Conscience and Contraception
In the wake of the recent HHS regulations concerning women’s preventive services, and in the amidst the outcry over the allegedly much-too-narrow religious exemptions, Matthew Archbold of Creative Minority Report accuses the Catholic Health Association’s Sister Carol Keehan of being pleased that the Obama administration is requiring health insurance companies to cover contraception without a co-pay.
I’m going to assume that Archbold just egregiously misread the Catholic Health Association’s letter of response to the new requirements because the letter itself clearly says that the association “is very concerned about the inadequacy of the conscience protections with respect to the coverage of contraception.” Rather, the CHA is pleased—nay, “delighted”—that “health insurance coverage must include critical screening services without any cost-sharing.”
Archbold’s primary complaint, however, regards Sr. Keehan’s claim that the administration “does not intend to include abortifacient drugs as covered contraception,” a statement that puts her at odds once again with pro-life groups and the USCCB. Archbold calls her claim a “shocking and disgusting untruth.” Perhaps because the allegedly offending drug, ella, was approved by the FDA without being classified as an abortifacient, Sr. Keehan chose not pick a fight with the administration over its classification when publicly expressing concern about the new regulations. Presumably she wants to persuade the HHS to broaden the religious exemptions. Or perhaps she agrees with the FDA. In any case, she certainly provoked pro-lifers with her statement. And the banners have risen!
I imagine the outcry over conscience protections and the heated infighting among Catholics strikes most of our society as not a little crazy. After all, despite the official teachings, most Catholics use contraception and see nothing wrong with their doing so. The immorality of contraception makes no sense to our contemporary culture. People don’t buy the religious arguments against its use; nor are they persuaded by non-religious arguments, such as those premised on the biological purpose of the sexual organs constituting some kind of absolute moral norm.
Moreover, we generally uphold contraception as a right, something worthy of public support and funding, even if some fringe crazies find it morally objectionable. And don’t we all pretty much have to support something with our tax dollars we find objectionable? Seriously, what’s the big deal? Well, the big deal is that some Catholics not unreasonably want to practice their faith freely and without being forced by the government to cooperate materially with something their religion has always deemed immoral.
Frankly, whether the Catholic Church’s position on contraception is right on the money or just plain nutty, the HHS is acting rather stupidly by so clearly infringing on religious liberty. It fuels the notion that the Obama administration doesn’t care about protecting people of faith, and it’s likely to provoke a long-term backlash. Issuing the regulations but with stronger and broader religious exemptions may not have pleased all Catholics or others morally opposed to contraception, but it would have stifled complaints about the infringement upon religious liberty.
Besides, would the proposed benefits of the new regulations have suffered much as a result?
Comments are closed.
I’m going to assume that Archbold just egregiously misread the Catholic Health Association’s letter of response to the new requirements
I think you are being overly charitable.
Archbold’s primary complaint, however, regards Sr. Keehan’s claim that the administration “does not intend to include abortifacient drugs as covered contraception,” a statement that puts her at odds once again with pro-life groups and the USCCB.
I have not read a statement from the USCCB that says this. Certainly the hopelessly corrupt and dishonest pro-life movement is saying something like that. Sr. Keehan is correct that the administration does not intend to include abortifacients. However, scientists at FDA may disagree with Sr. Keehan and the USCCB as to what is an abortifacient.
I’ve been called worse.
From the USCCB press release to which I linked:
Cardinal DiNardo added: “Catholics are not alone in conscientiously objecting to this mandate. The drugs that Americans would be forced to subsidize under the new rule include Ella, which was approved by the FDA as an ‘emergency contraceptive’ but can act like the abortion drug RU-486. It can abort an established pregnancy weeks after conception. The pro-life majority of Americans – Catholics and others – would be outraged to learn that their premiums must be used for this purpose.”
One of ella’s suspected mechanisms of efficacy is to alter the endometrium so that a fertilized egg does not attach to the uterine wall, and dies. This mechanism is known to the FDA, because it carefully documents exactly this in its description of the properties and uses of ella.
The Cardinal believes that this mechanism makes ella an abortifacient, because it causes the death of a fertilized egg (i.e. under Catholic teaching, a human being). This is an entirely logical deduction from a combination of science and Catholic teaching.
The FDA does not think that this counts as abortifacient, because it holds to the definition of pregnancy as only beginning when the fertilized egg attaches to the uterine wall. (There is no particular scientific reason to hold that definition: it’s held for ideological and political reasons — “magical thinking”.)
