Conscience and Mandates

National Catholic Reporter
Distinctly Catholic

21 July, 2011

Reprinted by permission of National Catholic Reporter,
115 E Armour Blvd, Kansas City, MO 64111

Michael Sean Winters*

The rights of conscience are at the very heart of American history. . . In the jurisprudence of the Supreme Court, the rights of conscience have been vindicated by a long line of First Amendment cases that have raised the bar very, very high against those who would seek to impose their will against the conscience of a citizen.

Yesterday, the Institute of Medicine released its suggestions for what procedures should be mandated for inclusion in private insurance plans under the health care reform law. Some of the proposals seem non-controversial enough: They recommend, for example, that a more sophisticated, and expensive, test for the virus HPV, which is linked to cervical cancer, be part of the mandated services. That is all to the good. But, the recommendations also tread on some highly contentious areas regarding contraception and, worse, abortifacients. Those suggestions go to the Department of Health and Human Services which will formulate the final rules governing mandated coverage. To be clear, the recommendations released yesterday are just that, recommendations.

I am no scientist nor a moral theologian, so I will focus on what is, to me, one of the most pressing aspects of these regulations, the need to protect conscience.

The rights of conscience are at the very heart of American history. Many of the early colonists came to these shores seeking refuge from religious persecution, although the Puritans did not extend those rights to others once they arrived and set up shot. Roger Williams, however, did establish a religious justification for the rights of conscience in his colony of Rhode Island. This impulse to deny the community to right to coerce the conscience of an individual was leavened in the eighteenth century by Enlightenment influences and the First Amendment stands as a central tribute to, and protection for, those rights. In the jurisprudence of the Supreme Court, the rights of conscience have been vindicated by a long line of First Amendment cases that have raised the bar very, very high against those who would seek to impose their will against the conscience of a citizen.

As Catholics, we locate our concern for conscience differently from the way Locke or the Puritans or the Supreme Court did, but not that differently. For us, the rights of conscience are rooted in our beliefs about human dignity. In Vatican II’s Decree on Religious Liberty, a document that failed to resolve some of the deeper anthropological and theological issues surrounding conscience rights, the Church nonetheless affirmed its commitment to freedom of conscience, a milestone in the Church’s history.

Earlier this year, when the administration released its new conscience regulations, I made the point then, and it remains relevant to this discussion: Liberals should be ashamed of themselves when they cease to defend the rights of conscience. Simply from a PR perspective, it makes sense for the USCCB to solicit the aid of non-Catholic groups that defend First Amendment rights. Not only will this show that our case is more than one of special pleading, it will show that our stand is principled in every regard. The right of a woman to procure an abortifacient does not trump the right of a female doctor to refuse to provide one. Liberals need to do their homework before they dismiss the Church’s concerns.

A couple of other points come to mind. In a statement, HHS Secretary Kathleen Sebelius said the recommendations were “based on science and existing literature.” Well, I suppose John Locke still counts as “existing literature.” But, more to the point, science can only tell us so much and I am philosophically allergic to the kind of creeping scientism that believes that branch of human inquiry can solve all issues. It can’t. The insidious, racist book “The Bell Curve” claimed to be scientifically based, but the conclusions of that book stand condemned as inhumane nonetheless on philosophic grounds. As my mentor Leon Wieseltier said at the time, and which I have quoted before, “There is not a chart in the world than can explain the role of charts in the world.”

Second, there are some conservative Catholics – George Weigel comes to mind – who have argued that the bishops’ conference diminishes the “voice” of individual bishops. But, within hours of the release of the new recommendations from the Institute of Medicine, the USCCB had a statement critiquing them. The USCCB was able to respond quickly, forcefully and intelligently because it has staff that monitors these issues, just as local Catholic Conferences monitor such issues at the state level. Individual bishops could scarcely afford to keep full-time staff in Washington to monitor these matters. Richard Doerflinger does great and important work at the USCCB defending life, calling our attention to challenges facing the Church. I do not always agree with his conclusions but I am very glad to have him at the USCCB doing what he does.

