Fostering the Global Common Good: The Relevance of Catholic Social Teaching to Public Health Debates

Abstract

Given the scope and intensity of its impact, the COVID-19 pandemic proves instructive as an example of the shortfall in regnant legal and policy approaches to global health issues. Secular discussions of such issues tend to rely on a perspective best described as “policy realism”, with current international arrangements and institutions viewed as the acceptable context for future reform. Much of recent Catholic social teaching (hereinafter, CST) has challenged such realism in fundamental ways. While CST is often dismissed as merely prophetic in its tone, I defend its salience by assessing several aspects of its distinctive perspective: (1) the broad theological and anthropological vision reflected in the Catholic framework of basic norms, especially the norm of solidarity; (2) issues that arise in identifying different modes of moral discourse in modern CST; and (3) an effort to resolve such apparent tensions that unifies a distinctively Catholic approach to global health even as it suggests a series of “talking points” between the Catholic theological vision and various secular philosophical and political perspectives.

1. Introduction

The tradition of modern CST, since the papacy of Leo XIII (1878–1903) offers a distinctive set of lenses through which to assess and justify the basic goods of human flourishing, which include both individual health and the communal good of public health. Catholic natural law reasoning is both axiological and deontological: moral imperatives are generated by reflection on the basic goods that contribute to human flourishing, and such reflection generates both duties and rights concerning health. There are virtue-based duties of all persons to act, to the extent they can, as responsible stewards for their own health. There are also the rights of persons to adequate health care, with entitlements to basic care to be guaranteed by social institutions as concomitants of human dignity. In addition, there are the requirements of the common good that provide the larger context that both justifies and constrains the claims of individuals to pursue their own ends within society. The latter point is especially relevant to the COVID-19 context, in which some have resisted wide-scale vaccination efforts in the name of individual “liberty”. As I will discuss, such claims to unfettered individual freedom have no basis in Catholic thought. Individuals have duties to protect and promote their own health and the health of others. Persons also have rights to such protection and promotion as individuals and as members of the larger society. At the same time, the common good provides the appropriate framework for understanding persons as necessarily social, with rights and duties both justified and constrained by that foundational awareness.

In what is perhaps the most comprehensive recent overview of the fundamental values invoked by CST, Anthony Annett identifies a range of basic norms that he describes as “concrete principles” of CST (Annett 2022a, pp. 42–66). While each of the principles Annett identifies might serve to inform an analysis of collective obligations in response to the COVID-19 pandemic, my focus here will be CST’s recent emphasis on solidarity as a virtue that should animate both individual and social morality, especially its relevance to the functions of multilateral institutions in the context of ever-greater global interdependence. In the context of the COVID-19 pandemic, I will argue that the appeal to solidarity supports both the global right to vaccination and the general duty of persons to avail themselves of the vaccine as a necessary contribution to the common good. The warrants at work in CST’s arguments for a right to basic health care, ordinarily discussed within the context of individual care, a fortiori justify the provision of the goods of public health, where the Catholic understanding of individual claims as necessarily situated in the context of larger society is especially obvious in its implications and application. The Catholic case for a global responsibility to provide effective vaccines to all persons at risk, as well as the duty of individuals to be vaccinated, follow directly from the moral and theological warrants for CST’s distinctive understanding of the rights of persons vis-a-vis the requirements of the common good. Moreover, the norm of solidarity helps to resolve certain tensions that may arise in interpreting the relevance of the Catholic vision to the global discussion of public health. Especially as developed in the writings of John Paul II (but also invoked regularly by his two successors, Benedict XVI and Francis), solidarity emerges as a virtue that should animate both individuals and institutions, especially the institutions of government.

My discussion will also engage two aspects of the vaccine discussion raised by certain “dissenting” Catholic voices: first, the charge of “moral complicity” in the evil of abortion insofar as the recent vaccines, as well as earlier ones, have relied on decades-old research that included the use of cell lines initially derived from abortions; and second, the issue of whether and to what extent various policy “restrictions” on personal behavior (e.g., mask mandates, limits on or refusals of public access, required quarantine) are justified or challenged by a distinctively Catholic understanding of personal liberty of conscience. In each instance, I judge the “dissenting” voices to be in error. In addition, while the Catholic literature on the second topic—that of justified restrictions during the pandemic—is not extensive, I conclude that the answers follow straightforwardly from a distinctively Catholic understanding of individual rights as necessarily exercised within and constrained by the requirements of the common good.