When Sister Keehan says, “We appreciate that the Administration does not intend to include abortifacient drugs as covered contraception”, I have no idea what she means. Is she using ‘abortifacient’ in the FDA’s sense, or in the Catholic sense? She risks coming across as incredibly naive.
Paul,
I don’t find her statement confusing. The Administration has a clear policy of not including abortifacients. Keehan is allowing that while that is their intention, they may misjudge what is an abortifacient. The fact that you or some others may find this unclear does not justify Archbold’s nasty comment.
ella is not designed to alter the endometrium. However, the endometrium is very sensitive and a vast number of prescription drugs can cause it to be less “sticky.” While it is an accident and not a design of ella, so is caffeine, certain non-prescription drugs, sudden weight loss, lack of vitamin E, physical exercise and stress.
Air pollution from CO2 emissions have a profound enough effect on women’s’ endometrium that the proposed cap and trade bill so earnestly opposed by the conservatives would have resulted in a decline of implantation failures greater than the total number of elective abortions in the USA.
Of course, no one should hold their breath waiting for the Right-to-Life Movement to support cap and trade.
Kurt: “I don’t find her statement confusing. The Administration has a clear policy of not including abortifacients.”
And your reply is confusing for the same reason that Keehan’s is. Which definition of “abortifacient” are you using? The federal government is using the completely arbitrary definition that a drug is only abortifacient if it affects the fetus after it becomes implanted. But the fetus is already human long before that point. (Some more information on related issues about the definitions of such words, see here.) So the Catholic Church holds that a drug can indeed be abortifacient if it acts to kill the fetus even before the point of implantation.
Kurt: “ella is not designed to alter the endometrium. However, the endometrium is very sensitive and a vast number of prescription drugs can cause it to be less “sticky.”
The FDA documentation shows that ella induced fetal loss in a significant percentage of the animals that it was tested on. That’s a direct causal measurement. For things like caffeine, there have been some studies that showed a correlation between caffeine intake and miscarriage — and other studies that did not show any such correlation. Those studies have thus not shown any clear risk because of caffeine. Even if the studies had shown a definite correlation with caffeine intake, that would still not necessarily demonstrate that caffeine was the problem, because of the usual distinction between cause and correlation.
For such things as air pollution, while it is conceivable that there are some causal factors, they haven’t been clearly demonstrated, and in some cases (CO2) changes would require such a dramatic change in the whole of society that it would be hard to extremely calculate any overall effect on miscarriage rates.
Kurt: “The endometrium is affected accidently by a wide variety of prescription and non-prescription drugs, caffeine, stress, jumping jacks, and air pollution.”
Please provide evidence of the effect on the endometrium. Miscarriage rates can be correlated with those activities, but what studies have actually measured the effect on the endometrium of (e.g.) jumping-jacks? (Are you somehow conflating miscarriage rates with endometrium changes?)
Let’s start with this matter.
And your reply is confusing for the same reason that Keehan’s is. Which definition of “abortifacient” are you using?
I’m not using a definition nor do I think Keehan is. She is noting, for whatever its value, that the Administration has accepted the principle of not including abortifacients. Then comes the discernment of what is an abortifacient.
Discernment? I can tell that the federal government has no trouble at all using the word ‘abortifacient’ in one particular, specific, precise way. And I can tell what the definition is that the Catholic Church uses. They are as different as death and life.
The federal government is not at all “misjudging” what abortifacient means. It’s the way it is because it would be incredibly uncomfortable, for ideological reasons, for many people to have to say ‘the contraceptive pill may be abortifacient’. Were the federal government to decide to change the definition back to accord with “pregnancy begins at fertilization”, only a few milliseconds would elapse before Planned Parenthood and its supporters would create an enormous pushback.
That’s what the government’s definition is all about — to maintain the comfortable status quo.
Gotcha, Paul. This is why I left the Pro-Life movement. It is not enough to believe in “X.” To be “Pro-Life” you also have believe that everyone who believes anything (even partially) contrary to “X” is knowingly and viciously evil. (with occasional exceptions for members of the Republican Party).
If at some point in the future there is room in the Pro-Life movement for those of us that simply believe in life principles and wish to act accordingly to defend life but without any judgment on if others are evil or just lacking in understanding, let me know. I’m not holding my breath.
This is Sr. Keehan’s great sin. She dared to hold open the door that the President might be a person of good will but mistaken analysis. To dare suggest that Obama is not the world’s most worthy target of vile hatred earned her the condemnation of Archbold and his ilk.
There are perfectly sound medical reasons for defining pregnancy from implantation rather than conception. An estimated 60% to 80% of embryos conceived do not implant. “Nature” is a colossal failure when it comes to “pregnancies” measured from conception.
