Conscience Protections and Subsidiarity

Conscience Protections and Subsidiarity January 25, 2012

The Obama administration’s refusal to provide adequate conscience protections to Church-affiliated institutions that do not wish to pay for contraception is fundamentally wrong. Obama has lost the vote of Michael Sean Winters over this. Given the depraved condition of the modern Republican party, I’m not sure I would go that far, but I know where he is coming from. Not only is this decision wrong, but it represents a betrayal of those who fought hardest and took the most heat – even death threats – for supporting the Affordable Care Act.

But let’s be clear about why it is wrong. I have little interest in American constitutionalism, but I have a major interest in Catholic social teaching. And in this domain, the decision was wrong because it was a violation of subsidiarity. Specifically, instead of simply furnishing help, the federal government stepped over the line and usurped the power of a lower level authority in the social order. By providing too much “subsidium”, the government suffocated the legitimate autonomy of religious institutions offering health care coverage. As Pius XI put it, the role of the state is to “furnish help to the members of the body social, and never destroy and absorb them”.

Part of the problem is the way that left-wing liberalism has developed in the United States, insofar as it seeks to curb the autonomy of religious entities once they step onto the public square. The closest comparison to the Obama decision would be the French government decision to ban certain religious garb in public schools, notably the headscarf frequently worn by Muslim women. In both cases, it is a violation of the autonomy of the religious entity, which does not lose this autonomy when it enters the public square. And this principle is far bigger than any fights over the merits of providing contraceptives (or wearing scarves in France). It would apply equally if the federal or state government attempted to interfere in the way Catholic schools, hospitals, or charitable institutions deal with undocumented workers and their families – a live issue in the United States today.

Another example would be the provision of social welfare in countries with a strong Christian Democratic tradition, such as Germany and the Netherlands. Here, the welfare system is funded by the state, but managed by subsidiary mediating institutions – including religious bodies – in a fully autonomous manner. This model of a publicly financed and privately governed welfare arrangement stems directly from the principle of subsidiarity. But such a model seems inconceivable in the United States.

But let’s be clear about something else too. From this same perspective of Catholic social teaching, positions like those of Robert George also don’t hold any water. George is almost gloating over Obama’s betrayal of the Catholics who supported him. But George and those like him tend to misapply the principle of subsidiarity themselves. Rather than too much help, they would have the government provide too little. Sticking to the health care arena, these people opposed the Affordable Care Act based on what Pope Paul VI referred to an unbridled liberalism that “exalts individual freedom by withdrawing from it every limitation” and which is based on “an erroneous affirmation of the autonomy of the individual in his activity, his motivation and the exercise of his liberty”. This is the basic right-wing liberalism in the United States that is mis-named “conservatism”. Specifically, these anti-Obama Catholics on the right opposed attempts to provide near-universal healthcare by means of strict regulation of insurance companies, an individual mandate, and subsidies for the poor. The individual mandate, as an “attack on autonomy”, continues to draw the most ire.

But this approach is fully in line with Catholic social teaching. It gels with our collective obligation as a society to provide healthcare to everybody through solidarity. It is also warranted through subsidiarity. As Pius XI put it, “the right ordering of economic life cannot be left to a free competition of forces” and needs a directing force. John XXIII stated clearly that “intervention of public authorities that encourages, stimulates, regulates, supplements and complements is based on the principle of subsidiarity”.

If the market cannot provide, the state must step in to fix the problems (directly through solidarity, indirectly through subsidiarity). And indeed, John Paul II noted that “there are many human needs which find no place on the market. It is a strict duty of justice and truth not to allow fundamental human needs to remain unsatisfied, and not to allow those burdened by such needs to perish.” It is hard to think of a better example than health care. John Paul also notes that the free market must be “controlled by the forces of society and by the State, so as to guarantee that the basic needs of the whole of society are satisfied”. Health care is such a basic need. The fact that the United States, alone among the wealthy countries, does not provide it to all is a major source of scandal.

