The Heart Has its Reasons: Thoughts on a Theology of Courage

The Church in the United States has been too comfortable for too long. She needs to move from assimilation to mission, from lethargy and mediocrity to apostolic witness.

(James Coleman/

Editor’s note: The following address was given at the Catholic Medical Association’s 92nd Annual Educational Conference on September 7, 2023.

My comments today are not what I originally intended. A title like “the heart has its reasons: thoughts on the theology of courage” can go in all sorts of directions. But two names, two men, kept intruding on my work. And they finally hijacked it. The reason why is simple. Each of their lives, in very different ways, confirms the words of Moses to the Israelites in Deuteronomy 30:19, “I call heaven and earth to witness against you this day, that I have set before you—life and death, blessing and curse; therefore, choose life, that you and your descendants may live.”

Most of us have heard that Bible passage before; many of us dozens or even hundreds of times. But it’s just lines of ink on a page until the words take on flesh and blood. And what those words mean speaks directly to the heart of our conversations at this CMA conference.

I said there were two men, two intruders, two hijackers, responsible for this talk. So, I’ll begin with Michael Burleigh. He’s the first.

Burleigh is a British author and one of Europe’s greatest living historians. But I think his best book is often overlooked because it’s so painful to read. Death and Deliverance, written nearly 30 years ago, is a history of the German euthanasia campaign from 1900 to 1945. The Third Reich murdered roughly 300,000 men, women, and children in its Aktion T-4 program, from 1939 through the end of the war. And it was done in the name of purifying the genetic pool; in other words, to improve social hygiene and the nation’s economic health. The targets were the mentally and physically infirm. And the program became a very useful “dry run” for the Holocaust. The mercy killings were first carried out by injection. But that was too slow. Later they were handled by mobile vans and sealed infirmary rooms for handling large groups at a time.

All of this sounds quite wicked. And of course, it was. But it wasn’t illogical. On the contrary: It was perfectly rational…if by “rational” we mean consistent, methodical reasoning from the premise of racial cleansing and its urgency. It would be easy to blame all this on a gang of evil Nazis. But that would also be dishonest. The Third Reich simply operationalized what much of the German medical establishment had already been urging—involuntary euthanasia for the diseased and disabled—for nearly 40 years. Medical personnel took an active and willing part in Aktion T-4, and the German scientific community joined the bandwagon. Zyklon B gas wasn’t cooked up in Hitler’s basement, but by cooperative German chemists in mainstream national labs. The Reich simply “followed the science” to Auschwitz and Birkenau.

All of which is appalling. But the main lesson we need to learn from it today, here and now, is this: The German institutions entrusted with protecting and providing for these so-called “patients” were nearly all run by Catholic and Lutheran medical and religious personnel. And nearly all of them folded under pressure. They were weak. They were cowards. They went along with the regime. And the blood of the innocent is also on their hands. That’s the lesson Michael Burleigh captures with unforgiving clarity.

Obviously, the Germany of 1900 and 1939 is a long way from America in 2023. The realities are very different…though maybe not quite so different as we’d like to think. But more about that in a moment.

I said there were two hijackers who took control of this talk. Here’s the second.

In 2008 a young Virginia man with Down syndrome fell into a septic tank on his family’s property when the cover collapsed. His father jumped into the sewage and stink to keep his son’s head above water long enough to be rescued. Tomorrow, September 8, marks the 15th anniversary of the death of Thomas Vander Woude. He died saving his son. He did it, purely out of love for a human being otherwise seen as flawed, defective, and unworthy of life by a great many people. And the proof of their callousness is a simple statistic. Ninety-six percent of Down syndrome children today, are killed in their mother’s womb.

My point in sharing these things is simple. The events that Michael Burleigh recounts, and the example of Thomas Vander Woude, suggest two very different understandings of human dignity and purpose. They’re two incompatible responses to Deuteronomy 30:19; responses that, each in its own way, prove the truth of that biblical verse. If we choose and defend life despite all its imperfections, our descendants will multiply and live. And in living, in creating a future, their lives will enrich the meaning of our own. If we fail at that, if we choose wrongly, we sooner or later fill the world with confusion and pain. Those are the alternatives.

