Who Makes Your Health Care Decisions?

The provider, apparently. Or your state legislator. Or the local Catholic bishop who oversees services provided by your hospital.

If we consider health care a civil right, a human right -- and that's a big IF; the AMA and other health care organizations have resisted this approach for decades, saying as Rand Paul has recently, that private institutions should not be required to treat blacks, for instance -- then the ability of these entities or individuals to deny services (and informed consent and meaningful referrals) is a violation of those patient rights.

Pew takes a look at the inherent discrimination in provider refusal clauses (so-called "conscience clauses") that allow not only individual providers but institutions to refuse services, information about available, legal services, or meaningful referrals.

Their subject line for the article is an infuriating: "Are Health Care Workers Obligated to Treat Gays and Lesbians?" Now substitute your favorite minority in there, like Women, or Elders or the Disabled? What about Mexicans? Or Blacks? Or maybe Unmarried Women? Or Gun Shot Victims? Or AIDs patients?

Read my May post about conscience clauses.

My feeling is that the intent of conscience clauses may originally have been to protect doctors and health care practitioners from performing services they are religiously opposed to -- I understand the need for conscientious objection, so long as the patient is given proper and legal information and access to those services. But the practice has become hospitals and individuals exerting their moral "teaching" on individuals (a pharmacist lecturing an unmarried woman about extra-marital sex and refusing to fill her birth control prescription). It's part of the mission to reform "ungodly" behaviors like abortion, extramarital sex, gay sex, or oddly, removal from artificial life support. Because Roe v Wade most likely won't be overturned, the effort over the last three decades has been to limit access to reproductive services; this has now spread to other "pro-life" services that are also on the platform.

Here's a clip from the Pew article:

How do the Michigan and California cases differ from cases involving doctors and abortion, or cases involving pharmacists and birth control?

The most important difference centers around the fact that federal and state legislatures have enacted laws granting exemptions for obstetricians and other health care professionals with respect to abortions (and, in a much more limited way, for pharmacists with respect to birth control). The abortion-related legislation reflects the view that people should not be forced to perform an act that they perceive as life-destroying. At the same time, legislatures have not been inclined to exempt health care professionals from laws forbidding discrimination based on characteristics such as race, gender or sexual orientation. Courts might not want to fill this gap and create those exemptions. Courts generally see anti-discrimination laws as serving important social purposes, and they are often concerned that such laws could be undermined by exemptions.

Another important distinction involves the possible extent to which services are withheld. Indeed, there might be a considerable difference, particularly from the government’s perspective, between an obstetrician’s refusal to perform abortions and a therapist’s refusal to counsel a gay man. The obstetrician has not refused to care for an individual or group of people, but only to perform a specific service. By contrast, the therapist’s refusal denies all services to anyone in a same-sex relationship with issues arising from that relationship, even though the therapist remains willing to provide comparable services to those in heterosexual relationships. The therapist’s decision could therefore be seen as undermining the state’s interest in protecting gays and lesbians from discrimination.

What arguments have been made by those who, like the student therapist in the Michigan case, seek moral or religious exemptions?

People who seek these exemptions usually make the following arguments. First, they assert that they are not opposed to serving gay or lesbian clients; rather, they are religiously opposed to aiding or facilitating certain aspects of same-sex relationships. For example, in the EMU case, Ward argued that she did not want to counsel a client with respect to his homosexual relationship but was willing to counsel him about other aspects of his life. Second, they contend that federal or state constitutional protections of religious liberty entitle them to these exemptions. Finally, proponents of such exemptions argue that granting an exemption will cause little or no harm to gay and lesbian clients because equally competent professionals are ordinarily willing to provide the services. Indeed, they say, as long as the number of exemption-seekers is small, and the number of professionals willing to serve such clients is large, the gay and lesbian clients will have adequate service.

Ward explicitly relied on the American Counseling Association’s Code of Ethics in arguing that she should be entitled to refer a client to another counselor in the EMU program if she determines that her personal moral convictions make it impossible for her to work effectively with that client. In the California case, the North Coast Women’s Care Medical Group made a similar argument about referral, though in that case, the referral would have been to a fertility specialist outside the North Coast group, because no one within the group was both willing and qualified to treat Benitez.

Rationing or Rational Care.

Yesterday PBS posted an excerpt of the Miller Center event "Debating the Ethics of Rationing End of Life Care," a roundtable that included Dr. Arthur Caplan, Dr. Ira Byock, and some guy with a Texas accent going on about "faceless bean-counting bureaucrats." And a nurse, Marie Hiliard of the USCCB's Advisory Council and the National Catholic Bioethics Center.

Oh wait, that was Kenneth Connor from Center for a Just Society where it's all about Judeo-Christian values all the time, whether you're Jewish or Christian or not. Cause if you're not, God and your government think your health care should be! Connor is so radical, I have no idea why he was even included here; his participation only legitimizes the Just Society premise (Their God makes your health care decisions, not yours) and muddies the chance of a productive conversation. I guess the organizers were going for "fair and balanced" controversy.