One way to look at subsidiarity is that it seeks to balance the scales between different groups, by providing just the right amount of help from above (neither too much nor too little) to achieve a harmonious social order. This is certainly what Pius XI had in mind. Paul VI put well when he said that “when two parties are in very unequal positions, their mutual consent alone does not guarantee a fair contract; the rule of free consent remains subservient to the demands of the natural law”. In such a case, the state must step in to correct any imbalances. In the United States, there is a huge imbalance between people and insurance companies, especially those on the individual market. The Affordable Care Act seeks to correct this unbalanced relationship by forbidding insurance companies from denying coverage at whim, calling for state-level exchanges to help level the playing field between insurers and insurees, and making sure the poor are not excluded from health care because they cannot afford it.

In other words, through the Affordable Care Act, societies of a superior order are adopting “attitudes of help (“subsidium”) — therefore of support, promotion, development — with respect to lower-order societies” (as the Compendium puts it). And while the Obama administration’s decision on conscience protections goes too far, critics of Obama from the Catholic right would not go far enough. Both are unbalanced under Catholic social teaching.

"You seem to be using “life” in several senses. To me, “life” as in “pro-life” ..."

Four Episodes from a Consistent Life ..."
""God’s solidarity with the powerless" You have a profound problem metaphysically with that one. It ..."

Was Jesus Raped?: David Tombs on ..."
"No the book is not dogmatic, and it has been controversial since it was written. ..."

Was Jesus Raped?: David Tombs on ..."
"Mary of Agreda in the Mystical City of God describes a specific Grace received from ..."

Was Jesus Raped?: David Tombs on ..."

Browse Our Archives

Follow Us!

What Are Your Thoughts?leave a comment
  • Pingback: Conscience Protections and Subsidiarity « Circle or Line under Most Beautiful Absolute()

  • MM writes, “Specifically, these anti-Obama Catholics on the right opposed attempts to provide near-universal healthcare by means of strict regulation of insurance companies, an individual mandate, and subsidies for the poor. The individual mandate, as an “attack on autonomy”, continues to draw the most ire. But this approach is fully in line with Catholic social teaching.”

    My personal problem with it, is not that I necessarily oppose the idea of government-run healthcare or socialized medicine, because, as stated elsewhere, I don’t. What bugs me about the individual mandate is that it strikes me as a sneaky way of trying to accomplish the same goal as socialized medicine, only pretending that it’s being accomplished through the private sector. In other words, politically, they knew that socialized medicine would go over like a lead balloon, so they pretended the ACA was something else.

    If they want socialized medicine, let them try to persuade the electorate of its merits, and once that is accomplished, implement it. Rather than reaching into my wallet to transfer money from one private citizen to another, get it from me the old-fashioned way, by taxing me. If you can’t get the people to agree to such a tax, then let it go until you can persuade them.

    By the way, I like your argument about the administration’s policy being a violation of subsidiarity.

    • Rodak

      Agellius —

      I don’t think there was anything “sneaky” about the individual mandate. It was seen as a cop-out on Obama’s part by the progressive segment of his base. It was frankly discussed at the time by liberals as a fall-back position–a compromise with the base–since socialized medicine was not going to fly. All of this was thoroughly discussed on the political media, right and left.
      If there was anything disingenuous about the discussion, it was the “personal responsibility” crew on the right suddenly deciding that personal responsibility wasn’t such a good idea, if proposed by the left-center administration. It suddenly became a virtual desecration of the Constitution, if not a desecration of the graves of the Founding Fathers.

      • Rodak: You’re right, “sneaky” was the wrong word.

    • Kurt


      All I can see here is that you think the Affordable Care Act should not have been enacted unless it was promoted using the Right-wing’s focus group tested phrase for it (“Socialized Medicine”). I’m sure progressives would like to say that the Right should only oppose single-payer health care by using our focus group tested term for it (“Medicare for All.”)

      Needless to say, (well, I guess it does need to be said) the100% phony right-wing complaint here is that the private sector — otherwise the source of all economic efficiency — has a role here. Catholic and progressive preferences would totally be on the side of consumer controlled (not government; not corporate) health care providers financed by social insurance premiums. Centerist and center-right elements in this country would accept government management before they would ever consider consumer empowerment. The hard right and the TEA Party, on the other hand, will just keep on making any objection to prevent universal coverage even if it contradicts their previous objections.

