Extract A series of attention-grabbing lawsuits and a crop of new legislation have spotlighted a long-gathering movement to vastly expand the scope of policies allowing health care providers, institutions and payers to refuse to participate in sexual and reproductive health services by claiming a moral or religious objection. In some cases, these radical new policies are intentionally designed to undermine, if not actually eliminate, the ability of governments at all levels, and even private businesses, to balance providers’ “conscience” rights with the ability of patients to exercise their own conscience and gain access to health care services that they want and need.
Extract Conclusion Using this framework, I propose a more protective principle for free exercise protection than currently exists, one that requires a heightened scrutiny of all laws that burden religious liberty, even neutral laws of general applicability. This review should examine carefully the need for the government law and the possibility of an exemption or accommodation that will not undermine the purpose of the law. However, I would not go as far as some states in providing almost absolute free exercise protection from government laws serving important government interests. Rather, the principle I advocate requires a balancing of interests tipped to favor laws protecting third parties’ from harm over religious claimants’ objections. The Catholic hospital conflict demonstrates how even under this more protective free exercise principle, the rule of law and the self–limiting principle of the liberty of conscience and religious liberty operate as justifiable limits on the scope of free exercise protection. The hospitals’ free exercise interests must be balanced against the potential harm to patients who cannot access necessary reproductive health care and information, which means that in many cases exemptions for religious hospitals will be denied.
Journal of the American Women’s Medical Association
Abstract Physicians are independent moral agents whose values, like those of nonphysicians, are shaped by personal experience, religious beliefs, family, and lifetime mentors. Most individuals are free to exercise their moral values in the ways that they see fit within the boundaries of legality. Physicians’ moral values take on special significance, however, when considering services patients may request but that contradict that physician’s moral beliefs, such as termination of pregnancy. In this article I analyze the competing obligations to self and to patient that a conscientiously objecting physician must consider when his or her personal morality affects his or her relationship with the patient. Despite each physician’s freedom to choose his or her mode of practice and which services to provide, a physician with a moral viewpoint that would prevent even counseling on certain options should consider practicing in an area of medicine in which the patient’s right to full disclosure of options and informed consent is not compromised by the physician’s personal moral stance.
Extract This Note examines Petitioner’s constitutional argument in Catholic Charities v. Superior Court as applied to a California statute drafted with a narrowly drawn “conscience clause” exemption. First, this Note describes the background for Roman Catholic opposition to contraceptives, and contrasts the reasons behind women’s rights activists’ claim for equal access to contraception as a part of reproductive freedom. Second, this Note examines the preeminent cases decided by the U.S. Supreme Court, the U.S. Court of Appeals for the Ninth Circuit, and the California Supreme Court, as well as the relevant federal statutes and administrative decisions used by the California Court of Appeal in deciding Catholic Charities. Third, this Note describes in detail the arguments advanced by the Petitioner in Catholic Charities and the court’s resulting analysis. Concluding that the Court of Appeal of California correctly decided against the Petitioner in Catholic Charities, this Note examines the possible impacts of that decision on society’s view of women and on the Catholic health care system. Finally, this Note concludes that the California Supreme Court will affirm the appellate court’s decision and hold that the mandatory inclusion of prescription contraceptives in insurance plans, even for institutions whose religious beliefs are contrary to the mandate, does not violate the Free Exercise Clause or the Establishment Clause of the U.S. or California Constitutions.
Abstract This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women’s powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously-based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of ‘reproductive health’ as one that supports women’s reproductive self-determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone-marrow or blood donations for their children’s survival. Women’s unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity.
Extract This note questions the wisdom of those who contend that Catholic health providers, to constitutionally qualify for government assistance or be permitted to merge with public entities, must be stripped of that which makes them most effective – their religious identity. The threat to sectarian healthcare has steadily been on the rise as can be seen in actions such as the American Public Health Association’s recent approval of a policy statement recommending more government oversight to preclude the dropping of reproductive services when Catholic and Non-Catholic hospitals merge. Section II explores why these mergers occur and why certain services are subsequently dropped. Section III applies a historical analysis to refute the argument that public and private are meant to remain separate. After establishing that pluralism has been and is presently the foundation of the American society and its healthcare, section IV evaluates whether the Establishment Clause or the Free Exercise Clause of the First Amendment is in danger of violation by mergers between Catholic and Non-Catholic hospitals. Finally, section V addresses the argument that Catholic healthcare mergers constructively deny women, most especially indigent women in rural areas, the right to reproductive services, namely abortion.
Extract Conclusion The trend of hospital mergers between religious and non-religious hospitals may continue to threaten access to reproductive health services, especially for patients who already have limited access because they live in rural areas or have low incomes.l” However, as this essay suggests, there are several avenues that concerned citizens and activists can take to try to prevent the loss of these vital services.l ” The creativity and determination of those who commit themselves to ensuring that reproductive health services will continue to be available to all who desire them has resulted in several viable legal and practical methods of intervention. Although I believe it is important to respect the religious rights and beliefs of others. when the expression of these beliefs encroaches on patients’ rights to access basic health services, intervention is appropriate and necessary. I hope that public outcry, in the forms of legal and grassroots action, will persuade state actors, legislatures, hospital administrators, and clergy to properly acknowledge patients’ rights and participate in the creation of acceptable solutions to the financial problems that hospitals increasingly face. We need solutions that do not deny essential health services to any group of people.
Journal Synopsis All jurisdictions in the US require proof of vaccination for school entrance. Most states permit non-medical exemptions. Public health officials must balance the rights of individuals to choose whether or not to vaccinate their children with the individual and societal risks associated with choosing not to vaccinate (i.e., claiming an exemption). To assist the public health community in optimally reaching this balance, this analysis examines the constitutional basis of nonmedical exemptions and examines policies governing conscientious objection to conscription as a possible model. The jurisprudence that the US Supreme Court has developed in cases in which religious beliefs conflict with public or state interests suggests that mandatory immunization against dangerous diseases does not violate the First Amendment right to free exercise of religion. Accordingly, states do not have a constitutional obligation to enact religious exemptions. Applying the model of conscientious objectors to conscription suggests that if states choose to offer nonmedical exemptions, they may be able to optimally balance individual freedoms with public good by considering the sincerity of beliefs and requiring parents considering exemptions to attend individual educational counseling.
Extract “Conscience clauses,” protecting the free exercise of religion in ethical decision-making by religiously affiliated hospitals, I believe, should continue to be absolute in reproductive medicine where the hospitals are clearly and unmistakably religious and patient choices of providers are free and fully informed. This conclusion is compelled by the free exercise clause of the First Amendment, as well as by the national interest in preserving and promoting diversity in the voluntary health care sector.
Abstract Treatment refusal, when resulting from a choice based on certain religious principles requires a study of the effect of the Charters of human rights and freedoms into the obligation to reduce the harm that is imposed on any victim. To lay down the parameters of such an obligation, the author analyzes the effects of various cases of refusal to afford treatment in light of rules from private and public law. Owing to the rather small number of precedents dealing with this issue, she seeks inspiration from foreign jurisdictions so as to forge a proposed method for interpreting provisions adapted to the specifics of Québec and Canadian law. The author does reach the conclusion that resorting to constitutional exemption is sometimes a necessity in order to respect freedoms of conscience and religion.
