If Catholics insist upon either total separation or final victory over people and institutions they disagree with on abortion they won’t be able to maintain their traditional presence in the health care system, said Bouchard.

“We would have to get out of that business. We would kind of be like the Amish or other more sectarian Christian communities who obviously have deeply held Christian beliefs but they’re not about to get tangled up with public policy and pluralism to run institutions,” he said.

Bouchard will be the key speaker at this year’s Dominican Family of Toronto lecture and seminar Oct. 16, 8 p.m. at Madden Hall, University of St. Michael’s College. The lecture on “Catholic Health Care and the Common Good” on the Friday evening is free. A Saturday morning seminar and discussion on “The Viability of Catholic Health Care” costs $35 and requires pre-registration at bioethics.usmc@utoronto.ca, or call (416) 926-2335.

The United States Conference of Catholic Bishops has urged Catholics to press for health care reform without endorsing any particular plan. The debate “should not be buried by partisan politics or misleading exaggerations of what the emerging legislation does or does not include,” the bishops said in a Sept. 4 message. “We hope that civil dialogue will produce an affordable method that provides ready access to quality, comprehensive and affordable health care for every person living in the United States.”

Getting Americans to think about health care in a new way is going to be difficult, said Bouchard.

“Americans think so differently about these things,” he said. “We have a kind of prevailing social ethos or cultural mindset of a type of individualism that does not sit well with anything that smacks of the common good or of social goods.”

Catholics need to be involved in large scale public health care because it extends basic elements of Catholic faith into the world, according to the Dominican priest.

“The reason our health care institutions are so widespread is because of our notion of sacramentality,” Bouchard said. “We see these institutions as really a kind of sacramental presence of the church in the world.”

Bouchard rates the massive change from religious to lay leadership in Catholic hospitals in recent years as the biggest challenge facing Catholic health care in both the United States and Canada. Strong leadership grounded in a Catholic ethos is going to be necessary if Catholic hospitals are to continue with a distinctive mission, he said.

“The risk of compromise that comes with being involved in this pluralistic society with a ministry, and also the challenge of preparing lay leadership for the future to continue what religious communities did in the past — I think those are both enormous challenges,” he said. “The survival of Catholic health care will depend on whether we are able to do those things or not in a pretty short time.”