Religious liberty: The church-state debate over women's health ...

In recent months, the Catholic Churchs push to protect religious freedom has intensified.

The spark that ignited this latest debate was the Obama administrations requirement that insurance companies, including those affiliated with Catholic hospitals and other parochial medical institutions, provide coverage for contraception, drugs that terminate pregnancy and other medical interventions to those who want or need them.

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Fortnight for Freedom

The U.S. Conference of Catholic Bishops is sponsoring a two-week long great hymn of prayer for our country, called Fortnight for Freedom.

The vigil begins Thursday and ends July 4.

Our liturgical calendar celebrates a series of great martyrs who remained faithful in the face of persecution by political power, a church announcement states. Culminating on Independence Day, this special period of prayer, study, catechesis and public action will emphasize both our Christian and American heritage of liberty.

Dioceses across the U.S. have scheduled special events during this period. The Diocese of Charleston is planning a Fortnight for Freedom Mass at 7 p.m. Friday at the Cathedral of St. John the Baptist. It will be followed by an all-night Eucharist Adoration.

On Saturday, a Eucharistic procession is to begin at 9 a.m. The faithful will start at the Cathedral, walk to King Street, down to Murray Boulevard and end at the Battery where a benediction will be performed.

Adam Parker

The federal rule states that insurance companies must pay for such procedures without imposing prohibitive co-pays or deductibles, not that doctors must perform them. Churches and many nonprofit religious institutions are exempted.

The Department of Health and Human Services, which is responsible for administering the rule, argues that its trying to level the playing field. The federal requirement is designed to ensure that all Americans have access to basic services, including contraception.

Its important to note that our rule has no effect on the longstanding conscience clause protections for providers, which allow a Catholic doctor, for example, to refuse to write a prescription for contraception, wrote HHS Secretary Kathleen Sibelius in USA Today in February. Nor does it affect an individual womans freedom to decide not to use birth control.

Many of the patients who receive care at Catholic-affiliated hospitals are not Catholic themselves, or in any case do not agree with or follow the churchs teachings on contraception, abortion, sterilization or stem cell research. Moreover, many medical professionals who work at Catholic hospitals are not themselves Catholic.

The 2008 National Survey of Family Growth revealed that 98 percent of sexually active Catholic women in the U.S. who are older than 18 are as likely as non-Catholic women in the same category to have used some form of contraception banned by the Vatican.

The church argues that whats at stake is a fundamental principal of democracy: religious liberty. People of faith and religious institutions, it says, should not be forced by the government to provide coverage for contraception and sterilization when it violates their beliefs.

The HHS rule tightens policies already in place, making it more difficult for religious employers to avoid the requirements, according to Catholic officials.

Even without a religious exemption, religious employers can already avoid (existing) contraceptive mandates in 28 states by self-insuring their prescription drug coverage, dropping that coverage altogether, or opting for regulation under a federal law (ERISA) that pre-empts state law, states the U.S. Conference of Catholic Bishops. The HHS mandate closes off all these avenues of relief.

Under the new regulations, its likely that self-insured entities that dont qualify for the exemption would have to bear the cost of the mandate.

A Catholic doctor in private practice can invoke a long-standing personal conscience clause that exempts him performing procedures or administering medicines he considers immoral. Exempt from the new HHS rule is a religious nonprofit whose purpose is to inculcate religious values, that primarily employs persons who share its religious tenets, and primarily serves persons who share its religious tenets.

The Catholic Health Association on Friday rejected this exemption. The group, which has been a key ally in Obamas health care overhaul, said the government should either broaden the exemption for religious employers or pay directly for the birth control coverage.

So should a Catholic hospital (or school or charity) that serves non-Catholics or Catholics who disagree with the church on these issues be required to provide such services, just as non-parochial institutions are required to do so?

The Constitution guarantees freedom of religion the right of people to practice their faith without government interference (unless it endangers the public).

But it also guarantees the right of individuals to exercise their own consciences without being subjected to others religious rules and morality.

The Post and Courier asked Catholics, an attorney and a doctor in the community to comment on this issue.