In other words, moderator Susan Dentzer, editor in chief of Health Affairs, set up the premise that two doctors are pitted against two "pro-life" activists.

Byock and Caplan make strong cases. The other two have Luntz-like talking points. I can't help but feel that a great opportunity was missed here.

Watch the entire broadcast here.

Strengthening the Advance Directive.

Thaddeus Pope at Medical Futility blog makes a great point about the president's recent move to strengthen advance directives. And to his post, I add my own point: at institutions where provider refusals (so-called conscience clauses) prevent patients from receiving treatment and information they desire, this effort will have no effect. Like at the 624 Catholic hospitals and hundreds of denomination health care facilities around the country. Pope's post in total:

On Thursday, President Obama directed DHHS to promulgate regulations that would "guarantee that all patients' advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients' representatives otherwise have the right to make informed decisions regarding patients' care."

Now, hospitals already have statutory and common law duties to respect advance directives. Indeed, compliance is already required by the PSDA and regulations pursuant to the PSDA. If the new regulations are to add anything meaningful, perhaps they will mean that DHHS will (after two decades) actually enforce the PSDA.

That would be a great benefit. In contrast, the effect of DHHS regulations on LGBT individuals seems far more limited. Sure, the risk of federal enforcement may chill some hospitals that ignore advance directives appointing LGBT partners. But most LGBT patients do not have advance directives. And LGBT partners are rarely recognized as authorized decision makers under default surrogate statutes. Therefore, since DHHS merely enforces compliance with state decision making law, most LGBT obstacles will remain. The real problem is with state law.

Tobin Removes Hospital From CHA Network

In a well-known rift during the health care debate, the Catholic Health Association supported the bill, the US Conference of Catholic Bishops did not. Now Bishop Thomas Tobin has removed a Providence Rhode Island hospital, St. Joseph's Health Services, from the CHA network, proving the power that ultra-conservative bishops have over localized health care delivery. Tobin's called St. Joseph's affiliation with CHA "embarassing." You can read the entire story at HuffPo.

Tobin's famous for his condemnation of Catholic legislators who don't toe the increasingly conservative doctrinal line. Last summer he had a very public spat with Representative Kennedy over Kennedy's stance on abortion, saying that the legislator should refrain from taking communion and examine his faith.

According to the article, only one other hospital has broken with CHA since the health care debate. The name of that hospital has not been released.

Who Speaks for the Catholic Church?

Hugh McNichol argues that all those organizations out there tacking "Catholic" onto their name are not the true moral voice of the Catholic church. The USCCB is. He notes the CHA and other organizations who endorsed the health care bill despite USCCB and other Catholic opposition. Yet, dissent in any church is not new. Who represents the millions of Catholics in the US, some say, is the millions of Catholics in the US - who are much more liberal on issues of gay marriage, women's rights, use of contraceptives, and yes, abortion.

An excerpt from McNichol's post is below. But what his article fails to note is this: What weight should Catholic theology, whatever theology the church decides on or we as a society choose to mark as "official," have in the laws that provide health care to a pluralistic society?

And does the over-sized participation of Catholic organizations (hospitals, long term and hospice facilities, HMOs) immediately determine that they have a right to discriminate against the multi-faith society they serve?

However, during the process of due diligence the Catholic Health Association endorsed the proposed legislation despite the reservations and the lack of approval of the United States Catholic Conference of Bishops. Additionally other groups of women religious, such as the Leadership Conference of Women Religious, endorsed the legislative package and clearly endorsed its ratification.

The question needs to be asked; are these organizations accurately reflective of the authentic teachings of the Catholic Church? For the most part the use of the term, “Catholic,” in the organizations title provides a somewhat tacit seal of approval which implies adherence to authentic Catholic teachings as proclaimed by the Magisterium of the Catholic Church.

However, such an application of the adjective, “Catholic,” does not always hold true to the organizations purposes and objectives. The Catholic Health Association for example is an organization that offers a loosely held confederation of health facilities that were formerly initiated and managed by religious communities. While the facilities operate under a general charter that embraces the “Spirit of Catholicism”, there is nothing in their charter that makes them answerable to the United States Catholic Conference of Bishops as it relates to their operating policies and procedures. In effect, the CHA is actually a trade organization that represents the interests of health care organizations that were formerly run by religious communities of priests or religious.

The president of Catholic Health Association was present for the public signing of the health care legislation into law at the White House this week. Sister Carol Keehan, DC. Sister Carol Keehan is a member of the religious group, Daughters of Charity. She has indeed lobbied for many years for the passage of a universal health care package that safeguarded all American citizens, especially the rights of the poor and challenged groups in American society. Sister Keehan for years has worked in the health care field and has even been recognized for her achievements by secular organizations and even Pope Benedict XVI in bestowing the papal honor, Pro Ecclesia et Pontifice (For Church and Pope) Award. However, despite her personal achievements, the implied approval of the entire legislative package, now federal law placed the Catholic Health Association in direct contradiction and de facto in opposition with the American Catholic Bishops.