It’s tempting to imagine that events like those that occurred in Germany can’t happen here. And in a sense, that’s true. They can’t. History never repeats itself. But the patterns of human thought and behavior that create history, the patterns that made events like those in Germany possible, do repeat themselves all the time. And they can happen here. They’re already happening here. That requires us to ask why—because to fix a problem, we need to understand it first. If we translate all this into medical terms, we might put it this way: Diagnosing an illness accurately determines the medicine needed to treat it. Such is the case with individuals. And likewise with cultures.

We can all sense that something is “wrong” now with everyday American life. That’s implied in the theme of this conference: Be not afraid. The United States is the richest, most powerful nation in human history. Even its poorest citizens live better than most of the world’s population. And yet the Wall Street Journal noted just two weeks ago (Aug 23) that 27 percent of respondents to a recent federal survey had symptoms of anxiety disorder. That’s more than triple the number than just four years ago. The result is a “booming business” of anti-depressant drugs and treatments, which are now used by more than 13 percent of the population. In like manner, a 2020 study by the health giant Cigna found that 61 percent of American adults now suffer from loneliness, a jump of 7 percent since 2018. And I could go on with the litany of dysfunction, but what’s the point? You’re the professionals. You already know this stuff.

The real pandemic in everyday American life is fear. And we try to mask ourselves away from it with a culture of distractions, consumption, and delusions. All of which serve as anesthetics, and none of which finally work.

We’re afraid of being poor. Of being crippled. Of losing what we have. Of being lied to. Of being hurt. Of being cut away from the herd. We’re afraid of being worthless and unproductive and isolated, and held in contempt by others. And most of all, we’re afraid of dying. Of course, that’s always been the case. But there’s a special intensity to it now because our material appetites have eclipsed our belief in the transcendent. Now, often without knowing why, many of us find the supernatural—implausible and irrelevant.

At the same time, life has become too big. The scale and complexity of our institutions, our hospitals, our corporations, our politics, and especially our problems, dwarf us. And we’re reminded of that every day by the dilemma of information overload and the invasive noise of the media. Nothing you or I can do will prevent a war with China or even end the war in Ukraine. Yet we can’t escape hearing and worrying about both. Technology, for all its benefits, not only changes so much about our daily lives, but changes it at an escalating pace. It turns solid things we knew about the world into liquid, and it cuts our psychological and social stability out from under us. The result is a feeling of confusion and isolation. Which leads to frustration. Which leads to anger. Which then leads to depression and an abdication of personal responsibility.

The greatest strength of the American character—respect for the individual and his rights—also turns out to be its greatest weakness. Self-absorption disconnects us from each other. It leads to fragmentation and conflict. And the result is the transfer of more and more real power to government—to manage the turbulence. Which is what we’ve seen happen over the past several decades. The panic surrounding the COVID virus just sped up the process.

We need to see all of this through the lens of God’s Word. The First Letter of John, chapter 4, verse 18, reminds us that “perfect love casts out fear.” And that implies that the reverse is also true: Fear drives out love. Love is the glue that sustains all human relationships. It’s the saving grace of our humanity, the connecting tissue between people and generations. It gives us a framework of meaning by embedding us in a narrative of hope larger than ourselves and the limits of this world. And fear does the opposite. Fear is the infection at the heart of modern life. It makes us miserly and selfish. It robs us of our nobility by lowering the horizon of our desires. It dulls our appetite for something more and higher than the latest streaming service. And worst of all, it makes us cowards.

We’re told relentlessly these days that we live in a rationalist and scientific age, free from superstition and illusion. An age when we can master the limitations of nature. But there’s something pathetically naïve in every such desire, especially the hunger to somehow defeat death. And in response, the great Jewish medical ethicist, Leon Kass, asks the one key question: Why would anyone want another 70 or 700 or 7,000 years of this-worldly life if it has no higher meaning beyond ourselves, no final goal other than a better version of “more of the same?” He ends one of his best essays with these words:

[We need to] resist the siren song of the conquest of aging and death. [Instead,] let us…lift our voices and properly toast…to life beyond our own, to the life of our grandchildren and their grandchildren. May they, God willing, know health and long life, but [may they] also know the pursuit of truth and righteousness and holiness. And may they hand down and perpetuate this pursuit of what is humanly finest to succeeding generations for all time to come.