Third, one of the political challenges for the Church in fighting these recommendations is that the number of pro-life Democrats serving in Congress shrunk drastically after last year’s midterm elections in part because groups like the Susan B. Anthony List attacked them and helped fund their opponents. Yes, they had differences over the health care reform law. And, the SBA List has every right to make their position known and support whom they like. But, why did they not try to replace pro-choice Democrats with pro-life Republicans? By going after pro-life Democrats with whom they had relatively minor differences, they have greatly weakened the bargaining power of the pro-life movement within the counsels of the Democratic Party.

Finally, and following up on a theme I have been addressing of late, I wish the USCCB statement had acknowledged some of the good in the new recommendations. After all, there has long been a deficit in coverage for procedures that are unique to women, and redressing that imbalance is a good thing. I understand that we must all set priorities. I understand that there is something morally shocking about the fact that our political leaders spend so little time addressing the lack of health care for the poor and the immigrants. But, I worry that the Church too often appears as a scold in public debates, always defensive, always rejecting. It costs us nothing to praise what is good.

This will be a big issue in the weeks and months ahead. Already professor Stephen Schneck, director of the Institute for Policy Research & Catholic Studies at CUA, and a man who took a lot of heat for his support of Sebelius’ nomination, put up a post last night on the public theology list-serve that read: “Plan B and similar should not be covered. The rationale for including such items in category intended for critical basic medical care is unpersuasive. Planned Parenthood and similar organization already provide contraception free to poor women. Moreover, on the face of it, the mandate seems to be at odds with the executive order that got some pro-life support for the health care bill. It’s time for the administration to be clear about its respect for religious concerns about life issues. At the very least, religious and conscience exemptions need reaffirmation now.” HHS would be well advised to listen to Schneck.

All of us have an obligation to inform ourselves about conscience rights. To that end, here are some of the more recent posts, including one by Schneck and another by Professor Robert Vischer of University of St. Thomas Law School in Minneapolis, that I ran here earlier this year.

USCCB Finds Weakening of Health Care Conscience Rule a ‘Disappointment’

Affirms Some Positive Elements

USCCB News Release 11-036
FOR IMMEDIATE RELEASE
February 18, 2011

United States Conference of Catholic Bishops

WASHINGTON (February 18, 2011)—The Obama administration’s final rule rescinding important elements of a federal regulation protecting the conscience rights of health care providers is a disappointment, but there are also reasons for hope, said Deirdre McQuade of the Pro-Life Secretariat of the United States Conference of Catholic Bishops (USCCB).

“The Administration’s action today is cause for disappointment, but also offers reasons for hope regarding an emerging consensus in Washington on the need for clear conscience protections for health care providers,” said McQuade.

“It is very disappointing that the Administration has chosen to eliminate much of the existing regulation on conscience issued in December 2008. Among other things, the final rule issued today eliminates important clarifications that would have helped in interpreting and enforcing longstanding federal statutes protecting the conscience rights of health care providers. It also eliminates a regulatory requirement that recipients of federal funds certify compliance with those statutes.

“However, it is welcome news that the Administration says it will take initiative to increase awareness of the conscience statutes, work to ensure compliance with them, and require that government grants make clear that compliance is required. We look forward to working with the Administration and Congress to ensure that these endeavors are carried out, so providers receive the full conscience protection they are due.

“We also hope that the Administration will place its full support behind efforts in Congress to clarify conscience protections and make them more secure, by endorsing such initiatives as the Protect Life Act (H.R. 358), the No Taxpayer Funding for Abortion Act (H.R. 3), and the Abortion Non-Discrimination Act (H.R. 361).”

  • Past USCCB letters supporting the Bush administration regulation, and opposing efforts to rescind it.

Why ‘public’ should not mean ‘atheist’

The Ottawa Citizen

Iain Benson*

Nothing in our theories or history should support turning religious believers and their communities into second-class citizens when it comes to public involvement and funding. In short, atheism and agnosticism ought not to be favoured public claimants in Canada any longer. . .
Full Text

Rights Commission threat “blasphemy against the human spirit”

College of Physicians secrecy said unacceptable

News Release

For Immediate Release

Protection of Conscience Project

“Blasphemy against the human spirit.” That is how the Protection of Conscience Project describes a threat by Ontario’s Human Rights Commission to punish doctors who refuse to do what they believe to be wrong. The rebuke is found in a submission to the College of Physicians and Surgeons of Ontario.

