Commentary Religion

On Contraceptive Coverage, It’s Not Up to Obama to Decide What is More “Catholic”

Frances Kissling

The President seems unaware of the fact that Catholics who matter have disagreed with the Vatican’s current prohibition on contraception. Catholics, including institutions within the Catholic community, are free to follow their conscience on contraception. It is not up to the Obama administration to decide what action is more “Catholic" on the matter of contraception.

See all our coverage of the Birth Control Mandate 2011 here.

This article was amended at 2:22 pm Friday, November 25th to add a missing paragraph and missing words in three sentences.

When it comes to contraception, Catholics have stopped listening to popes, bishops and other institutional leaders.  It seems the only person left listening is President Obama. Obama, however, lacks the theological training—and it would seem the scholarly advice—needed to figure out if the bishops and various hospitals, universities, and social service agencies clamoring for a broadened “religious exemption” from new federal regulations really need them in order to be good Catholics. The regulations require insurance plans offered by employers to cover contraception without a co-pay, although they exempt churches and other specifically religious institutions from the requirement. The United States Conference of Catholic Bishops and other groups have been lobbying for a much broader exemption.

The President seems unaware of the fact that Catholic disagreement with the ban on birth control goes far beyond the average Catholic layperson. Some bishops, many priests, religious orders, theologians and church-related groups have publicly and privately disagreed with blanket prohibition of contraception. All of them, individuals and institutions, are free to follow their conscience on contraception and there is ample evidence that many of the very groups asking for an exemption from the new federal regulations have not followed church regulations religiously. Some within the organizations may agree with the ban, but not all, and none are required to do so.   

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Of course, it would take courage for organizations such as the Catholic Health Association (which sent a letter to the Department of Health and Human Services in September supporting a broader exemption) or Catholic Charities to publicly buck the U.S. bishops,  just follow the law and give their employees health insurance that makes it more possible to avoid pregnancies they cannot afford or do not want; but after all, being a Catholic is all about courage and helping the poor and marginalized. A fair number of employees of Catholic institutions are low-income workers, struggling to get by on a minimum wage. We Catholics are taught to follow our conscience rather than the positions of the Catholic church, even if it means getting kicked out of the church.  If Obama’s current religious advisers don’t know that, all he has to do is call one of the most trusted of Catholic theologians, Fr. Richard McBrien of Notre Dame. McBrien will repeat what he has said in his widely used text Catholicism:

If, after appropriate study, reflection and prayer, a person is convinced that his or her conscience is correct, in spite of a conflict with the moral teachings of the church, they not only may but must follow the dictates of their conscience rather than the teachings of the church.

Centuries earlier Thomas Aquinas said the same thing.  Yet, the Catholic-affiliated institutions asking for a religious exemption insist that corporations, like persons, have a conscience.

There is every indication that the conscience of these institutions tells them the church prohibition on contraception is wrong. Survey data and the behavior of these institutions evidence widespread disagreement with the official, but not infallible prohibition. Modest due diligence on the part of the administration before it grants a broader exemption is called for. They would discover that it is not only ordinary Catholics who believe birth control results in responsible parenthood and healthier relationships (98 percent of sexually-active Catholic women have used methods of birth control prohibited by the Vatican), but also bishops conferences, priests and theologians worldwide. The administration would also find numerous examples of “Catholic” agencies that have disregarded the prohibition and are providing or have provided contraception, including contraceptive sterilization.

That foundation of dissent from the 1968 Encyclical “Humanae Vitae,” which dashed Catholic hope of a new openness on sex and reproduction, was found in the statement of the Vatican spokesperson, Msgr.F. Lambruschini who assured reporters that it as not infallible a statement not contradicted by the Vatican. He then disturbed many of the world’s bishops by claiming the encyclical required “the assent of the faithful.”

That demand for assent to a non-infallible teaching opened a floodgate of commentary by Bishops’ Conferences around the world, hedging their bets on the encyclical and expressing sympathy with Catholics who decided not to follow it. The Canadian bishops wrote:

In accordance with the accepted principles of moral theology… persons who have tried sincerely but without success to pursue a line of conduct in keeping with the given directives, may be safely assured that whoever honestly chooses that course which seems right to him does so in good conscience. 

The Dutch bishops were more forthright. All nine met and issued a statement that said they “consider that the encyclical’s total rejection of contraceptive methods is not convincing on the basis of the arguments put forward.” If the Dutch bishops did not find the Catholic prohibition on birth control convincing who is the President to de facto affirm a Catholic doctrine by providing some Catholics with an exemption from public policy mandates supported by popular, scientific and medical opinion?