  • Peter Paul Fuchs


    Let me see if I have this right. The part of the Catholic community most known and identified for these anti-contraception stances, namely the reactionary Catholic right, has been giving “death threats” (your words) to progressive Catholics over health care. Such issuing of “death threats” over religio-political difference in health care is the ultimate definition of religious fanaticism. (Well perhaps penultimate, since actual murder and death would be the ultimate.). Now given this very atmosphere of fanaticism and intolerance in their view of health care matters, which has been demonstrated to have existed by your own comments, you are further suggesting that the highest office-holder in the land is somehow required to specially indulge this apparently manifestly fanatical community,and privilege the issues that happen to exercise them over his responsibility to peace, law-abiding men and women of good will whose circumstances make them interact in some way with said community due to health care needs. And according to you especially because the community mostly known for the very position you are are claiming deserves more consideration is also known for the worst of fanaticism– death threats. Thanks for clarifying. That it is all about “life” supposedly makes it all the more quixotic.

  • While I basically agree with everything MM has written, I simply don’t think it’s feasible in a country whose political culture is so steeped in the endorsement of Social Darwinism that is implicit in Radical Protestant Fundamentalism, which is the “anti-spirituality” that passes for the “religion” of the so-called “conservatives” of America. They CANNOT, because of religous beliefs, live in a country that would fully embrace European-style social democracy. What they call “liberty” is too important to them, and too much a part of their Protestant theological orientation. (And before anybody like Rodak starts howling about this and citing Denmark and Sweden as examples of why I’m wrong, please note that I actually believe that European Lutherism is closer to Roman Catholicism than Protestant America is. Those two Scandinavian social democracies are more “Catholic” in political culture than America is.)

    • Peter Paul Fuchs


      I have to agree, there were some good points in MM’s post, and your defense of his views is better yet. But the wrench in your logic — at least potentially for most orthodox Catholics — would be this. The state funding of churches in some European countries, by way of “mediating” approaches as you say, comes with a big cost. All churches are much more constrained even in their OWN PULPITS about what views they can express. The antics of the Catholic bishops in this country, just in terms of rhetoric alone, would long ago have landed many in jail. Of course they want to avoid getting even close to that there, so they self-censor. That is the real reason that right-wingers dislike those polities. Not for vast and vaunted sense of “liberty”, which has tones of fighting real violent oppression, etc. That is a mere cover. It is just the more tawdry desire to run their mouths and offend whom they want , when they want, make careers off it pathetically (Robert George), and make a little name for themselves (Chaput). What is lost in all this is that all those colluding with the vast nonsense of these people, even by omission, will be judged by history harshly. Past figures can be contextualized by myriad local and cultural factors. Now with fast communication there is no such excuse, and there will not be, and I see no reason whatsoever to be delicate about that fact.

    • Rodak

      @ digbydolben —

      Then why aren’t the European Catholic nations more like the Scandanavian social democracies than they are like the decayed remnants of facist hell-holes?

      • Peter Paul Fuchs


        I don’t know for sure, but on several trips to Italy to go to lovely hill-town and eat the most incredible food in every small restaurant you happened to find along the way, the words “decayed hell-hole” don’t come to mind. More like “charming” and “delicious”. If you want a look of real decay, mixed improbably with very 1% looking boutiques, check out Bologna where the communists (!) have ruled locally for a long time I believe. It’s mixture of decay and pricey elegance for ridiculous looking hand-bags brought some sort of “hell” to my mind. And yet one can go into a church there and see one of the most amazing and little known paintings in all of Italy, Donato Creti’s Charles Borromeo Distributing Alms to the Poor.

  • Rodak

    (sp!) fascist

    • Rodak

      @ Right. It’s paradise for tourist with a fanny bag stuffed with capitalist gelt. No argument there.

      • Peter Paul Fuchs


        Oh well I fancied myself a modern-day Berenson on that trip, but probably was tourist through and through. But fanny pack; that’s cruel! The highlight was Arezzo and Piero della Franscesca’s Finding of the True Cross. Thus, the highlight were the incredible frescos immortalizing what turned out to be one of the most egregious fake relics of all time. Thus the circle is complete! On that same trip was a great exhibition of Giacomo Balla in Milan, one of the famous futurists. Now there is the definite connection to fascism that you seem to be pining for buddy!

