Today the Weekend Reader brings you Good Catholics: The Battle Over Abortion in the Catholic Church by the former editor of Conscience magazine, Patricia Miller. Good Catholics explores the conflicts that arise when religion and women’s issues collide. Abortion and birth control are deemed sinful by the Catholic Church, whose reach goes beyond those who adhere to its doctrine. The Church now finds itself at a crossroads, where their hardline views are being met with fervent criticism from both outside and within. In the excerpt below, Miller examines what happens when an adult life is put at risk by the religious views of an organization, and the repercussions of challenging the Church.
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In November 2009, as the battle over health reform raged in Washington, a twenty-seven-year-old woman nearing the end of her ﬁrst trimester of pregnancy was admitted to St. Joseph’s Hospital and Medical Center in Phoenix, Arizona, suffering from pulmonary hypertension. Doctors told the mother of four that she had a nearly 100 percent chance of suffering heart failure and dying if she carried the pregnancy to term. They recommended an immediate therapeutic abortion to save her life. The recommendation went to the Catholic hospital’s ethics committee, which included Sister Margaret McBride, a Sister of Mercy who was an administrator at the hospital. The ethics committee approved the abortion under the rationale that its primary purpose was to save the woman’s life, not terminate the pregnancy. The abortion was performed and the woman survived. Six months later the decision came to the attention of Phoenix Bishop Thomas Olmstead. He condemned the hospital for approving the abortion and announced that Sister McBride was automatically excommunicated because of her participation in the decision to allow the abortion. “In the decision to abort, the equal dignity of mother and her baby were not both upheld,” Olmstead said.
Olmstead was suggesting that a woman who could otherwise be saved be allowed to die to protect the letter of the Ethical and Religious Directives for Catholic Health Care Services, which said that direct abortion couldn’t be allowed under any circumstance. Hospital administrators and Sister McBride defended the abortion as the correct decision because both the woman and the baby would have died without it. “Morally, ethically, and legally, we simply cannot stand by and let someone die whose life we might be able to save,” said hospital president Linda Hunt. In December 2010, Olmstead stripped the hospital of its Catholic affiliation after it refused to promise that it would never again perform an abortion to save a woman’s life.
The McBride case was a dramatic example of the willingness of the Catholic bishops to place Catholic dogma over patients’ needs and raised serious concerns about their oversight of Catholic hospitals. “The need to accommodate religious doctrine does not give health providers serving the general public license to jeopardize women’s lives,” said a New York Times editorial.
It also illustrated the bishops’ insistence that they alone had the right to deﬁne the parameters of the provision of health care at any institution related to the Catholic Church. It was an issue on which the bishops were increasingly intransigent and on which they had found an accommodating partner in the Bush administration. The administration had included a Catholic health plan in the federal employees’ health program that tailored its beneﬁts to comply with the restrictions in the Directives. It excluded coverage for abortion, sterilization, contraception, and artiﬁcial insemination even though the plan, OSF Health, offered contraception coverage through a third-party provider under other programs.
Because obviously no one could force Catholics to utilize banned services if they didn’t want to, the implication now was that their premiums couldn’t even go toward a plan that offered such services. And since the federal employees’ health program was already prohibited by law from covering abortion, it was clear that an effort was under way to elevate less controversial services such as contraception to the same level of moral approbation as abortion. But it was on the issue of conscience clauses that the Bush administration was especially accommodating to the bishops. Bush’s PEPFAR pro- gram included an exemption for religious providers who didn’t want to distribute condoms, which was custom-made for Catholic agencies like Catholic Relief Services. Bush signed an appropriations bill in 2005 that included the ﬁrst federal conscience clause. This broadened the abortion exemption to a wide range of health care entities, including health maintenance organizations and other insurers, and included the right to refuse to refer for abortions.