For various reasons, pregnancy is sometimes counted from from the first day of the last menstrual period, which of course is well before conception. The reason is that it is relatively easy to know the date of the last menstrual period, whereas the date of conception is rarely known.
From a religious standpoint, what is the purpose and eternal fate of the alleged persons who, in huge numbers, come into being at conception and die before implantation? And if we consider them real and protect them from “abortifacient” drugs, is that our only obligation to them? A woman who smokes heavily, for example, is lessening the chances for implantation should she conceive. Is cigarette smoking abortifacient?
Kurt: “To be “Pro-Life” you also have believe that everyone who believes anything (even partially) contrary to “X” is knowingly and viciously evil.”
I think that the federal government’s definition of “pregnant” makes about as much sense as saying, “The Moon is only the Moon if it is at least 30 degrees above the horizon”, or “If someone kills you when you’re moving, it’s not murder. But if you standing still, then it is murder.” It’s plainly disordered thinking.
But as to exactly what degree particular people should be morally blamed for their reasoning, I don’t know, and haven’t said. (Also, you seem to think I am a conservative. Nope.)
David Nickol: “There are perfectly sound medical reasons for defining pregnancy from implantation rather than conception.”
Then feel free to present one. Your principle seems to be (and I have to guess, because you haven’t said) something like: “If the fetus might die before birth, then you’re not pregnant.” But that won’t do. (“Congratulations Mrs. Smith, you’re pregnant. It’s a nine-pound girl.”) Or perhaps: “If there’s a 30% chance that the fetus might die before birth, then you’re not pregnant.” But then why 30%? Or any other such number???
David Nickol: ‘ “Nature” is a colossal failure’
I know what Nature is, but what does Nature inside double-quotes refer to?
I think that the federal government’s definition of “pregnant” makes about as much sense as saying….But as to exactly what degree particular people should be morally blamed for their reasoning, I don’t know, and haven’t said.
You certainly have come close. I don’t see why you cannot accept Sr. Keenan’s statement that the Administration does not have the intent, even if their reasoning is flawed.
And to re-state the matter which you seem to allow no person of good will to dissent from, we have a prescription medicine which is designed to prevent the release of an egg to avoid pregnancy. That is not something which is an abortion. A side effect of the medicine is that it makes a woman’s uterine walls less “sticky.” Should the medicine fail and the egg be fertilized, the fertilized egg would not be killed by the medicine, but it would be less likely than its normative 40%-20% chance of sticking to the uterine wall. Other medicines, foods and other factors also have an impact on the stickiness of the uterine walls.
Paul Connors:
I will not raise the question why so many pro-lifers feel compelled to be snarky and sarcastic.
The reason why it makes sense to define pregnancy as beginning with implantation is that it is practical. Tests for implantation are widely available and inexpensive, and tests for conception are not widely available and expensive. Outside of a fertility-research laboratory, there is very little reason to attempt to detect conception. I am not sure how many women would want to know, given the odds of losing the very early embryo, that they have conceived. Odds are it would not mean a baby is in their future, whereas odds are that when implantation has been detected, the woman will have a baby.
As I think I mentioned, pregnancy is also often measured from the first day of the woman’s last menstrual period, which is before conception could possibly have taken place. Why? Because, like implantation, it is much easier to know the date that it happened than it is to know when conception took place.
Also, there can be a certain strangeness about identifying pregnancy as beginning with conception as in the case of in vitro fertilization. Is the woman whose eggs have been fertilized in a test tube pregnant? Or is she pregnant when the embryos are transferred to her womb? Or is she pregnant when an embryo implants? I would say she is pregnant if and when implantation takes place.
The only time I can think of that there is any practical relevance to knowing whether conception, but not implantation, has taken place is when having discussions as to whether certain drugs (devices, activities, etc.) prevent implantation. I can understand that the issue is of real importance to those who believe that a true person exists from the moment of conception, but even the major pro-life organizations don’t seem to be interested in branding oral contraceptives (or even emergency contraceptives) as abortifacients, so this is pretty much a minority issue.
It is almost impossible to find an objective evaluation of the pill as a contraceptive versus an abortifacient. When you google for information, you inevitably get pro-life propaganda and not scientific information. In any case, assuming the pill actually does work occasionally by preventing implantation, there is a question as to whether that is an intended effect or an unwanted side effect. If you listen to the television ads for drugs, almost all of them have death as a possible side effect, but they are not sold as suicide pills.