2. CST: The General Background

While Catholic reflections on issues of justice and social ethics have long drawn on a scholastic tradition of natural-law reasoning and, more recently, on scriptural themes, CST generally refers to papal and episcopal documents beginning with Leo XIII’s encyclical Rerum Novarum in 1891. The so-called “social encyclicals” continue to the present, with later popes sometimes using the anniversary dates of the publication of Rerum Novarum to issue encyclicals that draw upon, even as they extend, key elements of Leo’s analysis. Such celebratory encyclicals include Pius XI’s 1931 Quadragesimo Anno on the fortieth anniversary of Rerum Novarum, Paul VI’s 1971 Octogesima adveniens on its eightieth anniversary, and John Paul II’s 1991 Centesimus Annus on its one-hundredth anniversary. In overview, CST reveals both continuity and development, with three aspects especially prominent. First, CST self-consciously brings the Catholic theological tradition to an engagement with the political and socio-economic conditions of modernity that, depending on the historical circumstances at the time of publication, will offer different emphases. Thus, Leo XIII was especially concerned with the rights of workers in an era of largely unfettered capitalism. Forty years later, Pius XI, amidst the rise of communism and fascism, highlighted the dignity of persons in the context of intermediate institutions and voluntary associations with an appeal to the principle of subsidiarity. Paul VI, drawing from the writings of his predecessor, John XXIII, emphasized the global dimensions of human rights claims. John Paul II criticized the inadequacies of both collectivist economic systems and unregulated market approaches, emphasizing the need for both perspectives to offer safeguards to protect the dignity of persons, with particular attention paid to the needs of the poor.

Second, the social encyclicals illustrate the varied theological and philosophical warrants at work in Catholic teaching. Appeals to natural law reasoning, drawing on traditional Thomistic understandings, are significant. At the same time, and increasingly since the papacy of John XXIII, one finds the language of individual rights based on the dignity of persons, including civil, political, and economic rights. Moreover, especially since the papacy of John Paul II (1978–2005) and continuing in the social encyclicals of Pope Benedict XVI (2005–2013) and Pope Francis (2013–), one finds appeals to human solidarity as a central theme, an emphasis that reflects an increasingly global perspective on such issues as poverty, immigration, and environmental devastation.

Third, the range of warrants at work in CST reflects the broad audience for such documents: persons for whom expressly theological and scriptural themes will resonate, as well as others of “good will” for whom natural law and humanistic appeals may prove persuasive. While these different warrants may at times generate tensions, especially in the context of social and religious pluralism, there are ways to view Catholic social teaching as distinctive in its own right while also often intersecting with other perspectives in political and social ethics.

3. The Norm of Solidarity

In CST since Vatican II, access to health care, including the ready availability of vaccines in the context of the COVID-19 pandemic, has been deemed a positive right, i.e., a justified entitlement claimable by individuals from society. The warrants for this understanding are expressly theological, involving a number of themes and principles that, while interconnected, can be analyzed separately. I have analyzed most of those themes extensively elsewhere and will not review the first six of them here beyond listing them again as norms central to the Catholic conversation (Lustig 1990, 1993, 1996, 2012). The first six of these themes are (1) the dignity of persons, (2) the common good, (3) subsidiarity, (4) social justice, (5) distributive justice, and (6) the so-called “preferential option for the poor”. However, a seventh theme, that of solidarity, has emerged as a core emphasis in the encyclical literature since the papacy of John Paul II. Herein, I analyze its development as a unifying norm in recent CST, one that helps to illuminate the responsibilities of individuals and institutions in the context of the current pandemic.

In the social encyclicals of the last three papacies, solidarity has emerged as perhaps the central value invoked in the ongoing tradition. To be sure, solidarity as a political concept long predates its use in Catholic discussion. It first appeared in Napoleon’s 1804 code civil and was invoked as a principle for reordering society by various political and social theorists during the nineteenth and early twentieth centuries, especially in the writings of French socialist Charles Fourier (1772–1837). The term first appeared in Catholic teaching in Germany in the late nineteenth century in the writings of social reformer Franz Hitze (1851–1921) and the Jesuit Heinrich Pesche (1854–1921). In the modern encyclical literature, cognates of solidarity are invoked in other explicit appeals from the earlier decades of CST. It seems clear that the value of solidarity was at least foreshadowed in the two major encyclicals of John XXIII, Mater et Magistra in 1961 and Pacem in Terris in 1963, in Paul VI’s 1967 Populorum Progressio, as well as in Gaudium et Spes in 1965, a core document of Vatican II. However, solidarity appears in full-blooded fashion only in the social encyclicals of John Paul II and continues to be cited regularly in the writings of his successors (Doran 1996).

