Obama, Conscience & Catholic Hospitals

Michael Sean WintersMarch 02, 2009

The Obama administration has decided to repeal a last-minute Bush administration regulation granting wide protections to health care workers from being fired or otherwise penalized for a religiously based unwillingness to perform acts they find morally objectionable. The decision is regrettable even though it is not very surprising. The administration says that the regulation’s language was too vague and sweeping, but that they are intent on crafting a new regulation that would not force anyone to perform an abortion.

We should approach regulations issued in the last month of an administration with prima facie suspicion. These are usually sops to important constituencies that are so generally unpopular, a president would not have dared to push them until he was headed out the door. This does not entirely get the Obama administration off the hook but if George W. Bush was so concerned about the conscience of health care workers, why didn’t he bring forth this regulation earlier, specifically when the state of Connecticut passed laws requiring Catholic hospitals to perform procedures they had previously found morally objectionable.

The Catholic bishops should study what happened in Connecticut. They will learn how not to proceed this time. The legislature was planning to pass a law requiring that all hospitals give Plan B, emergency contraception, to women who came to them and said they had been raped. This contraception sometimes functions as an abortifacient, so the Catholic hospitals declined to provide the medicine. For weeks and months, the Connecticut bishops took to the airwaves, they had pastoral letters read at all Masses, they threatened that they would close hospitals before they would provide Plan B. When the bill passed anyway, the bishops said that they could live with it because it only required a test that did not definitively determine whether or not an embryo had formed. Just so, there was sufficient doubt to permit the procedure.

I am all for casuistry, but the way the bishops of Connecticut handled the debate over Plan B was a disaster. You can’t rant about Armageddon for weeks and then say, "oh, never mind, we can live with this." This merely confuses your own flock. The place for casuistry is in the negotiations behind scenes, which the bishops should be having with the administration now.

What should come of all this? First of all, the bishops need to decide where they want to draw the line. Of course, a hospital has a right to expect certain things of its doctors: I do not suppose that anyone would want to hire a strict Christian Scientist as a surgeon anymore than I would hire a non-English speaker for the role of Hamlet in an English language production. There should, however, be a bright line around abortion of any kind, including the administration of drugs that might be abortifacients. If we can live with this provided no ovulation test takes place, then say that now and draw the line around surgical abortion procedures. This line also cuts the other way: Apart from abortion, a Catholic health care worker at a public hospital should expect to adminster contraception just as a Baptist waiter at a café should expect to deliver drinks.

But, that is not enough. The bishops should push for a second line that protects all Catholic hospitals from having to perform any procedure they find morally objectionable. This would, in effect, overturn the Connecticut law. Just as you would not go to a devout Christian Scientist for surgery, you shouldn’t go to a Catholic hospital for contraception.

Most importantly, the bishops and lay faithful need to confront the Obama administration not on Catholic grounds: He is not a Catholic. Our objection should be on liberal grounds. The coercion of conscience is arguably the greatest sin in liberalism. A woman’s right to an abortion is, under current jurisprudence, undeniable. But, does that right trump the freedom of conscience of the health care worker? Just as we do not force women to have an abortion (as in China), how can we, on liberal grounds, compel a health care worker to perform an act they find gravely sinful?

Belief in the liberty of conscience was the central contribution of the American hierarchy (prompted by Father John Courtney Murray, S.J.) to the discussions at the Second Vatican Council, resulting in the conciliar document Dignitatis Humanae, and the term has been much confused ever since. But, today, in this debate, we must be crystal clear: It is profoundly illiberal to force people to act according to beliefs they do not share. If that is not what liberalism is about, it isn’t about anything. And, if that is not what Obama is about, then he is no liberal. Our hearts and our hospitals should be off-limits to those who wish to compel us to participate in affronts to the dignity of human life.

Michael Sean Winters

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15 years 8 months ago

Marie Rehbein, Your irrationality continues unabated, hence the excitable suggestion that medical personnel who are conscientious objectors are deceiving women to prevent them making choices. If women are really intent on taking the morning after pill, one individual's conscientious refusal to play a part in that process will not be anything more than an annoyance; they can go somewhere else and get it. You are confused about what it is you are demanding Pro Life medical personnel to do. You suggested that Pro Lifers should inform the Obama administration of their views. Now you have adjusted your line and merely said they can express their perspective to their elected official. There is a world of difference between the two. You use the term ''established pregnancy'' by which you mean after implanation to define abortion. Pro Lifers don't. If you weren't aware of that, you should have been. You say that the Catholic Church accepts that it is legitimate for rape victims to use Plan B. Not so. But I'd like to see you come up with a textual reference to support your claim. And I expect something pretty impressive here. I want to see a quotation from the Catechism of the Catholic Church or the Code of Canon Law. Failing that I'll accept a quotation from a member of the Pontifical Academy for Life, sourced and referenced of course but make it snappy. Your comments about future Pro Life administrations were of a piece with your excitable tone. I suspect it's down to desperation. Notwithstanding the follies of the Obama administration on abortion, the fact is that is that Americans are increasingly Pro Life. Polling shows that a plurality of Americans favour either sweeping restrictions on abortion or outright abolition. In the US Pro Lifers have got the Pro Choice brigade on the run and both sides know it. That is something which pleases me greatly.