The granting of an exemption from regulations that are in the best interest of public health and enhance the lives especially of women should never be a political act, but rather a careful, factual appraisal of an urgent and clear religious claim.

Many Catholic religious leaders have conducted that appraisal and found Humanae Vitae wanting. French, German, British, Belgian, and other bishops, while cautious not to openly challenge the teaching itself, issued statements that stressed the right of Catholics to follow their conscience. U.S. bishops, as always eager to demonstrate their loyalty to Rome, towed the line. American priests and theologians were far less constrained. Some theologians and priests immediately issued a Statement of Conscience that rejected Humanae Vitae. The authors felt so strongly that they published the statement in the Washington Post, leading D.C. Cardinal Patrick O’Boyle to punish about 40 of its signers who reported to him. The courage shown by those theologians and priests would be welcome among the leaders of today’s high-powered Catholic charities.

Among the signers was a revered DC Jesuit, Horace McKenna. Fr. McKenna was a passionate advocate of the poor who eventually founded D.C.’s SOME (So Others Might Eat). Based on his experience of hearing the confessions of DC’s poorest Catholics, he made it clear to Cardinal O’Boyle that he would tell them in confession that they were not bound to follow the prohibition. In short order, the Cardinal stripped him the right of hearing confessions.

In order to avoid punishment and conflict, most dissent on contraception by Catholic agencies is quiet. Catholic social services agencies treating migrant workers have had contracts with Planned Parenthood to provide contraception for their clients; Catholic hospitals allow doctors who have offices on their premises to prescribe birth control, some mergers between Catholic and non-Catholic hospitals accommodate family planning – and historically even found a way to provide contraceptive sterilization. Some deals fly under the radar and survive; others are squashed.

The bishops and cardinals have not changed.  Unfortunately, there are few Horace McKennas left who will stand up for the poor against the tired efforts of bishops to demand public policy that conforms to their narrow view of what it means to be Catholic. If Horace McKenna were president of Catholic University or ran Catholic Charities instead of Larry Snyder, he’d be lobbying the bishops to provide birth control for poor women and migrant workers rather than fighting for the right to deny janitors, college students and healthcare aides insurance for contraception. He certainly would not be supporting the bishops, who, in the face of an Amnesty International report on the immorally-high rate of maternal death in the United States and the increasing poverty of women and children coldly claimed that pregnancy was not a disease and contraception not preventive medicine.

Today’s bishops are a cold-hearted, power-hungry lot.  Not a Raymond Hunthausen among them. In 1986, Archbishop Raymond Hunthausen of Seattle was charged by the Vatican with allowing sterilizations to be provided in the diocese’s hospitals–-as well as lack of firmness on altar girls and gays. He was, for a time, denied the right to run his diocese; Bishops Donald Wuerl was appointed as “co-adjutor” of the diocese to ensure orthodoxy. Wuerl has risen to the rank of Cardinal and now presides over one of the poorest of the dioceses, Washington D.C. In the church today, only orthodoxy is rewarded.

The heavy hand of the Vatican also came down on the Sisters of Mercy. In 1980 after a five-year study, the Sisters, who then ran one of the largest hospital systems in the United States (only the Veterans Administration was larger) , decided that good medical care included providing postpartum contraceptive sterilization when women requested it. To deny them would subject the women to a second medical risk if they were sterilized at a later date. The Vatican got wind of the possible change in policy and threatened to put the whole community in “receivership” and take over their hospitals, schools, and everything else if they did not change their mind and prohibit sterilization. The Sisters capitulated, fearing greater harm to their patients if the Vatican were in charge.

Can the Obama administration decide which action was more “Catholic,” the Vatican’s power grab, or the sisters desire to provide women with the safest medical care? Can or should the state get itself in a position of closely scrutinizing the validity of religious and moral claims for an exemption from public policy decisions?  We have just such a process in place for deciding whether a request to be exempt from military service: The state decides on a case-by-case basis if the claim is genuine or motivated by fear, laziness, or other less-than-honorable reasons. If we are to grant broad exemptions to religious institutions, should not a similar process be used? 

Best Obama stay out of the internal theological disagreements Catholics have about reproductive health. Best he focus on implementing the long-standing policy consensus that family planning is essential to women’s health and empowerment and contributes to the social and economic wellbeing of all. The religious exemption the HHS has drafted which exempts organizations that have the inculcation of religion as their primary purpose and which employ and serve primarily members of their own faith respects unambiguous religious institutions.  Combined with the conscience protection offered to individuals it is more than adequate protection of religious liberty.


