As a first attempt at an overview, three major areas of Catholicism in the German Empire were examined as part of historical research into the prominent role played by the Christian churches in the healthcare system: the health policy positions of the Catholic party Zentrum and associations (“political Catholicism”), the church’s involvement in healthcare (“social Catholicism”) and the theological discussion of medicine and the medical discussion of religiously relevant issues (“intellectual Catholicism”). In the social sector, church involvement was increasingly evident in rural regions neglected by the state. In many places, Catholic rural nursing took the first step towards community-based health care. While the church actors were innovative here, in other instances the tendencies towards inertia were so obvious that the church had to face up to the public debate. This applies to the problem areas of overworking religious sisters in nursing, the hygiene standards of church facilities, and the abuses in psychiatry, as expressed in the widely discussed “Alexian scandal”. The demand to employ nuns as midwives also testifies to the antagonism between the demands of modern medicine and the requirements of church law. 

These and other problems of medical practice were closely linked to various debates within the church. In addition to the senior clergy and individual priests with an interest in health policy (often at the head of associations), the participants in the debate were the religious orders and the increasingly organized professional groups in the healthcare sector, especially Catholic doctors. While competition with other actors, especially from the state and Protestantism, became the defining category in politics and healthcare, the moral-theological course was more strongly characterized by self-assurance within the Church. The reference to changes outside the church varied greatly depending on the problem area. In the question of the beginning of life, the new scientific findings on fertilization were fully incorporated. On the other hand, when weighing up the various treatment options, there was a greater skepticism towards medical progress; there was no demand to undergo “extraordinary” measures to preserve life. In conjunction with the strong reception of pastoral medical literature written by doctors among the clergy, it cannot therefore be assumed that there was a general attitude hostile to (natural) science, but rather that there was great concern that materialistic and anti-religious attitudes could lead to a shift in previously accepted medical practices.

On the part of Catholic doctors, the willingness to adapt to the guidelines of the Roman magisterium and moral theological manuals varied, but a fundamental relevance and practicability was usually assumed. In this way, the project’s research was able to show that and how healthcare was a field in which Catholicism’s confrontation with modernization processes took place in an exemplary manner: with social pluralization, with new domains of secular sciences, with changing technical possibilities. There were already signs of the dissolution of the confessional milieu that had just been formed – not least due to pastoral care bishops and the Kulturkampf: health policy demanded coalitions, the practical necessities in health facilities prevented drawing of strict confessional boundaries, and the conflicts of loyalty between Catholic doctors. Roman magisterium and medical chairs were not always decided in favor of moral theology. On the other hand, Catholic institutions and personalities showed exemplary forms of self-assertion in securing their identity, which demonstrated the possibility and necessity of value orientation in independent institutions and personal convictions in the face of benefit-optimizing tendencies in the state and medicine – and thus forerunners of later civil society.