Catholic health care in this country has long had a conflicted relationship with the health-care system at large. Tentative steps toward compromise have been stalled by post-Dobbs changes in abortion access and continued fights over transgender care. Most recently, as part of an ongoing effort to realign federal regulations with the Supreme Court’s 2020 decision that discrimination against transgender people is a form of sex discrimination, the Biden administration proposed a new rule to expand nondiscrimination protections in health care for transgender people. The U.S. Conference of Catholic Bishops opposes it.

The bishops believe that such rules violate the Ethical and Religious Directives for Catholic Health Care Services (ERDs), which lay out “a theological basis for the Catholic health care ministry.” Their position hinges on two arguments: (1) Catholic opposition to performing certain procedures is morally justified because the procedures do not constitute health care, and the refusal to perform them is not discriminatory; and (2) even if one disagrees with Catholic opposition to these procedures, forcing Catholic hospitals and medical professionals to perform them and thus violate their consciences should be opposed because it would pose a danger to conscience rights for all.

However, there are problems with this approach, which is unlikely to withstand the combined pressures of weakening Catholic political power, rising political and cultural polarization, and growing difficulty in accessing health care of all kinds, especially the kind not permitted under ERDs. Catholic health care thus faces a challenging future. Those who want Catholic institutions to remain substantively Catholic and to provide medical care within the constraints of Catholic medical ethics must articulate a more robust definition of pluralism and conscience rights. Here are four considerations for articulating that vision.

First, some Catholic health-care policies do discriminate against transgender people. Many in Catholic health care argue that criticism over supposed discrimination against transgender patients is misplaced: Catholic hospitals will not perform certain procedures for anyone of any sex or gender.

That’s certainly true of some procedures, like vaginoplasties or tubal ligations. But the U.S. Health and Human Services anti-discrimination regulations are not referring to those. Doctors can choose the focus of their practice, and no law is going to force them to perform a procedure they don’t have the skills and experience to perform. Instead, what is explicitly mentioned are hysterectomies, which Catholic hospitals can and do perform, in line with the Catholic ERDs. It’s not true that Catholic hospitals decline to perform this specific procedure for everyone and for every reason. They perform this procedure for everyone with every medical diagnosis except for gender dysphoria. And this is the core of the disagreement.

The only reason to perform a hysterectomy on a cisgender woman with endometriosis but not on a transgender man with gender dysphoria is if one has decided that gender dysphoria—a medical condition recognized in the DSM-5 and covered by insurance—is different from other medical conditions. That is a permissible distinction to draw in Catholic ethics. But legally, treating some diagnoses recognized by the broader medical community differently from others based on the gender associated with those diagnoses is the very definition of sex discrimination. “We wouldn’t perform that procedure for anyone with gender dysphoria” falls a little flat as a defense when the only people with that diagnosis are, by definition, transgender. Legally and logically, Catholic hospitals’ refusal to perform these hysterectomies discriminates against transgender people.

Does this mean that Catholic practitioners and providers should be forced to violate their consciences and sincere religious beliefs? No. But it means Catholic hospitals are going to need an affirmative carve-out from nondiscrimination law. They need to convince lawmakers, and the voting public, that Catholic hospitals deserve an exception. It’s no longer good enough, if it ever was, to argue that Catholic hospitals don’t discriminate. Instead, Catholic hospitals need to argue that allowing them to remain substantively Catholic is good for American pluralism—and, crucially, that Catholic conscience rights don’t have to interfere with anybody else’s rights.

Second, not all consciences are equally protected in health care. If the best defense of Catholic health care is conscience rights, Catholics must answer: Whose conscience? Patients, institutional providers, and individual providers can all be said to have one, and Catholic social teaching speaks powerfully in favor of religious liberty and freedom of conscience. But Catholic application of that principle can feel self-interested, as though it is only concerned with the kinds of restrictions that bear on Catholic consciences per Catholic theology. Catholic advocacy for conscience rights in health care has resulted only in concern with the kind of positive coercion that is the focus of Catholic moral teaching (the need not to participate in evil) while being uninterested in protecting others, especially religious minorities, who understand religious liberty as being more about the right to do things that are ethically mandatory.

A conscience argument that will win in the public sphere has to be more pluralistic than that. Americans are unlikely to accept the peculiarly Catholic idea that it’s worse to be forced to do something wrong than it is to be forcibly restrained from doing something you believe to be right and necessary.