These groups are asking you to join them in telling the White House not to capitulate to the United States Conference of Catholic Bishops and throw women under the bus on contraceptive coverage:

Catholics for Choice

National Women’s Law Center

Physicians for Reproductive Choice and Health

Feminist Majority Foundation

Emily’s List

Planned Parenthood Federation of America

NARAL Pro-Choice America

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Health Systems

What Happens When a Catholic-Run Clinic Comes to Your Local Walgreens?

Amy Littlefield

“It causes us great concern when we think about vulnerable populations ... [who] may need to use these clinics for things like getting their contraception prescribed and who would never think that when they went into a Walgreens they would be restricted by Catholic doctrine,” Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, told Rewire.

One of the largest Catholic health systems is set to begin running health clinics inside 27 Walgreens stores in Missouri and Illinois next week. The deal between Walgreens and SSM Health has raised concerns from public interest groups worried that care may be compromised by religious doctrine.

Catholic health systems generally follow directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, contraception, tubal ligations, vasectomies, and fertility treatments.

“We are concerned that the clinics will likewise be required to follow the [directives], thereby severely curtailing access to important reproductive health services, information, and referrals,” MergerWatch, the National Health Law Program, and the American Civil Liberties Unions of Illinois and Missouri wrote in a letter to Walgreens on Wednesday. They also sent a letter to SSM Health.

In a statement emailed to Rewire, Walgreens said its relationship with SSM Health “will not have any impact on any of our current clinic or pharmacy policies and procedures.”

SSM Health emailed a statement saying it “will continue to offer the same services that are currently available at Walgreens Healthcare Clinics today.” If a patient needs services “that are beyond the scope of what is appropriate for a retail clinic setting, they will be referred to a primary care physician or other provider of their choice,” the statement read.

A spokesperson for SSM Health demurred when Rewire asked if that would include referrals for abortion care.

“I’ve got to check this part out, my apologies, this is one that hadn’t occurred to me,” said Jason Merrill, the spokesperson.

Merrill later reiterated SSM Health’s statement that it would continue to offer the same services.

Catholic health systems have in recent years expanded control over U.S. hospitals, with one in six acute-care hospital beds now in a Catholic-owned or -affiliated facility. Patients in such hospitals have been turned away while miscarrying, denied tubal ligations, and refused abortion care despite conditions like brain cancer.

Catholic health systems have also expanded into the broader landscape of outpatient services, raising new questions about how religion could influence other forms of care.

“The whole health system is transforming itself with more and more health care being delivered outside the hospital,” Lois Uttley, director of MergerWatch, told Rewire. “So we are looking carefully to make sure that the religious restrictions that have been such a problem for reproductive health care at Catholic hospitals are not now transferred to these drug store clinics or to urgent care centers or free-standing emergency rooms.”

Walgreens last year announced a similar arrangement with the Catholic health system Providence Health & Services to bring up to 25 retail clinics to Oregon and Washington. After expressing concerns about the deal, the ACLU of Washington said it received assurances from both Walgreens and Providence that services at those clinics would not be affected by religious doctrine.

Meanwhile, the major urgent care provider CityMD recently announced a partnership with CHI Franciscan Health–which is affiliated with Catholic Health Initiatives–to open urgent care centers in Washington state.

“We’re seeing [Catholic health systems] going into the urgent care business and into the primary care business and in accountable care organizations, where they are having an influence on the services that are available to the public and to consumers,” Susan Berke Fogel, director of reproductive health at the National Health Law Program, told Rewire.

GoHealth Urgent Care, which describes itself as “one of the fastest growing urgent care companies in the U.S.,” announced an agreement this year with Dignity Health to bring urgent care centers to California’s Bay Area. Dignity Health used to be called Catholic Healthcare West, but changed its name in 2012.

“This is another pattern that we’ve seen of Catholic health plans and health providers changing their names to things that don’t sound so Catholic,” Lois Uttley said.

 

In the letters sent Wednesday, the National Health Law Program and other groups requested meetings with Walgreens and SSM Health to discuss concerns about the potential influence of religion on the clinics.

“It causes us great concern when we think about vulnerable populations, we think about low-income people… people who… may need to use these clinics for things like getting their contraception prescribed and who would never think that when they went into a Walgreens they would be restricted by Catholic doctrine,” Lorie Chaiten, director of the Reproductive Rights Project of the ACLU of Illinois, told Rewire.

The new clinics in Walgreens will reportedly be called “SSM Health Express Clinics at Walgreens.” According to SSM Health’s website, its initials “[pay] tribute” to the Sisters of St. Mary.

“We are fairly forthcoming with the fact that we are a mission-based health care organization,” Merrill told Rewire. “That’s something we embrace. I don’t think it’s anything we would hide.”

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