To appreciate the importance of solidarity in John Paul II’s thought, it is helpful to situate it within the larger context of personalism, the theologically informed philosophy that shapes his approach to ethical issues at both the personal and institutional levels. As a priest and cardinal archbishop before becoming Pope John Paul II, Karol Wojtyla was a serious scholar and author, with particular interest in exploring the phenomenology of the person as the most appropriate focus for understanding the nature of human freedom and responsibility. While a professor of ethics at the Catholic University of Lublin in Poland, Wojtyla authored two significant books on personalism (Wojtyla 2013, 1979). In Love and Responsibility (Wojtyla 2013) and The Acting Person (Wojtyla 1979), he synthesized traditional scholastic understandings of human nature with insights from phenomenology. In his writings, he emphasized the inviolable and transcendent worth of each human being as the necessary safeguard against the dangers of materialistic and reductionist views. By underscoring the transcendent worth of persons as the necessary starting point for ethical reflection, Pope John Paul’s personalism seeks to avoid perspectives that would view persons as isolated individuals pursuing “consumerist” ends or as “units” of a larger collectivity. Instead, personalism insists upon the irreducibility of persons in their freedom. However, in that affirmation, the “liberty” central to the personalist account is not that of the atomistic individual, but of the socially situated self, with direct implications for understanding the appropriate relations between self and society.

At the same time, this personalism is expressed in terms of an anthropology that maintains a fairly traditional understanding of an objective moral order. It is that combination of commitments—to the inviolable dignity of the person as a subject who freely pursues the shared and definable goods of human flourishing—that leads to John Paul’s emphasis on solidarity as a norm. Viewed theologically, solidarity is best construed as a holistic virtue of both individuals and institutions that serves to integrate the more focused emphases of other theological norms (e.g., distributive justice, the preferential option for the poor, specific rights claims). In its integrating function, it has significant theoretical and practical promise as a value that both unifies CST and reinforces its growing call for international mechanisms to support personal rights and to enforce collective obligations in pursuit of the global common good.

While there are etymological precedents in CST for solidarity as an ethical norm, earlier terms (e.g., relationship, agreement, cooperation, interdependence) often appeared primarily in descriptive fashion, i.e., as features of the increasing complexity of modern socioeconomic circumstances. In an illuminating analysis of John Paul’s explicit use of “solidarity” as a norm in its own right, Constance Nielsen observes the decided shift in terminology one finds in John Paul. While earlier encyclicals had noted the facts of modern interdependence, John Paul speaks in Sollicitudo Rei Socialis about how solidarity, as an effective virtue based in fraternal love, can transform interdependence:

… in a world divided and beset by every type of conflict, the conviction is growing of a radical interdependence and consequently of the need for a solidarity which will take up interdependence and transfer it to the moral plane … [T]he idea is slowly emerging that the good to which we are called and the happiness to which we aspire cannot be obtained without an effort and commitment on the part of all, nobody excluded, and the consequent renouncing of personal selfishness.

(Pope John Paul II 1987, #26)

Nielsen comments that, for John Paul, “[s]olidarity does not replace interdependence, it transforms it. It elevates human unity to a higher moral dimension” (Nielsen 2007, p. 321). This transformation has implications for both individuals and institutions. As John Paul continues,

I have wished to introduce this type of analysis … in order to point out the true nature of the evil which faces us with respect to the development of peoples: it is a question of a moral evil, the fruit of many sins which lead to “structures of sin”. To diagnose the evil in this way is to identify precisely, on the level of human conduct, the path to be followed in order to overcome it.

(Pope John Paul II 1987, #37)

What, then, constitutes the aforementioned “path to be followed”? Here, John Paul is quite explicit:

… it is the virtue of solidarity: This then is not a feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far. On the contrary, it 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 person, because we are all really responsible for all.