By this time, the issue of conscience refusals was becoming increasingly contentious, as the bishops were joined by elements of the Christian Right in asserting the need for greater conscience protections for health care workers, who they charged were regularly being forced to violate their faith in the provision of certain services. Organizations like Pharmacists for Life campaigned for the right of pharmacists to refuse to dispense or refer for oral contraceptives or emergency contraception (EC) on the discredited grounds that they were potentially abortifacients. Reports of conscience-based service refusals mushroomed. There were hospital nurses who refused to care for patients before or after emergency abortions, doctors who refused to prescribe the Pill to unmarried women, and infertility clinics that turned away lesbian patients. Conscience exemptions were now being used as a political tool to block access to services to which some objected or to make moral judgments about the provision of care to certain patients.
In 2008, the health care community was in an uproar after the Bush administration used the regulatory process to codify the right of almost any health worker—including those ancillary to a procedure like schedulers or janitors—to opt out of providing any service to which he or she had a religious or moral objection. Women’s health advocates, medical associations, and even drugstore chains were quick to express alarm about the regulation, not only because of its unprecedented scope and potential impact on patients’ access to care but because it seemed to purposely conﬂate abortion and contraception. They said the rule could be used to circumvent laws that required insurers to cover prescription contraceptives or hospitals to provide EC to women who had been raped—two issues of special importance to the Catholic bishops.
By the dawn of the Obama administration, however, the bishops were losing ground on conscience exemptions. They lobbied unsuccessfully in Arizona to broaden that state’s narrow religious exemption to its contraceptive equity law, which covered only churches, to include any religious employer, such as Catholic hospitals and universities. The bishops in Connecticut lost a bruising two-year battle for an exemption to that state’s new “EC in the ER” law despite putting up a ﬁerce ﬁght. The Obama administration undid the sweeping Bush conscience exemption, noting that federal law still protected providers from being compelled to participate in abortions. Then, in August 2011, the Department of Health and Human Services (HHS) announced that all employer-based health plans would be required to provide contraceptives to women at no cost under its proposed rules for the preventive services guaranteed to all individuals under the Affordable Care Act.
In deference to the Catholic bishops, HHS proposed a narrow conscience clause that exempted nonproﬁt organizations directly involved in the inculcation of religion that primarily employed individuals of the same religion, like Catholic churches and other houses of worship. However, Catholic-affiliated institutions like universities and hospitals that served the general population and employed non-Catholics would have to provide contraception through their plans. Many of these employers had chosen to self-insure—that is, serve as their own insurers—to circumvent state contraception mandates, but they would be required to comply with federal law.
The type of narrowly drawn conscience clause proposed by the administration had been sanctiﬁed by two closely watched state supreme court decisions in New York and California. The U.S. Supreme Court let both decisions stand, which was seen as a major victory for a limited application of conscience clauses. But in the ensuring years since the 2006 New York decision, not only had the Christian Right become activated on the issue, but the question of conscience clauses had spilled beyond health care as efforts advanced to ensure equality for same-sex couples. Catholic Charities affiliates in Boston and Illinois closed their well-respected adoption agencies rather than comply with state mandates that they provide adoptions to gay and lesbian couples.
Then in September 2011, shortly after the Obama administration announced the contraceptive mandate, HHS announced that it would not renew a contract with the USCCB to provide assistance to victims of inter- national human trafficking because the bishops’ organization refused to provide women who had been subjected to rape or forced prostitution with access to comprehensive reproductive health care, including abortion, EC, and family planning and sexually transmitted disease counseling. Where HHS saw the need to provide all medically appropriate services to these women, the bishops claimed anti-Catholic discrimination, especially because political appointees at HHS had overruled a program evaluation that rated the USCCB as the top-performing contractor in terms of service provision. Sister Mary Ann Walsh, a spokesperson for the USCCB, said that there was a “new, albeit unwritten rule of HHS, the ABC rule—Anybody But Catholics.
If you enjoyed this excerpt, purchase the full book here.
Excerpted from Good Catholics: The Battle Over Abortion in the Catholic Church by Patricia Miller. © 2014 by University of California Press. Reprinted by permission.
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