Religious conscience
The recent mandate by the Department of Health and Human Services requiring medical insurance to cover contraception or possible abortion-causing drugs raises some serious questions about religious liberty in our country.

For example, if institutions of the Catholic Church are forced to provide birth control coverage, it would be a violation of Church teaching and of Catholic conscience. This would amount to a dismissal of religious liberty.

Many people are focusing on the Catholic Churchs teaching on birth control, but this is not the principal issue in this discussion. The essential issue here is the question of religious liberty. Perhaps a different example might help us to see things in a different light.

In devout Jewish observance, pork cannot be eaten. I know some Jewish people, however, who do not observe this custom, and who regularly eat pork. Moreover, there are nutritionists who would argue for the benefit of eating pork in our diet, and who might think this restriction is mistaken.

However, even in light of these points, if our government was to force a Jewish butcher to sell pork or a Jewish school to serve pork at lunch time, it would amount to a violation of religious liberty. The government would be violating Jewish conscience, and overstepping its appropriate boundaries.

With this example, we can review the HHS mandate. There are many Catholics who might use birth control, and there are many professionals who argue for its beneficial use in our society. The Catholic Church has a response to these arguments, but this is not the issue at hand. The issue is whether a private and/or religious institution is able to follow its beliefs and the dictates of its conscience.

As Americans, we have always defended and prided ourselves on this religious liberty to all people, their communities and institutions. The HHS mandate challenges this freedom, and must be suspended.

Fr. Jeffrey Kirby, director of vocations, Catholic Diocese of Charleston

Not a new issue
Access to birth control has changed the lives of women, children and families for the better. The rule issued by the Department of Health and Human Services, as modified in February by the Obama administration, requires all new health insurance policies to cover birth control, along with other essential preventive services.

All churches and other houses of worship are exempt from this requirement. Religiously affiliated organizations, such as hospitals and universities, may opt out of contributing to the contraceptive coverage, in which case the insurance companies will be required to cover this cost.

No Catholic Church or institution will be required to sanction contraception or to pay for birth control for anyone. This is not about religious freedom.

And despite the current hue and cry, this is not a new issue. Twenty-eight states already require insurance plans to include contraception. The EEOC, the body that enforces federal civil right employment law, issued an opinion over a decade ago making clear that refusal to provide insurance coverage of birth control is sex discrimination. The highest courts of California and New York have rejected claims that requiring coverage of contraception violates the First Amendment.

The U.S. Conference of Catholic Bishops does not have the final word on religious liberty. Real religious freedom protects the beliefs and decisions of everyone, including women who work for a living. The Catholic Bishops are free to oppose all birth control. They may certainly use their resources to convince the women of the United States of the wisdom of that position.

It is not, however, a loss of institutional freedom of religion for access to contraception to be protected as part of a national health policy.

Susan Dunn, legal director, ACLU of South Carolina

More than contraception
As an obstetrician/gynecologist, I consider contraception one of the most important tools in my toolbox. I prescribe medications like birth control pills and intrauterine devices to treat many problems that my patients have, including abnormally heavy periods causing anemia, premature ovarian failure, thickening of the uterine lining that leads to uterine cancer, pelvic pain resulting from endometriosis and male pattern hair growth resulting from hormonal imbalance.

In addition, studies have shown that taking birth control pills reduces a womans risk of ovarian, uterine and colon cancer.

I am frustrated when people talk about contraception as a matter of convenience. In fact, contraception has been regarded by the CDC as one of the most important preventive health advances of the last century because of its positive impact on the health of women and children in our country.

Spacing births by about two years helps reduce ones risk of pre-term delivery, low birth weight, pre-eclampsia and even maternal death. Some women have medical conditions, like heart disease, that make pregnancy life-threatening; for them, life depends on preventing pregnancy.

When I meet with patients, I try to provide information about all treatment options available to them, answer their questions and develop a plan that respects their own beliefs and goals. It is upsetting to me when they walk away from my office without treatment because their insurance company doesnt cover certain treatments based on ideology or politics.

In my opinion, the lives of women and children are worth too much for these kinds of games.