(Pope John Paul II 1987, #38)

In her analysis, Nielsen draws together a number of earlier notions in CST that serve as precedents for John Paul’s explicit formulation of solidarity. There are two important aspects to John Paul’s discussion of the term. As a norm, it has extensive implications for both individuals and institutions. On the one hand,

while the earlier tradition rested primarily upon the twin categories of justice and charity, there was another animating love that went beyond the individual act of charity in the giving of superfluous wealth—a love that had social impact and worked for the common good … It is a love that promotes justice, goes beyond justice, seeks to perfect the structures of society, and is willing to go beyond self for the sake of others. Solidarity springs from this discussion of love. Yet, if the term solidarity is truly to be a development, it cannot simply be another term for the love already described. It goes beyond charity.

(Nielsen 2007, p. 336)

How, then, does solidarity “go beyond” charity? Unlike both charity and justice, which “can always be reduced to individual acts or personal dispositions that may or may not affect the common good” (Nielsen 2007, p. 337), John Paul draws out the necessarily social implications of solidarity at the level of culture, which is even “more fundamental to the ordering of society than either State or market” (Nielsen 2007, p. 341). Most profoundly, in Nielsen’s judgment,

Solidarity is neither a political nor an economic concept. It is a Christian virtue for the formation of people who will then go on to transform culture. They will naturally use the State and the market for the purposes for which they are intended. Their solidarity will motivate struggles for justice, and great acts of charity. In all they will be dedicated to the development of each and every human person.

(Nielsen 2007, p. 342)

Lest one confuse matters, while solidarity is “neither a political nor an economic concept”, it provides a rich context of reflection that has powerful implications in the analysis and critique of current global issues, including that of effective access to the basic goods of health care. As Anna Rowlands observes, the power of solidarity as a norm is that it integrates the sometimes more restricted emphases of other principles in three ways: “as an anthropological fact and theological reality; as an ethical principle or moral outlook; and … as a structural and institutional imperative” (Rowlands 2021, p. 265).

Each of these functions helps to provide a useful lens through which to consider the nature and scope of personal and social responsibilities during a pandemic. As an anthropological and theological reality, the pandemic serves as a stark reminder that we are inevitably interconnected, and that we are, in fact, both our own and our brothers’ (and sisters’) keepers. As an ethical principle or moral outlook, solidarity invites us, indeed challenges us, to understand our necessary interdependence as both a fact and a value. We become ever more fully ourselves in cooperation and, ultimately, in communion with others. As a structural and institutional imperative, solidarity offers a perspective on persons and institutions that views them as necessary partners rather than as antagonists in pursuit of the common good.

In light of solidarity, one can rather straightforwardly make the Catholic case for global basic rights within the context of what is called “the universal destination of earthly goods” (Second Vatican Council 1965, #69). John Paul II calls that concept “the first principle of the social order” (Pope John Paul II 1981, #19). The dignity of persons is affirmed as fundamental even as it is justified and constrained by the requirements of the common good. Thus, the “universal destination” remains a general norm for regulating the excesses of both an unfettered libertarianism and an unrestrained collectivism. It has served to both justify and limit property holding since the time of Aquinas. While private property is recognized as a legitimate feature of economic life, it is ultimately assessed in light of its contributions to the common good and regulated as necessary. According to Annett, the practical implications of the “universal destination” include both the taxation of excessive profits and the redistribution of overly concentrated wealth. In the context of COVID-19, he concludes that it justifies overriding the intellectual property protections of pharmaceutical companies by making inexpensive generic versions of the vaccine widely available (Annett 2022b).

When linked to the virtue of solidarity, “the universal destination” principle generates a powerful critique of current global realities. This critique points to the need for significant reform of current international approaches to ameliorating issues of global import, including climate change, hunger, lack of access to basic medical care, and inequities of access to the goods of public health. Central to that reform will be a recognition of the inadequacy of continuing to engage large-scale problems in piece-meal fashion, especially when one acknowledges the links between and among putatively separate issues. The more that such “systemic discernment” is encouraged, the more that integrated solutions will need to be sought as the necessary and compelling implications of recent Catholic discussion.