Now everything I’ve said so far is analysis, and analysis has its place. But simply knowing a problem is useless—if we don’t do anything about it. So, in these last few minutes of my comments, I want to pose two very simple questions: Why are we here at this conference? And, Why do we do what we do? In the end, priesthood and medicine are quite similar vocations. I use that word “vocations” deliberately, because in each case our work is a calling, a kind of ministry. It’s not merely a “profession.” I became a priest because I wanted to help people; help them discover their dignity as children of God and help guide them home to heaven. I suppose you could say that a good priest is a doctor of the soul. It demands everything a man has to offer, every bit of his energy and attention.

Medicine demands the same. You accept those demands because you entered the medical field to help people; to heal them; to give them sound bodies and minds so they could live the gift of this life to the fullest. And here’s what that means. Whether we’re conscious of it or not, whether we’re in a generous mood on any given day or not, what we do—what you do—is a form of giving ourselves to others for their sake and benefit, not merely our own. And there’s a word for that. It’s called “love.” Love is a matter of the heart. It’s irrational, at least in a purely materialist sense. There was nothing utilitarian or transactional about Thomas Vander Woude’s decision to jump into the filth of his septic tank. Nor was it instinctual. He knew very well what could happen. He did it because he loved his mentally disabled son more than himself. And it was his heart, not some cost/benefit computation, that gave him the courage to do it…because love, as the First Letter of John says, drives out fear.

C.S. Lewis described the chest, the human heart, as the “indispensable liaison officer between cerebral man and visceral man.” Blaise Pascal said that “the heart has its reasons which reason knows not.” Both saw clearly that it’s the heart, not just our rationality, that makes us distinctly human. It’s the heart that gives us love and courage, neither of which can ever be reduced to mere instinct and biochemistry. It’s the heart that elevates us into something more than just very smart animals with appetites. In fact, one of the reasons why C.S. Lewis found the trend of modern science so troubling was its particular appetite for creating what he called “men without chests,” men without higher moral law, men without the constraints of love.

I’ve lived most of my priesthood believing that Catholics have a home in America. We might lose some arguments and win some others in the course of our nation’s life, but the voice of the Church would at least be respected. I find that harder and harder to believe now. We have a culture that was unimaginable just 30 years ago. Physician-assisted suicide; “gay marriage”; FBI thuggery toward pro-life activists and the monitoring of Catholic churches; government attacks on pro-life clinics; transgender “medicine” for young people that isn’t really medicine at all but an obscene form of child abuse; anti-Catholic intolerance in board certification and medical school admission; the brainwashing of medical students with progressive ideologies – I could go on and on.

At the end of my life, I don’t want to be held accountable for the kind of cowardice my predecessors had 90 years ago in Germany. I don’t want the burden of explaining my lack of a backbone to the God of love. And I don’t think you do either. Which means, as Catholics, we need to change the way we think and act. Because whatever we’ve been doing so far hasn’t worked. The Church in the United States has been too comfortable for too long. She needs to move from assimilation to mission, from lethargy and mediocrity to apostolic witness.

And that very much involves the Catholic Medical Association. Medicine is the front line in the central moral conflict of our age: Who is man, and what does and doesn’t serve human dignity. We’re not powerless. None of us is ever really powerless because we each have a voice. Every time as an individual or as a group we say “no” to evil policies and “yes” to good ones—as forcefully as we can—we throw sand in the machinery of institutionalized wickedness. And of course, that has a personal cost, and we need to be willing to pay it. If we’re not, then we should stop trying to fool ourselves and others by claiming to be Christian.

This past year, as I travelled around my diocese celebrating the Sacrament of Confirmation, I noticed that an unusually high number of young girls were choosing St. Joan of Arc as their confirmation saint. In the Diocese of Lincoln, we confirm at the age of eleven. So asked one of these eleven-year-old girls, why she chose St. Joan of Arc. She looked me and said, “Bishop, St. Joan of Arc was a very brave girl, and I don’t want to be afraid anymore.”

Before she went into battle on her mission to save France, against tremendous odds, Saint Joan Arc was asked if she was afraid. The young saint replied, “I am not afraid, for God is with me. I was born for this.”

Brothers and sisters, we were born for these times, we were made for these times. God put us on this earth for this very moment in history. And we must believe this with all our minds and all our hearts.