Catholic employees and medical students at non-Catholic hospitals are protected under federal law. They cannot be forced to perform abortions, sterilizations, euthanasia, or certain contraceptive procedures that contradict Catholic teaching, nor can they be punished for their refusal to do so. The Church lobbied for that. But there’s no corresponding protection for employees at Catholic hospitals whose conscience conflicts with that of their bosses.

For example, the University of California has several partnerships with Catholic hospitals, under which state employees and students at state medical schools spend part of their time under the state’s supervision and on the state’s payroll, but under the Church’s roof and governed by the Church’s rules. This has prompted an ongoing debate within California, driven by medical professors who feel that this arrangement forces them to practice medicine in a way that they consider unethical and contrary to their values. Under the Church’s definition, those doctors’ conscience rights are not being violated because they are not being forced to do something they see as unethical. But the doctors, in their own understanding of and relationship to their consciences, experience the relationship as a violation of their ethical autonomy.

The state briefly considered a policy that would allow state-affiliated medical providers to perform procedures forbidden by the ERDs inside Catholic facilities if, and only if, delaying treatment until the patient could be moved to another facility would be detrimental to their health. The Catholic hospitals pushed back and said that this policy would force them to cancel their university partnerships, with the result that tens of thousands of mostly low-income patients would lose access to esteemed University of California specialists.

Conscience always plays a role in the provision of medical care. No hospital or medical association allows every doctor to perform every procedure their conscience may compel. Very few doctors are comfortable performing every legal procedure a patient may demand of them. And medical providers are almost always prevented from providing even life-saving care to an adult patient if the patient’s own conscience directs otherwise. The question is not whether conscience can be a limiting factor in health care but how to balance all the consciences at play. A basic starting principle is clear: A person who believes only in conscience rights for people who agree with them does not, by definition, believe in conscience rights. Conversations about conscience are fundamentally conversations about compromise.

Convincing the public that Catholic invocations of pluralism and conscience rights are sincere means considering whether any compromise to accommodate the consciences of health-care workers who disagree with Catholic hospitals is possible. Cooperation with evil is a serious matter, and if Catholic hospitals and moral theologians truly believe that no compromise is permissible, secular actors will have to respect that. But Catholics should not be surprised or offended if those secular actors come to the same conclusion.

The state of California ultimately backed down in its dispute with Catholic health-care partners. Next time, it might not. California voters may someday decide—in a world where doctors who provide transition-related procedures face increasing violence and threats—that it’s immoral to spend taxpayer dollars supporting hospitals that won’t employ those doctors. Catholics who insist that compromise is impossible do not have standing to complain about that choice. If Catholics present conscience rights as an all-or-nothing, us-versus-them matter, they shouldn’t be surprised if the response is “nothing” and “them.”

Third, without better access to health care, patients have no conscience rights of their own. Health care should always focus on patients. The best defenses of conscience rights for providers should, too: it’s important for patients to be able to choose doctors who align with their values. If a patient wants a procedure that a Catholic hospital can’t provide, that patient has the freedom to go somewhere else. But providers who are forced out by laws that don’t respect their consciences have no immediate recourse to other livelihoods.

However, this articulation of compromise assumes a fully functional, expansive, and affordable health-care system. We don’t have one. We have a system that makes it very hard to just “go to another doctor.” Somewhere between one-third and 45 percent of young adults have no primary-care physician. That’s not just Millennial fickleness and laziness. Accessing a PCP is hard. I have had five different insurance plans in the seven years since graduating from college. With each new plan, I need to spend hours on the phone finding a physician who accepts my insurance, who is accepting new patients, whose office is accessible to my home or work, and who can offer me an appointment that is neither months in the future nor conflicts with an essential obligation—if I ever find one at all. I’ve never felt able to choose my PCP based on other factors that might be important to me, like gender or area of expertise.

The problem is even more pronounced in rural areas and for patients who need specialty care. Nearly 15 percent of plans for sale on the federal marketplace have no in-network providers at all in key specialties like oncology and endocrinology. Many contain fewer than five providers within a radius of 100 miles of the most populous city in the network—100 miles! Some 16 percent of Americans live more than thirty miles from their nearest hospital, and around five hundred hospitals nationally receive special funding as the sole hospital in their communities.

More than 6.2 million people—3 percent of U.S. adults—reported having visited an out-of-network provider against their will within the last year because they were experiencing a medical emergency. This number was higher among lower-income adults, both because they more frequently utilized emergency medical care and because lower-cost insurance tends to have fewer in-network providers.

Catholic hospitals fill crucial gaps in this inadequate health-care system. In a time of unprecedented hospital closures, rural Catholic hospitals have been expanding. And Catholic hospitals based in urban areas are more likely than their competitors to accept patients on Medicaid. This is an incredible and essential service. But it means Catholic hospitals’ patients are quite simply less likely to have chosen to be there. They have nowhere else to go.

