Subsidiarity: What could it require?

1. Subsidiarity:What could it require? Philip Boyle, Ph.D. STL Vice President, Mission & Ethics

2. Objectives Grapple with the meaning and implications of a foundational principle of Catholic social teaching Identify one or two examples & threats to the subsidiarity in your own work environments Relate commitment to the subsidiarity to the provision of person-centered care and other health care activities Reflective integration

3. Subsidiarity • From: subsidium (latin) which means help (reserve line of battle) • Involves an ordering of relationships in society to promote the common good • “needs are best understood and satisfied by the people closest to them and who act as neighbors to those in need” • ( Pope John Paul II Centesimus Annus – 1991)

4. Subsidiarity • Subsidiarity requires those in positions of authority to recognize that individuals have a right to participate in decisions that directly affect them, in accord with their dignity and with their responsibility to the common good. • Decisions should be made at the most appropriate level in a society or organization, that is, one should not withdraw those decisions or choices that rightly belong to individuals or smaller groups and assign them to a higher authority.

5. Subsidiarity • A higher authority properly intervenes in decisions when necessary to secure or protect the needs and rights of all.

6. Subsidiarity • What values are protected by encouraging subsidiarity? • What are the advantages of “empowering” persons to participate in decisions that affect them/their lives?

7. Subsidiarity • What values are placed are placed in jeopardy for not fostering subsidiarity? • What are the disadvantages/risks of empowering persons to participate in decisions that affect their lives?

8. Assumptions/ corollaries • The dignity of the person • Dignity is expressed in free choice • The common good • Propose exercise of authority/power • Caring for those who are poor • Their dignity requires their direction & involvment • Participation/ Association • Participation == subsidiarity • Solidarity • Radical interdependence; nature of assistance • Stewardship • Proper use of resources

9. The Condition of Labor(Rerum Novarum) 1891 • Leo XIII recognizes there is an appropriate role for the authority of the state which must be balanced with the rights of workers. Subsidiarity not specifically mentioned though groundwork laid for future development

10. Quadragesimo Anno The Reconstruction of the Social Order 1931 • Pius XI explicitly makes the principle of subsidiarity the guiding norm upon which the social order is to be restored. “…it is an injustice and at the same time a grave and evil disturbance of the right order to assign to a greater or higher association what a lesser and subordinate organization can do.” (#79)

11. Christianity and Social Progress(Mater et Magistra) 1961 • The individual is the foundation, cause, and end of all social functions. Men and women should first take responsibility for their own initiative and labor, and the state should only intervene to promote justice and prevent harm. The state should intervene to redress economic imbalances or political tensions when necessary. • “…they should have this goal in mind, that citizens in less developed countries…feel themselves to be the ones chiefly responsible for their own progress. For a citizen has a sense of his own dignity when he contributes the major share to progress in his own affairs. Hence, those also who rely on their own resources and initiative should contribute as best they can….those in authority should favor and help private enterprise in accordance with the principle of Subsidiarity, in order to allow private citizens themselves to accomplish as much as is feasible. • .

12. Peace on Earth(Pacem in Terris) 1963 • The principle of subsidiarity is applied to the international situation and appeals for the establishment of an international public authority to address the urgent economic, social, and political problems of the day. A higher authority is needed to protect and promote the universal common good. Subsidiarity governs international relations…but also expresses need for an international body to protect international common good. “…because of the vastness, complexity and urgency” of the problems, individual states are not able to tackle them with any hope of success.

13. Populorum Progressio The Development of Peoples 1967 • Paul VI affirms the need for international authority to coordinate the establishment of just political and economic spheres and draws on the principle of subsidiarity.

14. Tradition • Economic Justice For All (USCCB) – 1986 • “…CST has long stressed the importance of small and intermediate sized communities…exercising moral responsibility. These mediating structures link the individual to society as a whole in a way that gives people greater freedom and power to act. Such groups include families, neighborhoods, church congregations, community organizations……All these groups play a crucial role in generating creative partnerships of the pursuit of the public good……

15. Case examples • Shared governance—Magnet status • Mission discernments • Access to care: federal state or local? • Health systems: Federal or state? • Outside health care • When can 3rd parties intervene? • Child welfare • Police interventions • Exhausted all other means • Grave risk for non-intervention • Civil rights; busing • Nudge—”Libertarian paternalism” Behavioral econ

16. Shared GovernanceA Contemporary Example of Subsidiarity T. P. O’Grady: • “An organizational framework which enables sustainable, accountability-based decisions…represents the partnership between all who provide services and support in the system”

17. For Further Reflection…. “Approximately 90% of decisions belong at the point of service. To the extent decisions are not made where they belong, they ultimately work to impede or obstruct the work they were engendered to enable.” (O’Grady, 2001) “Implementing…shared governance means that the relationships, decisions, structures, and processes will be forever changed at every level of the system…The work is often overwhelming, treacherous, noisy, slow and time consuming.” (O’Grady, 2001)

18. Shared Governance:What goes on at your ministry? • Reflective Integration a tool by Robert G. Hess, RN, PhD. • In your institution, please circle the group that CONTROLS the following areas: • 1= Management/administration only • 2= Primarily management with some staff input • 3= Equally shared by staff and management • 4= Primarily staff with some management input • 5= Staff only • Determining what activities your professional colleagues can do in their daily practice. 1 2 3 4 5 • Making hiring decisions about professionals within your discipline. 1 2 3 4 5 • Selecting products used in your professional practice. 1 2 3 4 5 • Determining activities of ancillary personnel. (aides, clerks, secretaries, assistants etc.) 1 2 3 4 5 • In your hospital, please circle the group that INFLUENCES the following: • Adjusting staffing levels to meet fluctuations in work demands. 1 2 3 4 5 • i

19. Shared Governance:What goes on at your ministry? • Given the questionnaire: • Does any group dominate? • Is any group excluded? • What are the benefits and risks posed by those who control, participate in, or have official authority over, decision making?

20. Subsidiarity • How would you describe the management style at your site? • Command and control • Lassez faire • Collaborative • Empowering • Other

21. Challenges of Subsidiarity in Your Organization • Where is your organization vulnerable in terms of subsidiarity? • What are some practical steps you could take in your leadership role to reduce that vulnerability?

22. How do we promote and defend subsidiarity? • Person-centered care • We respect people’s consciences, especially in matters of how to promote their health and well-being (both physical and spiritual) • People should be free to refuse treatments that they consider, with a reasonable and informed conscience, to be too burdensome or no longer offer a reasonable hope of benefit.

23. Subsidiarity • What traits, virtues, skills do you have or need to work in this way? • Can you name a place in your organization where subsidiarity is alive and well?

24. Subsidiarity at work • Where is your organization “vulnerable” in terms of subsidiarity? • What are the biggest obstacles to working in a way that respects subsidiarity? • As a leader in your ministry, what are some practical steps you could take to insure implementation of this principle?