post. I brought all of it - my
religious traditions, education, American culture, friends,
family and experiences in public and private life - to
the decisions at HEW, and I needed every bit.
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