Subsidiarity and Participation in an Age of Catholic Mega-Systems.

While the number of Catholic healthcare facilities has held stable over the last several decades, Catholic healthcare has followed the trend of merging facilities and systems into "mega-systems." These consolidations can be beneficial for creating continuums of care, lowering operating costs, ensuring long-term viability, and sharing physical, digital, and human resources. However, with larger systems comes a practical need to be integrated to some degree, and the pressure to standardize policies and practices across regions is present. To address this need and pressure, the Catholic Social Teaching principles of subsidiarity and participation should guide system and local administrators. Subsidiarity and participation encourage all decision making to happen at the most local levels and to include as many of the people those decisions affect as possible. I will review both the pragmatic benefits of keeping decisions as local and rooted as possible as well as the moral benefits of allowing as many administrators and health care professionals to exercise and form their virtues as moral agents. In a time when changes to medical care have created many procedural responsibilities and cut into time spent in moral witness, institutions, even mega-systems, should remain attentive to the ways in which the moral agents of their system are formed and exercised.