4. Two Misunderstandings among Catholic Commentators on COVID-19

There are two aspects of the recent discussion of COVID-19 in Catholic circles that merit further scrutiny here. First, some Catholic voices have cautioned against using any forms of the COVID-19-vaccine that relied, in their development, on earlier cell lines generated from the tissue of aborted fetuses. That charge has been raised before with the use of other vaccines, most notably the vaccine for rubella, and it is useful to summarize briefly the recent position paper of the United States Conference of Catholic Bishops that offers general approval of vaccine use (United States Conference of Catholic Bishops 2020). As David Cloutier observes, “the vaccine controversy raises the larger question of how to evaluate the present use of benefits derived from past evils” (Cloutier 2021, p. 20). To their credit, the bishops draw useful distinctions in response to the charge of moral complicity. They focus on the question of receiving a vaccine whose development employed the use of cell lines initially generated from tissues of an act of abortion, which Catholic moral theology deems intrinsically evil. The bishops are not reconsidering the licitness of abortion, nor the question of using cells taken directly from fetal tissue, but the use of vaccines whose “process of production or testing includes the use of cells taken from a cell line (HEK-293) that is virtually ubiquitous in basic medical research” (Cloutier 2021, p. 21). Cloutier cites the important analysis offered by Catholic scholar Cathleen Kaveny, who challenges the appropriateness of the charge of “cooperation” by critics of vaccine use. Kaveny distinguishes cases of “cooperation”, which involve judgments about direct and indirect complicity, from cases of “appropriation”, which involve the use of the “fruits of an initially evil act” (Kaveny 2000, p. 281). In light of Kaveny’s detailed analysis, Cloutier concludes that efforts to analyze at least some cases of appropriation according to categories of cooperation are, in effect, mirror images of that concept: “in cases of appropriation, you are not helping the evildoer; it is the evildoer who is (unintentionally) helping you” (Cloutier 2021, p. 21).

A second document from the Vatican raises another seeming confusion. The document states that vaccination “is not, as a rule, morally obligatory” and “must be voluntary”, and that those who “for reasons of conscience, refuse vaccines” must avail themselves of alternative measures (e.g., masking) to serve the common good (Congregation for the Doctrine of the Faith 2020). Here, as Cloutier observes, the document seems to suggest that such objectors to vaccination are praiseworthy, a judgment seemingly at odds with the subsequent statement of Pope Francis that receiving the vaccine is “the most reasonable solution for the prevention of the disease” (Pope Francis 2022). Numerous politically conservative voices have interpreted policy “restrictions” on personal behavior (e.g., mask mandates, limits on or refusals of public access, required quarantine) as infringements upon personal conscience or violations of freedom of religious practice. As noted above, some Catholics may mistakenly interpret their opposition to vaccines as a refusal to cooperate materially with abortion. That judgment, as the bishops’ letter indicates, is erroneous; as Kaveny persuasively argues, “appropriation” rather than “cooperation” is the preferable framework of moral analysis. However, independent of that potential concern with cooperation, some Catholics may claim such an unfettered “freedom of conscience” in refusing public health restrictive measures. That judgment is equally mistaken. Traditional Catholic moral theology makes clear that, in service to a proclaimed “right of conscience,” there is the prior duty to “rightly inform” one’s conscience (Lustig 2012). As should be abundantly clear from my earlier review of solidarity, it is unjustified to equate the Catholic understanding of personal freedom with a libertarian commitment to unfettered individualism. From first to last, the Catholic tradition is, as Charles Curran defines it, a “both/and” tradition: persons and community as well as persons in community (Curran 2002). To show indifference to the health of one’s neighbors by rejecting basic public health measures amidst a pandemic in the name of individual “liberty” is to fundamentally misread CST.

5. The Relevance of CST in the Public Square

Given the political context of pluralism in most of the developed world, one might ask how a distinctively Catholic conversation can contribute to an analysis of our collective obligations in response to the current pandemic. A more full-blooded reading of pluralism would likely celebrate, rather than discourage, the vibrancy of various voices in the public square about complex issues, which may be expressed in distinctive fashion. James Gustafson has reminded us that moral discourse, whether theologically inspired or not, may function in several ways. He discusses four “modes” of moral discourse—ethical, prophetic, narrative, and policy discourse. Each mode, Gustafson suggests, functions in the moral deliberations of particular communities and society at large, but none, as a singular emphasis, is sufficient (Gustafson 1990). Ethical discourse may be the mode most familiar to us—the language of basic norms, rules and principles, rights and duties, and the vocabularies of consequentialism and deontology. Ethics frames our reflections as we justify choices in a pluralistic society where a common narrative cannot be assumed. However, ethics tends to work within the status quo of current moral, legal, and political theory, and seems far less engaged with the larger anthropological or sociocultural picture. Prophetic discourse, by contrast, is often passionate in its sweeping indictments of larger cultural trends and social sins. It highlights those large-scale background features that the ethical mode in the foreground tends to underplay, but it seldom offers fine-grained analysis of particular issues. Narrative discourse is the language of story rather than argument. Before all else, narrative is about inspiration, about the ways that character is shaped by the stories we tell. Finally, there is the policy mode of moral discourse, which tends to work with the values already embedded in the choices we have made. Seldom if ever prophetic, it asks not “What is the good or the right choice?” but, within a range of alternatives, “What is the reasonably good and feasible choice?”.