15 years 8 months ago

Rebecca H. Not allowing implantation is different from aborting a pregnancy. The article you cite in Wikipedia describes that distinction. It is only in the very specific Catholic teaching on the matter that one could remotely interpret that trying to prevent a fertilized egg from implanting carries the same moral weight as putting an end to a developing fetus. Since most US citizens are not Catholic, it would truly be an imposition of religious beliefs upon someone of another faith, whose religion teaches that contraception is OK, for a health care provider to fail to prescribe contraception or Plan B without making it clear to the patient that this failure has nothing to do with actual medical issues concerning the patient. When we discuss this regulation, we are not discussing it only with NARAL, NOW, and Planned Parenthood. We are discussing it with people of other religions who have a right to follow the teachings of their faith. Clearly, a hospital that is known to be Catholic can be identified easily as not the place to go looking for contraceptives. However, if a doctor working in a non-Catholic hospital wishes to exercise conscience rights according to Catholic teaching, then he or she should be willing to make clear that he or she is doing so. I once had a realtor who followed Jewish Law and would not work on Sundays. She sold a lot of houses nevertheless. Similarly, a doctor who makes it known that he will not prescribe contraception and/or will not make referrals for abortion is not likely to suffer for it.

15 years 8 months ago

Comments on this regulation from women's rights groups object to the fact that the health care providers are not required to make it known to the patients in advance that they will not be informed of or provided with the full range of legal health care options because of the provider's moral objections to some options. In other words, a woman might not be given a prescription for birth control pills for reasons that have nothing to do with her medical needs or concerns, but only with the doctor's belief regarding the morality of birth control pills. Under the regulation, as is, she would not have to be told that this is the doctor's imposition of his morality on her situation, but could be sent off believing that such a prescription was not in her best medical interest.

15 years 8 months ago

Marie Rehbein, I'm afraid the irrationality is all yours. You well know that some birth control pills, including what is known in the US as Plan B and in the UK as the ''morning after pill'' may have an abortifacient function. You know, therefore, that Pro Life medical personnel cannot be a party to their use and cannot refer patients to personnel to do the dirty work for them. Catholics, in particular, are prohibited from having anything to do abortion at any stage under the sanction of grave canonical penalties. The regulation may well be changed - and changed again under a future, more enlightened administration. Be that as it may, conscientious objectors are as entitled to their civil liberties as those, like you, who oppose them. It is frankly absurd to suggest that they should inform patients in advance of their views, not least because this could presage a witchhunt of Pro Lifers in the medical professions and it is startlingly McCarthyite to say that they should inform the Obama administration of their views. No government has any business collecting records about the views of its citizenry, Ms Rehbein, this really is civil liberties 101. I don't need to convince you or anybody else that some birth control pills may have an abortifacient function. The fact is that that function has not been explicitly ruled out by pharmaceutical manufacturers or other scientists and that is all that is necessary for conscientious objectors to know. The other year I learned that there are cases of babies being born alive, surviving attempts to kill them in the womb by abortion. Following your impeccable reasoning I deduce from this that abortion is not, in fact abortion, or clearly even birth control.

15 years 8 months ago

Marie, preventing implantation may not be the same as a vacuum aspiration in the first trimester which is itself different to a D&C in the second, or a D&E in the later stages, in the sense that the further along the gestational scale you go, the process becomes more bloodcurdling and more distressing for everybody. But in a crucial sense all four, from prevention of implantation through to D&E, achieve the same outcome: ending a human being's cycle of life and that is what is important to Pro Lifers. There is a qualitative difference between preventing conception from occuring and stopping an embryo implanting in the womb. For Pro Lifers it doesn't matter where the embryo is situated, whether that be in the fallopian tubes or in a petri dish but the fact that it exists. If you want, think of Pro Lifers in this sense as very strict vegans, or hardcore pacifists, or strict Frummers. All have lines drawn around certain activities, be it not co-operating with agression, not handling any animal products, or strict adherence to the Mosaic law which it would be cruel and counterproductive to force them to transgress. Is the view that human life must be protected from conception to natural death just a religious one and then just restricted to Roman Catholics? I would argue not. For one thing it isn't just Roman Catholics who object to Plan B, or even just Christians, or for that matter believers. The Pro Life cause is bigger than that. Just because the Roman Catholic Church articulates the Pro Life case does not mean that that case is uniquely Roman Catholic. Still less does it mean that the honest conviction that all human life should be protected is unworthy of respect. An individual who refuses to take part in an abortion does not stop a women from obtaining one. It is unreasonable for the state to impose its particular view of morality on conscientious objectors. If conscience rights are eroded, the civil liberties of all suffer.

