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Religion, Ethics and Public Policy

by Joseph A. Califano Jr. ’52

Joseph A. Califano Jr. ’52My 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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