Markkula Center for Applied Ethics

A Spoke in the Wheel

Margaret R. McLean

Margaret R. McLean is the director of bioethics at the Markkula Center for Applied Ethics and the Center’s associate director. Views are her own.

If I asked you to list the most vulnerable people in the world, children would likely top the list. If we know anything about the life and ministry of Jesus, we know that he cared deeply about vulnerable people—the widow, the orphan, the traveler, the child. His work was that of healing individuals and communities—curing leprosy and blindness; admonishing his followers to be like children, to care for those who have no coat or who are left for dead on the roadside.

Now, we look at the painful reality of the scandal of children sexually abused by priests and the cover-up perpetrated by bishops and wonder where is Jesus in all of this?

The answer is obvious. Jesus is with the children—now adults—who were brutalized by men they trusted and who will carry deep scars forever. Their childhoods cannot be restored; their hearts cannot be mended. But, their stories can be told and believed and can teach us how to protect and care for the vulnerable today. They can point the way for how we treat another vulnerable group—the sick, those on the margins of everyday life due to illness of body, mind, and spirit.

As a medical ethicist, I meet patients and families in the unfamiliar surroundings of hospital rooms, forced to answer questions they never wanted to answer, living through uncertain days of decision, more vulnerable than they could have ever imagined. What lessons can we in health care learn from the brokenhearted and their stories?

  1. Hierarchies corrupt. The willingness of bishops to dismiss victims’ stories of abuse, to pay huge sums for silence, and to protect the priestly perpetrators exposes the dangers of unchecked power in institutional cultures. What my colleague, Ann Skeet, wrote last week applies not only to the ecclesiastical institutions but to health care as well: “Placing the dignity and respect of every individual in every organization as its primary concern is the only way an institution can exist and thrive.” Patients and families must be the focus of concern.
  2. Truth is hard. Telling the truth is particularly hard for those who have been brutally victimized and who stand to be victimized again by those in power—having their stories dismissed, being threatened with worse. Young children don’t understand and cannot explain what is happening to them and may blame themselves, thinking the abuse is somehow their fault. Listening to patients’ stories and believing that they believe what they’re saying is true will engender the trust so necessary for patient care and healing.
  3. Scars last. Adverse childhood experiences (ACEs) are stressful or traumatic events that include abuse and neglect. Children exposed to chronic, stressful, frightening experiences such as sexual abuse can suffer from disrupted neurodevelopment, leading to impaired cognitive functioning and diminished coping skills. Unhealthy coping mechanisms contribute to depression, substance abuse, suicide, long-term health challenges (e.g., diabetes, heart attack, and liver disease), risk of sexual violence, and premature mortality. ACEs impact individuals, families, and society. Prevention of childhood adversity, promoting healthy childhood development, and employing trauma-informed care for patients who suffered through adverse events as children are all necessary to providing good health care and preventing future disease and disability.

In 1933, shortly after Hitler’s election as Chancellor, the young pastor, Dietrich Bonhoeffer, exhorted the German church: “We are not to simply bandage the wounds of victims beneath the wheels of injustice, we are to drive a spoke into the wheel itself.” As the Catholic Church struggles to bandage the wounds inflicted by sexual abuse, it must do no less than drive a spoke into its own abusive wheel, not merely apologizing but learning from its mistakes and stopping such egregious injustice in its tracks.

Sep 4, 2018

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