Is the current Catholic institutional apparatus - hospitals, schools, and social service organizations- sustainable in the long term? How do you expect these Catholic institutions to change over the next few years or decades?

It is no insult to the sacrifices and the fidelity of those heroic Catholics to say that their great works came into being and were sustained for up to a century for contingent reasons which no longer exist,  or to observe that our circumstances – cultural, legal, political – no longer permit institutions of that sort to bear true and faithful witness.

Their achievement is no less admirable because their works were spared existential threats (like the HHS mandate) by contingent circumstances, too. Notwithstanding an ambient anti-Catholicism, theirs was a society which cherished religion, which believed in Providence and judgment and hell, which valued genuine devotion to Jesus Christ, and which maintained, in both law and culture, Biblical morality about killing, sex, and the family.

A Catholic institutional ministry needs, a double immunity, or twin free spaces: first, to conform all its “deeds” to the demands of morality; second, to “proclaim” the Word of the Lord. Carrying on a vibrant institutional witness allows those who experience a Catholic ministry to see the path of moral righteousness (which John Paul II in Veritatis Splendor said is the way of salvation for those who faultlessly fail to profess Catholic faith). Explaining such a perspicuous witness permits those who come near to encounter a living vision of the meeting place of heaven and earth.

Zones commodious enough for faithful witness in word and in deed are soon liable to be scarce. The critical mass of committed Catholics needed to run mega-institutions is already hard to recruit. The “chao[tic] ambiguity” of organizations negotiating leases upon their Catholic identity with the secular powers is destined to grow. The civil law could drive any Catholic institution from the field at any moment, whether the driver is “reproductive freedom” or some item on the “sexual-orientation equality” agenda.

The prognosis for today’s mega-institutional ministries is grim. We already see, if only through a glass, darkly, that the half-billion dollar hospital, the research university, and publicly subsidized Catholic Charities cannot be sustained as genuine Catholic apostolates. Tomorrow belongs to the smaller, leaner ministries already at hand (like the Catholic Worker House, Saint Vincent dePaul, and hospice), and to those which faithful Catholics call into being.

In the gathering gloom we can see some promising, concrete pathways for a Springtime of institutional ministries. These ways fall into two main groups. One is comprised of modified versions or recognizable adaptations of today’s institutional ministries. The other marks out pressing needs and objectives, where the shape of an institutionalized response must be drawn up.

Thinking first about opportunities recognizably like today’s roster of ministries, we should continue to cultivate that small minority of existing Catholic colleges which are committed to bearing perspicuous witness to the Gospel as they educate our sons and daughters. There is, maybe, room and need for one more foundation, that of a small, brilliant liberal arts college—call it a “Catholic Swarthmore.”

The most promising new initiative in higher education is likely to involve colonizing public and private (non-Catholic) universities with Catholic residential colleges. These new institutions would offer more than hot supper, a flat-screen TV, and a bed. These colleges would invite residents (and others interested) into a Catholic educational and social milieu too. They would also provide young, educated Catholics the means by which they could cultivate an adult faith, and acquire a faith-filled understanding of culture, political life, and economic enterprise. The educational component of these colleges should be challenging and sustained, much like courses offered for credit in the host university (though these offerings would almost certainly be ineligible for formal academic credit). Donations to these colleges should be strenuously pursued, so as to under-sell dorms, frat houses, and off-campus apartments. The needed development efforts are unlikely to succeed without substantial episcopal leadership.

In healthcare the future of Catholic care lies, first, in expanded hospice work. For it is there that the spiritual realities which should, and once did, suffuse the art of healing still come to the fore. In addition, various bands of doctors, dentists, nurses, and other medical professionals could organize a week or more of “shock treatment” for underserved populations, especially among immigrants. The venue could be a “pop-up” storefront or a mobile treatment center. It is also past time for a distinctively Catholic “Doctors Without Borders” to be founded.

In social services, the future lies with services to immigrants, prisoners, parolees, and other very marginal social groups. At the level of public policy, Catholics should work with others of good will to make and maintain just immigration and criminal laws. All persons should do what they can to see to it that the just laws are fairly enforced. At this level there is no room for a specifically Catholic institutional ministry. Nor should the American bishops get involved with these matters, beyond articulating forcefully the relevant basic principles of justice. These principles include duties which migrants owe to their host society, such as their duty to become familiar with and to make their own the cultural patrimony of their new political community.

With regard to undocumented immigrants, small Catholic institutional ministries could and should meet legitimate material needs which no one will meet, and do so even at the margins of legality. But perhaps the most distinctive service which such a ministry could perform is to ameliorate the moral hazards of living outside the law. These people are consigned practically to lives of secrecy and deception. Their lot is peculiarly prone to treating others unfairly, such as when an undocumented person with neither license nor insurance causes a fatal auto accident. No cure for these temptations and ills is within the gift of any Church group. But Catholics would better witness to their Savior’s love for migrants if they ceased conspiring with them to deceive the authorities, and instead did all that they can do to make migrants’ lives upright.

