Redefining Health Care Downward

The clash between the current federal government and Catholic institutions in the United States over mandates for abortifacient contraceptives mirrors one that has already occurred at the local level in many states. (See the “Table of Legal Mandates” [PDF file] at the website of the National Catholic Bioethics Center.) Marie T. Hilliard, J.C.L., Ph.D., R.N., Director of Bioethics and Public Policy at the NCBC in Philadelphia, wrote an essay three years ago entitled “Contraceptive Mandates and Immoral Cooperation” about the moral dilemma posed by such mandates. The essay begins:

As the largest provider of nongovernmental, non-profit health care in the United States, Catholic health care is susceptible to being viewed as just another secular institution engaged in the welfare of the larger society, and at its behest. Those who wish to deny the ministerial nature of Catholic health care have capitalized on this misperception for their own political agendas. Advocates for abolishing sexual mores, for providing abortion on demand, and for redefining the human being as the bearer of rights have engaged political structures in their pursuit of reshaping Catholic health care in their own image. They have made some subtle and some blatantly obvious attempts at changing the public perception of the purposes of Catholic health care. These have escalated into legislative initiatives that attempt to force Catholic health care to violate the tenets of the Catholic Church in the delivery of health care.

Hilliard reviews the history of the saintly lay women, monks, nuns and friars who from the fourth century on founded hospitals as a Christian service to society in general. Nowadays when the religious freedom exercised in such ministries conflicts with recently-minted “rights” (e.g. to so-called “emergency contraception”), the government tactic is to restrict the former.

To define a religious employer as primarily hiring or serving its own members is the antithesis of the historical role of a religious ministry. The classic example of this can be seen in the parable of the Good Samaritan (Luke 10:29-37)…. States such as New York and California require that to be considered a religious employer one must have as a purpose the inculcation of religious values. It would be very interesting to see the response of state legislatures if Church ministries attempted to apply the very criteria that these legislatures have stated define a religious ministry: that is, for a Catholic hospital to hire only Catholic workers and to treat only Catholic patients, or those willing to be evangelized in the faith.

Hilliard goes on to observe that “Not only have state legislatures redefined Church ministries, but so have the courts.” It was inevitable, then, that the executive branch of government would insist on having its turn.

Marie T. Hilliard, who is both a registered nurse and a canon lawyer, shows in a closely reasoned argument why Catholic institutions cannot simply go along with contraceptive mandates and write them off as an unfortunate but unintended bad consequence of the good work of providing health insurance to their employees. “There is nothing more essential to the completion of an act than the payment for the act, which would not be completed without such payment, thus making the material cooperation immediate.” And both Catholic moral theology and canon law state that immediate material cooperation in an immoral act is illicit. But the problem does not end there.

“The evil of cooperating in contraception and abortion [coverage] is not the only evil to be averted. By cooperating with contraceptive mandate laws, Church employers are forcing their employees to contribute to the insurance pools that pay for the immoral prescriptions and services. There is a third evil to be averted…. By collaborating, even under protest, with contraceptive and abortifacient mandates, the Church is paving the way for further government intrusions.”

The situation at the state level has not been encouraging. “The Church has made every legal attempt to overturn the contraceptive mandate laws. To date [2009], all efforts to secure judicial recourse have failed.” Hilliard warns that the Church must take decisive action and draw a clear line in the sand. “Eventually the Church will have to say, ‘Enough. We will not be complicit in the violation of moral law.’ This will require significant employee relations and public relations campaigns to demonstrate the source of the problem: violation by the government of religious freedoms that the drafters of the U.S. Constitution intended to protect.”
 
The essay by Marie T. Hilliard was published in Catholic Health Care Ethics: A Manual for Practitioners, second edition (Philadelphia: National Catholic Bioethics Center, 2009), 275-281.  The manual is available at the NCBC bookstore.