  • Kurt:

    I can only speak for myself and not for “the right”.

    I am personally persuaded that socialized medicine might not be so bad, based on things I have read, and on the oft-ignored or -denied fact that medical care *must* be rationed in one way or another. The way we’ve been doing it hasn’t worked, since people are given incentives to demand the very best and latest drugs and equipment heedless of cost, which endlessly drives up premiums.

    Ideally I would like to see both insurance and government healthcare done away with, since I believe that would cause care to be rationed in the same way food, clothing and housing are. But assuming that’s not going to happen, I think the next best thing is to have it under central control, so that there is at least a chance of implementing some kind of rational rationing.

    I simply don’t like the idea of government forcing people to transfer money to another private citizen, whereas taxation is an idea I understand and am used to (the appropriate level of taxation being another issue).

    • Kurt

      I simply don’t like the idea of government forcing people to transfer money to another private citizen,

      Are you saying the government should be the provider of health care, British style? Would you find it unjust for a society to have mandatory school attendence laws but not run a public school system,instead providing vouchers to parents to use at independent schools?

      • Kurt writes, “Are you saying the government should be the provider of health care, British style?”

        I’m not entirely sold on the idea, but I’m open to it. I like it better than a mandate forcing citizens to purchase products from private parties.

        Kurt writes, “Would you find it unjust for a society to have mandatory school attendence laws but not run a public school system …”

        Yes, I would. Note that I’m excluding the vouchers part since I think that makes the analogy inexact.

        You write, “… instead providing vouchers…?”

        Now, would I like the ACA better if, instead of requiring people to purchase private insurance, it taxed people and then gave them vouchers with which to purchase private insurance? It’s an interesting idea. That would be a way of rationing care, I suppose, if the insurers were not allowed to charge more than the amount of the vouchers. But then, if the government were requiring a certain level of care, yet was not willing to pay enough for it, insurers would probably start dropping out of the business.

        So, I think I’m still leaning towards a government-run system. Again, not my ideal, but better than the “individual mandate” in my opinion. Also as I said before, our current system does not ration care effectively, resulting in ever-increasing premiums. I don’t see how the IM solves that problem.

  • Matt Bowman

    Except that the US Bishops also support universal health care, and decided clearly that it would not be acceptable to passg it with provisions that allow this exact danger. And you declared at the time that this danger was an imaginary creation of the radical right (including the USCCB).

  • Chris Sullivan

    I disagree with Mornings Minion (one of the first times I ever have).

    It seems to me that subsidiarity argues for consideration also of the conscience of the employee and their right to choose contraception in good conscience, and that of the state authorities to exercise their conscience to provide medical services necessary for the Common Good as they see it. Religion’s right of conscience ends where it infringes on the conscience of others.

    There is no such thing as any absolute right of religious bodies to impose their consciences on their employees. What if 7th Day Adventists insisted on denying blood transfusion coverage for their employees ?

    The contention that contraception coverage actually violates Catholic teaching is full of holes. At worst it would be rather remote cooperation with evil. And the Church simply does not teach that contraceptive use is always immoral. It is only immoral in genuine marriage. Not outside marriage, in rape, coerced sex in marriage, prostitution, treatment for hormonal conditions or heavy periods, or to limit HIV transmission (condoms).

    And how is the state to decide what the conscience of Catholics actually is on contraception ? Go with the Pope ? Or his Comission on the pill which overwhelmingly voted to approve the pill? Or the Bishops who often disagreed with the Pope ? Or the priests, most of whom certainly disagree ? Or the laity, 95%+ of whom use contraception ?

    I hate to say this, but the more I think about, the more it seems to me that the Obama administration’s decision here (and I am not an Obama supporter) is more in line with Catholic teaching on conscience, subsidiarity and contraception than the US Bishops.

    God Bless

    • Kurt

      It seems to me that subsidiarity argues for consideration also of the conscience of the employee and their right to choose contraception in good conscience, and that of the state authorities to exercise their conscience to provide medical services necessary for the Common Good as they see it.

      Yes, but I think the weak point in this is that employers are expected to be part of the scheme as well. If employers were taken out of the matter, then the conscience problem for church-related employers is resolved.