Those who are imprisoned, those diverted from prison, and those recently released from state’s custody constitute a promising field of institutional ministry. Our society is presently most unforgiving of our offenders. They can scarcely find a place in the modern economy; their communities of origin are usually morally chaotic, and almost nobody else cares very much about these folks. Perhaps the most distinctive contribution a Catholic institutional ministry could make in this area is to act always with a view to requiring a proper moral responsibility in all persons ministered to, for the tendency among the relatively few others who are willing is to excuse or explain away the depredations of offenders, to treat criminals as if they are the victims.

Many of the controversies surrounding Catholic institutions relate to the Church’s teachings on sexuality. Are there particular ways Catholic institutions can address the underlying causes of those controversies—that is, how can Catholic institutions affect culture surrounding sexuality?

In the area of human procreation, government, market, and cultural powers are conspiring to indoctrinate our young people, especially young women, into grossly immoral practices and the mentality which rationalizes them. One challenge to any institutional remedy is that the most morally freighted areas of medicine are undergoing ideological purification. Headlines about pharmacists and Plan B, about the American Psychological Association and its disapproval of reparative therapies for same-sex attraction, and about compulsory abortion training in medical schools, all illustrate this point. Most recently, the state of California made it illegal to administer any therapy to any minor—even with parental consent—intended to change one’s same-sex attractions. In addition, our country’s increasingly centralized methods of service delivery and payment— think of Obamacare and the HHS mandate—make it difficult to engage in a Catholic ministry, if it is to be a source of a professional’s full-time remunerative employment.

The Catholic inroad here may be gained by thinking of systematized free or pay-as-you-go services, provided off-the-grid by healthcare professionals whose livelihoods are secured elsewhere. The need extends from soup-to-nuts; that is, from morally upright birth control all the way to proper post-natal care. Perhaps the most urgent need here is that which calls for the most distinctively Catholic response. The “Catholic” value-added in this neighborhood of issues is usually limited to instigating compliance with the moral law; natural family planning is the crown jewel value. But even that worthy means must be nested within a moral horizon which is almost wholly unexplored since Humanae Vitae.

The focal point of that horizon is surely this question: how is a young couple to discern the number of children which Jesus is asking them to bear, and to raise? No question is more central to each spouses’ discernment of his or her personal vocation than integrating one’s parental responsibilities with all one’s other personal and professional commitments. These other responsibilities are among the “serious reason” which Pope Paul VI affirmed (in HV) could justify spacing children, or even postponing them for an indefinite time. Each couple must answer this question for themselves. But there are general considerations which obtain, and most couples could use much more sensitive but challenging advice than they are presently getting. (In fact, most seek and receive none.)

An institutionalized response to this crisis would include pastoral guidance from the Pope all the way down to the parish pulpit. It might also include organizing mature Catholic couples into a network of consultors, available in each parish to help younger couples discern their path. These volunteer services could be, and should be, promoted by the Pastor, and perhaps be made obligatory in the way that similar arrangements are for Baptismal preparation.

The second area for new foundations is the whole psych-industrial complex. Ours is a world in which “experts” medicate unhappiness and treat shame as indicator of mental illness. These same “authorities” hold that regular sexual satisfaction is essential to well-being, and that anyone who says they lack a [sexual] fantasy life is either lying, or sick. These disciplines (psychology, psychiatry, counseling, other “mental health” services) have always been mine fields for seriously Christian people, on both the giving and the receiving end of treatment. The situation is now more perilous than ever, as the properly moral perspective has been driven to the margins of training and practice.

There is nonetheless probably more genuine need for sound services of this general type than there ever has been. The stresses of modern living and the dissonance of navigating a secularized world causes people to judge themselves to be unhappy, and in need of therapeutic intervention. Frequently, they do, and they are. The Catholic institutional response here almost certainly will have to mimic that of so many other areas just explored, namely, organized but informal networks of properly formed professionals, working for free or for whatever people can pay out of their pockets.

Finally, I’d like to ask for your thoughts on recent developments in the pro-life movement, which is in many places connected to the Church’s institutional ministries. ACLU lawsuits that are trying to force Catholic hospitals to provide abortion and contraception come in the wake of a number of abortion clinic closures, which are the result of restrictive abortion laws passed after the revelations about conditions in abortion clinics like the one run by Kermit Gosnell in Philadelphia. Also noteworthy are laws like the one recently signed by Illinois’ governor that forces facilities—including pregnancy centers and Catholic hospitals—that do not provide abortions to provide information about where to procure an abortion. It seems that abortion activists are responding to laws that hold abortion facilities up to hospital standards not by upgrading their own facilities, but by forcing their way into hospitals or otherwise hijacking pro-life clinics and hospitals. The Supreme Court ruled Texas’ Gosnell laws unconstitutional, which may slow the rate of closures, but it seems that the pro-choice movement is moving its emphasis away from abortion clinics. What exactly is happening, and how should we respond?

I think that the future of abortion as a practice is probably more in the direction of medical [e.g. abortion pills] rather than surgical procedures.  The upshot of the recent Supreme Court decision will surely be to embolden lower court judges (who by and large are ideologically hostile to the pro-life cause) to declare restrictive abortion laws unconstitutional.

I recently had an essay published in Public Discourse in which I explored this topic in more depth.