Citing writers and philosophers in the democratic tradition, as well as the landmark Morgentaler decision of the Supreme Court of Canada, the Project argues that to force doctors to act against their conscientious convictions is “to deprive them of their essential humanity.” It calls the proposed policy “profoundly offensive and demeaning.”

“To abandon one’s moral or ethical convictions in order to serve others is prostitution,” states the submission, “not professionalism.”

The brief denies that doctors who refuse to do what they believe is wrong are violating the Human Rights Code. It explains that they are concerned about “complicity in wrongdoing,” not race, sex or other patient characteristics.

The Project submission addresses the College draft policy, Physicians and the Ontario Human Rights Code. Deadline for comment on the policy was extended to 12 September following protests when news of it became public.

The President of the College told the National Post that the draft has been revised, but refuses to make it public. Project Administrator Sean Murphy finds College secrecy unacceptable.

“At least two substantial briefs reached the College only on Friday,” he said. “The National Post story appeared Saturday. It seems very unlikely that College officials could have considered either submission before revising the draft. This brings into question the validity of the consultation process.”

“But the more important issue,” he said, “is that decision-making that impacts fundamental freedoms should be conducted transparently, not secretly. Why keep the revised draft secret? Is there something to hide?”

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Related Links:

Proposed policy could severely limit freedom of Ontario physicians

Canadian Physicians for Life

For Immediate Release

(Ottawa) – In a letter today to the College of Physicians and Surgeons of Ontario, the president of Canadian Physicians for Life, Dr. Will Johnston, expressed concern over a draft policy relating to freedom of conscience and the lack of sufficient notice given by CPSO to all interested stakeholders that a consultation process, which officially ends today, has been underway since the end of June.

Canadian Physicians for Life is asking the College for a 90-day extension on the deadline “due to the importance of the issues at stake and the lack of opportunity interested stakeholders were given to comment on the proposal.”

The draft policy, that CPL only learned of late yesterday, would appear to severely limit the freedom of Ontario physicians to practice according to their conscientious/religious beliefs. The College apparently posted the draft policy document, “Physicians and the Ontario Human Rights Code” on its website at the end of June and had set a deadline of today for input on the proposal.

In his letter, Dr. Johnston expressed surprise that the College would not have been more proactive in soliciting input on a policy that could have profound impact on both individual doctors and on the profession as a whole. CPSO does not appear to have issued a news release on the consultation process, and pro-life physicians have been taken by surprise.

Dr. Johnston wrote, “The College must have been aware that groups such as Canadian Physicians for Life — which represents doctors from across Canada who respect the dignity of all human life, regardless of age or infirmity — would have concerns with the College’s view that “decisions to restrict medical services offered….that are based on moral or religious belief may contravene the [Ontario Human Rights] Code, and/or constitute professional misconduct.”

“Refusal on conscientious or religious grounds to refer a woman for an abortion could be deemed professional misconduct under this new policy,” Dr. Johnston said.

A similar requirement (that doctors must make abortion referrals regardless of their conscientious beliefs) was put forward in a July 2006 guest editorial in the Canadian Medical Association Journal. It triggered such a firestorm of controversy, that the Journal was compelled to publish a letter from CMA’s Director of Ethics stating that CMA policy did not require physicians to refer for abortions if it would violate their conscientious or religious beliefs.

Dr. Johnston concluded, “There could be serious problems with what the Ontario College is proposing and we need time to study the implications of this policy in detail. If doctors feel coerced into compromising their deepest convictions as a result of this policy, certainly that’s a problem-not only for the integrity of physicians, but also for the welfare of their patients.”

For further comment, please contact:
Will Johnston, MD, President
Canadian Physicians for Life
ph: 613-728-5433
email: info@physiciansforlife.ca


Canadian Physicians for Life is an educational organization representing physicians who hold that reverence for every human life lies at the root of all medical tradition. Through the ages, this tradition has been expressed in the Oath of Hippocrates. It was rephrased in modern times in the Declaration of Geneva (1948), which says in part, “I will maintain the utmost respect for human life, from the time of conception; even under threat, I will not use my medical knowledge contrary to the laws of humanity.”