      • Chris Sullivan


        An appropriate solution may well be state provided health care which includes free contraception. That would take employers out of the loop.

        God Bless

      • Kurt writes, “I think the weak point in this is that employers are expected to be part of the scheme as well. If employers were taken out of the matter, then the conscience problem for church-related employers is resolved.”

        Which is another reason to oppose the individual mandate. The idea, I suppose, is to keep it in the private sphere and thus avoid the charge of “socialism”. But when you also have the government mandating coverage for things that violate people’s consciences, then you have a situation where the government is mandating that people violate their consciences *in the private sphere* — not only forcing people to provide coverage for such things, but also forcing people to *purchase* such coverage, thereby funding it for others (since you have no intention of using it yourself) with private funds. A bizarre situation and one which makes me quite uncomfortable.

      • Kurt


        The intellectual flaw in what you state, however, is that the Church herself is voluntarily in violation of that standard.

    • Thales


      A person’s right of conscience or a religion’s right of conscience often infringes in some way on the conscience of the state and the conscience of others. There’s nothing strange about that. The state has exercised its conscience in order to serve the Common Good by requiring that all citizens to pay Social Security taxes, or requiring all citizens to serve in the army when called, or requiring all prisoners to be treated equally — but the Amish’s right of conscience to not pay Social Security is still respected, and so is the conscience of the pacifist conscientious objector, and so is the Jewish prisoner seeking special kosher food. We live in a civil society where we, as a society, think that it is good that certain special rights are recognized and given to those who have certain religious or deep-seated beliefs; and these rights will often single out the religion for special treatment and/or place a burden on the rest of us. As I said, there’s nothing strange about that; that just the nature of conscience rights.

      The question then becomes, what are the religious and conscience rights that our society should respect even though they may burden the rest of us (like not requiring a pacifist to fight in a war, or a doctor to conduct an abortion), and which are rights which go too far that our society shouldn’t respect (like the religious belief to conduct a honor killing). It’s always a balancing act.

      Now about the particular topic before us: I see that you think that an employer’s right of conscience to not pay for contraception is a right that shouldn’t be respected. That’s fine, but that makes me curious as to whether you see a distinction with abortion. Suppose an employee wants to exercise her right to seek an abortion in good conscience, and suppose the state authorities exercise their conscience to provide medical services necessary for the Common Good and determines that abortion should be covered as a necessary medical services. Do you have a problem with a rule requiring employers to pay for abortions? If so, what is your reason for distinguishing between paying for contraception and paying for abortion?

      • Chris Sullivan


        I think that the case of procured abortions (as opposed to operations to save the life of a mother which result in the foreseen but unintended death of the baby or of emergency contraception which might have a very low risk of unintended abortion) is quite different to that of contraception.

        Procured Abortion is intrinsically evil, contraception is not.

        One’s right to abort ends at the point where it meets the right to life of the one aborted, just as the employers right to conscience ends at the point where it meets the employees right to conscience.

        God Bless

        • Chris writes, “Procured Abortion is intrinsically evil, contraception is not.”

          On the contrary. The Catechism states, “‘every action which, whether in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible’ is intrinsically evil…” CCC 2370.

      • Thales


        Interesting point of view. Is it fair to say that your position is that a person’s right of conscience stops where it meets the right to life of an unborn human being? If so, I agree with you. Except I would go further, and would respect people’s conscience rights that go beyond the mere moral objection to helping end a human life. (I delve more into this idea below in point 1.)

        Now I’ve got a couple of points, which I think makes your position fuzzy:

        1. You say “Procured Abortion is intrinsically evil, contraception is not.” That’s your position, and that’s fine. But that’s not the official position of the Catholic Church, nor is it the position of many individual Catholics — to them, contraception (i.e., any act which renders procreation impossible; not simply ingesting contraception pills for medical reasons) is an intrinsically evil act, whether inside of marriage or outside, in cases of prostitution, etc. So let me suggest a better distinction for your position, which I allude to in my first paragraph: “that procured abortion involves the ending of the life of a human being; contraception does not. Therefore, one is more morally objectionable than the other. And I would respect the conscience of one who objects to cooperating with the ending of a human life; but I would not respect the conscience of one who objects to cooperating with a different intrinsically evil act (i.e., contraception) but that is not as bad as procured abortion because it doesn’t involve the ending of a human life.” Is that fair for me to say about your position? That distinction makes sense to me. But, as I said above, I disagree with it, since I think a civil society could (and should) protect a larger group of conscience rights, like objection to contraception, as I don’t see that to be an undue burden on the rights of others.