Effectively contesting regulations that infringe on conscience requires expending just as much energy, time, and money contesting the conditions that create them. The HHS explained that the proposed anti-discrimination rule was needed because, “[a]s a practical matter…many patients and their families may have little or no choice about where to seek care.” If nobody is ever forced to choose a Catholic hospital when they’d rather be elsewhere, much of the justification for the rule and other policies like it disappears.

Health-care access isn’t just an additional social-justice issue that the Church should be concerned with in its own way. It’s also a religious-liberty issue.

Finally, for now, the key to compromise is transparency. Catholics, like all people, tend to overestimate how much other people are thinking about them. Catholic hospitals assume that patients have a general idea about procedures they are barred from performing. But this is a flawed assumption

It’s not necessarily that patients don’t know what the Catholic Church teaches. Sometimes they just have different definitions of abortion and contraception than the Church does and are surprised to learn about, say, differences in the treatment of incomplete miscarriages. Sometimes they don’t know that a hospital is Catholic—as is the case for more than one-third of women receiving their reproductive care at a Catholic facility.

And yes, sometimes, the medical norm and the Catholic teaching are so deeply at odds that patients and doctors couldn’t imagine a conflict. For example, many OB/GYNs consider it ideal to perform a tubal ligation during a C-section because it eliminates the need for an additional procedure, with an additional incision and anesthesia, which can cause complications. The ban on the procedure in Catholic hospitals can take people by surprise, either because the procedure seems so common, sensible, and innocuous—or because they unexpectedly end up giving birth in a Catholic hospital.

Or, consider that doctors don’t categorize hysterectomies as a form of “sterilization” at all, and so they sometimes find themselves surprised to learn that transgender hysterectomies are barred on those grounds. As one doctor who unwittingly scheduled her transgender patient for a hysterectomy at a Catholic hospital put it, “No one would ever, ever do a hysterectomy exclusively for sterilization. I have never even had a hysterectomy [at this hospital] questioned.”

A lot of misunderstanding and confusion could be avoided if patients were informed at the outset that a hospital is Catholic and what the ERDs mean for them. When this possibility was raised in a New York Times article a few years ago, however, the Catholic Health Association’s senior director of theology and ethics replied that no business, whether a contractor or a car salesman, is “going to lead off with what they don’t do.”

That explanation might work if Catholic health care functioned first as a business with primarily economic concerns. But that would sell Catholic health care short. Concern for patients combined with clear expression of Catholic commitments regarding care should be the goal, and transparent implementation of this should take priority over worries about the bottom line.

The Catholic health-care tradition matters. It brings something important to larger conversations about how faith is lived through action and about acting within one’s ethical beliefs. It brings something important to the Church, in that millions of people who may never otherwise come into contact with Catholicism interact with it when they come through the hospital doors. It’s worth defending. And the best way to defend it is to clearly articulate respect for conscience rights within the context of America’s pluralistic society while advocating for greater access to health care for all.

When I was in college, I was part of a campus ministry that held weekly Bible studies and worship services. Occasionally, we evangelized. One of our campaigns invited students to text late-night questions about God in exchange for grilled-cheese sandwiches delivered to their dorm rooms. Another rallied around a simple message: “You are more”—more than your grades, your accolades, or your rejections. We gave out “You are more” laptop stickers and invited our peers to hear preaching on where their true value could be found. And every year, we distributed free books to students as they left the dining hall. One time—or maybe several times—that book was The Reason for God, Tim Keller’s 2008 New York Times bestseller, which argues, methodically, for the existence of God and the truth of the Gospel. Keller died on May 19 of pancreatic cancer.

I spoke up in the Bible studies, sang in the worship services, and put a “You are more” sticker on my laptop. I even became the student ministry’s co-president. But I never volunteered to answer late-night questions or hand out books. I never represented our faith in each year’s public debate with the college atheist society. Evangelism was a little embarrassing to me. I was worried about losing my friends, offending my classmates, and damaging my reputation. These are not good reasons to keep quiet about one’s faith. Nevertheless, these fears prevented me (often, they still do) from trying to bear witness to the Gospel. “For am I now seeking the approval of man, or of God? Or am I trying to please man? If I were still trying to please man, I would not be a servant of Christ,” writes the apostle Paul in his letter to the Galatians. Oof.