I know what Nature is, but what does Nature inside double-quotes refer to?
“Nature” refers to an entity that doesn’t exactly exist—a kind of personification of the way certain physical, chemical, and biological processes work. I don’t think it would make sense to speak of nature, not in quotes, being a success or a failure.
Kurt: “I don’t see why you cannot accept Sr. Keenan’s statement that the Administration does not have the intent, even if their reasoning is flawed.”
These issues over ella are not new. (E.g. see here from a year ago.) Keehan must be familiar with them. Likewise, the federal government must also be familiar with them. There is no evidence that the government has accidentally misunderstood their own definition, and no evidence that they are trying to genuinely avoid abortifacient drugs. Thus, Keehan’s comment arrives in a vacuum of anything that would allow it to be understood in some reasonable way.
(Your other comments on ella do nothing to negate the fact that ella is a known fetus-killer. Whether that is by design or indirect, that fact has to be included in any moral calculation.)
David Nickol: “The reason why it makes sense to define pregnancy as beginning with implantation is that it is practical.”
The question is: Practical for what purpose? It’s horribly impractical if the intention is avoid killing fetuses.
David Nickol: “It is almost impossible to find an objective evaluation of the pill as a contraceptive versus an abortifacient.”
There are scientific papers, but many of them are only to be found behind paywalls. And even if those are studied, there is still no firm conclusion to be reached — it’s very hard to do the necessary investigations in an ethical way.
I know I’m an outsider to this conversation, but just a quick observation — there seems to be some talking past each other about defining “pregnancy.” I think Paul’s definition of pregnancy is “carrying the human entity that is at some stage of development from conception to birth”, whereas David points out some other definitions of pregnancy (from the first day of menstrual cycle, from implantation, etc.). But I think this is talking past each other. The issue here is the death of a human entity, regardless of when you define pregnancy. Now though some may disagree, there are perfectly sound medical and scientific reasons for thinking that there exists a living human entity from the moment of conception onwards, and that is what the Church also believes. With this premise, generally any intentional act to kill this living human entity, including taking medication that alters the endometrium, is morally wrong.
Thus, Keehan’s comment arrives in a vacuum of anything that would allow it to be understood in some reasonable way.
The nature of our disagreement is your assertion that your views are reasonable and all views to the contrary are not. Therefore no one claiming to discern matters differently than you can be a person of good will.
Your other comments on ella do nothing to negate the fact that ella is a known fetus-killer.
Ella has no interaction with the fertilized egg. Like many pharmaceuticals and non-pharmaceuticals, it has a negative impact on the endometrium. A woman taking Ella will not release an egg and therefore there is no fertilized egg with a chance of implanting. Extended poor nutrition of fertile women will have a negative impact on the endometrium, therefore cuts in Food Stamps and WIC are known fetus-killers.
Thales,
It is not so much a matter of talking past each other. It is rather that when someone like Paul Connors disagrees with you, it is important for him to dispute everything you say. (I am sure he would say the same thing about me, and it might be true, although of course I don’t think so.) I just got quite a fight from someone over on Mirror of Justice because I argued that The Catechism of the Catholic Church and YOUCAT were reliable guides to the Catholic faith.
My point is that it is reasonable and convenient to take implantation as the beginning of pregnancy, even though it takes place after conception. It is also reasonable and convenient to take the onset of the last menstrual period as the beginning of pregnancy, even though that took place prior to conception. In fact, as I understand it, when we talk of the age of a fetus, or the length of a pregnancy, we generally are talking about gestational age, which is measured from the first day of the woman’s last menstrual period. So when a woman has an abortion at 9 weeks, the fetus is actually about 7 weeks old.
As I said, the only time I can think of when it is important to define pregnancy as beginning with conception is in discussions about “abortifacients” that allegedly interfere with implantation.
I really don’t see why the word pregnant must bear all the weight it does. It seems to me there are ample ways besides pregnant of describing the situation in which a woman has conceived but the embryo has not implanted yet. It’s the period after conception but before clinical pregnancy.
I would assume most people who define pregnancy as beginning at implantation rather than conception sincerely believe that implantation is the appropriate marker for the beginning of a human life. Without exception, everyone alive today was conceived and implanted. Nobody alive today failed to implant and lived to tell about it. There may be some people who secretly believe that a person is present from the moment of conception and, for evil motives, claim life (and pregnancy) truly begins at implantation so they can say (even though they don’t believe it themselves) that preventing implantation is not abortion, but I don’t think there are very many of them.
With this premise, generally any intentional act to kill this living human entity, including taking medication that alters the endometrium, is morally wrong.