In light of Gustafson’s distinctions, it is helpful to consider which mode or modes function most prominently in applying CST to the recent pandemic. As ethical discourse, Catholic thought challenges us to achieve a better balance between the language of rights and that of duties. Persons have basic rights, both negative and positive, but the language of the common good offers a useful corrective to the not-uncommon stridency of rights language. Neither utilitarian average outcomes nor unfettered individualism will survive the scrutiny of common good considerations. As prophetic discourse, CST affirms the necessary limits on private property in order to fulfill the requirements of solidarity and the common good. In that light, it emphasizes the necessity of a robust social safety net, including access to basic public health. So too, CST, by emphasizing certain themes in the Christian story, especially the universalizing tendency of Christian love, invites broader reflection about global responsibilities for the meeting of basic human needs. As a result, CST increasingly discusses the rights of persons and the scope of the common good in global terms. What might have once been dismissed by policy “realists” as largely utopian notions formulated at a fairly general level have taken on a new and practical urgency in light of COVID-19 and its aftermath. In this regard, the pandemic is a stark reminder of the quite literally global consequences that have challenged the sufficiency of Westphalian commitments to the primacy of the nation-state on a range of global issues.

The encyclicals, as well as numerous episcopal statements by Catholic bishops addressed to their national constituencies, have targeted such issues with an appeal to the universalizing impulse of CST. An earlier language of natural law already espoused certain basic norms as foundationally social in their implications and bindingness. The language of human rights based on personal dignity, while drawing on the legacy of that earlier methodological emphasis on natural law, has increasingly spoken of the full panoply of rights—civil, political, and socioeconomic—in universal terms. All persons have claimable entitlements to the concomitants of human dignity. That assertion, sometimes dismissed as either wishful thinking or, at best, as a promissory note for its realization in some distant future, is decidedly “realistic” as a Catholic commitment precisely because of the theological perspective that informs it. If we are equal members of the human community, equally deserving of dignity, then remediable inequities in the creation and distribution of the basic goods of human flourishing must be addressed. The force of the normative logic at work in the theological claim is clear in two basic respects. First, systemic indifference to global needs that rest on outmoded conceptions of “balance of power” politics must be challenged as violations of the rights of those excluded from such calculations. Second, in light of the first conclusion, there are duties increasingly incumbent on global alliances and institutions to address remediable inequities in meeting basic human needs (in the current case, access to vaccines).

To this point, I have considered the general Catholic case for a right to basic health care, one that moves along a steadily globalizing vector. At the same time, we must acknowledge certain tensions that arise when seeking to interpret and apply CST, because, at times, it employs Gustafson’s different modes of moral discourse in ways that defy easy integration. For example, as prophetic discourse, CST emphasizes access to basic health care as a universal right, while understanding, according to the principle of subsidiarity, that the scope of that right will often be contextualized in ways that make universal guarantees difficult to specify with precision, much less to implement fully. So long as current patterns of resource distribution are determined primarily at the regional or national levels, how professedly universal rights are to be instantiated raises fundamental challenges to their provision. However, if one seeks to interpret CST as something closer to a policy mode of discourse, that would appear to temper, if not undercut, the universalizing impulse reflected in the prophetic language of human rights, especially in view of the variable local and regional contexts to which considerations of subsidiarity will apply. Indeed, looking though a policy lens might well lead to a judgment similar to that offered by Joel Feinberg about global claims of basic positive entitlements. According to Feinberg, while such claims should not be dismissed as nonsensical, given current realities, they should be construed as what he calls “manifesto rights,” i.e., statements that offer visionary perspectives on ideals toward which we should aim but which cannot be implemented at present (Feinberg 1970).