        2. Your position doesn’t acknowledge the abortifacient effect of some contraceptive pills. For example, I believe that the “morning-after” pill is covered by the new rules. I’m not sure what you position is, but for many Catholics, these abortifacient contraceptive pills are the moral equivalent of procured abortion. So the distinction I’ve tried to articulate for you in point 1 falls apart.

    • Chris,

      And what if Jehovah’s Witnesses*, operating an organization with an explicit Jehovah’s Witness identity, operating explicitly for goals designated by the principles of their religion, actually did refuse to pay insurance for blood transfusions? What of it? Suppose I say they obviously have the moral right, and that their religious consciences should be respected. What actual argument do you have that this is wrong? Where is the actual detriment to common good? And where would be the benefit to the common good in making the government force them to do otherwise?

      Your “how is the state to decide” argument strikes me as a nonstarter; if taken seriously it would require that there be no religious protections at all, since this is just a standard religious freedom problem, and is handled differently depending on the situation.

      Likewise, we aren’t anywhere near religious organizations “imposing” their consciences; if a state were to require all organizations to have insurance programs that pay for euthanasia, and religious organizations want an exemption for it, who is really imposing on whose conscience? And refusing to pay for insurance for X is consistent with people having insurance that covers X; they just have to get it themselves rather than making their employer pay for it.

      * (Seventh Day Adventists, contrary to what seems to be a common misconception, don’t forbid blood transfusions, they just require that the procedures meet very high standards of quality — healthy living is a big part of Adventist life — and so typically only do them in emergencies when the provenance of the blood is clear; thus Adventist hospitals in good standing often have quite good blood transfusion programs. It’s Jehovah’s Witnesses who forbid blood transfusions, and even they only forbid whole blood transfusions.)

  • Pingback: Our God King Manages to lose the vote… | Catholic and Enjoying It!()

  • Jason

    Nobody is forced to work anywhere in America. The beauty lies in finding your own professional path. If having free birth control is an important issue to me, then I’m welcome to look for employers who offer it. An employee willfully choosing to work for a Catholic organization should adhere to their employer’s chosen standards, or find another job. I have never made the connection in having health care – let alone free birth control – to be my employer’s responsibility. Through free enterprise, the companies that offer good benefits will no doubt retain more employees. A private business owner has the right to offer whatever compensation package he/she wishes … and a person has the right to apply or not. The hard-line stance by Obama isn’t even needed. Nobody addresses the real problem of astronomical health care costs, they just want to argue over who pays. It should not be the employer, health care should be affordable for all without the smoke and mirrors political nonsense.

  • Julia Smucker

    MM, this is just the sort of thing I mean by prophesying from the center. Well said, well done.

  • Anne

    Generally speaking, American government respects the religious consciences of its citizens unless those consciences make demands that violate the fundamental human rights of other citizens who cannot decide for themselves — e.g., when religious groups refuse vital medical care to children, even their own children, or to those so disabled by illness they’re completely dependent on others. Unfortunately, this particular issue involves such a convoluted situation, just *whose* conscience — religious organization or employee — takes precedence may be hard to fathom; at least fair minds differ.

    Beyond that, I wonder how this relates to what church organizations normally demand of their health plans ? Do they normally demand that all covered drugs, procedures and protocols in effect in hospitals, medical clinics and pharmacies meet Catholic moral standards? And who decides? Do no plans offered by Catholic organizations cover vasectomies? Sperm retrieval in infertility treatments? Infertility treatments not approved by all Catholic moralists? Etc. Or is the fundamental issue here the fact that birth control pills will be covered 100%? Would it be OK if patients paid part of the bill? Surely the amount paid by the plan is beside the point.