Thales,
Just one more point. If this is true, then it seems to me that there is an obligation not merely to refrain from intentional acts, but to take reasonable steps to identify and refrain from all acts. If cigarette smoking alters the endometrium to make it less likely for implantation to take place, then women of childbearing should not smoke. If 60% to 80% of those conceived are dying because they fail to implant, it is incumbent on human beings to investigate this massive dying and do what is reasonably possible to prevent it.
2274 Since it must be treated from conception as a person, the embryo must be defended in its integrity, cared for, and healed, as far as possible, like any other human being.
If 60% to 80% of babies were dying from unknown causes within a few days after birth, surely we would be under a tremendous obligation to figure out why and do whatever was possible to stop it. Why is this not the case for early embryos? Where is the concern?
It seems to me that a closer analogate to the high mortality rate among concepti would be the high mortality rate among, say, those 90 years old or more. I wonder, for example, what percentage of those aged 90-95 don’t make it out of that age range. It is a fragile time of life.
Thales: “The issue here is the death of a human entity, regardless of when you define pregnancy. “
Of course. And my central point, all along, is that the language used to describe these issues should not hide the fact that they can involve the death of a human entity.
Literally millions of people use words in ordinary ways: pregnant = new human on its way and that contraceptive = something that prevents this.
But, as I’ve been describing, each of those words is assigned a radically different meaning by (e.g.) most of the medical industry and the federal government.
Literally millions of women (and their teachers) are wholly convinced that contraceptive pills work absolutely 100% of the time by preventing ovulation, and thus think that there is no possibility whatsoever of conception.
If you turn to page 13 of the densely-packed prescribing information for a typical contraceptive pill, you find the text: “COCs lower the risk of becoming pregnant primarily by suppressing ovulation. Other possible mechanisms may include cervical mucus changes that inhibit sperm penetration and endometrial changes that reduce the likelihood of implantation.”
What should be on page 1 as a warning is instead hidden in extremely non-obvious language much later on.
And if some rare woman should go to a doctor and say, “Does this mechanism mentioned on page 13 mean that it could affect my pregnancy”, he can reply with a straight face, “No, that won’t affect your pregnancy.” But they would be talking past each other.
I wonder, for example, what percentage of those aged 90-95 don’t make it out of that age range. It is a fragile time of life.
Brett,
Are you implying that medical science does next to nothing for nonagenarians and is not working to extend their lifespan? That would be false.
Here, for example, is a bit from a medical paper titled Outcomes of Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in Patients Aged 90 Years or Older.
Is there no National Institute on Aging?
I would be interested to know if anyone can find evidence of anything at all being done to investigate and prevent early embryo loss in human beings.
Aside from the pro-lifers who are gravely worried about “abortifacient” contraceptives, nobody seems to care at all about early embryo loss in humans. In cattle, it’s actually a matter of some concern, since it affects productivity, and the problem is being researched. But to the best of my knowledge, nobody is working on the problem, or considers it a problem, in humans.
Your response strikes me as similar to one I often get on this topic. “Everybody dies.”
Are you implying that medical science does next to nothing for nonagenarians and is not working to extend their lifespan? That would be false.
Nope. Not saying that at all.
I realize that I’m late to respond, but a couple of thoughts:
David,
Maybe we’re still talking past each other. My point is who cares about how one defines pregnancy — we’re talking about the intentional killing of the human entity post-conception. There is good reason to think that this is the immoral murder of a human person, even though you may disagree. I, the Catholic Church, and many others think the intentional destruction of test-tube embryos (which obviously have never been implanted), is similarly the immoral murder of a human person.
Why is this not the case for early embryos? Where is the concern? It is the case for early embryos. There is research looking into how miscarriages can be avoided, and plenty of people consider miscarriages to be a sad event akin to losing a baby.
Re: smoking during pregnancy vs. abortifacient: There is a difference between intentionally killing one’s child by placing the child in the middle of the road, and putting your child at risk of death by driving a car with your child in it (because there is always a chance of death by car accident). One is morally culpable, and one isn’t. (I also realize that at some point, the endangering one’s child without actually intending the child’s injury passes from non-culpable to culpable — consider putting one’s child in a car without a seatbelt or car seat, or consider drinking to excess regularly while pregnant.)
Re: smoking during pregnancy vs. abortifacient: There is a difference between intentionally killing one’s child by placing the child in the middle of the road, and putting your child at risk of death by driving a car with your child in it (because there is always a chance of death by car accident). One is morally culpable, and one isn’t.
