Difference. The concept leaps out at the reader from the subtitle of the first article in this issue: Dan Dugan's label of "different" for ethics committees in religious healthcare organizations. The concept makes other appearances herein. It is worth lifting out as we close, file, and use the contents of this Bulletin.

Needless to say, at the Park Ridge Center we think about differences constantly. Twenty years ago the culture did not need one more medical ethics institute in which religion played no part. There were any number of good ones, be they freestanding or related to clinics and universities. Some allowed religion in and sometimes even nurtured it, but at the margins. At most, however, there were and are inhibitions or instincts, and sometimes formal restraints, that militate against using the language of faith when assessing medical ethics.

The culture, we thought and think, did need one medical ethics institute in which religion did play a central role. Hence the Park Ridge Center for Health, Faith, and Ethics.

Seeing a need and setting out to address it is one thing. Making good on the promise of religion in the discourse is another, and a more difficult one. So religion in its various forms and under whatever labels makes a difference. What? How?

After a score of years we do not claim to have clear, definitive answers to such questions, and neither does this newest Bulletin provide more than clues. Those clues are valuable, however, for they point to both the possibilities and the frustrations connected with the faith-makes-a-difference theme.

The most urgent and most lasting reason to move to a faith-centered focus is a simple one: most people, when they face crucial moral and ethical questions, somehow bring into play their religious commitments. They may not do so frontally, systematically, or clearly. Most of us know too little about the import of spiritual convictions when these bear on politics, economics, or medicine. The religious traditions are themselves too multiple, too diffuse, and often too ambiguous. Differences within religious communities are often more vivid than are those among them.

Yet in diffuse but never unimportant ways, patients and those who reason about their dilemmas have religious outlooks in the front or the back of their minds as they hear ethicists speak, as they often do, in the coin-of-the-realm language that often sails under the label "secular rationality." Against which we have nothing, except that it offers only one way of looking at reality. People who are ill or who would remain healthy deal with what troubles them in a variety of additional modes, giving some of them priority.

Significantly, Dugan and others deal with the topic where there are church laws and codes by which medical institutions or caregivers and patients must abide. Roman Catholicism in respect to reproductive issues is Dugan's most vivid example. Seventh-day Adventists, Latter-day Saints, Christian Scientists, Mennonites, Jehovah's Witnesses, and others also tend to be more prescriptive than are more mainstream Protestants and some kinds of evangelicals.

Put all their voices together in ethics committees in secular clinics, and one is likely at first to be confused, even repelled. Why introduce voices that mainly complicate conventional patterns of reasoning? But even within religious healthcare organizations formal attempts to bring specific religious themes to bear can often thicken the discourse more than it can solve the problems and resolve the dilemmas.

Those who look for neat solutions and definitive resolutions may walk away from the scene. They may feel that paying attention to the intuitions, memories, communities, traditions, habits, affections, and hopes of patients and ethicists alike will muddy efforts to deal with the world of patients. They are not wrong about the thickening, the muddiness, the complication. But they are wrong if they think they will have done justice to the needs before them if they rule the religious voices out.

The Park Ridge Center cannot advertise solutions or resolutions. We can, however, address "real" worlds—not just those invented at some distance from patients, who are and likely ever shall be somehow religious.