A careful reader of modern CST will not be indifferent to such tensions among modes of discourse, nor of the need for further specification of their implications for particular issues. Nonetheless, whatever the cautions appropriate in distinguishing prophetic from policy discourse, the Catholic arguments, if they are to illuminate a path forward, will exhibit a form of what might be called a “hopeful realism”, i.e., a commitment to expanding health care access as widely as possible, precisely because the primary theological warrant undergirding that impulse is that of the dignity of all persons made in the image of God. Seen in that light, fundamental failures to expand access are to be judged not simply as unfortunate consequences of the genetic and social lotteries, but as failures to honor the requirements of personal dignity, distributive justice, the common good, and solidarity. Each of these norms is fully justified in CST as a moral claim; the challenge remains to instantiate them as legal and political realities. The complexities of that “translation” of rights—from moral claims to global political realities—cannot be denied, nor can the power of the “Catholic case” for such progress to be realized.

6. Public Health and the Global Common Good

In light of CST’s recent emphasis on solidarity, which I reviewed in Part III, I turn now to the specific context of public health and the development and provision of vaccinations in a pandemic situation. The argument here is a straightforward one. The Catholic perspective on health and health care involves the language of both duties and rights. Each person, insofar as possible, has a duty of good stewardship for his or her own health as God’s gift. In a time of pandemic, a key aspect of that duty is to educate oneself about the COVID-19 vaccine as a contributor to one’s own flourishing, despite the prevalence of extreme public misinformation and disinformation. The correlative of that individual duty is the right of access to vaccination by all persons as a necessary prophylactic in the defense of one’s own health. However, the Catholic duty to oneself is amplified by the duty to contribute to the common good—in this instance, the overall benefits of universal vaccination to the population at large. The Catholic case that justifies both the duty of one’s own health stewardship and the right to basic health care is cogent and persuasive as a general claim about ordinary medical care involving individual patients. It justifies, with equal or even greater force, the duties and rights involved in public health measures, where the focus, while involving access by individuals, is preeminently concerned with population health. Granted, persons comprise communities; thus, “public health rights” entail individual claims. However, as we have seen, the Catholic vision of personal dignity as situated in and fulfilled by participation in the larger community is especially relevant to matters of public health. A libertarian notion of individuals unencumbered by larger social obligations makes no sense regarding either the science underlying the pandemic or the need for community-based rather than merely individual measures of prevention, protection, and mitigation.

In his final two chapters of Cathonomics, Annett draws specific global implications of the Catholic social vision, offering a lengthy list of specific but interlinked recommendations on a range of topics, including international tax policy, sustainable development goals, debt relief, and trade and subsidy policies (Annett 2022a, pp. 249–85). It is important to acknowledge the complex synergies between and among the many ostensibly “separate” policy concerns that he reviews. It is also worth emphasizing yet again that CST has increasingly emphasized the global dimensions of solidarity as a norm: first, a recognition that the world is ever more characterized by interdependence, and second, in light of that interdependence, an ever-greater need for effective international mechanisms, especially a reformed and strengthened United Nations.

Pope Francis has placed particular emphasis on the importance of reforming the current world order through a more robust commitment to a global vision of solidarity. In his most recent encyclical, Fratelli Tutti, written after the outbreak of the pandemic, Francis stresses the urgency of moving beyond what he deems both outmoded and ineffective earlier perspectives on global problems (Pope Francis 2020, #172, #173). In addition, in an address to the United Nations General Assembly, he describes the sweeping nature of the choice we face:

We are faced, then with a choice between two possible paths. One path leads to the consolidation of multilateralism as the expression of a renewed sense of global co-responsibility, a solidarity grounded in justice and the attainment of peace and unity within the human family, which is God’s plan for our world. The other path emphasizes self-sufficiency, nationalism, protectionism, individualism, and isolation; it excludes the poor, the vulnerable, and those dwelling on the peripheries of life. That path would certainly be detrimental to the whole community, causing self-inflicted wounds on everyone. It must not prevail.

(Pope Francis 2020)

Notice the moral vision at work in Francis’s words: global co-responsibility and solidarity within the human family, understood in universal terms as the foundational virtues for both persons and the institutions acting on their behalf. Such virtues, Francis observes, stand in clear contrast to the cramped visions of nationalism and individualism often voiced in current political discussions.

The starkness of the choice Pope Francis presents underscores the urgency of the decisions we face. Since the time of Leo XIII, CST has been especially concerned with the inequities generated by the effects of modernization on the dignity of persons and the common good. CST affirms both subsidiarity and solidarity. On that joint basis, it critiques the excesses of both capitalism and socialism, depending on the historical context within which a particular encyclical is written. However, especially now, in light of the increased interdependence and global nature of many of our most pressing problems, the ”society” within which persons live requires a broader framework of analysis and application than in earlier times. The “national interests” of states should therefore include, as a necessary feature of their reckoning, meeting the remediable basic needs of all, both citizens and “foreigners”. How those needs are to be met may be accomplished through a variety of institutional mechanisms, depending on circumstances—direct governmental aid, public–private partnerships, and incentivization of market distributive patterns. However, that basic human needs should be met is not in dispute, and global institutions should be held accountable on that basis. Such personal rights and collective obligations are well-developed moral claims in CST. The challenge remains to make them legally and politically binding.