Except your example does not apply to these contraceptives. If these contraceptives work as designed, no egg is fertilized. You are taking the fact that as a side effect, they decrease the mucus on the uterine wall. Should the contraception fail and should the egg be fertilized, the fertilized egg will not be directly harmed but is less likely to stick to the womb. Smoking, stress, air pollution and many medicines have the same effect.
Kurt,
That’s incorrect — these contraceptives don’t always prevent an egg from being fertilized. Some are fertilized, and these contraceptives are also designed to affect the endometrium so that a fertilized egg does not attach to the uterine wall. Thus they are abortifacient.
And, no, intentionally affecting the endometrium to prevent implantation by the abortifacient contraceptive is not like smoking or stress. Though there is some indication that smoking or stress may be a cause of miscarriages, the science is not definitive. Science is very unclear about what factors prevent an embryo from implanting — but there is one thing that we do know with clarity: these contraceptives do prevent implantation. If it were known that smoking prevented implantation, and a woman smoked intentionally to stop her pregnancy just like a woman can take abortifacients to stop a pregnancy, then they would be equivalent. But that is not now the case.
Thanks, Kyle. For a while, it seemed to me that Vox Nova had adopted the position that the Catholic pro-life movement was so “hopelessly corrupt and dishonest” that its concerns could be dismissed out of hand. I no longer have that sense, and I am pleased that the blog today inspires serious reflection on the teachings of our faith.
Ron,
I have my complaints about much of the pro-life movement’s priorities and manner of addressing the life issues, but, unlike MZ below, I wouldn’t call it hopelessly corrupt and dishonest. After all, in my own minute way, I’m part of the movement.
Kyle,
Yes. The Cardinal believes ella is an abortifacient. The scientists at the FDA do not. The administration does not intend to include abortifacients. Their intention can be sincere regardless as to if the Cardinal or the scientists are correct in how a particular pharmacutical operates. Hence Archbold has misrepresented Sr Keenan.
Yes, it’s also possible that Sr. Keehan’s understanding of ella may match that of the FDA.
But she has not said that.
The principle of conscience is being extended into virgin territory. I’m simply unaware of any previous precedent for people being able to claim their consciences were violated because a person exercised a corporate privilege. Certainly their are other ways for an action to be immoral, but typically a violation of conscience requires at least mediate cooperation with evil if not immediate. And no, not all fungible acts are acts by proxy. The standard for treating a proxy act as immediate is very significant.
As for workers, even there, there are limitations on their conscience rights. Simple knowledge that a product can be used in an immoral way is not enough to effect a conscience violation, because such knowledge is not immediate cooperation in evil. A hardware store that sells axes is not required to perform an examination of conscience with their customers to ensure they aren’t going to use the ax for murder. That store employee cannot claim their conscience rights are violated if their boss won’t allow them to question each customer over the intent of their purchase. In the case of health care workers, they often have access to information that they are not ordinarily entitled to have. Such information they are legally proscribed from disclosing to others. So significant is this information that medical professionals can face up to the loss of their license over disclosure. Medical professionals are not given this information so that they can have license over the moral choices of their patients. Just as a confessor is absolutely proscribed from warning parishioners to not leave Fred alone in their house because he confessed to thievery, medical professionals are not to use privileged information to unduly interfere in the agency of their patients. I’m sorry if this makes being a medical professional hard. Priests have similar problems, but a conscience violation it doesn’t make.
As for abortifacients, no Catholic pharmacy, be it hospital or otherwise, is required to stock them. Certainly it is within legitimate advocacy to seek their ban. A focused effort such as what the CHA is engaging may actually be helpful in that regard. Mixing strong arguments with extremely weak ones, like fiduciary conscience rights, is a very poor strategy toward achieving goals.
Rest assured Ron, the pro-life movement is hopelessly corrupt and dishonest. Its concerns should be ignored until validated by credible sources.
So if a Catholic who’s morally opposed to contraceptives owns an insurance company, his or her conscience rights are not being violated when the HHS says the company must cover contraceptives? I fail to see how the answer isn’t yes.
I would say no to your pure hypothetical. There are of course no insurance companies owned by individuals as a practical matter.
Insurance is a fiduciary arrangement. Would you extend the same conscience privilege to your employer and your Flex Spending Account plan? Should they be able to determine what drugs are reimbursable under that plan? Should your bank have the conscience privilege to not honor checks written on your behalf to accounts they deem unworthy?
N.B. These are not frivolous concerns by the way. Pressure was put on banks and investment houses in relation to doing business in South Africa under apartheid if you recall.
