If you haven't followed the link to read Archbishop Nichols text, this comment is not going to make much sense. I think there is a very interesting parallel between Archbishop Nichols idea of an intergenerational exchange in the context of health care and something that Pope Benedict XVI was going to say had he been allowed to speak at La Sapienza university in January 2008. Pope Benedict is, in passing, commenting on how he as the Pope might be able to justify speaking at a university where some would say that, speaking from the perspective of faith, he cannot therefore also be speaking from the perspective of reason.
At this moment I would like to only briefly note that John Rawls, although denying to comprehensive religious doctrines the character of "public" reason, nevertheless sees at least in their "nonpublic" reason a reason that cannot, in the name of a secularly hardened rationality, simply be disregarded by those who support it.What I found most interesting about Archbishop Nichols lecture was something that was not in his text, but which he said during the discussion/questions at the end of his lecture. In the field of education, it is a common place of Catholic teaching that the prime responsibility for the education of children rests with parents, and that others who contribute to the education of children (ie teachers and schools) do so as collaborators with the parents enabling them to fulfil their responsibility at the level at which an expertise is required that they as individual parents do not have. Archbishop Nichols suggested that the provision of health and social care should be seen in the same sort of way. It is not the hospital, National Health Service (NHS) or social services that have the prime responsibility for delivering health and social care to individuals or to society as a whole. The first responsibility rests with families (towards their family members who are sick or elderly) and with neighbours (towards those nearby who are sick or elderly). The hospital, the NHS and social services are then to be seen as collaborating with members of society in the care for the sick and elderly, enabling society to fulfil its responsibility when that requires an expertise and a level of resources that would otherwise not be possible.
He sees a criterion for this reasonableness in, among other things, the fact that similar doctrines derive from a responsible and validly grounded tradition in which, over a long period of time, sufficiently good argumentation has developed to support the respective doctrine. What seems important to me in this affirmation is the recognition that experience and demonstration over the course of generations, the historical background of human wisdom, are also a sign of its reasonableness and its enduring significance. In the face of an a-historical reason that tries to construct itself through a-historical rationality, the wisdom of humanity as such -- the wisdom of the great religious traditions -- is to be valued as a reality that cannot be with impunity thrown into the dustbin of the history of ideas.
Not only does this have implications for the relationship between national government and the health and social care system (the latter or not instruments of the policy of the former), but it also has implications for how employees in health and social care services view their role. Rather than being at the service of the government or employer, their employment mechanism, be it public or private sector, is instead at the service of civil society, at the service of what the Catholic Church would call the "common good". It also has a profound implication for the relationship of communities to their local health and social care institutions. Communities should not let these institutions take over their responsibility - they still have a duty to care for their weaker members through acts of charity and service.
[The agenda of "patient choice" in the NHS might appear to be supportive of this perspective. However, such "patient choice" is confined by national policy, so I suspect that its support of this perspective is more apparent than real.]