Understandably no legislation is perfect and there are many imperfections in the Obama Health Care package. The fact remains there can only be one unified voice that represents the United States Catholic Church and that responsibility resides with the American Catholic Bishops. While the American Bishops have worked consistently towards the goal of a universal health plan for all Americans with concessions made for Catholic beliefs, their voice was in fact not loud or strong enough to curtail other groups such as the Catholic Health Association or The Leadership Conference of Women Religious from usurping the mantle that rightly belongs to the United States Catholic Conference of Bishops.

Excusing Discrimination and Perpetuating False Information.

I can only say this: I'm ashamed of this behavior and I hold the Republicans responsible for encouraging it with blatant lies about what the health care bill will do. Excusing this discrimination is reprehensible.

Rep. Steve King (R-Iowa), a leading voice in the tea party movement, said Sunday that protesters’ recent use of racial and homophobic slurs toward Members of Congress was no big deal.

“I just don’t think it’s anything,” King said, emphasizing that the incidents were isolated. “There are a lot of places in this country that I couldn’t walk through. I wouldn’t live to get to the other end of it.”

To focus on a few incidents is “embellishing something that is determined to undermine the people,” said the Iowa conservative.

King’s remarks come a day after tea party protesters spat on Rep. Emanuel Cleaver (D-Mo.) and shouted a racial slur at Rep. John Lewis (D-Ga.); both are African-American. A protester also shouted a sexual slur at Rep. Barney Frank (D-Mass.), who is openly gay.

Another Republican lawmaker also brushed off the racial epithets and suggested they were prompted by the parliamentary maneuvers being used by Democrats to pass a health care bill.

“When you use a totalitarian tactics, people, you know, begin to act crazy,” Rep. Devin Nunes (R-Calif.) said Sunday on C-SPAN. “I think that people have every right to say what they want. If they want to smear someone, they can do it.”

Nunes added that the slurs were “not appropriate” but that he would “stop short of characterizing the 20,000 people protesting, that all of them were doing that.”

Tea party protesters have flooded the Capitol grounds in recent days in protest of health care reform. On Sunday morning, organizers directed protesters gathered outside the Capitol to get gallery passes and flood the building for the day.

King was among a handful of GOP Members firing up protesters on the Capitol steps Saturday evening to help block passage of the bill. Rep. Louie Gohmert (R-Texas) told the crowd to “remember the Alamo” and that the only difference between that fight and the health care fight is that “if we lose this battle, millions of Americans are going to die.”

Working for Disability Rights and End of Life Rights.

Oh, I'm under fire again. This time mostly from Canadians, likely because the euthanasia bill C-384 is back in debate this week. Opponents are lashing out, even across the border. And at me for what I would consider an incredibly benign post that is all history of disability rights in Canada. Geesh.

I don't know the Canadian bill intimately, admittedly, though I have had interaction with Alex Schadenberg of the Canadian Euthanasia Prevention Coalition. I think he seems like an alright guy with a poorly-defined mission. His work is predicated on legislating his idea (of life) and death that is no longer valid and has been rapidly changing for the past 40 years. I admit that medical advancement has muddied that definition, he does not. "Go get-em" he says to Stephen at Not Dead Yet. I'm -em.

Not Dead Yet caught up with my Vancouver Sun link and dug around til they found the last time they (and "pro-lifer" Jill Stanek) wagged their fingers at me. Stephen posits that supporting Death with Dignity (the aid in dying bills in Oregon and Washington, as I do) means that I'm out to kill the disabled because, um, allowing terminally ill patients, who I admit can be classified as disabled because of their illnesses, to decide when and where to end their lives means that I have some deep-seated intent to start killing anyone that looks at me askance.

I don't mean to be flip about this, nor evasive. I've been accused of not addressing disability rights in my advocacy for end of life rights. I haven't because, while I understand the justified fear that the disabled have of state laws, and of society's and the medical profession's discrimination, I find the definition of "terminal" to not include someone in a wheelchair.

When you're accustomed to systemic discrimination, seeing your fellow-travelers is sometimes difficult. I'm advocating for patients' rights - and that means the right of every one of us, regardless of our color, class, gender, education, or functionality, to make our own medical decisions. The legalization of Death with Dignity in Washington and Oregon doesn't in any way cheapen or make vulnerable the lives of any member of society.

Yet this is the case that many make, out of fear, out of mis-directed self-defense, or out of lack of information regarding the end of life experience and the DwD laws. And this was the case that Bad Cripple made at his site yesterday, oddly lumping me with every person who's ever offended or misunderstood him:

As for the first example, I have news for Neumann: if I have learned anything in the last thirty years of using a wheelchair it is that all people with a disability are not valued to some degree. There is no slippery slope involved. Just ask any paralyzed person or anyone with a disability. Better yet go to a school board meeting and listen to one and all cluck about the need for equal access and then vote down the need for that expensive elevator or lift on the school bus. There is no over reaction here . Indeed, if disability activists are guilty of anything I would argue we are too passive. We need to be more vigorous in asserting our inalienable rights as citizens.