It’s misleading to think that this issue somehow only affects large insurance companies. Suppose an individual Catholic owns a small company and decides that the company will set up a group health plan to cover its employees. Under the current legislation and regulations that company’s group health plan must pay for contraception. And that applies even if the group health plan is self-insured.
(And note that here ‘contraception’ refers to the federal government’s current definition of that word, which includes actions that under Catholic teaching are counted as abortifacient, i.e. murder.)
MZ: “Should your bank have the conscience privilege to not honor checks written on your behalf to accounts they deem unworthy?”
Try going to your bank with a check for $100, and persuade the cashier that you’re going to use your cash right now to buy a nice sharp axe to chop off the heads of some small children. See what happens next — it’s not going to be “Well, I suppose we have a fiduciary duty, so here’s the money and good luck.”
In most cases the cashier would still cash the check. (That didn’t quite fit my scenario but oh well.) Note that you require the voluntary submission of privileged information.
Considering there is a big hullabaloo in Ireland right now over priests being compelled to act on privileged information, I’m thinking there should be less difficulty in understanding the matter. Admittedly in the case of the priest, we claim there is ‘seal of the confessional’ that compels the priest not to act on his privileged information. Lawyers have similar obligations as do accountants. Medical professionals have always had such obligations.
Why does insurance being a fiduciary arrangement ethically matter here? Doctor/patient relationships have been considered fiduciary relationships, as have teacher/student and priest/parishioner relationships. Surely you think doctors, teachers*, and priests should have an appropriate degree of religious freedom and not be required to provide a service that conflicts with their religious teachings?
*At, say, a private Catholic school.
The fiduciary aspect is incidental to the doctor/patient relationship. In insurance, the fiduciary aspect is pure.
If someone has an issue selling health insurance, they are free not to do so. Personal disagreement is not enough to make a social obligation unjust; it is not enough to establish a conscientious objection. Such requires mediate to immediate cooperation with evil.
For that matter, the evil of contraception does not rise to the level of social concern to be personally vested in the decision of others. When contraception was illegal, one had personal warrant to prevent the use of contraception by others. It is not.
You can make an argument that an insurance company helps prevent the use of contraception by not covering it for someone who can’t afford it and therefore has no access to it otherwise than through insurance, and that’s an important argument for consideration, but that’s not the angle from which I’m here approaching the question of religious freedom.
Clearly there’s material cooperation by an insurance company in the goods and services they cover. If those who run the company have a conscientious objection to materially cooperating in covering certain goods and services they deem immoral, and yet they are made to cover them, they are being forced to act against their consciences if they remain in the insurance business. Now maybe the requirement that they do so is no great evil. Perhaps their consciences are ill-formed or mistaken about the morality of what they refuse to cover, and they really should get out of the insurance business for the good of society. There are, I think, occasions in which it’s acceptable to require behavior that goes against someone’s religion. We rightly place some limits on religious freedom.
But, of course, I’d still expect those people whose freedom is curtailed to get pissed off and respond through the political process.
One can make the argument that certain actions will reduce incidence. That does not make them issues of conscience arguments.
Your second paragraph gets closer. Here we are talking clearly about remote cooperation with evil. Conscience rights have never applied to remote cooperation. Certainly there is nothing wrong with the insurance company refusing to cover contraceptives just as there is nothing immoral about home insurance companies not making earthquakes a covered peril. They aren’t issues of conscience but prerogative. The Randian grocery store clerk doesn’t have his conscience rights violated when his boss makes him process the Food Stamp cards. The priest doesn’t have his conscience rights violated when he acquits the sin of the child molester. Each of these may be distasteful and we may not want to do them, but a conscience violation they do not make.
And just to be absolutely clear, contraceptives have long been covered by the government for the poor. This is the same country where states forcibly sterilized mentally ill people after all. This is about appeasing middle class women. Personally I oppose the proposal, but not on conscience grounds.
M.Z.: “Here we are talking clearly about remote cooperation with evil. Conscience rights have never applied to remote cooperation.”
It’s unclear whether you are talking about conscience rights that the government chooses to recognize, or conscience rights that Catholic teaching asserts. As far as Catholic teaching goes, even remote cooperation with evil (whether active or passive) has to be avoided whenever it reasonably can. So conscience rights can indeed apply.
There may well be many cases where remote cooperation can’t be reasonably avoided (as you point out, a banker may well be releasing money that will be used for immoral reasons — but banks can’t reasonably asked to investigate into every single use of released money. And the same, e.g., for a shop that sells knives.) But such an argument doesn’t apply in every case of remote cooperation.