While I didn’t help distribute The Reason for God, I did take a copy for myself. I read the book over a summer break, far from campus and its associated pressures. Turns out, it was nothing to be embarrassed about. Keller, a pastor-theologian who had founded a church of thousands in Manhattan and written many other books—on the prodigal son, prayer, marriage (with his wife, Kathy), and pain—wrote with clarity and compassion. He quoted from poets and philosophers, theologians and scientists. “Tim wasn’t an original scholar,” Peter Wehner wrote in the Atlantic. “His strength was synthesis and integration.”

In The Reason for God, Keller acknowledges that the reader’s concerns about Christianity are reasonable: the problem of evil, the Church’s involvement in injustice, sin and hell. He had answers to each—never overreaching, always upfront about what he couldn’t know, nevertheless confident. On the fervor of fundamentalists: “The people who are fanatics are not so because they are too committed to the gospel, but because they’re not committed enough to it.” On judgment: “Can our passion for justice be honored in a way that does not nurture our desire for blood vengeance? Only if I’m sure that there’s a God who will right all wrongs and settle all accounts perfectly do I have the power to refrain.” 

Keller took his readers and critics seriously; he never implied that secular people were stupid or morally inferior: “No matter who performs it, every act of goodness, wisdom, justice, and beauty is empowered by God.” In fact, many people outside of the Church had identified the same problems—the existence of suffering, the need for transcendent human rights, their own enslavement to career or money or power—that Christians were concerned with. The challenge was to offer a compelling response to those problems. “We all have fundamental, unprovable faith commitments,” writes Keller. The question is: “Which set of unavoidably exclusive beliefs will lead us to humble, peace-loving behavior?” “Freedom is not so much the absence of restrictions as finding the right ones,” and grace “is only a threat to the illusion that we are free, autonomous selves, living life as we choose.”

Nobody reading this book, I felt, could think that they were being tricked—that the real difficulties with believing in Jesus were being sidestepped. “No view of God can be proven,” Keller acknowledges as he prepares to delve into arguments for the creation of the universe, the reality of the sin, and the historical fact of the Resurrection. “But that does not mean that we cannot sift and weigh the grounds for various religious beliefs and find that some or even one is the most reasonable.” At the close of the book, after offering a presentation of the Gospel, Keller encourages readers not to pray the sinner’s prayer in a moment of ecstasy, but instead to pause. Interested in Christianity? Examine your motives, count the cost, and visit a local church in order to begin the “lifelong process” of repentance and belief. Also, take heart. “You don’t have to wait for all doubts and fears to go away to take hold of Christ,” he writes. “Don’t make the mistake of thinking you have to banish all misgivings in order to meet God.”

When I learned of Keller’s death, I thought about my encounters with his books and sermons, and found them, as I always had, comforting. They were both intelligent and invitational, serious and warm. Never bombastic, never frenzied, never making an altar call they hadn’t earned. There are so many pastor scandals, so many faith-mongering hypocrites. Here was a trustworthy “celebrity” Christian who seemed to deserve his reputation. I was proud to be in the community he represented.

Keller’s impact was quantifiably enormous: his multi-site Manhattan congregation, which attracted thousands of young professionals; the hundreds of other churches supported by his organization, City to City, including the church I attended when I lived in New York; his best-selling books; his irenic presentation of Christian beliefs in secular publications like the New York Times and the Atlantic and the New Yorker. He was a public intellectual. But his impact was also personal, for nearly every evangelical I know. I can’t count how many references to his teaching I’ve heard from the mouths of other pastors on Sunday mornings, always with a tone of respect, even deference: Tim Keller said this, so chances are, it’s right.

His style of argumentation also resonated with secular people, and with people from other faith traditions. He wrote and preached assuming that they were in his audience; he stayed after his sermons for question-and-answer sessions. “I cannot despise those who do not believe as I do,” he writes in The Reason for God: 

Since I am not saved by my correct doctrine or practice, then this person before me, even with his or her wrong beliefs, might be morally superior to me in many ways…. The Christian’s identity is not based on the need to be perceived as a good person, but on God’s valuing of you in Christ.

That message was appealing to outsiders, and sobering for those of us already in the Church. We “older brothers” of the prodigal son story were too assured of our own righteousness—or in my case, too timid about the truth of what we believed. Rereading The Reason for God this week, almost a decade later, I’m still impressed by passages like this one: 

The Christian gospel is that I am so flawed that Jesus had to die for me, yet I am so loved and valued and that Jesus was glad to die for me. This leads to deep humility and deep confidence at the same time…. I cannot feel superior to anyone, and yet I have nothing to prove to anyone. I do not think more of myself nor less of myself. Instead, I think of myself less. I don’t need to notice myself—how I’m doing, how I’m being regarded—so often.