    In any case, a fact that’s constantly overlooked by those who see this issue in cut-and-dried terms is that birth control pills are the treatment of choice for several medical conditions, not just for contraception. Women, Catholic and otherwise, take such medications regularly for endometriosis and cystic acne, not to mention various hormonal imbalances. To refuse to offer plans that cover these seems discriminatory in itself.

    • Peter Paul Fuchs


      You last paragraph shows sharply why for many the RC Church’s position is just a fanatical desire to pretend real health concerns don’t exist. Thus, the position has a delusional element that is unavoidable, no matter how diplomatic one might want to be with fellow citizens of an ancient faith.

    • Thales

      Would it be OK if patients paid part of the bill? Surely the amount paid by the plan is beside the point.

      No, it’s not beside the point. The amount of connection (or the level of “material cooperation) to the immoral act is important. It’s one thing to offer a plan where employees can choose on their own to purchase contraception; it’s another to offer a plan where the employer pays for the contraception chosen by the employee.

      • LongtimeReader

        In any case, a fact that’s constantly overlooked by those who see this issue in cut-and-dried terms is that birth control pills are the treatment of choice for several medical conditions, not just for contraception.

        Anne, from the tone many here have taken toward those who dare ingest these evil “chemical” (and add polycystic ovary syndrome to the list of conditions it treats ) I doubt anyone will address in a fair manner.

      • Thales

        Honest question to LongtimeReader and Anne:
        I know that some contraceptive pill brands have non-contraceptive uses, as you mention. But does Plan B and ella have any non-contraceptive use?

      • johnmcg

        Presumably, most Catholic organizations do not cover contraceptices today, as these rules have not yet gone into effect.

        Is it the case that Catholics and non-Catholics are currently denied birth control pills prescribed for theraputic reasons to treat these conditions? This seems like the type of thing the press would love to make a fuss about.

      • johnmcg

        I am going to repeat my challenge to LongtimeReader and Anne claiming that denying coverage for birth control pills is discriminatory and puts women’s health at risk.

        It has presumably been the policy for any number of years for Catholic organizations to not offer coverage of birth control pills.

        I do understand that they can be used theraputically, but it is also my understanding that there are alternatives for most theraputic uses, though I could be mistaken.

        If I am mistaken, and there is no alternative, I would expect there to be more than a few “horror stories” over the past few decades. A women studies professor who took a job at a Catholic university and was unable to treat her PCOS. A poor immigrant housekeeper at a Catholic hospital who suffered cystic acne because her insurance would not cover medication to help her.

        This is not the type of story I suspect the media would be shy about covering. They love to portray Catholic institutions as failing to live out Jesus’s call to charity, particularly when the reason is scruples on sexual issues, and even more so when the victims are women.

        So, again, where are these stories? Or are you just throwing this out in the hope that we would feel guilty and shut up?

  • Jason

    Why not free insulin? This is the drug that we must force religious organizations to offer? If free birth control – to be used for whatever reasons – is important to you as an employee, then make your own efforts to secure it. I just don’t understand the entitlement. Take care of yourselves – do not look for government to make your life better. They have to take that money from someone else to give it to you.

    • LongtimeReader

      Thales – you are moving goalposts. Did I bring up Plan B? Your knowledge of types of oral hormones indicates that you are far more concerned with other women’s gynecological business than I am.

      Hormones have been, and still are, prescribed for conditions other than prevention of pregnancy. The prescription may indeed be the same pill taken by a woman who is using it for contraception. The fact that this not uncommon occurrence is not addressed in the larger debate, or when it is it has its legitimacy challenged is discouraging. That was the point.

      • Thales


        I brought up Plan B because that too is covered by this new regulation. That’s not moving the goalposts; that’s establishing where the goalposts are in the first place.

      • johnmcg

        Reading some more on the topic, it seems that most Catholic employers do make pastoral exceptions to cover theraputic use of birth control pills, and the primary problem is the occasional overzealous bureaucrat who denies coverage. See the discussion here ( and David Gibson’s comment at 9:34 am. on 1/31.

        That thread does refer to one “horror story” of a woman in Georgetown who lost on ovary. Again, this seems to be a problem with incorrect application of the policy rather than the policy itself.