Comparing murder to depriving the disabled of school buses is over-reaction. Again, I agree that our society should work much harder to accommodate the disabled, to wipe away prejudices. Anything less than equality for the disabled is discrimination, plain and simple. But claiming that every supporter of Death with Dignity is out to end the lives of every disabled person is over-the-top.

As for the second example, I doubt Neumann goes through the same mental gymnastics or experience the fear people with a disability do when they go to the doctors office or hospital. Perhaps Neumann can appreciate the difference between the terminally ill and disabled but I assure you most people, doctors included, do not. How else do I explain comments made to me such as "I would be rather be dead than use a wheelchair" or "Are you sure you wish to receive medical treatment" or "How longe have you suffered paralysis?" A clear message is being sent and it is not positive. Indeed, it is deadly and with the right spin can be lethal in some circumstances. My existence is open to question, my life less valuable. This is not paranoia but rather a social fact.

I didn't make those comments, nor would I. I believe that a disabled person has the same rights to be informed of their medical status and options as anyone else. But fear of a law that applies to terminal patients and working to oppose the rights of the dying does not protect the disabled from prejudice. BadCripple's existence should never be open to question! His life is never valueless. Hideous discrimination does exist. This we must work to end.

Sacrificing the rights of some for the fears of others never works. Or every black man with a bandana on his head and his hand in his pocked would be jailed away from every prejudiced little old lady who thought he was out for her purse. In other words, fear is powerful and often justified but it cannot be used to sanction the innocent acts of others.

Somehow I doubt anyone has openly questioned the value of Nuemann's existence or asked her if she really wished to receive medical treatment. Frankly I do not want Nuemann's sympathy or anyone else's for that matter. What I want is support; support for my civil rights. That support starts at the beginning, middle and end of life. I have not had that support from anyone aside from my family, friends and doctor or two. What an indictment on society. How can something as unimportant as the ability to walk have such profound social consequences. Worse yet when I assert my rights I get called "paranoid" by people like Nuemann with a political goal--the legalization of assisted suicide. This is depressing to me and I sincerely doubt I can sway the views of people such as Nuemann. Hence this why I write more about disability rights than the politics of assisted suicide.

Asserting one's rights is not what I was calling paranoid; working to end the rights of others in order to assert oneself is reactionary. I may not be in a wheelchair but I will always support civil rights, equality and autonomy for those who are. I may not understand the kind of discrimination the disabled receive but I do know what it's like to have others legislate me out of my own health care decisions.

And here's the reply I posted at Bad Cripple, below. It's sparked a lot of productive conversation. You can read the other comments here.

My advocacy is for patients' rights. I don't know what it's like to be in a wheel chair, nor what it's like to be black or gay or old and feeble. But as a woman, I know what it's like to have my decisions about my health impeded by the government, society, and other groups. I'm not writing to offer sympathy but empathy, that quality that binds advocates to their objective of protecting individual rights in health care delivery.

What you and I disagree on is the definition of death. Until about 40 years ago, death meant the almost simultaneous cessation of breathing, heart beat and brain function. But not so today.

With respirators and defibrillators we can sustain the first two indefinitely. CPR, 911, paramedics can make our hearts beat and our lungs breath. This is a brilliant thing; yet only 15% survive resuscitation to leave the hospital.

My point is that we have the technology to sustain life but also prolong death. And so the definition of death has changed; natural death is less and less common as we are given feeding tubes, respirators, pace-makers and increased artificial means of maintaining the body. In a world where something like 75% of society says it would like to die at home, 80% die in facilities.

What does this have to do with disability? We will all be disabled at some point. By age, by disease, by other health issues. But we all deserve the ability to make our medical choices. It is this ability - this right - that I advocate for.

What Not Dead Yet, Alex Schadenberg at Euthanasia Prevention Coalition and you miss in my writing is my support for Death with Dignity as legalized in Oregon and Washington (US). DwD involves only the terminally ill with 6 months to live, of sound mind, getting a prescription from their doctor that allows them to choose when and where they die. They are dying of their disease. They are not suicidal.

This is not at all different from a family member honoring one's advance directive to remove a respirator or forgo a feeding tube, nor from a patient's choice to end experimental treatments for cancer. It is a choice for as natural a death as we can have. It is a choice to not lie in a hospital, fully sedated for the remaining 6 weeks of life.

We, as members of developed countries where life-prolonging treatments can simply keep us "alive" for longer than God's planned, must now legally struggle with this new definition of death. And we must do so in a way that honors every patient's choice. Regardless of their race, economics, age, or medical condition.

This is my advocacy: To end futile, unwanted care which prolongs suffering; to educate patients' on what their rights are; and to work to help all of us plan for the end of life so that the decisions are in our hands.

In my work for patients' rights, I'm more of a fellow traveler than, unfortunately, you realize.

Hiring Pledges and Faith-Based Initiatives in DC.