For all the difficulties of integrating the various modes of discourse in CST, in this pandemic situation, there is merit in viewing the prophetic and policy modes of discourse as more complementary than opposed. The Catholic conversation is not merely prophetic in the often dismissive sense its critics intend. The power of the prophetic voice in the context of global issues is also to challenge the adequacy of a relatively complacent realism. Several such challenges come readily to mind. As I close, I offer several points by way of summary emphasis.

First, if the goods of health care, including public health goods, are the necessary concomitants of personal dignity, they are entitlements to be honored and provided for all persons, not merely as utilitarian “average” outcomes. Either Catholic rights language is meaningful or it is not. If the former is true, then the implications of the Catholic case for expanding public health guarantees on a universal scale are decidedly reformist in tone. Indeed, if taken more seriously at the policy level, such “prophetic” discourse about a morally justified universal right of access to basic health care carries implications for broadly systemic restructuring and reform of current global political institutions.

Second, while the goods of health care, including public health goods, are personal entitlements justified on theological grounds, Catholic natural law theology offers a series of “interim norms” (especially of social and distributive justice) that find areas of overlap and affinity with other moral perspectives that are not theologically grounded. A few examples will suffice here. “Revised natural law” approaches affirm that certain fundamental “truths” about human flourishing are rationally available to all persons engaged in practical reasoning without appeal to particular theological or philosophical premises (e.g., Finnis 2011). Appeals to the “common morality” are central to the dominant theory of “principlism” in biomedical ethics developed by Tom Beauchamp and James Childress (Beauchamp and Childress 2019). In political ethics, Michael Walzer (2019) and Peter Singer (2016) appeal to certain broadly shared intuitions that undergird global appeals to basic justice. Amitai Etzioni and other proponents of communitarian theory speak of the crucial function of social commitments in the flourishing of persons (Etzioni 2004). In such instances, and many others, a workable consensus can be accomplished even without convergence at the level of fundamental theoretical commitments. Granted, all such comparisons would require significant and rigorous exploration to be fully persuasive, but rather than the usual “straining of gnats” among various camps of theorists, I simply affirm, by way of summary here, the powerful plausibility of achievable consensus among different perspectives at the level of policy choice and crafting.

Third, if the goods of health care, including public health goods, are necessary concomitants of human dignity, and if, in fact, global welfare guarantees are now achievable (see, e.g., Sachs 2006; Thurow and Kilman 2009), then, in light of plausible policy consensus, what can now be accomplished (e.g., eradication of hunger, basic health care as a global right) should be accomplished. In a reversal of the usual Kantian dictum, in this situation, “can implies ought”. Past incapacities may have left the claims of positive entitlements, including the goods of public health, as more akin to Joel Feinberg’s “manifesto rights” (Feinberg 1970). Our current capacities shift the burden of moral proof immediately, and the burden of legal proof must be shifted as quickly as resources and institutions can be reconfigured to make such claim rights both legally and morally binding.

Fourth, the nation-state framework is no longer fully adequate (if it ever was), given the urgency of the moral and political tasks at hand. “Balance of power” politics is increasingly ineffective, both in its squandering of available resources and in its tendency to deny or ignore the universal positive rights of persons. Therefore, new multilateral mechanisms should be developed and implemented, including (according to principles of subsidiarity, social and distributive justice, and solidarity) a mix of international, global, and public/private partnerships to meet the needs of persons irrespective of the former constraints of national borders.

Finally, in keeping with Annett’s emphasis on the interlinkage of global issues, strategies of coordination and prioritization should be emphasized in order to overcome piece-meal bureaucratic “solutions” that fail to integrate the often competing tactics at work on putatively “single” issues (Annett 2022a, pp. 249–85). As Annett’s analysis clarifies, such bureaucratic silos too often tend to define targets for policy intervention in an unduly restrictive fashion. By so doing, they undercut the effectiveness of larger strategies of response and limit the vision required to actualize universal human rights within the context of the global common good.