        So, I think it’s not fair to claim that Catholics have not addressed the issue of theraputic uses of birth control pills. Catholics have been addressing this for some time. We may be able to improve how we address it, but I don’t think it’s a terribly releavant issue in the current debate about the mandate.

  • Pingback: Bishop Morlino and the Contraception Mandate « Vox Nova()

  • Anne

    “It’s one thing to offer a plan where employees can choose on their own to purchase contraception; it’s another to offer a plan where the employer pays for the contraception chosen by the employee.”

    Technically, neither the employee nor the employer would pay directly for contraceptives under the mandate; the insurance companies have to pay 100% for the mandated services and providers (pharmacies in this case) can’t charge more than whatever they agree to pay. At least that’s the way it works when preventative care is offered free under insurance plans. I’m not sure how such medications would be covered if prescribed for specific medical conditions, however. No one has addressed the issue in any forum I’ve read, but it’s a practical concern. Do insurance plans Catholic organizations offer now cover birth control pills when they’re prescribed to treat disease? I’d guess they do, but I don’t know.

    This matter of who pays for the contraceptives may actually explain why the Obama administration thought this shouldn’t be the concern it has become to Catholic organizations. The federal mandate is, technically speaking, directed at insurance companies, not at employers per se. On the practical level, who pays will be a matter negotiated between providers and insurance companies. Neither employers nor employees will pay for the birth control pills. That’s a matter between the government, the insurance companies and the pharmacies involved. Now, the bishops see it in terms of material cooperation with sin on the simple grounds that contraceptives will be available through Catholic insurance plans. But the fact is virtually ALL insurance plans will be offering contraceptives free of charge if the mandate holds (except for the few strictly religious groups that somehow got exempted without question). Still, it’s not accurate to say Catholic employers will be forced to pay for contraceptives. What they’ll be forced to do is offer plans that, like virtually all American health plans, offer free contraceptives thanks to the federal mandate.

    You can extend the guilt, if you wish, by saying all Americans, Catholic and otherwise, are being forced to invest in contraceptives since the federal government subsidizes most employer-paid plans, and most will — in fact, already do, at least in part — cover contraceptives. But that’s carrying this reasoning much farther than the bishops do now.

  • Anne

    “Why not free insulin? This is the drug that we must force religious organizations to offer? If free birth control – to be used for whatever reasons – is important to you as an employee, then make your own efforts to secure it. I just don’t understand the entitlement.”

    The rationale behind the mandate is that providing preventative care for women (contraceptives, breast cancer screening, PAP smears, etc.) will prove less costly in the long run than treating the complications of pregnancy, including abortion, reproductive cancers, etc. Like it or not, we all pay in one way or another when our fellow countrymen get sick, and women’s health comes at a slightly higher overall price tag than men’s, thanks to the many varied and expensive ways we malfunction, esp. reproductively.

    Similar mandates with regard to health care coverage for children have been proposed in the past, and accepted.

    • Thales

      The mandate covers sterilization procedures too. So I think at least a part of the rationale of the mandate is better described as a rationale that “preventing pregnancy, whether by contraception or sterilization or morning-after pills, will be less costly in the long run than treating the complications of pregnancy”. But to us, as Catholics, preventing pregnancy by contraception or sterilization is not a legitimate rationale. Killing every person on their 50th birthday is definitely less costly in the long run than treating subsequent health complications, but that’s not an acceptable rationale either.

  • Anne

    Just for the record, what I wrote above does NOT equate pregnancy with disease or malfunction, although the complications of pregnancy can involve both.

  • Pingback: To Prophesy from the Center « Vox Nova()

  • Carleen Panameno

    Recent research coming out of the National Anemia Action Council (NAAC) has found that the common practice of administering blood transfusion to traumatic brain injury patients may actually be increasing the risk of mortality as well as “composite complication including multi-organ failure.”The study, which lasted over a seven-year period, found that of the 1,150 TBI patients, approximately 76 percent were found to be anemic at some time period during their first week after administration to the hospital because of their TBI incident. The anemic group was said to have increased complications compared to non-anemic patients and of the “anemic group, 76 percent received blood transfusions during their first week and the transfusion in this group was associated with more complications and a higher mortality rate than patients who were not transfused.”^

    Our favorite website