Worldwide Religious News reports on the new requirement at Catholic Charities in Washington DC that incoming employees sign a pledge that they will not "violate the principles or tenets" of the church. While Catholic leaders deny that this new requirement is a result of the DC ruling that Catholic Charities can't discriminate against same sex couples, the article notes:

Catholic Charities, one of the region's largest nonprofit organizations, has been trying to develop a way to continue its multimillion-dollar social service partnerships with the District while not recognizing the city's same-sex marriage law, which the D.C. Council approved in December. Employees were told this month that the agency was changing its health-care coverage to avoid offering benefits to its workers' same-sex partners.

And here's the rub of faith-based delivery of social services. How do (federally funded) organizations justly serve a pluralistic society when their employees are asked to pledge discrimination against those individuals the very organization is charged with serving? (As well, denying health care coverage to all employees to avoid inadvertently treating a queer couple who's slipped through the hiring process any bit of equality is absurd and hateful.)

But here is the very position that our governmental reliance on faith-based organizations has put Catholic Charities (and World Vision, see below) and every other doctrinal provider of health care or other social services in: how to serve a society that does not abide by your discriminatory world view? The Catholic Church's conservative leaders have decided to dig in their heels.

From the article:

Salmi said the new language "is more of an expectation than a condition. It's letting people know this is the culture." Asked if that meant employees could speak or act against the church without being fired, Salmi said: "We can't speculate on the hypothetical. It's handled on a case-by-case basis."

A former vice president of the organization's human resources department, however, said the new language appeared to be a change.

"Putting it in a letter and requiring a signature, that's a condition of employment. There's no way to dance around that," said Wayne Swann, who served 3 1/2 years on Catholic Charities' board of directors and an additional four years as its vice president.

On the basis of Supreme Court rulings, President George W. Bush issued executive orders allowing faith-based social service groups that receive public money to discriminate in their hiring practices. As a candidate, President Obama sided with those opposing such hiring limits and vowed to stop them. But since Obama took office, the issue has remained under study by the Justice Department.

Federal and D.C. laws explicitly give religious groups exemptions from bans on religiously based employment discrimination, but some church-state experts point to federal funding statutes -- including those for Head Start and the Workforce Investment Act -- that ban such preferences. The Establishment Clause of the Constitution prohibits discrimination in government-funded programs, they say.

"Taxpayers shouldn't have to pay for positions to which they can't apply, solely on the basis of their faith," said Dan Mach, director of the ACLU Program on Freedom of Religion and Belief.

There is no hard data on the percentage of faith-based social service groups that have religious hiring requirements in an effort to maintain their faith identity. World Vision, one of the largest Christian relief organizations in the world, requires U.S.-based employees to sign a statement saying they agree with the organization's tenets or the Apostles' Creed.

The "Natural Law" Justification for Discrimination.

At the Catholic-right site Ignatius Insight, there's an interview today with J. Budziszewski, author of a new book titled The Line Through The Heart: Natural Law as Fact, Theory, and Sign of Contradiction and a professor of government and philosophy at University of Texas at Austin.

I post this because I'm often sloppy in my accusations of Catholic discrimination in health care, employment, and human rights. This interview - and perhaps this excerpt from it - shed light on the doctrine behind that discrimination, a doctrine that denies social change, scientific knowledge, and evolving ideas of human equality by preferencing learned prejudice and privilege.

Ignatius Insight: What are some basic ways in which understanding natural law can help Christians in addressing "hot button" moral issues such as "same-sex marriage" and abortion?

Budziszewski: Very few people know anything about natural law theory. Yet "in our bones" we all experience the reality of natural law, because it is rooted in our creational design, woven into the fabric of the human person. We can't help but notice certain obvious things about ourselves.

This gives Christians a certain advantage in conversation, if only we can learn to rely on it. Who doesn't see that life and innocence are good? Who doesn't know deep down that innocent life should never be deliberately destroyed? Who hasn't noticed that men and women need each other, that there is something missing in each sex which needs to be balanced by the other? Who isn't at least half-aware that marriage is the family-forming institution, the motor that turns the wheel of the generations, the only form of association that can give a child a fighting chance of being raised by a mom and a dad?

Don't start with what people don't know. Start with what they do know. Weave together reminders of the obvious.

Ignatius Insight: You write, in a chapter titled, "Constitution vs. Constitutionalism," that although we Americans aren't sufficiently on our guard about the Constitution's flaws, we don't sufficiently cherish what is good about it either. What are some of those good qualities, and how unique are they to the Constitution?

Budziszewski: In fifth grade, my teacher told the class that the Founders of our republic invented checks and balances. Thank God, that wasn't true. As I learned in later years, they were actually the beneficiaries of more than twenty-three centuries of experience and reflection on the matter.

For revolutionaries, they were unusually conservative, and tried to squeeze lessons from every bit of learning at their disposal. They knew that no Constitutional republic can endure without a certain level of moral character, or without a certain respect for natural law, on the part of both statesmen and ordinary citizens.

On the other hand, they knew that there is never enough virtue or wisdom to go around, so they took additional precautions as well. Besides providing for checks and balances, they established courts; they refused to concentrate all powers in the same set of hands; they allowed the population to select their own representatives; and they tried to make sure that no single faction would ever be able to dominate the government.