15 years 8 months ago

Red Maria, You are absolutely right that it is unreasonable for the state to impose its particular view of morality on conscientious objectors. That is, in fact, what the regulation, properly written, would prevent the state from doing to all parties involved. Allowing it to stand as written would be like allowing someone at the agriculture department to decide that because he is a strict vegan, you too must live as a vegan, or like allowing a strict pacifist in the defense department the discretion not to pass on the instruction to deploy the military to protect your neighborhood from invasion by another country. I believe that life begins when the egg is fertilized. I believe that is when my life began. However, I appreciate that despite that being the case, there are some lives that will not make it for reasons that should remain beyond my control. I do not believe that I have the right to insist that someone else sacrifice herself to gestate a person that has been imposed upon her by a criminal, for example. The distinct difference between preventing implantation and removing a developing embryo or fetus is the implicit permission given by the woman who does make the effort to prevent implantation. She has in effect entered into a contract to provide gestational space to another human being and should not be entitled to break that contract.

15 years 8 months ago

Substitute "abortion" for "birth control pills" in Marie Rehbein's whinging comment. She undoubtedly would. But hers is a mendacious argument whichever way you cut it. Patients shouldn't impose their own amorality on doctors. And women have no "need" of abortifacient pills either. Pregnancy is not, repeat not, a disease. But concsience is very much a democratic right.

15 years 8 months ago

Red Maria, I would not substitute abortion for birth control pills. I don't know why you would presume such a thing. Your strong feelings on the matter of abortion seem to be making you irrational. The regulation will be changed. It would behoove doctors who wish to have their conscience rights protected to inform the Obama administration that their consciences will not permit them to perform OR PROVIDE REFERRALS FOR abortions, and that they are willing to make that clear to patients before providing them with medical care. However, Red Maria, you will not convince anyone that birth control pills are abortifacient. Just the other day I learned of an acquaintance who became pregnant despite the use of birth control pills and who will be delivering a baby in the not too distant future.

15 years 8 months ago

Some institutions tacitly allow physicians to write birth control scripts off site or something like that, I've been told, while holding whole-heartedly and firmly to an anti-abortion policy. Is this the best way given the fact that most regard birth control and abortion quite diffrent moral issues? I believe that Catholic hospitals will suffer even more of an exodus of qualified obstetricians as they refuse tubal ligations and birth control scripts, but are right to draw the bright red line at abortions. It is the real posssibility of terminating the opportunity to have a child at a catholic inistition that is at risk unless some hard choices are made.

15 years 8 months ago

Well, Red Maria, defending the deception of women to prevent them from making choices to which you object is likely not what most medical professionals seek to defend when they wish to claim a conscience right. Your belief that participating in our democracy by expressing your perspective to your elected officials dooms you to being victimized in a witch hunt is a paranoid projection. Perhaps it is something we should consider a possibility should another so-called pro-life administration come into power. Perhaps then women's rights will be such that all their decisions pertaining to reproduction will have to be scrutinized by government officials. However, it is not something that is likely under the current administration. Just so you know, Plan B is an attempt to prevent implantation in case there is a conception, which odds are there isn't. It is only abortifacient if it removes an established pregnancy. (Even the Catholic Church accepts that it is legitimate to use Plan B after a rape when the victim does not have an established pregnancy.) However, contraceptive birth control pills prevent pregnancy by suppressing ovulation. If you equate not being able to suppress ovulation and having a baby result as being the same as having a baby survive an abortion attempt, you are beyond reason.

15 years 8 months ago

http://en.wikipedia.org/wiki/Abortifacient Some forms of "contraception" actually allow for fertilization but not implantation; hence, Red Maria's correct statement that some pills are abortifacients. People become pregnant even while on the pill simply because the pill is not absolutely 100% effective.

15 years 8 months ago

Red Maria, Your narcissism continues unabated. The following is from the USCCB: A woman who has been raped should be able to defend herself from a potential conception and receive treatments to suppress ovulation and incapacitate sperm. If conception has occurred, however, a Catholic hospital will not dispense drugs to interfere with implantation of a newly conceived human embryo.2 www.usccb.org/prolife/issues/abortion/ecfact.shtml The following is from the NCBC: Catholic hospitals have always provided contraception for the victims of sexual assault. This was usually done with a medication or medications which would prevent ovulation. If an egg is not released from the ovary, the victim cannot become pregnant. There was a difficulty here, however, because some medications appear to have a negative effect on the lining of the womb that might prevent an implantation of a new human embryo if one is engendered as a result of the assault. This would amount to an early medical abortion that would not be allowed. www.ncbcenter.org/07-10-03-Connecticut.asp There are many people working to oppose abortion. Those who are reasonable and receptive to the objections of those who support abortion make headway in their efforts. Those whose primary purpose is to be offensive and self-righteous, like you, set them back. Please see my comment to Rebecca H. for further clarification as to why this last minute Bush regulation is being rescinded. You may not recognize the Obama administration as elected officials, but I assure you that unlike the first George W. Bush administration, they were fairly and honestly elected.

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