Medicine, The Clinician and Money
Basil (330-379)
On Social Justice: Four recently translated homilies on texts such as Mt 19.16-22, “To the Rich”, [The translation of which is available above] and Lk 12.16-21, “I Will Tear Down My Barns”, which were likely written in 368 during the greatest famine in the history of Caesarea. The work of Basil, who was a priest in the diocese of Caesarea at that time, formed the basis for what would subsequently become the foundations of the modern hospital system, with the complex of care that he developed later taking on the name of the “Basiliad.”
Gregory of Nyssa (335-395)
Homily on the Love of the Poor
John Chrysostom (347-407)
On Wealth and Poverty: Six homilies on the Parable of the rich man and Lazarus (Luke 16:19-31, )
Thomas Aquinas (1225-1274)
Summa Theologica
Second Part of the Second Part (SS), Q. 66
Of Theft and Robbery (Nine Articles)
Article. 1 - Whether it is natural for man to possess external things?
Article. 2 - Whether it is lawful for a man to possess a thing as his own?
Mary Hirschfeld
Harvard-trained economist who transitioned in her later career from a college professorship to a PhD in Aquinas from Notre Dame which gave rise to the book below:
Aquinas and the Market: Toward a Humane Economy
Mary Hirschfeld on comparing contemporary economics with economics as understood by Thomas Aquinas.
Her related journal articles can be found here.
Interview with Mary Hirschfeld “On comparing contemporary economics with economics as understood by Thomas Aquinas.”
The above resources will be expanded upon in future posts, especially as regards Basil, his view of the Christian’s use of personal resources for the good of others and how the outworking of those principles laid the foundation for the formation of the world’s first hospital system.
In this introductory post, however, we will interact primarily with Aquinas’ view of our utilization of wealth and private property, as presented in the Second Part of His Summa Theologica, SS.Q. 66 (which is situated within the context of his discussion of the Cardinal Virtues). And as we have no expertise on Aquinas, we will rely heavily on the analysis and insights of noted economist Mary Hirschfeld who completed a PhD at Notre Dame on Aquinas (The thesis of which was entitled, Virtuous Consumption in a Dynamic Economy: a Thomistic Engagement with Neoclassical Economics. Dissertation directed by Dr. Jean Porter, July 2013).
To begin, the central question which seems to keep resurfacing as one enters medical training, then completes residency and finally moves onto a salaried position in medicine is “How much do I really need?” (Not, we might add, “How much can I earn?” or “How much do I deserve to earn?”). While it is true that the particular amount of what we truly need obviously changes as we move through various life stages, this question still remains, “How much do I truly need”—and it must be continually revisited, it seems, all throughout our lives.
In light of this central question, Aquinas’ answer in SS., Question 66 seems to provide us with, possibly, the most helpful direction (Note: These two articles are very short, only two pages if you have the time to read them). In working through his answers, we begin with a basic background to Thomistic thought (The quotations below all refer to Hirschfeld.)
There are the “lower forms of reason” that can be manipulated “through incentive.” Then there are the “higher forms of reason” that “discern which goods are genuinely worthy of pursuit”
Our modern economic system utilizes the lower form, addressing persons as “objects to be manipulated” rather than “human beings who can be addressed.” Furthermore, economic analysis drives the formation of political policy built upon this “manipulation of incentives to induce behavior and outcomes” that are deemed “desirable.”
In Q. 66, Thomas deals with the particular issue of private property. Though himself part the Dominican order, whose friars were to be itinerant preachers living in mendicant poverty, Thomas argued that owning property was not, in and of itself, forbidden. The reason for this, he argued was that the “power to procure and disperse”, that is the “managerial aspect of owning property” may be suited to private ownership because it can motivate a work ethic to maintain it.
That is the management of property. With regard to how we actually “use” property, Thomas believed that we should do so “as if it were in common”, which is to say, as being “ready to share with others in their need.” There is not a command. Only a posture, which, we might add, if it actually leads us to action, will enable material goods not to isolate us further and further apart but to draw us together into deeper unity.
This, however, requires us to develop a totally different conception of economics and apply a different framework to the way we view it currently. Private property, it may be said, does indeed “channel my natural self-concern”, which can be beneficial in the right management of that property. The end of that property, however, is not my “personal happiness”, but rather the development of character and virtue that contributes to better relationships and a healthier, Christ-centered community. This is a very important point—Material possessions do not engender happiness; rather they are merely means that can (in the best scenario) enable the pursuit of that which is higher.