I’m doing better at this. I’m more confident in my friendships, more anchored in my faith, and less anxious about my reputation. But sometimes telling strangers at a party that I work for a publication called Christianity Today is still an exercise in self-mortification.

I’ve also recognized that not all my resistance to “evangelism”—in-the-moment evangelism, quick-fix evangelism, confrontational evangelism—is bad. Some of my aversion is temperamental, but most of it is practical. Some people have their conversion experiences in a single worship service after receiving a cool laptop sticker; others need just a single one of their late-night questions answered correctly. But many, perhaps most, of us need to weigh our motives and count the costs, again and again. Many need not just one sermon, or one conversation, but dozens, hundreds: patient engagement, and personal affection, relationship above all else.

This is where Tim Keller really triumphed—not just as a thinker, but as a pastor characterized by kindness. He valued dialogue; he respected those who disagreed with him; he cared about people as people, not as names he could add to a list of saved souls. In the aftermath of his death, some of his critics have called his signature “winsomeness” a weakness. They say he avoided the culture wars too assiduously; he wasn’t willing to fight the right fights, or at least, to fight them aggressively enough. 

Nothing could be further from the truth, as Tim Keller himself helped me understand. “The real culture war,” he wrote, “is taking place inside our own disordered hearts, wracked by inordinate desires for things that control us, that lead us to feel superior and exclude those without them, and that fail to satisfy us even when we get them.” In the world as Keller understood it, weakness was strength and meekness was power and children entered the kingdom first. The King died on a cross and rose again; the new heavens and earth were at hand. The battle had already been won, and Keller wasn’t here to fight it anew. He was simply here to share the good news.

For a writer of his generation, Colm Tóibín might be the closest thing to a celebrity the twenty-first century is capable of producing. The source of his popular appeal, however, can be a little tricky to pin down. Tóibín’s novels are often understated and elliptical, driven more by small human interactions than by plot. His most critically acclaimed work, 2004’s The Master, is a dense, involuted treatment of the life and emotional weather of Henry James as the specters of old age and death loom. Even his most commercially successful novels, including Brooklyn (2009) and Nora Webster (2014), are far frostier and stranger than their warm popular reception would lead you to believe. 

Though Tóibín is most famous as a novelist, he’s also a prolific and omnivorous essayist, regularly turning out lengthy pieces of criticism and cultural commentary for publications like the London Review of Books and the New Yorker. Over the past three decades, he’s published a celebratory homage to the city of Barcelona; travelogs detailing a walking tour along the Irish border and investigating the state of European Catholicism in the mid-1990s; studies of the Irish dramatist Lady Gregory and the American poet Elizabeth Bishop; and themed essay collections on the lives of gay artists, writers and their families, and (of course) Henry James.

In a way, it’s surprising that a writer so prolific shouldn’t have a Selected Essays, but the peculiar qualities of his criticism, which tends to be information-dense and quote-heavy, might offer an explanation. Tóibín doggedly pursues his own curiosities, leaping down rabbit hole after rabbit hole and reveling in the warren. That his earliest nonfiction outings, including Bad Blood: A Walk Along the Irish Border and The Sign of the Cross: Travels in Catholic Europe, were essentially peripatetic pieces of journalism makes sense. A leisurely stroll is the clearest model for his nonfiction style.

His latest collection, A Guest at the Feast, comes closest to being a general compendium, though its contents are weighted in favor of a particular subject of abiding interest to Tóibín: religion. The book is anchored by three essays on popes, and three essays on writers concerned, in one way or another, with religious themes. This may seem odd to some readers, since religious themes aren’t terribly prominent in Tóibín’s novels, where they emerge (if they emerge at all) in oblique ways—for example, as imposed silences, dictating what may and may not be said. Unsurprisingly, the collection as a whole is interested in “religion and its shadowy aftermath,” to borrow a phrase from Tóibín’s essay on Marilynne Robinson. Dealing with the shards of a religious tradition, as Tóibín’s essays make clear, can be intensely clarifying—after all, when things break up, they are quite literally made particular, and can be examined from all angles.