Ignatius Insight: Modern liberalism claims to be all about toleration, equality, and freedom. Yet it seems to be increasingly intolerant, unfair, and controlling. What are some of the essential flaws with modern liberalism that lead to such a paradox?

Budziszewski: Virtue requires the exercise of judgment. The virtue of courage, for example, isn't just about suppressing fear, but about suppressing it at the right times and for the right reasons. If a fireman dashed into a burning house to save the pencil sharpener, we wouldn't call him courageous, but rash and witless.

In the same way, the virtue of toleration isn't just about putting up with bad things, but putting up with certain bad things in certain ways for the right reasons. We ought to tolerate disbelief in God, because faith, by its nature, cannot be coerced. But if someone thought we should tolerate rape and murder, we wouldn't call him tolerant, but foolish and wicked. Do you see the paradox?

In order to know which bad things to tolerate, we must judge well about goods and evils. Liberalism, unfortunately, denies this. It redefines tolerance assuspension of judgment about goods and evils. Here enters a second paradox, because it is literally impossible to suspend all judgment about goods and evils. For example, there is no morally neutral way to define marriage. Laws that conceive it as monogamous put polygamy at a disadvantage; laws that conceive it as polygamous put monogamy at a disadvantage; and laws that attempt to be open to both monogamy and polygamy conceive it, in effect, as polygamous.

The way so-called liberal tolerance actually works is that it condemns the moral judgments of non-liberals, but enforces its own moral judgments by pretending that they are not judgments. This is really a disguised dictatorship.

Why We Let Catholic Health Care Discriminate.

The Moderate Voice has a great discussion going about the benefits and detriments of Catholic health care in the US. If you read here often, you know that the Catholic Church controls the services provided at the 624 hospitals - and hundreds of long-term care, hospice care and other institutions - in the US.

The post is a little long and emotional, as well as full of disinformation. But the comments area is fascinating and gives a good look at the high emotions that surround this issue.

For decades the Catholic church has worked to perpetuate the belief that they are too big a part of health care to be forced to operate without discrimination. What would the country do if the church pulled out of hospital operation?? In fact, they have worked in this field for centuries as part of their mission to care for the poor and sick. While I believe that the purpose is sincere, nonetheless, they discriminate against patients by not providing the full spectrum of legal, medically sound services. And they refuse to provide proper informed consent or referrals. In essence, they use the reverence that society has given the moral goodness of the church to discriminate against women, gays, elders and the poor by deciding what "conscience" those patients should have.

Here's my comment on the site:

Fantastic discussion. A couple of corrections: Catholic hospitals get 50% of their funding from the government, just like every other non-profit hospital. Less than 3% of their income is from donation so they are clearly not providing Catholic health care with Catholic donations. And Catholic hospitals - all 624 of them - statistically do no more "charity" work than other non-profits. In fact, all hospitals are required by federal law to treat the uninsured.

The best analogy is a company town. The company provides the jobs, the housing, the schools, even owns the grocery story. They are "too big to fail" in that town. One can say, oh thank god for the company, without it we would have no jobs or schools or groceries. But the truth is that the company then dictates all aspects of the town's life. And if the company says women should not be able to plan how many children they have or that a terminal patient can't be removed from artificial nutrition and hydration when they wish, the company is exercising it's size and monopoly to the detriment of employees rights.

When a pluralistic society finds itself subject to the doctrine of a religious health care institution, patients' rights are violated. Those who suffer the most are the poor and minorities in society. But we are bashful about calling out this issue because we give reverence to the "good intentions" of the Catholic church and those of us with voices have the resources to go elsewhere.

Reproductive services clinics have risen over the past 38 years to provide what Catholic and other denominational hospitals have not. They serve the poor and provide services unobtainable elsewhere.

I do believe that denominational healthcare is a discriminatory practice in the US but I also accept that the dictates of the Catholic hierarchy are not necessarily what's practiced in Catholic hospitals. Yet, that dissent cannot erase the fact that Catholic Ethical and Religious Directives discriminate against the poor, women, elders, gays and others by not informing patients' of all legal and medically-sound treatments and providing meaningful referrals. If we continue to privilege provider (and institutional) conscience over patients' conscience, we perpetuate this discrimination. Denying this is dishonest and a disservice to equality and individual conscience in this country - as well as a violation of equal rights.

This Man Is An Elected Official in Virginia?!

You may not yet have heard about Eugene Delgaudio, an elected official on the board of supervisors in Louden County, Virginia. But the gay community has had to listen to his hideous hatred for more than a decade. He won reelection as recently as 2007. I'm on the GOPUSA mailing list and the nastiness below came by my inbox today. Beware. It's a hideous mass that I post for one reason: only awareness can kill discrimination and hatred this deep.

Some extra reading for you, if like me, you're in shock that someone with this resume can hold elected office:

Kyle at RightWingWatch, 2010.

Dana Milbank at the Washington Post, 2005.

The Corner, National Review Online, 2005.