This is why the Church needs the CMA to grow—in its numbers, its influence, and its resources. It can’t stay the same and do the work that needs to be done now so urgently. So that’s the task I leave you with today, and I’m well aware it’s hard. But it’s urgent and sacred work. And the good news is that Scripture tells us more the 350 times to “be not afraid.” So, I think it’s trying to tell us something.

We just need to listen.

(Editor’s note: Thomas Vander Woude was incorrectly identified as “Wouden” in the original posting of this essay.)

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About Most Reverend James Conley 3 Articles
Most Reverend James Conley is the bishop of Lincoln, NE.


  1. Kudos to the Lincoln diocese for their commitment to Catholic school education for Catholic children.
    Some stats from Lincoln (2021)
    Total Population: 621,418
    Catholic Population: 94,698
    Diocese Patron: Immaculate Conception
    134 Parishes
    167 Priests (129 active in the diocese, 10 outside the diocese, 28 retired or inactive)
    10 Religious Priests
    5 Priests from other Dioceses
    Deacons: 1 permanent; 2 transitional
    30 Seminarians
    146 Religious Sisters
    11 Religious Brothers
    23 Catholic Elementary Schools
    4,506 Elementary Students
    6 Catholic High Schools
    1,760 High School Students
    515 lay teachers; 49 priests who teach, 36 sisters who teach
    1 Diocesan Seminary
    1 Religious Seminary
    4 Catholic Hospitals
    5 Catholic Nursing Homes (4 homes for the aged; 1 residential care for the disabled)
    21 Centers for Social Services and Assistance
    1 Home for Women and Children
    1 Day Care Center

    • The Great Divide is between those bishops who believe in a morally coherent sacramental life and those who do not.

      …that is, those simplistics who dismiss coherence is just another word for “politicized.” As between those “rigid bigots” at the USCCB who at the beginning supported going forward with “Eucharistic coherence” and those starry-eyed congregationalists who did not.

      From the first group, the diocese of Lincoln has nearly 100,000 members and 30 seminarians. From the second group, my archdiocese has over 800,000 members but only 16 seminarians. Nearly a 1600-percent (!) disparity. But also a reflection of the Continental Divide between the brain-stem West Coast culture and the Heartland.

  2. With gratitude to God for the courage of CMA and the good bishop from the Diocese of Lincoln. The essay should ignite the spark of love in hearts to learn more about CMA and to support their efforts. Again, with heart-warming thanks to Bishop Conley, with prayer that he continue to fill and enlarge the footsteps of his stalwart predecessor, Fabian Bruskewitz. The diocesan website contains info on the orthodoxy of this diocese. Kudos, too, for the Diocese for inviting the FSSP in 1993 to open its seminary there in 1993. As a devotee of the TLM and the FSSP, I cannot think more highly of and with grateful thanks to the diocese which God has blessed. May the prayers of the good people in the diocese continue to keep barbarian principles at bay. Thank you, Bishop Conley. May God bless you with every good gift of the Holy Spirit.

  3. The correct spelling of the heroic father’s last name is Vander Woude. Please add a correction. People should read more of this courageous and loving Virginia family. They are the stuff of holiness in the ordinary life which we are all called to.

  4. I was especially moved by these words: “we were born for these times, we were made for these times. God put us on this earth for this very moment in history. And we must believe this with all our minds and all our hearts.”

  5. Wow! Truly outstanding. Particularly powerful: the reference to Joan of Arc and how “we were born for these times”; “Our material appetites have eclipsed our belief in the transcendent”; and the definition of love as “giving ourselves to others for their sake and benefit, not merely our own”. All insights worth sharing, and re-reading. Thanks for such moving insights from a great shepherd and Bishop, and may God continue to bless him and all his good works.

    • Amen. Thank you for sharing your comments. They also led me to this article which I had missed earlier.
      Thomas Vander Woude’s son is a priest and a friend of our family. God bless him.

      We’re in the throes of a social contagion not unlike eugenics. Young people are being sterilized and castrated. The elderly, depressed, and infirm are offered euthanasia. Infants are lethally targeted for disabilities in utero. Every era’s social delusions look a little different but they seem to keep on recycling.

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  1. Bishop Conley Speech @ CMA National Meeting – The Finger Lakes Guild

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