**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 piecemeal 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.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** Not applicable.

**Conflicts of Interest:** The author declares no conflict of interest.

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