The collection’s title essay, a rambling piece of psychogeography, offers a magpie’s view of Tóibín’s artistic development. He quotes writers he admires, recounts the history of landmarks in his native Enniscorthy, and drinks his way through his student days in Dublin. At one point, he recalls finding a stash of forbidden books above his mother’s wardrobe, including Edna O’Brien’s The Country Girls and John McGahern’s The Dark. These texts, “samizdat Irish-style,” are tokens of “a great unsettling,” the seismic cultural shifts that occurred as Ireland opened itself to the world in the 1960s. The essay’s discontinuous, mosaic-like structure, treating every fragment of experience with equal weight, is a reflection of this disturbance. Tóibín is attempting to capture a culture, and a self, that has been fractured and riven by deep changes.

There’s always been something clinical about the tone of Tóibín’s writing, a severity that insists on the raw accretion of facts. At its worst, this tendency can make his essays feel like little more than collections of quotations. Elsewhere, it provides a powerful charge. “A Brush with the Law,” which recounts Tóibín’s fascination with Ireland’s Supreme Court, is a case in point. The essay’s lengthy explanations of court cases dealing with homosexuality bear a clear edge. Tóibín’s real aim is to demonstrate how religious ideas get filtered through the legal system, how legal arguments against homosexuality are often just moral arguments in disguise. In a sense, his method elevates pedantry to a moral art.

This understanding of religion as a richly material, specific, and grounded thing gives shape to the collection’s contents. Structured religion is, naturally, political, as Tóibín’s essay on Pope Francis, which charts the prelate’s maneuverings and continued silence during and after Argentina’s Dirty War, makes clear. Despite Francis’s reputation as “a poster boy for informality, humility and good-natured cheerfulness,” in Tóibín’s estimation he is fundamentally a shapeshifting figure, capable of an almost ecstatic vacillation. “Bergoglio could play the anarchist one moment and the next revert to his role as authoritarian,” he writes. That this degree of vacillation, the absence of a coherent center of thought and action, might be central to a successful papacy in the twenty-first century is the essay’s unspoken fear, one borne out by the fate of Benedict XVI, a deeply intellectual prelate firmly committed to theological revanchism.

Tangling with the paradoxes of religious life provides the foundation for many of the collection’s most powerful pieces, including, naturally, “The Paradoxical Pope,” Tóibín’s’s searching analysis of John Paul II. Written for the New Yorker in 1995, the essay appeared at a time when it seemed the Polish pope was on the way out, and there was the hope of massive reform in the Church. This focus on a moment of illusory optimism makes the essay a strange, almost autumnal read—after all, we know that John Paul II held on for another decade, and that he was replaced by Ratzinger, who was in some ways even more conservative. At the same time, it’s a remarkably prescient essay, a powerful example of Tóibín’s interest in the forces of compromise, which allow things to appear to change while really staying the same.

John Paul II, as Tóibín portrays him, was “a master of ambiguities.” His public performances late in life were defined by a dialectic of frailty and sudden strength, a “mixture of bemusement and power,” which Tóibín suggests was central to their appeal. His standard move of “on the one hand, forbidding debate, and, on the other hand, seeming sympathetic and open” cloaked the Catholic Church in a deceptive air of flexibility during a period of great geopolitical changes. Like the Catholic Church itself at the end of the long twentieth century, Tóibín is fascinated by the fact that, as John Paul II “grows weaker, the light in his eyes strengthens, and his performances become more powerful and fascinating.”

The collection is rounded out by a handful of essays on writers. “Putting Religion in Its Place,” an essay on Marilynne Robinson, is concerned with the question of how religion is to be treated in a novel. Tóibín seems to settle for a clear and relatively simple answer. “Making religious thought easy is part of the genius of Gilead,” he writes, and notes of Home, Robinson’s third novel, that in spite of her “interest in religion, the predicaments dramatized in the book—including the religious ones—are rendered mostly in human terms.” What Tóibín is praising is essentially embodiedness, which is exactly what makes most realist fiction successful: the religious or the social or the political (and so on) is made granularly present in the minds of the characters. There’s something slippery about Tóibín’s treatment of his subject, a lack of clarity in his own chosen terms, which is perhaps why the essay contains lengthy asides on a number of other writers, including Henry James and Ernest Hemingway. It’s as though Tóibín is a touch uncomfortable dealing with Robinson’s honest religiosity.

The most riveting essay in the collection is likely “Issues of Truth and Invention,” on the Irish novelist Francis Stuart, who during World War II delivered radio broadcasts from Berlin that were intended to convey German propaganda to his homeland (though he refused to make any anti-Semitic statements). Stuart managed to have a successful career after the war, publishing several novels that dealt with his experiences—whether unsparingly or not is still a matter of debate. Tóibín became a close acquaintance of Stuart’s toward the end of his life, and his attempts to wrangle with Stuart’s messy literary legacy propel the essay. But Stuart seems irreducible, and Tóibín is led down a path of generalizations. In his postwar novels, Tóibín writes, Stuart “created versions of himself and versions of the war and its aftermath that redeemed him, inasmuch as they could, from the ordinary guilt or blame that might attach to collaboration.” Behind this was Stuart’s need “to believe that he had gained something spiritual, some new insight into the human condition, during and after the war.”