Michael Laris, Washington Post, 2002.

You see, the Radical Homosexuals are storming through Washington demanding passage of their agenda.

And with the passage of Thought Control last year, they say NOW is the time to push their perverse "life-style" on every man, women and child in America.

And they insist YOU actually support them.

The Homosexual Lobby played a major role in electing Obamaand the majorities he enjoys in both houses of Congress.

I can only begin to imagine all the damage the Radical Homosexuals will do with their allies controlling the House of Representatives, the Senate and the White House.

As the President of Public Advocate of the U.S., I've devoted twenty-seven years to battling the radical homosexuals in Washingtone.

Backed by Hollywood celebrities, the media and millions of your tax dollars, the Radical Homosexuals have many Congressmen quivering with fear -- and they have a Radical Homosexual-friendly majority in control of Congress.

That is why pro-family Senators and Congressmen are counting on me to find out if you really support the Gay Bill of Special Rights and homosexual marriage as the radical homosexuals claim.

Frankly if you really do support the radical Homosexual Agenda -- or if you just no longer care enough to stand up for the family -- insiders in Congress say the entire Homosexual Agenda could pass in a matter of months.

*** Special job rights for homosexuals and lesbians. Businesses may have to adopt hiring quotas to protect themselves from lawsuits. Every homosexual fired or not hired becomes a potential federal civil rights lawsuit.

Radical homosexuals will terrorize day care centers, hospitals, churches and private schools. Traditional moral values will be shattered by federal law.

*** Same-sex marriages and adoptions. Wedding-gown clad men smooching before some left-wing clergy or state official is just the beginning.

You'll see men hand-in-hand skipping down to adoption centers to "pick out" a little boy for themselves.

*** Homosexual advocacy in schools. Your children or grandchildren will be taught homosexuality is moral, natural and good. High school children will learn perverted sex acts as part of "safe sex" education.

With condoms already handed out in many schools, Radical Homosexuals will have little trouble adopting today's "if it feels good do it" sex-ed curriculum to their agenda.

And to add insult to injury, lobbyists for the Homosexual Agenda are paid off with your tax dollars!

That's right, radical homosexual groups like the Gay-Lesbian Task Fo! rce and ACT-UP receive millions from the government.

Hundreds of millions of dollars flow from taxpayers to homosexual activists through funding for homosexual "art," so-called AIDS-awareness programs, and research grants.

And yet, Public Advocate receives absolutely no taxpayer assistance. My small office of volunteers and low-paid staffers are making quite a sacrifice to defend America's morals and values.

But hard work is not enough. Items like mail, stamps, and even this email cost money.

That is why I ask you to make a generous donation after youcomplete the American Morality survey today.

Repealing the Conscience Clause.

After more than a year of waiting for the Obama administration to address the hideous provider refusal laws that Bush passed in his last weeks of office, 365Gay reports that there may be movement to rescind - at least in part - some of the discriminatory restrictions:

(Washington) The Obama administration is expected this week to begin the process of repealing so-called “provider conscience” regulations that could have been used to discriminate against gays, people with HIV/AIDS, and women seeking abortions.

The regulations, instituted in the last days of the Bush administration, strengthened job protections for doctors and nurses who refuse to provide a medical service over religious beliefs.

Human rights groups say the regulations could impair LGBT patients’ access to care services if interpreted to permit providers to choose patients based upon sexual orientation, gender identity or family structure.

The regulations also threaten women’s access to comprehensive health care by permitting pharmacists to refuse to dispense contraception even when doing so significantly burdens the patient’s access, or to refuse to participate in an emergency abortion even when the woman’s health is at risk.

snip

The Bush administration rule was quickly challenged in federal court by several states and medical organizations. As a candidate, President Barack Obama criticized the regulation and campaign aides promised that if elected, he would review it.

Late last week the White House released a statement saying that Obama supports a “carefully crafted” conscience clause – not Bush’s version.

The administration early this week will publish notice of its intentions, opening a 30-day comment period for advocates on both sides, medical groups and the public.

The administration already held a comment period regarding the laws. I hope that the "carefully crafted" regulations will protect the conscience of all individuals, not just those of health care providers and denominational institutions hell-bent on discriminating agains gays, women, and elders.

Forced Feedings: The Bishops and Artificial Nutrition and Hydration.

Judith Graham at the Seattle Times has a great article today on the Catholic Bishops' latest dictatorial health care guideline - that the church decides when patients are removed from (or added to) artificial nutrition and hydration, not the patients. Graham writes:

The new directive, more definitive than previous church teachings, also appears to apply broadly to any patient with a chronic illness who has lost the ability to eat or drink, including victims of strokes and people with advanced dementia.

Catholic medical institutions are bound to honor the bishops' directive, issued late last year, as they do church teachings on abortion and birth control. Officials are weighing how to interpret the guideline in various circumstances.

What happens, for example, if a patient's advance directive, which expresses that individual's end-of-life wishes, conflicts with a Catholic medical center's religious obligations?

Gaetjens, 65, said she did not know of the bishops' position until recently and finds it difficult to accept.

