The Conscience Conundrum
Earlier this month, the Department of Health and Human Services (HHS) adopted new standards related to preventive services for women’s health. The Catholic reaction to the proposed standards--which are slated to go into effect sometime after the ongoing 60-day comment period--has been mixed. On the one hand, the standards have been praised for expanding access (especially among poor women) to services such as pap smears or mammograms. At the same time, the Catholic Health Association and the U.S. Conference of Catholic Bishops have strongly critiqued the new regulations because they require private health plans to cover all contraceptive techniques approved by the Food and Drug Administration, as well as female surgical sterilization.
But the Catholic outcry about these regulations has had more to do with conscience than with contraception, even though some commentators have presumed the opposite. In other words, the issue has been framed as one of religious liberty, not morality. Writing in America shortly before the new regulations were announced, Catholic University president John Garvey summarized the question this way: “the issue before HHS is not whether to allow sterilization, contraception, and abortion. It is whether to order insurance companies to cover these services, and employers and employees to pay for them, even if they view them as morally wrong.”
The HHS dust-up is the latest conscience-based confrontation between Catholic organizations and the government. Earlier this year, Catholic Charities in Illinois sued the state after the governor signed a new civil unions law. While the Catholic church opposed that law, the lawsuit was instead concerned with conscience. The law would have required Catholic Charities to consider adoption applications from gay and straight clients on equal footing, despite official Catholic opposition to same-sex unions. In the end, various branches of Catholic Charities in Illinois have discontinued foster care and adoption services. A similar situation arose in the nation’s capital after D.C. legalized same-sex marriage in 2010. Catholic Charities in the Archdiocese of Washington readjusted its health care benefits for their employees so as to avoid extending spousal benefits to those in same-sex unions. A less noted consequence was that Catholic Charities also transferred their foster care portfolio to another organization, after initially warning that they might have to cease providing social services altogether if forced to recognize the validity of same-sex marriages.
Many people react to these controversies based on their views about contraception or same-sex marriage, not conscience or religious liberty (for more about the "absurd attack on contraceptives," go here). The truly skeptical may even view conscience arguments as a smokescreen, a constitutional way to win moral arguments. Perhaps that is the case, but perhaps not.
Whatever one makes of the underlying neuralgic issues (which could be conscientious objection to war just as easily as contraception or gay marriage), it is helpful to remember that there are very good political reasons to take these conscience objections seriously. And these are the same reasons that inspired the religion clauses of the First Amendment in the first place. On one hand, government must not be in the position of telling religious organizations what to believe. On the other, overtly sectarian interests cannot serve as the basis of political decisions in a pluralistic society. Severed from third-rail social issues, these seem to be mostly uncontroversial political ideas.
Quite apart from these constitutional questions, there is a very practical and moral reason to safeguard conscience protections: the welfare of actual human beings hangs in the balance. Catholic hospitals and social service providers--those institutions most recently implicated in conscience debates--serve thousands of Americans of all faiths each year. They are a vital part of the country’s health care and social service infrastructure, and a vital part of the church's witness to the Gospel. Yet as noted above, church leaders seem increasingly willing to simply stop providing a given service when they judge it can no longer be offered in a way consistent with church beliefs.
That seems, at least to me, like the worst possible outcome, not only for those served by Catholic organizations, but also for a church that bears a special mission to care for the poor, the sick and the vulnerable. And in light of the country's longstanding respect for conscientious objection and religious liberty, it seems like a decision we should not have to make.