Money and resources can be something that enables us to live lives of virtue together in community. According to Aquinas, they are “instrumental goods,” the desire of which is “finite.” If this is indeed the case, then we must seek to identify how much material goods we truly need to live such a life of virtue. We can think here of the wisdom of Agur who asked for neither poverty nor riches but for only what he truly needed (Prov 30:8); for that which was appointed for him (חֹק [choq]). And if we happen to earn more than this amount, the remainder is, as Thomas understands it, “available to be shared with others.” In this way, the personal and the communal, the private and the public, the material and the spiritual come together.
With this, we might say metanoiaic insight, we return back to our current era in which the framework is dramatically different. The view of modern economics is based not on need so as to develop virtue, but rather, as Hirschfeld argues, on incentivizing work so as to maximize the gain of the highest possible material goods.
Is this not what we find as we move through our training?—Work as hard as possible to “get” the most we can. Need does not enter into the equation. Need may have been there in the early phases. Now there is only desire. Or in the language of an economist, we have “preferences” that we can “rank order” then “map onto a utility function” with the goal of “maximizing the utility function.” The objective, the endgoal, is to “satisfy as many preferences as we can given our limited time and resources.”
With such a “model” structured on desire an economist can first “predict human behavior.” (See for example the list of Nobel Prize in Economics awardees, like Daniel Kahneman’s work on “integration of psychological research into economic science, especially concerning human judgment and decision-making under uncertainty” or Heckman and McFadden’s “development of methods of statistical analysis of individual and household behaviour”, Mirrlees and Vickrey’s '‘contributions to the theory of incentives under conditions of asymmetric information” or, more recently, Thaler’s “contributions to behavioral economics”). With this behavioral model of desire and consumption established, the economist can then “elaborate an account of how the economy can work around” such statistically predicted human behavior.
Yet this “working-around” undergirds a very particularized conception of human happiness, built not on virtue but only on desire. If we have a “ladder of desires” and can “lay out all possible goods” and then “rank order them” according to our “preferences,” then there is, it seems, the continual drive towards more money and resources to enable the fulfillment of “more of these desires.” [Pick up more shifts. Work nights and weekends. Moonlight more often;] If we have “an infinite array of desires” then more work which brings in “more money” is “always better.”
Though it is, it seems, continually reinforced, is this view of reality actually true? Especially as the reality that confronts us is that we cannot gain infinite resources to ensure fulfillment of these infinite desires. There will, according to this modern economic framework, then inevitably have to be “trade-offs” with “cost and benefit analysis” so as to enable the most for us at any given time.
We can briefly add here as an aside (since many of us are in medicine or certain aspects of ministry), that if one of our “preferences” is to “do some charitable work” then it will still feel as though “it comes at my own expense.” I have worked hard. Now I have to “give up” “what I earned” for the “good of others.” It is a mentality of loss rather than a Kingdom Reality of tremendous gain.
The point is that we need to understand the proper use of our material goods not by starting with a general study of economics then working back towards our personal contexts, but rather by seeking a right understanding of the human person, situated in community in the Presence of God. To understand economics, as Hirschfeld contends, we “do not start with the economic issues.” Rather we “start with a deeper account about human nature and happiness and, ultimately, the world in which we live.”
As always, there is so much more that could be said, but this is, at least, a start. We cannot turn a blind eye towards the reality of money, or mammon (μαμωνᾷ, as Christ Himself call it, cf. Mt 6:24). It does affect us. It has the potential to change our behavior. It can lead us down a pathway of the Spirt of This Fallen Age. Or on the Narrow and Hard Path of the Kingdom.
Such a view of economics and material possessions, we hope, can be a helpful starting point in our ever-shifting worlds of work and salary. The emphasis must continually be, “How much do I/we truly need” (again, Agur’s question); with the goal being “the pursuit of a life of virtue” in community. With this tested in the fires of reality, we may actually be able to navigate the minefields of wealth that accompanies our professions in ways that truly motivate us towards real community, in which we are always “ready to share with others in need.”
In the words of Paul, “Let him that stole, steal no more: but rather let him labor, working with his hands the thing which is good, that he may have to give to him that is in need” (Eph. 4:28).