Dr. Angela Dempsey, assistant professor of obstetrics and gynecology, Medical University of South Carolina

Many dimensions
I was diagnosed in my early 20s with a severe case of endometriosis, a disorder affecting the ovaries that adversely impacts a womans reproductive system. Some of New Yorks best OB-GYNs advised that if I ever hoped to have children (and to avoid the need for a premature hysterectomy) I would need to use immediately and always the pill.

Obviously, my need to use the pill was always primarily medical. However, as I dated seriously and then married, it also served its more common use: to responsibly manage the enormous decision to have children.

The Catholic Church, in its effort to condemn unsanctioned birth control, oversimplifies this important issue.

In which category do I fit and how should I be judged? When does my medical need for the pill end and my moral prerogative to use the pill begin? It is unclear, even to me.

This conundrum reminds me, oddly, of a certain Italian art term: chiaroscuro.

Chiaroscuro literally means light-dark and in its very technical sense is used to describe the way in which gradual, fuzzy shading (in drawings and paintings) actually creates a more brilliantly visible, 3-D image. Renaissance painters perfected this technique.

Yes, there is obvious irony in the art method: the more unclear the edges become, the more vivid the image appears. However, there is a strange correlation between this particular technique and my circumstances. I am unable to delineate when I stopped using the pill for medical reasons and started using it as a method of birth control.

If, over the centuries, haziness has enabled the art world to better admire the picture, then why cant the church at least acknowledge the multiple dimensions of the current debate?

For the best Renaissance paintings are never flat.

Allison Farina Van Nostrand, Daniel Island

Generation gap
Todays generation feels disconnected from organized religion, and the Catholic Church lobbying Congress to ban insurance coverage of contraceptives is one action that makes some feel out of step with what the church teaches.

I had an eye-opening experience regarding what our youth thinks about organized religion when I returned to college this year in my 40s. A professor asked everyone in class to share what we felt about religion: how we grew up and if our beliefs have since changed.

My younger peers fascinated me, as all their answers seemed to be the same story told in different ways. Many come from Catholic, churchgoing upbringings but are no longer practicing Catholics despite maintaining their faith. They feel as though they sit at church and are being told what they should believe in, but faith to them is something personal and not what everyone else believes.

They also said that the Catholic Church has become too political, using religion as an excuse to take away human rights, as is the case with the contraceptive issue.

I asked my son, a 21-year-old student in Michigan, the same question, knowing that he stopped going to church but not knowing why, and was stunned that he echoed the exact same feelings as my classmates.

Now, Im sure that the Catholic Church would scoff at the secularization of todays society as leading to immoral young adults. But then how would they explain my sons rule-following morality and honorable behavior?

Nadia Bucholtz, Mount Pleasant
Continued commitment

Roper St. Francis Healthcares mission is to heal all people with compassion, faith and excellence. I have the honor of directing our Mission Department, and part of that effort includes attending to a cadre of chaplains representing many religions as are reflected by our diverse patient population.

The Roper St. Francis enterprise is founded on treating and employing people with varied backgrounds and religious beliefs.

Were a health care system with more than 90 facilities. One of our systems primary hospitals is Bon Secours St. Francis Hospital, the first Catholic hospital in South Carolina and the only one in Charleston. As a continuing affiliate of the larger Bon Secours Health System, St. Francis Hospital continues its commitment to caring for the whole person: physically, spiritually and emotionally.

At St. Francis Hospital, we follow the Ethical and Religious Directives for Catholic Health Care Services from the U.S. Conference of Catholic Bishops. The two-fold purpose of this document is to affirm the ethical standards of behavior in health care and to provide guidance on certain moral issues. We have a busy ethics committee and interested employees are encouraged to weigh in on pertinent issues.

Roper St. Francis Healthcare supports freedom of religion in its multifaceted expression and practice. We promote this Constitutional right, particularly as we live our mission by promoting such core human values as integrity, compassion, stewardship, respect, quality, innovation, justice and growth.

As a health care system, we will continue to pursue expanding accessibility of compassionate, patient-centered care to all people in the Lowcountry supported by an uncompromising commitment to quality and ethical standards.

Sister Kathleen Adamski, director of mission, Roper St. Francis Healthcare

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