Asserting that insurance is a “pure fiduciary relationship” doesn’t work to insulate from issues of conscience. That’s because what the relationship is must first be agreed on. The way that group health plans work is that a prior agreement is reached as to which expenses are going to be covered. After that, the fiduciary relationship comes into existence.
Since a Catholic will not want to remotely cooperate with any kind of abortion where it can be avoided, he will want to set up a group health plan that does not include covering expenses for such things.
That is what the federal government currently forbids, and that is exactly the point at which it is, in effect, claiming to own Catholic consciences.
All that Catholic health care providers need do is accept chickens in payment for service. I know that this proposal has been hooted at in the past, but it seems to provide a solution to the dilemma that is comparable in its profundity to the dilemma in question.
Just to clarify a point, this is from the ella label:
Saying something is possible does not mean it is a fact.
Asserting that ella is an abortifacient—even as defined by those who consider pregnancy to start at conception, not implantation—goes beyond what is known about the drug. There is no proof. This is even more the case for Plan B, and in the case of “the pill,” there is good evidence that there is no interference with implantation at all.
David Nickol: “There is no proof.”
And there is unlikely to be any proof: it’s obviously extremely difficult to come up with a medically ethical way of testing the assertion, one way or another. However, in the part of the FDA documentation that you didn’t quote from, ella is specifically contra-indicated if the recipient is pregnant or suspected to be pregnant. (And that would be using the magical definition of pregnant that the federal government uses, i.e. post-implantation of the fetus.)
Why would ella be contra-indicated in such circumstances if there were no proof? Because that documentation also reports on the effects of various dosages of ella on animals: there was a significant percentage of deaths to the fetuses.
So it’s entirely reasonable to suspect that ella will inflict death on some percentage of fetuses where the woman is already pregnant (and that’s using the realistic pregnant=post-fertilization definition of the word).
Morally then, ella has to be treated as abortifacient. (And much the same can be said for the pill and Plan B, despite your assertions to the contrary.)
See above. It is not so designed. The endometrium is affected accidently by a wide variety of prescription and non-prescription drugs, caffeine, stress, jumping jacks, and air pollution.
If someone has an issue selling health insurance, they are free not to do so.
Is this like the following? Which are alike and which are different?
“If someone has an issue running an adoption agency (that is required to serve same-sex couples), they are free not to run the agency.”
“If someone has an issue running a B&B (that must be open to same-sex couples), they are free not to run the B&B.”
“If someone has an issue running a wedding hall (that must be open to same-sex couples), they are free not to run the B&B.”
“If someone has an issue with being a pharmacist (and must supply contraceptives), they are free not to be a pharmacist.”
“If someone has an issue with being a nurse (and must assist abortions), they are free not to be a nurse.”
“If someone has an issue with providing wedding photography (and must be open to same-sex wedding), they are free not to do photography.”
[I don't have the answer to these questions, and I don't know which is fine and which isn't -- though I tend to more protection of conscience and religious liberty.]
You seem not to understand what a pure fiduciary relationship is.
MZ,
I wasn’t making a point about fiduciary relationships, but your comment made me re-read all of your comments, and it made me realize that I don’t get what you’re saying. (And so I echo Paul’s August 6, 2011 5:38 pm post). Your distinction about “pure fiduciary relationships” doesn’t stand up — suppose all insurance was required to cover abortions, what then?
I’m sorry I got to this discussion so late, but I have a question about the conscience clauses that I’m hoping someone can answer. (Again, I apologize for interrupting.) Here goes: Who exactly is exempted from having to provide free contraceptives under these conscience clauses? The various insurance plans that serve employers with religious objections? Most importantly, does
that mean the contraceptives will not be covered by these plans even if they’re prescribed for
other medical purposes? In other words, do these exemptions mean that female employees of religious organizations (schools, hospitals, as well as churches) won’t get
coverage for birth control pills they may be using for purposes other than contraception? After all, many women use these pills for the treatment of numerous conditions, from acne to endometriosis.
The Department of Health and Human Services has defined a “religious employer” as one that:
(1) has the inculcation of religious values as its purpose;
(2) primarily employs persons who share its religious tenets;
(3) primarily serves persons who share its religious tenets;
and (4) is a nonprofit organization” under specific sections of the Internal Revenue Code.
It’s an extremely narrow exception. Mother Theresa couldn’t qualify as a religious employer (she would fail test 1). And when Jesus sent out his Apostles into the world, the federal government wouldn’t even recognize Him as a religious employer (He would fail test 3).