"It seems very authoritarian," said the Evanston, Ill., resident. "I believe people's autonomy to make decisions about their own health care should be respected."

Part of the reason the Catholic church gets away with making these decisions for patients is because so few know how Catholic health care is regulated, by the church. About the history of this new policy on artificial nutrition and hydration, the case of Terri Schiavo is cited, an event that I would say is one of the primary roots of the church's recent restrictions:

The guideline addresses the cases of people such as Terri Schiavo, a Catholic woman who lived for 15 years in a persistent vegetative state, without consciousness of her surroundings. In a case that inspired a national uproar, Schiavo died five years ago, after her husband won a court battle to have her feeding tube removed over the objections of her parents.

The directive's goal is to respect human life, but some bioethicists are skeptical.

"I think many [people] will have difficulty understanding how prolonging the life of someone in a persistent or permanent vegetative state respects the patient's dignity," said Dr. Joel Frader, head of academic pediatrics at Children's Memorial Hospital in Chicago and professor of medical humanities at Northwestern University.

snip

The church's view is that giving food and water through a feeding tube is not a medical intervention but basic care, akin to keeping the patient clean and turned to prevent bedsores, he said.

Pope John Paul II articulated the principle in a 2004 speech, and the Congregation for the Doctrine of the Faith, an arm of the Vatican, expanded on it in a 2007 statement.

The new guideline incorporates those positions in Directive 58 of the U.S. bishops' Ethical and Religious Directives for Catholic Health Care Services.

There are several important exceptions. For one, if a person is actively dying of an underlying medical condition, such as advanced diabetes or cancer, inserting a feeding tube is not required.

"When a patient is drawing close to death from an underlying progressive and fatal condition, sometimes measures that provide artificial nutrition and hydration become excessively burdensome," said Erica Laethem, a director of clinical ethics at Resurrection Health Care, Chicago's largest Catholic health-care system.

A second exception has to do with bodily discomfort. If infection develops repeatedly at the site of the feeding tube, for instance, artificial nutrition and hydration can be refused or discontinued, Catholic ethicists agree.

A third exception is allowed when inserting or maintaining a feeding tube becomes "excessively burdensome" for a patient.

Under traditional Catholic teachings, patients may refuse medical interventions when anticipated burdens outweigh potential benefits.

"Decisions are made case by case," and that will continue, said Ron Hamel, senior director of ethics at the Catholic Health Association of the United States.

Of particular concern is whether Catholic medical centers will honor an advance directive stating broadly that a person does not want a feeding tube inserted.

Compassion & Choices, a group that supports the right of dying people to end their lives, suggested the potential for conflict is significant.

"Now, [Catholic] hospitals and nursing homes have no choice but to enforce Catholic doctrine universally over patient wishes," the group's president, Barbara Coombs Lee, wrote on her blog.

But most ethicists said they do not see a significant problem. Disagreements, they say, usually can be resolved by discussing people's end-of-life concerns, such as fear of being abandoned, fear of living in pain or fear of becoming entirely dependent on others.

It is rare for people to be very specific about their wishes.

"I have never seen an advance directive that says, 'If I am in a persistent vegetative state, I ask that you withdraw food and water,' " Laethem said.

The bishops' guidelines specify that patients' "advance directives are to be followed, so long as they do not contradict Catholic teachings," said John Haas, president of the National Catholic Bioethics Center. How those teachings will be interpreted has yet to be resolved.

Anti-Gay Rant Video from CPAC

Catch this anti-gay rant from yesterday's CPAC events. The hatred, intolerance and fear are shocking.

From the conservative (and misguided) PA Watercooler.

UPDATE: from TalkingPointsMemo, apparently Ryan Sorba is into beating women too. What a stud!

Mixing Images of Civil Rights and The Tea Party.

My friend Steve sent me this video which he decided to make after watching all the reporting on the tea party.

Faith and Racism.

Wendy Wood of USC conducted an analytical study of existing research into the link between religion and racism. Here findings are both expected and shocking.

One can only ask what the implications are for other discriminatory opinions in the US such as anti-reproductive rights and anti-social services. And, at risk of running out these implications too far, what this study says about the Tea Party-furcated Republican party, committed to “no”-ing our nation’s way to a complete stalemate under our current black-led administration.

From Science and Religion Today, where I found the study. Here's a clip:

The researchers found barely any difference between the amount of racism among religious fundamentalists and more moderate Christians. “Only religious agnostics were racially tolerant,” they write in their paper.
We shouldn’t be shocked, Wood explains:

Religious groups distinguish between believers and nonbelievers and moral people and immoral ones. So perhaps it’s no surprise that the strongly religious people in our research, who were mostly white Christians, discriminated against others who were different from them—blacks and minorities.

She also points out that people who are religious because they value tradition and social convention were especially likely to be racist, noting:

The effect stays significant even in recent years. For people who are religious for conservative reasons, they have become less racist in recent years as racism has become less socially acceptable. But even they are still significantly racist, just that the effect has reduced in magnitude.