These are sharp observations, and they cast a few brilliant patches of light onto the shadowed monolith of Stuart’s psyche. But a far more affecting note is struck at the start of the essay, when Tóibín is recalling his own memories of the elderly Stuart and his wife, Madeleine: “I knew they both lived in the shadowy spaces between knowledge and forgiveness; their response to this was not simple, and I never fully understood it, and I still don’t.” There is a sense, here, of abiding in mystery, of a magisterial silence scrupulously maintained—in a way, a fundamentally religious posture. Silence, in particular, has a paradoxical grace to it—it models the virtue of forbearance, but at the same time can be a product of conservative forces and inclinations, or of fear. But there are different types and qualities of silence. Bergoglio’s silence, one senses, was simple, an absence of noise. Stuart’s was something more complex, an immanent force, closer to a prayer than anything else. It’s no surprise that Tóibín would be drawn to it, like a moth to a votive flame.

A Guest at the Feast
Colm Tóibín
Scribner
$28 | 336 pp. 

Our culture is crazy for orphan stories. From Harry Potter to The Last of Us to The Batman, from Demon Copperhead to A Series of Unfortunate Events, we just can’t get enough of a good orphan yarn. Our fairy tales—and Disney films—are based on abandoned, tormented children. But of course, these are fictional tales. No one likes to hear, or write, about the real thing.

I know because I tried. I stumbled across the real thing in Northwest Alaska at St. Mary’s Mission back in the 1990s and considered writing a book about it. But I didn’t have the stomach for the gory details. Dipping your toe into Cinderella or Anne of Green Gables is one thing. But spending a decade researching and living with the true horror is quite another.

Christine Kenneally did just that for her new book, Ghosts of the Orphanage: A Story of Mysterious Deaths, a Conspiracy of Silence, and a Search for Justice. She spent more than ten years gathering documents, police reports, letters, diaries, and depositions; reading through trial transcripts; and interviewing hundreds of people to tell us what went on behind closed doors for decades at St. Joseph’s, a Catholic orphanage in Burlington, Vermont. The stories are at first unbelievable, not only to the reader, but also to the authorities. But Kenneally—and the lawyers who fought the battles for these now-adult orphans—patiently and unflinchingly stitch together the brutal reality.

When Americans think of orphans they think of red-haired Annie or nineteenth-century Oliver Twist. It’s all safely in the past or a continent away. But Kenneally is here to tell us that those orphan tales are closer than we think, geographically and temporally. The book is a deep, depressing dive into the stories of children forgotten but still walking—grown—among us. Not ghosts as the title suggests, but flesh and blood, in search of healing.

For anyone who attended Catholic school in the 1940s, ’50s, ’60s, or even ’70s, some of what the nuns at St. Joseph’s did will sound familiar. I found myself flashing back to nuns slapping children across the face, hitting us with big wooden paddles, and making us kneel as a group for extended periods when a suspected perpetrator refused to come forward. For years I have written about, and laughed about, what the nuns did at my school, Our Lady of Czestochowa, in Jersey City, New Jersey. But the St. Joseph’s stories go beyond the typical—and no longer acceptable—corporal punishment some of us endured. They are no laughing matter, and reading this book made me realize my own nun stories weren’t funny either.

Ghosts of the Orphanage grew out of Kenneally’s BuzzFeed investigative piece published in 2018, which was viewed more than six million times over six months. Kenneally won the Deadline Club Award and was a finalist for the National Magazine Award. But her book is one of those books that you want to put down time and again because the details are just too awful.

Kenneally mentions not once, not twice, but nearly a dozen times that the children were forced to eat their own vomit by the vicious Sisters of Providence, who ran St. Joseph’s. They were also severely beaten, kicked down stairs, locked in freezing attics and water tanks, hung out windows, burned with matches, used as guinea pigs by a pharmaceutical company, and sexually abused, not only by the nuns but also by the priests who worked as chaplains overseeing the orphanage. As with Holocaust stories, it’s hard to look away from what Kenneally herself calls “a series of unrelenting gruesome events.” Reading the book is itself, at times, an act of masochism. This is not to say there were not happy days at St. Joseph’s. Children sang, celebrated Christmas, took part in sports, and received a thorough education. But the good times do not balance out the wretched reality.

