The Conscience Clause: It's Not Just About 750,000 Hospital Employees

Here's an excerpt from my latest at The Revealer regarding the recent controversy over insurance coverage of contraception by Catholic employers:

And yet the Catholic Church knows that the issue of conscience clauses is about much more than the 750,000 hospital employees who musn’t get their hands on free contraception. At stake is the autonomy of the millions of patients who are treated at Catholic institutions each year. How many? According to the USCCB, there are currently 629 Catholic hospitals serving 20% of all patients in the country (about 50 of those hospitals are sole-providers, meaning there’s no other option for miles). That’s more than 35 million admissions every year, a total that still doesn’t include patients treated in emergency rooms, elder homes, or covered by HMO networks.

These conscience clauses, initiated with the Church Amendment, passed in 1973 only months after Roe v. Wade, have overlapped and evolved to not only protect the individual conscience of health care providers but, with the passage of the Weldon Amendment in 2005, that of “health care entities.” Much as Citizens United designated corporations as people, so have these clauses granted institutions conscience rights that supersede the rights of employees and patients. Not only are services that don’t comply with the Ethical and Religious Directives (ERDs)–written and approved by the USCCB–denied at Catholic institutions, but patients aren’t informed of them as medical options, nor are they referred to other institutions where they might receive them. Informed consent and referrals are considered violation of Catholic teaching.

Of course, the level to which institutions and providers comply with the Ethical and Religious Directives varies greatly. What the church demands, as statistics regarding Catholic contraception usage show, followers and employees have a long tradition of resisting. What often determines the compliance of facilities and employees with Catholic guidelines is the amount of interest the local bishop has in the affairs of institutions in his diocese. In the past decade, we’ve witnessed the appointment of increasingly conservative bishops and the pressure of presiding bishops to pay closer attention to hospitals, in part by the conservative turn of the church leadership and in part by the pressure on health care delivery from choice movements.

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