Helping move the narrative forward are the well-sketched personalities, particularly those of attorney Robert Widman and survivor Sally Dale, who spent twenty-three years in the orphanage, first as a child and then as a worker. We care about these fully formed characters and so need to know if justice will ever come. Will the horror, embedded in survivors’ memories and now ours, ever end? Will they get their day in court? As the criminal case builds, as the witnesses grow in number, and as the sharp diocesan attorneys start their attack, the story becomes a gripping nailbiter.

As with the sexual-abuse scandal, the Catholic Church’s conspiracy, coverup, and refusal to make amends is nearly as mind-boggling and horrific as the abuse itself. For decades, no one would listen to the stories of these orphans. They were silenced and ignored not only by the Church, but even by their own families and by authorities who thought it was all too terrible to be believed. What’s most shocking is the systemic nature of it all—“the Catholic Church’s institutionalized sadism, glorification of suffering and how commonplace abuse was in its institutions,” as Kenneally writes. The abuses were constant, out in the open, and accepted. “It was not one priest at one time,” says one of the attorneys. “It was Dante’s inferno.”

To show that St. Joseph’s was not an isolated case, Kenneally cuts between similar Catholic orphanage stories in Canada, Great Britain, and her native Australia, some involving the same order of nuns. But her main subject is St. Joseph’s, whose sheer number of survivors and abuses are sometimes hard to keep track of. A cast of characters at the front of the book would have helped. But as we find in the author’s notes at the back, these stories are just a few of the many Kenneally discovered.

At their peak in the 1930s, there were around 1,600 orphanages in the United States, with as many as 5 million children passing through their doors during the twentieth century. Many were not orphans at all, but were abandoned by those who couldn’t care for them, or simply taken from alcoholic or mentally ill parents. 

Many of the walking wounded repressed their memories and only came to think and speak about their years at St. Joseph’s when a support group was formed in the 1990s. But others, emotionally broken from years of experiencing and witnessing abuse, committed suicide, became homeless or addicted to drugs, or wound up in jail for their own violent or sexual offenses. Some, while still at St. Joseph’s in the late 1960s and ’70s, tried to burn the orphanage buildings down. Sally Dale herself contemplates suicide at one point, just so she doesn’t have to think about St. Joseph’s anymore.

The weak links in the book are the reports of deaths that residents say they witnessed at the hands of the nuns, deaths that Kenneally believes were covered up by the Catholic Church over the decades. There was the boy pushed by a nun out a fourth-story window who bounced on landing, the boy who froze to death when locked in the cupola staircase, the boy who was held by his feet over another staircase and dropped either intentionally or accidentally, and the boy who was thrown from a rowboat into a lake by nuns during a “sink-or-swim” lesson. There is the story of a nun smothering the illegitimate baby of another nun with a small satin pillow. Kenneally digs and digs, but in the end, no bodies turn up. “The deaths,” she writes, “still had a powerful aura of unreality.”

Is justice served? Only partially. A settlement is reached. No one gets their day in court. But after Kenneally’s BuzzFeed exposé, the statute of limitations on civil actions for childhood sexual abuse as well as for childhood physical abuse was lifted in Vermont. As we now know, post-Spotlight, it can take years for memories to resurface, and even more time to work up the courage to come forward. 

There are other small victories. In 2021, the St. Joseph’s Orphanage Task Force, set up by the attorney general to investigate the survivors’ claims, produced a report that officially validated many of the complaints. “No historical context,” the report states, “excuses the failure to protect these children.” The Sisters of Providence, whose order is based just over the border in Montreal, refused to cooperate with the investigation. “The goal of the church,” Kenneally writes, “is suprahuman and is measured in centuries: it has been working to control history.”

Though none of the nuns is punished, Kenneally names those who ran this “tiny totalitarian state”—Sister James Mary, Sister Jane of the Rosary, Sister Mary Vianney, Sister Claire of the Providence, Sister Noelle, and Sister Priscille, whom she visits and who admits to having pushed a girl out a window. Kenneally tells the backstories of these nuns, many of them who came from poor farm families in Canada and who were barely adults themselves when they entered the convent, ill-equipped to handle troubled abandoned children.

But at center stage are those who were abused, who are given their space and time to grieve—along with the reader—for their lost childhoods. We may not be able to right the past, but we can make the effort to listen to their stories.

Ghosts of the Orphanage
A Story of Mysterious Deaths, a Conspiracy of Silence, and a Search for Justice
Christine Kenneally
Public Affairs
$17.99 | 384 pp.